store for the future, as our research effort and support climbs literally astronomically? Above all, we need action now so that we will not be completely engulfed and eternally helpless. Today's preparation, as embodied in the provisions of this bill, will provide tomorrow's resources. Resources for efficient medical research, resources for adequate education, resources for use in all the fields touched by medical implications and advances. Information at the right time, at the right place, for the right person in the right form will be vitally needed. If we make no provision for these resources, we had better save our current research outlay, for its results will be permanently and irrevocably buried.

A particularly important feature of this bill is that its implementation, while including educational institutions, is not restricted to them. In our current concern for maximum advancement of educational programs at all levels we may overlook the fact that information needs and flow and learning occur throughout our economy and our geography, not solely in the teaching process and institution. I have mentioned the needs of industry. One must remember also the needs of scholars in other fields than medicine, at nonmedical institutions. One must especially remember the practitioner and the hospital. These people may be far removed from a medical school; yet their daily needs are increasing. The doctor must continue his education. His practice, and the work of this hospital staff, need more than ever the close contact with the latest laboratory development and the new clinical or surgical techniques. The regional medical library can best serve their needs, with services developed on a very broad scale. These services may include support of teaching and medical education, indeed. But they go far beyond, in providing a tailored, automatic, prompt, and continuing flow of information to all who need it.

This also requires specialists in medical information work, who are trained for this specific field and have not just drifted into it. The curricula of librarianship and information science are reflecting these needs. Attention is now given in several professional schools to thorough training in medical librarianship. We cannot find enough such specialists now; the supply must be stepped up. In conclusion, I wish to reiterate the support of our association for this bill. We believe it provides sound elements for expansion of facilities, available personnel, and improved medical communications. Thank you for the opportunity of appearing in behalf of this legislation.

Mr. BUDINGTON. First, we have been accustomed in recent years to supporting general research in the sciences to a very large extent, but no provision whatsoever has been made for the dissemination of the information generated in this research and particularly so through the medium of libraries, abstracting services and other similar means.

Second, I would emphasize that this bill has very broad effects beyond those of the education field typified by the libraries in industry represented in our association. Everyone knows now the many effects of cross-fertilization of fields and industrial libraries have considerable need occasionally for medical information for biological information and at the present time they cannot rely completely upon medical school libraries as a source.

The regional medical library action can help to supplement these sources which they need.

Third, I can only reiterate again the need for immediate action in these fields about which we have been talking this morning. Estimates currently are that there are something in the order of 200,000 articles yearly in the field of medicine and 10,000 monographs. It is almost impossible to control these now and to disseminate the information contained in them. It is only through the additional facilities provided in this bill that we have any hopes of succeeding.

Thank you, sir.

Mr. MACDONALD. Thank you very much.

Are there any questions of the witness?

Mr. O'BRIEN. Mr. Chairman, I would just like to make this statement. This I assume is the conclusion of the hearings. I don't recall since I have been on the committee any legislation which has such solid, enthusiastic, across-the-board support as this particular legislation has.

I might add further that I think all of us learned something this morning, that through the years we have built a gigantic reservoir of research knowledge. One of the witnesses said it would cost $3 billion a year by 1970. I think that, unfortunately, in building the reservoir we also are depending on a 1-inch main to get the stored material out to the public.

Thank you, Mr. Chairman.

Mr. MACDONALD. Thank you, Mr. O'Brien.

Without objection, I will include in the record at this point a statement by William N. Hubbard, Jr., M.D.

(The statement follows:)

STATEMENT OF WILLIAM N. HUBBARD, JR., M.D.

Mr. Chairman, I thank you for this opportunity to express my wholehearted support of the Medical Library Assistance Act of 1965.

Many distinguished national associations concerned with the health of the American public have supported this act. The President's Commission on Heart Disease, Cancer, and Stroke has included several recommendations which would be supported by this act and has emphasized the importance of these matters by stating:

"The Commission feels strongly that unless major attention is directed to improvement of our national medical library base, the continued and accelerated generation of scientific knowledge will become increasingly an exercise in futility."

The National Advisory Health Council of the U.S. Public Health Service has, on two recent occasions, made formal resolutions supporting programs which would be implemented under the provisions of this act.

My own testimony is based on 15 years of activity in administrative posts supporting medical education, health-related research and medical care. As the dean of the University of Michigan Medical School, a member of the executive council of the Association of American Medical Colleges and the Board of Regents of the National Library of Medicine, I have a privileged perspective of the communication needs in medicine and the related health sciences. The opportunity of serving on committees advisory to Federal agencies concerned with health problems has led me to a full appreciation of the importance of the role of the Federal Government in securing the health of the people.

SECTION 390. DECLARATION OF POLICY AND STATEMENT OF PURPOSE

This section reflects the complex variety of users that a modern library of the health sciences must serve. Requirements of the graduate or professional student, the researcher, the faculty, the hospital interns and residents, the postdoctoral fellow, the community practitioner, industry, and, not least, the requests of other health science libraries must all be met.

Although weekly and monthly serial journals now make up the bulk of the holdings of medical libraries, textbooks and monographs continue as important reference documents. Without diminishing the importance of these more traditional holdings, television tapes, photographic films and slides, audiotapes and visual displays are becoming of increasing importance as means of storing scientific information. Modern electronic forms of handling this information through the use of computers and microreproduction hold the promise of more efficient and more economical access to this stored information. Such electronic devices also allow access to the holdings of the library from distant areas and form the basis of predicting the development of a national network.

The policies enunciated in section 390 recognize the breadth and complexity of the problem of communications in the health sciences and the importance of the evolving library as a means of providing essential improvements in these communications.

SECTION 392. NATIONAL MEDICAL LIBRARIES ASSISTANCE BOARD

This section represents an extension of the existing function of the Board of Regents of the National Library of Medicine. I do not speak formally for that Board, but would assert that the mood of the membership is to accept the responsibilities defined under this section as representing a proper expansion rather than a digression from their established responsibility.

SECTION 393. ASSISTANCE FOR CONSTRUCTION OF FACILITIES

The need for increased manpower in support of the health of the Nation is well documented. Not only physicians, dentists, and nurses, but an array of related health workers of increasing importance to the system of delivering health service must be educated in our colleges, universities, and teaching hospitals; all of which require library facilities beyond those now available. Furthermore the need for maintenance of our health-related research effort requires the improvement and extension of our library system. As the postgraduate education efforts that are so sorely needed on behalf of the community practitioner are realized, he, too, will seek continuing access to the library.

It can fairly be said, then, that to achieve the improved health service that the American people deserve and demand, the capital expansion of our library system is essential. In my opinion, we must provide for capital expansion of the library system as it exists today as the foundation for its evolution into the health science information center that is needed. It will therefore be important to make a judicious division of the available funds for capital improvement so that we do not merely expand libraries as they have been traditionally conceived as repositories for printed information but include provision for their rapid evolution into "information centers" that take advantage of all the present-day improvements in communications techniques.

It is my opinion that the $10 million a year for the fiscal year ending June 30, 1966, through that ending June 30, 1970, is appropriate in order that the program can be reviewed at that time. I would predict that at the time of review in the future it will be found that significantly larger sums can be effectively expended in this category as most valuable contributions to the health of the people of this country.

SECTION 394. GRANTS FOR TRAINING IN MEDICAL LIBRARY SCIENCES

Our medical libraries need many more librarians than are now available or are likely to become available within the foreseeable future unless a strong effort is made to strengthen and accelerate our program for training in medical librarianship. These new librarians must not only have the established competence of organizing printed materials so that they are readily accessible to readers, but must become familiar with recent developments in electronic technology and information theory which will provide a new kind of bibliography control over the growing and changing mass of knowledge produced by our research programs and clinical experience. It is safe to say that there are few fields where teachers, researchers, and administrators agree so completely with librarians on the importance of a training program.

This section recognizes the need not only to provide improved training for new degree candidates in library sciences, but also allows for existing librarians and specialists in information sciences related to health to be given support in learning of the new developments in the field of electronic information storage and retrieval.

The addition of an internship program to the traditional period of library training will allow the recent graduate to enter the community much better prepared to undertake operating responsibility than has has been in the past.

This section, then, provides for the necessary improvement and expansion of training of the manpower responsible for the operation of medical libraries in the future.

SECTION 395. ASSISTANCE TO SPECIAL SCIENTIFIC PROJECTS

This section fills a most important need in that it provides the opportunity for physicians and scientists to utilize library resources to their fullest depth in writing up the original contributions that their efforts have produced. At the present time, these people have to steal time from their research, teaching, and patient care duties in order to utilize in depth the resources of the library.

These special fellowships would enhance their opportunity to utilize the unique facilities of the National Library of Medicine as well as supporting "in depth" literature reviews.

Intensive utilization also gives an opportunity to understand more clearly the limitations of the present library system. To the casual user of the library, these limitations may not be evident and he may therefore fail to obtain with precision and depth the information which he should have. From experience in the needs of intensive consumers of library service it will be possible to provide more precisely for improvements in providing that service.

SECTION 396, RESEARCH AND DEVELOPMENT IN MEDICAL LIBRARY SCIENCE AND

RELATED FIELDS

The importance of research and development in library science has been alluded to already in my testimony. At this point I would suggest that consideration be given to the establishment of a small number of health-science information centers which could serve as prototype models for the fullest exploitation of available modern techniques in information processing. In my opinion, the development of a few such models is of a very high degree of importance. It would allow for practical experience in a field which is now full of speculation about "what might happen." If these model units were established in areas with long experience with the more traditional library organization, then something akin to a controlled experiment could be conducted which allowed objective comparison of the advantages and shortcomings of the traditional as compared to the electronically based methods. Once established, such a prototype infor mation center in the health sciences would provide the resources for research, training, and experience in service which will be essential before a comprehensive national library can be most effectively designed. The established systems of the National Library of Medicine make it uniquely competent to lead such developments.

There are only a few institutions whose libraries are in a position to carry on this kind of research and development but their role as models is of crucial importance to the Nation.

SECTION 397. GRANTS FOR IMPROVING AND EXPANDING THE BASIC RESOURCES OF MEDICAL LIBRARIES AND RELATED INSTRUMENTALITIES

This section recognizes that we are not undertaking a dissolution of the existing library system but rather seeking full advantage of its optimum potential while adding to it the modern electronic developments which will give a new dimension to its power.

The provisions in this section will allow for those medical libraries which have heretofore been unable to take advantage of well-established methods of improving library service to acquire this enhanced potential. Such a simple matter as being unable to photoduplicate rapidly articles in journals so that the volumes themselves do not have to circulate is a distressingly frequent defect in existing medical libraries. It is a rare medical library that has a budget for the acquisition of magnetic tapes and films and the facilities for using them.

While I recognize that we must plan immediately for the development of an electronic computer-based national system for communications, I would assert that we should not forget that we have in existence a library system which, if given adequate support, will continue to be an essential component of any communication system in the health sciences. Home circulation of volumes from the medical library of the University of Michigan has increased 43 percent in the past 3 years. Loans within the library itself have increased by approximately 75 percent in that same period. I cite these figures to emphasize that we are by no means suggesting that we abandon the existing system since it is clearly a very attractive resource to its users. Rather, we look forward to securing the advantages of the present system while adding new and improved capacities.

SECTION 398. GRANTS FOR ESTABLISHMENT OF REGIONAL MEDICAL LIBRARIES More and more in the United States we are recognizing that health services of all kinds must be planned on a regional basis. The unnecessary duplication and self-seeking competition that can develop when isolated institutions pursue

their own development without reference to regional needs is a luxury that we cannot afford. Some early beginnings have been made in this kind of regional development. The New York Academy of Medicine, as an example, has for years collaborated with the hospitals, the medical society, and the universities in the greater metropolitan area in providing a central repository library and reference source. More recently, Harvard, Yale, and Columbia have announced their intention of developing communications that would allow their medical science libraries to collaborate more effectively. There are a few more instances that could be cited.

In general, however, the support necessary to function as a regional resource which can provide free loan services to qualified users and make available photoduplicated or facsimile copies wherever qualified requesters wish to retain them is unavailable. This section, therefore, addresses itself to those medical libraries which might wish to provide regional service and free loan service in addition to their traditional obligations. Where the budget of a medical library is sharply limited-as all of them are-it is very difficult to add the personnel and equipment that is necessary to meet the regional responsibility described in this section. The development of a physical plant which would provide this regional service without diminishing service to the existing users of the library makes necessary the provision for construction that is within this section.

As we look forward to the development of regionalization of health services of all kinds, it is essential that we have the means for developing regional medical libraries to serve as health science information centers.

SECTION 399. FINANCIAL SUPPORT OF BIOMEDICAL SCIENTIFIC PUBLICATIONS

An essential component of our present method of distributing new research information related to health is the publishing capacity of nonprofit societies and organizations. The costs of publication have risen to the point that even where advertising is solicited by the journal, the costs of publication are an important limiting factor in the journal's dissemination. Many journals are sharply limited in the extent to which they will accept charts and illustrations or bibliographic references.

Of particular importance is the need to supply biomedical scientific publications with the resources which will allow them to adapt their present indexing and abstracting to the needs of existing and projected computerized forms of bibliographic storage and retrieval. As we look forward to the development of a computer-based national network of libraries, the form of the information put into this system must be adapted to the needs of the electronic means of retrieving it. These changes in abstracting and indexing journals is an essential element of the development of a national system of libraries where free interchange of information is available. The grants authorized in this section will allow for a more complete and expenditious transmittal of information to those investigators and practitioners who have a need for it.

REGIONAL BRANCHES OF THE NATIONAL LIBRARY OF MEDICINE

There are in the United States geographic areas which do not now contain a medical library or group of medical libraries which are able to undertake the role of a regional resource. Where such a circumstance exists, the need of the people, in my opinion, should be met by the establishment of regional branches of the National Library of Medicine.

Mr. Chairman, it is obvious that we are not talking about support of the library function which is confined to giving readers access to printed materials. We are talking instead about the need for securing an essential regional health source which is capable of providing to students, teachers, researchers, and practitioners the up-to-date information which they must have in order to serve their role in providing for the health of the Nation. I urge passage of this Medical Library Assistance Act of 1965 as an essential component of the programs necessary to meet the health needs of the Nation.

SEPTEMBER 14, 1965.

Mr. MACDONALD. With that the hearing is concluded.

(The following material was submitted for the record:)