2. To improve the quality of access to these documents in terms of speed and ease and thereby insure the widest dissemination of research results and their application to health practice. 3. To avoid the necessity of costly duplication of extensive collections and lessen competition for library materials now in short supply. To establish and assist regional medical facilities in accomplishing these purposes an amount not to exceed $2,500,000 for any fiscal year is requested. The 5-year authorization of $12,500,000 would provide for the establishment and support of eight regional medical libraries. Two centers would be funded during the first year of the program, three centers the second year and three centers the third year. During the first 3 years most of the funds would be utilized to provide the necessary construction or renovation as required by the existing facilities with the remainder providing other resources. The amounts to be expended for construction as opposed to other resources will reflect the varying needs of the particular centers to be chosen and the limitation imposed by the legislation. Funding after the third year would concentrate on acquisition of books, journals, etc., and the additional services made possible by the earlier, nonrecurring construction expenditures. SECTION 399. FINANCIAL SUPPORT OF BIOMEDICAL SCIENTIFIC PUBLICATIONS The efficient provision of biomedical information to the health science community requires publication forms other than original journal articles. Translations. bibliographies, abstracting services, indexes and critical reviews are examples of the types of services which would be provided under this section. In addition, a program of analysis of the movement of information from the primary research articles to the scientific and medical consumer would be carried out in order to identify the specific needs for the many segments of that consumer group for these secondary publications. The 5-year appropriation authorization of $7.5 million would support 35 high-priority publication projects per year with the annual authorization of $1.5 million. SECTION 378. REGIONAL BRANCHES OF THE NATIONAL LIBRARY OF MEDICINE In geographical areas where no health science library exists which is suitable as a base for development as a regional library, this section would allow the establishment of a branch of the National Library of Medicine to serve the needs of that area. The $10 million, 5-year authorization would allow for the establishment and operation of one such branch. Major construction would be emphasized during the first years. The continuing support of the facility would be required during the remaining years of the annual authorization of $2 million. The CHAIRMAN. Dr. Sodeman, if you have information in your files. as to what you think will be needed in this program I would welcome such additional information as you can give us. What do you think the requirements will be, for example, for construction, or for training, or for these various purposes? We would like to get down to more specific items. If you gentlemen representing the American Association of Colleges will also favor us with this information, we would like to have it in the next few days because we hope to proceed with this as expeditiously as we can, and we would appreciate your cooperation. Dr. BERSON. Mr. Chairman, we will be delighted, jointly between the Association of American Medical Colleges and Council on Medical Education of the American Medical Association, we have collected a good bit of information that is relevant to the needs for construction and we will be happy to pull that together and make it available. The CHAIRMAN. It will strengthen this record a great deal and it will help us immeasurably. Dr. SODEMAN. Mr. Chairman, we do have some of these data in the chart in our presentation which we have submitted to you. We can expand that if you wish. The CHAIRMAN. Very well. If you think there is sufficient information in the chart that will be very fine. I notice there are a few tables that I have in mind though. But the charts you referred to will go into the record. Dr. SODEMAN. The need is stated. It is not translated into dollars. The need in volumes and so on is stated but it is not translated into dollars. We appreciate that. We know what you have in mind. On the other hand we do not like to authorize these open end appropriations around here. We have had some experience in the past on that. We would like to authorize what is needed but we would like to do it in a sufficient sum that the needs require but we will know where we are. We will be happy to transmit more information. (The following letters were subsequently received from the American Medical Association and the Association of American Medical Colleges :) Hon. OREN HARRIS, AMERICAN MEDICAL ASSOCIATION, Chairman, Committee on Interstate and Foreign Commerce, DEAR CONGRESSMAN HARRIS: At the hearing held on September 14, 1965, on H.R. 2142 and H.R. 6001, the Medical Library Assistance Act of 1965, you requested that any available information concerning the costs of medical library needs be furnished to the committee for its consideration. We can offer the following information about medical school libraries. As was stated in our prepared statement: "A comparison of the 87 existing medical school libraries with minimum standards recommended by a joint USPHS-AMA-AAMC committee showed that the average existing library was well below recommendations in space, volumes, and serial titles during the 1963-64 academic year." In the limited time available to us, we have searched our sources of information in order to provide additional data relating to the foregoing statement. The average unit cost per volume was estimated in 1961 at $9.40. The average unit cost per serial title was estimated at $11.19. (See: U.S. Office of Education, Library Services Branch "The Cost of Library Materials," by Frank L. Schick and William H. Kurth. Washington, D.C., 1961, ("Library Statistics OE-152029 A" supplement, 1962.) Construction costs for library space are currently estimated at $40 per square foot. Based on these figures, to bring all existing medical school libraries to the level of the minimum standards recommended, an estimate of the required expenditures would be approximately $18.8 million for books, $250,000 for serial titles, and $40 million for construction of new space. These items would total approximately $59 million. Since there are 12 new medical schools in development, the costs of their libraries should also be considered in addition to these figures. The above information relates only to a part of the costs of the proposed legislation, and does not cover such other items as the support of training of library personnel, development of new techniques of storing and retrieving new information, as well as other items covered by the bills. Unfortunately, we do not have available costs for these items. We hope that the foregoing limited information available at this time will be of assistance to your committee. Sincerely, F. J. L. BLASINGAME, M.D., ASSOCIATION OF AMERICAN MEDICAL COLLEGES, Congressman OREN HARRIS, U.S. House of Representatives, Committee on Interstate and Foreign Commerce, Washington, D.C. DEAR MR. HARRIS: The Association of American Medical Colleges would like to take this means of supplementing its statement in support of the Medical library Assistance Act of 1965 (H.R. 3142 and H. R. 6001). We recently completed a survey of all of the medical schools in which we asked cach institution to tell us how much construction they needed to meet their medical library needs, how much they estimated the construction would cost, and how much they needed for the support of "resources" as defined in the bills. Eight established medical schools and one developing school were unable to provide the figures concerning construction or did not need additional construction for which they had not already made provisions. Seventy-nine established medical schools and 11 developing medical schools reported a need for construction to meet the needs of their medical libraries that they estimated would cost $98.7 million. It is my opinion that these estimates will turn out to be somewhat low, since they work out to an average cost of $33 per square foot. Several of the institutions have had but little experience in estimating cost of constructing and fully equipping library space, and a number of people with such experience believe that the cost will average about $40 per square foot. If that turns out to be the case, the total cost for the construction would be approximately $119.4 million. If Federal grants provide 75 percent of the construction cost, as the bills provide, the Federal share would be $74 or $89.5 million, depending upon which of the above estimates of costs turns out to be correct. Since the bill as introduced authorizes an appropriation of $10 million for each of 5 years, the medical schools would have to provide more than 25 percent of the construction costs, if their known needs are to be met. In response to the question concerning additional "resources" as defined in the bills, six of the developing medical schools did not provide cost estimates. All of the existing medical schools plus six of the developing schools reported a total need for "resources" over and beyond those that can be procured from their present budgets that they estimate will cost $31.3 million. The AAMC does not have accurate figures concerning the needs for construction or resources in other eligible schools. We have some reason to believe that the needs for construction in the other health schools are substantially less than they are in medical schools, but that the need for resources is perhaps even greater. Since the bills as written would authorize the appropriation of $3 million for each of 5 years, it is obvious that the schools will have to find very substantial amounts of money from other sources if their needs for resources are to be fully met. We appreciate the opportunity to testify in support of this most important legislation and would like to repeat the hope that your committee will report it favorably and that it will be enacted soon. Sincerely yours, ROBERT C. BERSON, M.D., The CHAIRMAN. Thank you, gentlemen. Executive Director. The CHAIRMAN. The next witness will be Dr. Alfred N. Brandon, president of the Medical Library Association, and director of the Welch Medical Library, Johns Hopkins University. Dr. Brandon, we will be very glad to have your statement. STATEMENT OF DR. ALFRED N. BRANDON, PRESIDENT, MEDICAL LIBRARY ASSOCIATION, AND DIRECTOR, WELCH MEDICAL LIBRARY, JOHNS HOPKINS UNIVERSITY, BALTIMORE, MD. Dr. BRANDON. Thank you, Mr. Chairman and gentlemen of the committee. I have submitted a formal written statement on the part of the Medical Library Association in support of this bill. I would like to orally emphasize certain sections of that bill. The CHAIRMAN. Thank you very much. You may proceed. Dr. BRANDON. May I first direct attention to Section 394: Grants for Training in Medical Library Sciences: The most important elements in the success of any venture are the people who operate it. Funds for books, for buildings, for equipment (such as key punches, 53-762-65——7 sorters, and computers) will avail little if we do not have knowledgeable, imaginative, and dedicated people to transmit them into live library service. I think it would be accurate to say that we consider shortage of personnel plus shortage of training opportunities are our No. 1 problem. Dr. Dempsey has already alluded to this point, but to emphasize the magnitude of the problem I would like to point out that today there are seven head medical school library positions open. These are some of the top medical library positions in the country. It can easily be shown that subordinate positions and positions of lesser importance are also most difficult to fill with qualified librarians. It is the typical finding throughout the country. The truism holds as elsewhere that people go where opportunity beckons. H.R. 3142 provides for most of the opportunities which we have long sought: assistance for developing programs in medical library science and in the general field of communication in the health sciences; traineeships and fellowships for students seeking graduate degrees in these areas; internship programs in medical libraries, and retraining for those already working in the health information area. Section 396. Research and development in medical library sciences: In these modern times, the old cut-and-dried, haphazard methods for acquiring new knowledge and techniques in medical library science have failed. It is now necessary to adopt the methodology of the sciences and to formulate and prosecute programs of research and investigation which will yield information that will improve medical library techniques. In particular, funds are needed for research and development in the application of computers to the processing, storing, retrieving, and distributing of medical information. Such investigations have begun in some libraries, but money is sorely needed to train new investigators to support their investigations and to make available to them expensive equipment required for the development of new techniques. Thereby, the passage of H.R. 3142 will contribute to the development of wholly new medical library systems. Section 397. Grants for improving and expanding the basic resources of medical libraries and related instrumentalities is perhaps the most important part of this bill. Medical library collection needs based on suggested standards indicate a total of $102,732,952 would be needed to bring these libraries up to recommended strength. An analysis of needs would substantiate the propriety of suggesting a considerable larger annual appropriation for resources than the $3 million the bill presently contains. Administered wisely, this provision can in some way reach every aspect of the medical community: student, researcher, and practitioner of all health professions. It is important to recognize the magnitude of this need and to understand that the appropriation authorized by this section would hardly begin to provide the solution. Section 398. Sections 397 and 398 of the bill recognize that certain larger medical libraries extend their service beyond their immediate constituencies to share resources with nearby hospitals, medical schools, publishers, municipal, State, and Federal governmental agencies, as well as other public and private institutions requiring access to medical literature. In many cases, the members of these regional resources facilities are carrying most of the costs even though their own use of the library is a small proportion of its service load. The increasing amount of medical literature and the rising costs of operating a comprehensive medical library is outstripping the capacity of any one institution to furnish adequate support. The National Library of Medicine recognizes its inability to meet the medical literature needs of the entire Nation without support from a network of regional libraries. It is both economical and logical to prevent the deterioration of these reservoir libraries by furnishing Federal support in recognition of the vital function which they are already performing. Failure to secure greater support will result in less effective service which will jeopardize existing support. In many communities there are no other institutions able to meet these needs if existing regional libraries fall victim to rising costs and increasing demands without means of increasing income. In conclusion, the Medical Library Association, representing about 2,000 medical libraries and librarians throughout the world, wholeheartedly supports the provisions of this bill. The impact which Federal moneys, particularly grants for research and teaching in medicine, have had on U.S. medical libraries is profound. It has made the needs of the users far outstrip the abilities of the institutions with which the libraries are connected to support them. Unless the scientific information handling apparatus of the country is brought up to the level of the research, teaching, and patient care of this country, we may very well see either a decline in the status of our medical sciences, or find different and more expensive methods of reaching the same goals being attempted by society. We urge, therefore, that the House pass H.R. 3142, the Medical Library Assistance Act of 1965, speedily, and we hope that the necessary funds to implement it will be provided in the next Executive budget. Thank you. (Dr. Brandon's full statement follows:) STATEMENT BY ALFRED N. BRANDON, PRESIDENT, MEDICAL LIBRARY ASSOCIATION, AND DIRECTOR, WELCH MEDICAL LIBRARY, JOHNS HOPKINS UNIVERSITY INTRODUCTION Mr. Chairman, gentlemen of the committee, my name is Alfred N. Brandon. I am president of the Medical Library Association; chairman of its Federal relations committee; and director of the Welch Medical Library, Johns Hopkins University, Baltimore, Md. The Medical Library Association has designated me to present its views and recommendations on H.R. 3142. It is a privilege to ap pear before this distinguished committee to urge your recommendation of this bill which is of incalculable importance in the revitalizing of medical libraries whose mission it is to preserve, organize, and transfer published knowledge resulting from the research efforts that Congress has, itself, done so much to foster through its long and splendid support of health legislation. Section 393 Despite other programs of support for the construction of health-related facilities, medical libraries have never received an adequate share of assistance. A recent survey of 116 established medical, dental, osteopathic, and public health schools shows that 86 of their libraries were in need of funds for construction of new facilities and 18 needed funds for renovating existing library quarters. During the last 8 years I have visited most of the medical school libraries in the United States. With few exceptions, I found them overcrowded with little expansion possibilities in their present stacks. Seating capacities were generally low in relation to the clientele served and work areas for the librarians were at a premium. The enactment of this bill would do much to improve the physical facilities of medical libraries. The total estimated need for construction for medical, dental, osteopathic, and public health schools, both established and new, at 75 percent |