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ance: This committee has already been involved in H.R. 12, which, if enacted, would add a fourth major facility construction program with great benefits to health services for the public. Additional teaching facilities must be created if we are to meet foreseeable needs for health manpower.

3. Setting standards: Earlier in my testimony, I mentioned standards as one of the means we use to carry out our tasks. Since we have just been discussing health facilities this may be a convenient place to mention a third role the Service plays in improving health services.

It has been necessary for us to develop a number of standards for use in the Hill-Burton program. Others have been developed simply as a service and because they seem to be needed. These have been most useful in improving the quality and utility of new health facilities. They also serve a useful purpose as guides for the States in licensing and attempting to upgrade the quality of care in nursing homes, for example.

Other types of standards activity exist for safe milk, water, and food. We need such standards in carrying out our responsibilities in certifying interstate carriers-trains, airplanes, buses, and ships. We have power to enforce compliance only with respect to interstate transmission of communicable diseases. However, once the standards are developed, they are more widely useful to State and local agencies. Often they are incorporated by States or municipalities into their own laws.

4. Research. The fourth major role of the Service is in the conduct and support of research. The rising levels of health which this country has enjoyed over many decades are directly related to new knowledge generated through research. This is a familiar story and need not be repeated here.

The role which the Service plays in this area has, however, changed dramatically. Prior to World War II, our role was comparatively minor. The National Institutes of Health had just been established on its present location in Bethesda. Although we had a very active research program, it was small and largely confined to what we did in our own laboratories or in the field. We were just another one of the Nation's research laboratories.

The fundamental fact which changed this picture after World War II was that the Federal Government assumed a role in support of a nationwide expansion of our research capabilities. This happened in many fields.

In the field of health, the Service, largely through the National Institutes of Health, became the main instrument of the Government in carrying out this development. Some of this expansion took place in our own laboratories. But the major instrument was what we now call our extramural program-grants to support research in medical schools and other educational institutions, in hospitals, and other facilities.

The National Institutes of Health alone now supports about 40 percent of the Nation's medical research effort. The Federal Government as a whole supports about 62 percent. Industry accounts for 25 percent, and 13 percent comes from other non-Federal sources. Charts A and B, which I have already provided, or, if you prefer to deal with figures, the charts on pages 29 and 30 in the committee print, show clearly what has happened so far as the Service is concerned.

The second major development is the growing necessity for research in aspects of health that are not solely medical research. For instance, we need more research in better methods of delivering health services. We need more research in the environmental health sciences, and in the sociological factors involved in urbanization.

Research is now an essential tool in almost every major program in the Public Health Service.

The third major development is more recent. That is the development of specialized research centers to study health problems where they exist. This is particularly important for water pollution, shellfish sanitation, radiological health, certain aspects of communicable diseases, and certain types of community health problems.

Research now accounts for about half of our annual budget. The witnesses tomorrow will go into more detail on this subject.

5. Training. This is the fifth way in which the Service improves and extends health services. I have already described our involvment in training public health personnel for work in State and local health agencies.

The Service also plays a national role in training for research. Through fellowships and training grants, the personnel needed to man the increasingly complex research activities of the Nation are developed. Our investment in research training constitutes about 12 percent of our annual budget. (In fiscal 1962, the National Institutes of Health alone supported approximately 14,000 trainees and fellows.) The Nation's rapidly expanding research effort has made a Federal training role mandatory.

The Service thus far has played a more limited role in training for service, that is, training for personal health services-doctors, dentists, nurses, and so on. We do, however, have a number of programs where particularly acute shortages exist:

Our professional nurse traineeships program seeks to increase the number of graduate nurses prepared for positions as administrators, supervisors, and teachers in all fields of nursing. Nurses like these are in exceedingly short supply. Seven million, three hundred and twenty-five thousand dollars was available in 1963 which will give full academic training to approximately 2,000 nurses in this category, and short courses to approximately 7,000 nurses.

The Mental Health Institute has a major program to train the psychiatrists, psychiatric social workers, psychiatric nurses, and clinical psychologists needed to provide mental health services to the Nation: $19,375,000 was available in 1963 for this purpose.

We also have training activities directed toward developing highly specialized professional personnel for combined teaching and research careers neurologists and ophthalmologists, for example. Again, these men are in very short supply. Some States do not have a single practicing neurologist.

Overall, about one-eighth of the total Public Health Service budget is directed toward various types of personnel.

6. Planning. Another way in which we support improved health services for the public is through planning. Planning, of course, is an integral part of all our programs. We have long required the States to prepare plans as a basis for receiving Federal matching grants. However, planning is now assuming a broader dimension.

Health problems transcend political boundaries. Many of our larger metropolitan complexes sprawl out into several political jurisdictions. Increasingly, it is evident that comprehensive planning on a metropolitan area, or on a regional basis, will be required to develop sound integrated plans and programs.

The principle of areawide planning is now gaining acceptance in the construction of medical facilities and the development of programs to control environmental health hazards. Notably water pollution. Certainly, the areawide planning concept deserves to be extended to other areas of public health activity.

7. Health communications. New research findings have little utility until they are communicated to those who want and need them-to scientists, to physicians, and other health practitioners, and to the general public.

Such new knowledge must be communicated in a form which is understandable and usable. Consequently, health communications assume many forms, through many different media, tailored to fit the particular audience and the purpose of the communication.

All of us have heard about the so-called information explosion-the rapidly mounting body of new knowledge arising from the Nation's expanding effort in research. The inference is that this new knowledge is not reaching those who want and need it. There is no doubt that there is a gap-much wider than we would like-between what is known and what is being applied to prevent and relieve illness and suffering.

Responsibility for health communications is shared by many groups, governmental and nongovernmental, public and private. The Service, however, has responsibilities which are both general and specific. Section 301 of the Public Health Service Act authorizes the Surgeon General

to collect and make available through publications and other appropriate means, information as to, and the practical application of, such research and other activities.

Section 315 of the act says that

the Surgeon General shall issue information related to the public health, in the form of publications or otherwise, for the use of the public, and shall publish weekly reports of health conditions in the United States and other countries and other pertinent health information for the use of persons and institutions engaged in work related to the functions of the Service.

Responsibility for communications is written into our laws in a number of other places.

We do publish weekly reports of health conditions. But our efforts extend far beyond this. Health information is made available through newspapers, magazines, radio, television, through scientific journals, through pamphlets, brochures, and other devices. In spite of a rather substantial effort, we feel that we are not doing enough, or doing it well enough. We are actively seeking to extend and improve our efforts. This constitutes the eighth way in which we quite directly act to improve and extend health services for the public.

In addition, the Service supports another program-which is little known to the public-but which,again indirectly, plays a national role in improving health services: the National Library of Medicine.

The National Library of Medicine (NLM as we call it) was founded in 1836 as the library of the Surgeon General's Office, U.S. Army. In 1956, the National Library of Medicine Act (Public Law 941, 84th Congress) transferred the library to the Public Health Service. about a year ago it occupied its new building in Bethesda.

Just

In essence NLM is the Nation's central medical library. Anything that is published in the field of medicine and the medical sciences in this country or abroad can be obtained through the library.

It has the largest assemblage of medical literature in the world—as of July 1, 1962, it totaled 1,084,256 pieces, including books, journals, theses, pamphlets, et cetera-and it is all indexed so that information can be located easily. Individual scientists and scholars may use the library. Its services, however, are extended primarily through other libraries.

We often refer to it as the library's library. Each year the library responds to about 125,000 requests from other libraries. Last year some 2,000 libraries around the world received 2,250,000 pages of material, largely in the form of microfilm. To meet this volume of demand, NLM has one of the largest microfilming operations in the Federal Government.

The library also prepares Index Medicus which is the standard index used all over the world to search the medical literature. NLM is converting many aspects of its work to computer operation. In fact, it is pioneering in new directions which will do much to make the medical literature more manageable and useful.

Its project medlars (Medical Literature Analysis and Retrieval System) is now being installed and will be operational later this year. It is being watched by libraries all over the world as one of the basic solutions to the information explosion.

Mr. Chairman, I have touched very lightly on a very complex and important area of our operations. With your permission, I would like to submit a more detailed report for the record.

It is being prepared at the present time especially for this hearing. Mr. ROBERTS. Without objection it may be included in the record. (The report referred to is as follows:)

COMMUNICATION OF SCIENCE INFORMATION-PRESENT STATUS, PROBLEMS, TRENDS (INCLUDING THE NATIONAL LIBRARY OF MEDICINE)

I. COMMUNICATION AS BASIC TO THE PUBLIC HEALTH SERVICE MISSION

All programs of the Public Health Service rely upon communication for their effectiveness. Although the audiences, the subject matter, and the techniques of communication may vary from one program area to another, communication activities are essential to all.

Communications responsibility is, in fact, written into the basic legislation of the Public Health Service. The Surgeon General is required to meet at least one each year with all the State health officers to exchange information as well as to chart new policies, to "publish weekly reports of health conditions," and "to collect and make available the results of research." The responsibility to communicate is written into the law in a half dozen other legislative authorizations.

In addition, developing naturally as part of program operations, are communication activities which are shaped by the programs they serve, whether those programs emphasize research, community health service, or direct medical attention for patients.

Research activities of the Service

Research findings are of small value unless the results are passed out of the laboratory and, in the biomedical field, put to use to reduce illness and suffering.

Communicating the results of a research project is increasingly accepted, and emphasized, as an integral step in the research process.

The Public Health Service has a responsibility to distribute appropriately the information emanating from its own laboratories and a further responsibility, as a granting agency, to make certain that information flows freely from the laboratories of its grantees.

As the major sponsor of health research in the United States and as a research agency in its own right, the Public Health Service is concerned with the "information explosion," as both a producer and a user of science information. Health programs involving community activity

A primary mission of the Public Health Service is to expedite the effective application of medical knowledge to the needs of the American people. The Service thus acts as a middleman between the producers and consumers of medical information: that is, between the research institutions, on the one hand, and the practitioners and the rest of the public, on the other.

Effective communication in the development of community health programs, which are the means for transmitting information from the producers to the consumers, is complex and difficult. The clientele with which the Public Health Service works in developing community health programs consists of many highly diversified groups. Making information available to these different audiences, at varying levels of scientific sophistication, depends on a wide range of techniques.

Communication to the practitioner and the public of new biomedical information must result in changes in attitudes and behavior if benefits to the health of the individual are to result. This sometimes slow process involves both teaching and learning. Continuing education is an essential part of communicating science information.

Medical service to patients

The Public Health Service is a source of medical services for more than 1 million patients. These patients include American Indians, Alaska natives, merchant seamen, Federal prisoners, the U.S. Coast Guard, and others designated by Congress. Some of them, including people who do not read or speak English, pose unique problems in communication. Health information must be given to them in the simplest terms, whether in English or in their own language. Some are geographically isolated. In Alaska, for example, are patients who live in villages that can be reached only by plane or dogsled, and in the winter only by shortwave radio. At several of the hospitals in Alaska, Public Health Service physicians hold clinics nightly by radio with their patients in isolated villages.

Within the Public Health Service are physicians and their staffs, confronted by the many information problems facing all medical practitioners. Physicians in the hospitals and clinics of the Public Health Service include interns and residents. All need the best possible sources of scientific information to help complete their training. Public Health Service physicians with years of experience are concerned with obtaining the latest information in their specialties. It is essential to provide the best possible resources for continuing their medical education.

Service concern with communication

The Public Health Service represents a microcosm of the scientific community. Within the Service are scientists at their laboratory benches, physicians and nurses working in hospital settings, health educators, science writers, librarians. These employees have the same needs for information, and similar frustrations in obtaining it, as are experienced by their counterparts in other agencies of the Government or outside the Government.

It is in the interest of its own maximum contribution and with concern for the Nation's health that the Public Health Service seeks better ways of communicating science information.

II. THE NATURE OF THE COMMUNICATION PROBLEM

There appears to be agreement that a science information problem exists. Increasing attention is concentrated on coping with it.

In the executive branch high level attention has been focused on science information by the President's Special Assistant for Science and Technology, the President's Science Advisory Committee, and the Federal Council for Science

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