Mr. DONELAN. No, sir.

Dr. RUHE. No, sir.

The CHAIRMAN. Are there any questions among members of the committee?

Mr. MACDONALD. Mr. Chairman.

I have listened to your very fine statement, and I am glad to see that you support the legislation, as I do. I was just wondering if AMA did not feel this would be Federal interference with the practice of medicine and research.

Dr. SODEMAN. I believe the AMA believes that this is sound support for the health of the country.

Mr. MACDONALD. Obviously this would not be leading to socialized medicine, would it?

Dr. SODEMAN. I don't see how it can, sir.

Mr. MACDONALD. Because sometimes I have difficulty following the mental processes of the AMA. They support some things that the Federal Government does in the field of health. Other times they take a rather, shall we say, a drastic point of opposition to things that we in the Congress try to do to help the field of medicine.

Dr. SODEMAN. This bill would give support to each and every physician and researcher in sharpening his knowledge and the depth of his knowledge in medical science, and this is very important.

Mr. MACDONALD. I take it in that area the AMA gives it full support.

Dr. SODEMAN. There is full support.

Mr. MACDONALD. While in other areas they do not.

Dr. SODEMAN. It may be a matter of technique, sir.
Mr. MACDONALD. Thank you very much.

The CHAIRMAN. Are there any further questions?

Dr. Sodeman, thank you very much for your very fine statement. We are pleased to have you gentlemen here in support of this legislation:

Dr. SODEMAN. Thank you.

The CHAIRMAN. The next witness will be in behalf of the Association of American Medical Colleges, Dr. John Parks, George Washington University, in Washington, D.C., and Dr. Robert C. Berson, the executive director of the association.

Gentlemen, we are glad to have you. We shall be pleased to have your statement.

STATEMENT OF DR. JOHN PARKS, DEAN OF MEDICAL SCHOOL, GEORGE WASHINGTON UNIVERSITY, WASHINGTON, D.C.; AND DR. ROBERT C. BERSON, EXECUTIVE DIRECTOR, ASSOCIATION OF AMERICAN MEDICAL COLLEGES

Dr. PARKS. Mr. Chairman and members of the committee, I am Dr. John Parks, dean of the George Washington School of Medicine and a member of the Executive Council of the Association of American Medical Colleges.

This is Dr. Robert C. Berson, executive director of the association. We are pleased to have this privilege to speak in behalf of this proposed bill.

Speaking for all the 87 medical schools in this country who constitute the institutional membership of the Association of American Medical Colleges, I want to express enthusiastic and unqualified support for all provisions of this legislation and urge its passage at an early date.

While the major medical libraries in this country are located in medical school centers, large research complexes, and the medical societies of a few metropolitan areas, there are over 6,000 medical libraries serving smaller medical societies and community hospitals throughout the Nation.

For a number of years responsible reports have indicated that the medical libraries of the Nation are in a serious state of disrepair. It has been impossible for librarians to keep pace with the growing volume of scientific literature which is of such great importance to medicine. Productive medical research is dependent on access to the relevant literature. Each research project usually results in one or more published articles or periodicals and as the number of research projects underway in this and other countries has increased, the volume of published literature has grown at an astonishing rate. The protection of our national investment in research requires adequate provision for making the published results available to investigators.

Medical libraries play a very important role in the education of medical students, dental students, students of public health and veterinary medicine, other students in the health disciplines, interns, and residents. For health care everywhere it is of greatest importance that practicing physicians have access to appropriate parts of the published literature in order to keep abreast of new developments in the study and care of their patients.

This triple role of the medical library in providing a service basic to research, education, and patient care has made it difficult for existing national programs to meet the needs of medical libraries.

One of the most important traditions of science has always been the free exchange of knowledge between scientists wherever located. It can truly be said that the literature of medical science as well as the problems it attempts to solve transcends national boundaries. At the present time a considerable percent of the important new periodicals in medical literature are printed in languages other than English. There is a very active exchange of literature between our country and Russia, Germany, Italy and other countries all over the world. It is far more efficient to provide translating, abstracting, and bibliographic services to serve the entire English-speaking world rather than for each library to attempt this type of technical work. There are unparalleled opportunities for strong leadership at the national level through the National Library of Medicine.

The more than 6,000 medical libraries in this country reflect the efforts that have been made through hospitals, research institutes, professional societies, and medical schools to provide library services. It has been estimated that the present investment in medical libraries in this country is something over $300 million, essentially all of which has come from private, local, or State resources. The Medical Library Assistance Act of 1965 recognizes that these local sources will

continue to carry most of the library expenses. It also recognizes that Federal funds should be provided to augment these local funds and to strengthen the role of leadership of the National Library of Medicine in matters that can be handled effectively on a national basis.

Medical libraries are thought centers for medical scientists and physicians. Better medical library facilities are urgently needed to support the expanding educational and health programs of our Nation. The Association of American Medical Colleges strongly endorses the Medical Library Assistance Act of 1965 and looks forward to its early adoption.

That is our testimony, gentlemen. We shall be pleased to answer any questions.

The CHAIRMAN. Thank you very much, Dr. Parks.

Dr. Berson, do you have any further comment?

Dr. BERSON. No, sir. We shall be glad to attempt to answer any questions.

The CHAIRMAN. Are there any questions by any members of the committee?

I would like to make this suggestion for those of you who are very cooperative in making the record-I think I will start with Dr. Dempsey. I believe this record should show information to support the estimated expenditures. I would like more positive information as to what the estimates are. I know the bill proposes to utilize so much money for various purposes, but I do not see in any of your statements that have been presented yet any information as to what those requirements actually are going to be.

As an example, you testified for the need of certain construction. The Bureau of the Budget asked that this program be deferred, and I think with some merit, for at least a year in order that plans can be developed to provide more information. What I would like to know, Dr. Dempsey, is the justification for the amounts proposed for construction. We know that $10 million is estimated to be the amount that should be authorized. But maybe it should be $5 million or maybe it should be $15 million. There is no information here yet to indicate what the requirements will be. So, I would like to ask you, Dr. Dempsey, if you will give us more detailed information for the record to go along with your statement on what your estimated requirements will be for each of the budgetary items.

Dr. DEMPSEY. I will be delighted to furnish that.

The CHAIRMAN. For 1966, for 1967 and during the 5-year proposed program, so that we will have a record of what would be needed. (The information requested follows:)

MR. JAMES M. MENGER, PROFESSIONAL STAFF MEMBER, HOUSE INTERSTATE AND FOREIGN COMMERCE COMMITTEE

Mr. Menger, in response to Chairman Harris' request, we are transmitting herewith, two statements of appropriations requirements together with our justifications for the Medical Library Assistance Act.

The first of the statements is based on the authorization as set forth in the bill: The second embodies our recommendations for authorizations which could provide for maximum flexibility and efficiency of administration.

You will note that the 5-year totals are $117.5 million in each case.

Appropriations authorizations recommended by Department of Health, Education, and Welfare to carry out the proposed Medical Library Assistance Act of 1965 (H.R. 3142) [In millions of dollars]

Alternative method of authorizing appropriations to carry out H.R. 3142

SECTION 393. ASSISTANCE FOR CONSTRUCTION OF FACILITIES

Based on information obtained from various health professional organizations, from governmental agencies, and by its own resources, the National Library of Medicine has determined that an amount of $50 million made available over a period of 4 years will make a significant impact in reducing the backlog of construction and renovation needs of health science libraries. Since there has been very little new construction of health science libraries in recent years, it appears that the larger need is for new construction rather than for renovation of existing facilities. This is confirmed in the case of the study of medical school libraries conducted by the Association of American Medical Colleges in 1964. This study disclosed that 80 established medical schools required $87,217,062 for planned library construction. In addition new construction for freestanding medical libraries and those in other health professions such as dentistry, public health, osteopathy, and optometry will require an additional $10 million. At the 75percent matching rate allowed in the bill, these projects would require somewhat more than $72 million.

SECTION 394. GRANTS FOR TRAINING IN MEDICAL LIBRARY SCIENCES

The manpower deficit in the medical library field is evident when one considers that there are about 6,000 functioning medical libraries in the country but only about 3,000 librarians with specialized training or experience. It is not suggested that all these libraries need be manned by highly trained professional librarians. Many of the smaller ones could be operated by library technicians. At the present time less than 50 new medical librarians are being added to the manpower pool per year. The appropriation authorization ($1 million) contained in H.R. 3142, section 394, would permit the support of approximately 200 individuals per year for training in biomedical information work. Since not all of these would be in 1-year programs, it is estimated that between 125 and 150 new personnel could be added to the manpower force annually. During the 5-year period of this program, approximately 750 information personnel will be trained at 20 academically based training centers.

SECTION 395. ASSISTANCE TO SPECIAL SCIENTIFIC PROJECTS

This section would allow for support of qualified individuals who need to use the extensive collection of medical literature within the National Library of Medicine or within other large research libraries for the compilation of existing information or the preparation of original contributions in the sciences related to health. There are very few opportunities presently available to the medical scientist to devote a period of full-time effort to intensive examination of the scientific record and to produce a thoroughgoing evaluation and synthesis of the work that has been accomplished. This section authorizes the appropriation of $500,000 per year for this purpose. This sum will support the studies of approximately 25 medical scholars per year or approximately 125 individuals for the 5-year authorization of $2,500,000.

SECTION 396. RESEARCH AND DEVELOPMENT IN MEDICAL LIBRARY SCIENCE AND RELATED FIELDS

Research and development projects, utilizing grants and contracts, will be reviewed, selected, and supported on the basis of their potential contribution to the biomedical information field. Such projects will include studies designed to define the information needs of workers in the health field, to study means of improving access to and transmission of information, and to explore the institutional interrelationships of organizations and facilities engaged in the acquisition, processing, and dissemination of biomedical information.

The Medical Library Assistance Act will allow a total of $15 million over a 5-year period. Since much of such research and development work involves longterm observation and assessment it can be expected that many projects will require 3 to 5 years for completion. It is hoped that the funds for expected increases in cost per project on continuing projects can be balanced by the funding of some studies for no more than 1 or 2 years.

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

Resource needs for libraries in schools of medicine, dentistry, osteopathy, nursing, and hospitals is estimated to exceed $85 million. H.R. 3142 authorizes an appropriation of $15 million spread over 5 years. The large discrepancy between the need and the requested appropriation authorization is justifiable at this time because of two circumstances: (1) the program authorized by H.R. 3142 is a descending matching one and local funds will meet a part of the need, and (2) it is possible that the magnitude of the need for local resources will decrease with the rapidly developing technology. Because of the wide discrepancy between the need and the available funds, some rationale must be established for the most effective way in which to use the available funds.

The uses for which grants are made for resources may include but are not limited to the acquisition of books, journals, photographs, motion pictures and other films, and other similar materials; cataloging, binding, and other services and procedures for processing library resource materials for use by those who are served by the library or related instrumentality; acquisition of duplication devices, fascimile equipment, film projectors, recording equipment and other equipment to facilitate the use of the resources of the library or related instrumentality by those who are served by it; and the introduction of new technologies in medical librarianship.

Three main groups of library users need to be considered: (1) students and faculties in academic institutions; (2) physicians and other health professionals who are providing direct services to the public; and (3) research workers.

After careful review, the funds will be made available to selected libraries in professional schools in the health sciences, nonprofit, free standing libraries, and to institutions where research, teaching, or the practice of medicine play an important community role. It is not intended to provide support to all existing medical libraries, but rather to those who show promise in providing the greatest service at the least cost.

SECTION 398. ESTABLISHMENT OF REGIONAL MEDICAL LIBRARIES

The purposes to be accomplished by this section are the following:

1. To insure the equality of access to the documents comprising the scientific record of medicine by all professional workers in the health fields.