even under the direction of competent medical librarians in their community, these technicians could do much to help build up strong working collections in those hospital libraries which could then be backed up by the regional library from the more expensive material and the research type of material that might be needed by the staff of the hospitals.

Mr. ROGERS of Florida. Give us a rundown for the record on what you think might be necessary for a technician to have in the field you have just described.

Dr. BRANDON. Yes, I can cite some of the literature. I will be glad to append that to my report.

(The information requested follows:)

Annan, Gertrude L., Library technicians: need, training, potential. Bulletin of the Medical Library Association, 52: 72-80, January 1964.

Mr. ROGERS of Florida. Thank you, Mr. Chairman.

The CHAIRMAN. Mr. Macdonald.

Mr. MACDONALD. My question is so basic, that I should be fearful to ask it.

What does a medical librarian do?

Dr. BRANDON. It depends on the type of institution to which you are referring to as to how I can answer that question. Basically let us take a medical school librarian.

Mr. MACDONALD. Let us take a hospital.

Dr. BRANDON. All right. A hospital librarian should be an individual who has at least some training in library methodology, who has some knowledge as to how to retrieve citations to information requested by the practicing physician, or any hospital staff member.

Mr. MACDONALD. You mean a doctor comes in and says to the librarian, I have a tough case, I don't understand it but here are the symptoms and the librarian puts it through a computer or something and comes out with an answer.

Dr. BRANDON. That may be for the future. It is not for the present. Mr. MACDONALD. What happens at the present? Most doctors I know hate to admit they don't know what is wrong. The average doctor seems to know the answers. Would there be the need for a highly skilled doctor to go to the librarian and say he has a number of symptoms, what is wrong with the patient?

Dr. BRANDON. This is not the usual kind of question that the librarians get fortunately.

Mr. MACDONALD. What is the typical question?

Dr. BRANDON. The typical question is: I would like to know the most current literature in a specific subject area. Then the librarian

can, through consulting the printed indexes, through homemade indexes, or through a current awareness service, checking each journal as it comes into the library, be able to give many citations to the most recent literature which will help answer the problem which he has presented.

Mr. MACDONALD. Thank you.

The CHAIRMAN. Doctor, I thought what you and others had in mind was to provide assistance for these approximately 116 medical libraries in the medical institutions and so forth. Is that not true?

Dr. BRANDON. Yes, we want to build up the professional staff who are capable of using new methodologies for searching out the literature as it is requested by the researcher, or by the physician.

The CHAIRMAN. You don't think it should be extended to provide assistance for 6.000 libraries?

Dr. BRANDON. In one sense or another, it might through the establishment of regional libraries help all of the medical libraries. The CHAIRMAN. It will require more money than anybody has suggested. Probably more money than we will be able to get.

Doctor, thank you very much.

Mr. KORNEGAY. Mr. Chairman.

The CHAIRMAN. Mr. Kornegay.

Mr. KORNEGAY. How much will this bill cost, Dr. Brandon?
Dr. BRANDON. Totally?

Mr. KORNEGAY. Totally, yes.

Dr. BRANDON. I think it is $231⁄2 million per year.

Mr. KORNEGAY. Dr. Brandon, I think yours is a fine statement and the statement I am going to make is not directed to you. I got here a little late. I attended an executive session of another committee. I wanted to get here in time to talk to some of the witnesses for the administration. I see my good friend Dr. Dempsey is here. This is not exactly in his department but he is a representative of the administration and I would like for him to hear this.

This year this committee has spent a considerable portion of its time considering and acting upon and passing out bills that deal with public health, and which authorize the expenditure of hundreds of millions of dollars. Last Saturday I had a telephone call from the dean of one of the leading medical schools of this country, and which happens to be affiliated with what I consider to be one of the best VA hospitals. The dean of the medical school told me that unless something was done and done rather quickly insofar as upgrading the medical care in this particular VA hospital, the medical school was going to withdraw its affiliation. Because of the parsimonious attitude of the Bureau of the Budget and the administration in providing for this particular VA hospital, the medical school, in view of its reputation, could not much longer afford to remain affiliated with it. That was quite concerning to me because, as I understand it, the VA hospital system has trained about 30 percent of the Nation's interns and residents in the past 5 years and certainly is one of the most significant factors in medical education in the country today. My point is, while I am not opposed to this bill and all the others that we have passed out, what are we doing here when we constantly report out here and pass new legislation and spend a lot of money when apparently the Government is failing to take care of those plans and those plants that we already have. I just want to get that in the record. I have not had a chance yet to get into it and do a lot of studying about it and get a lot of facts but I did want to call that to Dr. Dempsey's attention over there. While he does not have anything officially to do with VA hospitals he is affiliated with the administration and might be able to give this word back to them that there is growing discontent throughout the country. Understand this is not this one situation that I know about but it may be true in other cities.

Thank you very much.

Mr. YOUNGER. Just for the record, I did not get your figure of the cost or your estimate.

Dr. BRANDON. Of the bill itself? The only estimate that I gave in my figures here had to do with section 397: Grants for Improving

and Expanding the Basic Resources, where I mentioned that the medical library collection needs, based on the suggested standards, indicated a total of over $102 million would be needed to bring them up to recommended strength.

Mr. YOUNGER. I think the bill itself provides for $19,900,000 a year for a 5-year program, round numbers, $100 million.

Mr. KORNEGAY. If the gentlemen will permit, I have been advised by the staff $50 million is only for construction. The total cost of the bill is $117,500,000 for the 5 years.

Thank you for letting me use you as the fall man, Dr. Brandon. The CHAIRMAN. Dr. Brandon, I am sure the others who are interested will get the hint from Mr. Kornegay and provide the information he would like to have.

Thank you very much.

Miss Germaine Krettek.

I believe you are representing the American Library Association here in Washington.

Miss Krettek, we are very glad to have you and we are glad to have your statement.

STATEMENT OF MISS GERMAINE KRETTEK, ASSOCIATE EXECUTIVE DIRECTOR, AMERICAN LIBRARY ASSOCIATION, WASHINGTON, D.C.

Miss KRETTEK. Thank you, sir.

My name is Germaine Krettek. I am associate executive director of the American Library Association.

The American Library Association is in favor of the Medical Library Assistance Act of 1965, H.R. 3142-Harris, and H.R. 6001-Fogarty: legislation designed to assist in the development of adequate medical library services and facilities in the United States. We feel that this measure is necessary and vital to the health of the Nation.

I have a brief statement, Mr. Chairman. In the interest of time, if you prefer, I would like to have it made a part of the record and to read excerpts from it.

The CHAIRMAN. It may be included in the record. You may proceed. I note it is a very short statement.

Miss KRETTEK. Then I will go ahead and read it.

In taking its favorable stand on this proposed legislation in the field of medical libraries and librarianship, the American Library Association would point out that it considers the provisions embodied in the medical bill, important as they are, as a supplement to the Higher Education Act of 1965, H.R. 9567, wisely passed by both the House and the Senate. In our judgment, this measure in support of basic higher education is of vital importance as a means of helping to solve the pressing current deficiencies in our college and university libraries, and to alleviate the alarming shortages in competent personnel to man our libraries of all types-college, school, public, and other.

Along with its position on this fundamental Higher Education Act, the American Library Association, as the oldest and largest library organization, is concerned also with the shortcomings in medical libraries and services. The association, moreover, has two constituent units which are particularly concerned in the development of medical libraries and related areas. One is the Association of College and Research Libraries, and the other is the Association of Hospital and

Institution Libraries. Both of these constituent organizations, which have special responsibility in these fields, endorse the proposals for medical library legislation.

At its meeting on January 27, 1965, the Association of College and Research Libraries board voted its approval of the proposed medical library assistance bill, noting that many institutions with medical libraries are members of ACRL and would benefit under the provisions of this bill.

The Association of Hospital and Institution Libraries also has expressed formally its concern for the pending medical library services bill. At the July 1965 Detroit conference, the AHIL Board went on record as strongly supporting the provisions of H.R. 3142 and urging its passage.

Various reports and documents prepared by medical committees, societies, and libraries show convincingly the great shortages in medical library resources, services, and buildings. These deficiencies are seriously affecting medical research, medical teaching, and medical practice. It is a matter of national concern to have them corrected.

In addition, the Special Projects Committee of the Association of Hospital and Institution Libraries at a recent meeting set forth the following additional deficiencies in the field of medical libraries:

Inability to maintain properly collections, preserve materials, and keep abreast of literature and trends because of the rising cost of medical literature, abstracting services and equipment, and lack of adequate and properly trained personnel to perform these services and duties.

Lack of coordination of resources and efforts to make readily accessible the materials to physicians and paramedical personnel, such as psychologists, social workers, and rehabilitation workers, as they are needed.

The Association of Hospital and Institution Libraries also advocates: The establishment of regional medical libraries: Books, journals, photostats, reference, and bibliographic services would be quickly accessible to medical and ancillary staff, such as nurses and therapists, in hospitals, clinics, mental health centers, and nursing homes in outlying communities were such regional libraries situated throughout the Nation.

In addition, we feel that the provisions concerning the establishment of regional libraries covered in section 398 (b) are highly important because of the need for continuing education by all practicing physicians, especially those located in more remote places. Medicine has changed and continues to change so rapidly that an ever-widening gap stretches between the work of the medical researchers and the practice of medicine by the physician. The role of the medical library is to help the practicing physician narrow that gap and keep pace with the acceleration in research and the health needs of the population.

In the field of medical research, the growth in funds has been steadily and encouragingly upward: $45 million in 1940; $148 million in 1950; $715 million in 1960; and a projected rise to $3 billion in 1970. This tremendous increase should have been accompanied by a corresponding one in the amount spent for medical library book and periodical resources, services, training of medical librarians, and building to bulwark such a program. But such has not been the case. If it is to be successful and fruitful, research in medicine and allied

fields must be supported by a solid foundation of library materials and by some method of quick retrieval of the information when needed.

Recent reports bear out clearly the sad state of the relative amount of funds allotted by the Department of Health, Education, and Welfare to medical library service. For example, in 1964 the Department received in appropriations $5.5 billion, of which $36.1 million, approximately 0.65 of 1 percent, were devoted to scientific and technical information, but less than $1 million was assigned directly or indirectly to the support of medical library activities.

The task is tremendous, especially when we consider that there are some 4,000 libraries operated by medical research institutions, medical schools, medical societies, schools of nursing, pharmacy, veterinary medicine, osteopathy, public health agencies, and other segments of the medical and health community. These libraries and their significance to the Nation can readily justify their claim for assistance from the Federal Government.

The American Library Association therefore strongly supports the Medical Library Assistance Act of 1965 and urges that this committee act favorably upon the measure.

Thank you, Mr. Chairman and members of the committee, for allowing me to present this testimony.

The CHAIRMAN. Thank you very much, Miss Krettek.

Are there any questions?

We appreciate having your statement.

Mr. Younger?

Mr. YOUNGER. On page 3, Miss Krettek, the estimate of funds which you gave there for 1940, 1950, 1960, and an estimate of $3 billion in 1970; where did those figures come from?

Miss KRETTEK. These are total national expenditures for medical research and include appropriations of the Department of Health, Education, and Welfare. These figures are from the Journal of Medical Education, volume 38, March 1963, page 146.

Mr. YOUNGER. From the Federal Government?

Miss KRETTEK. Yes, sir; there is a tremendous amount of research that is going on. In order for this research to be properly carried on and the effect of the research made available to those who need it, it is essential that there be good library service to control the information and make it available to those who need it most.

The CHAIRMAN. Thank you very much. We are glad to have your statement.

Dr. Logsdon, with the Association of Research Libraries, Columbia University.

STATEMENTS OF DR. RICHARD H. LOGSDON, DIRECTOR OF LIBRARIES OF COLUMBIA UNIVERSITY AND FORMER CHAIRMAN OF THE ASSOCIATION OF RESEARCH LIBRARIES; AND JAMES E. SKIPPER, EXECUTIVE SECRETARY, ASSOCIATION OF RESEARCH LIBRARIES

Dr. LOGSDON. Mr. Chairman, it is a pleasure, indeed, to appear in support of this legislation.

The CHAIRMAN. Doctor, I am going to suggest that you include your statement in the record because of the time and you give us a brief summary of your statement.