COMPENSATION OF MEMBERS OF THE BOARD OF REGENTS OF THE NATIONAL LIBRARY OF MEDICINE SEC. 4. Part H of title III of the Public Health Service Act which deals with the National Library of Medicine is amended by striking out, in section 373(d) thereof, "$50" and inserting in lieu thereof "$75". EXECUTIVE OFFICE OF THE PRESIDENT, BUREAU OF THE BUDGET, Washington, D.C., June 1, 1965. Hon. OREN HARRIS, Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: This is in reply to your letter of February 15, 1965, requesting the views of the Bureau of the Budget on H.R. 3142, a bill to amend the Public Health Service Act to provide for a program of grants to assist in meeting the need for adequate medical library services and facilities. The bill would authorize a program of grants to finance the construction of medical library facilities, the training of biomedical librarians and information specialists the expansion and improvement of medical library resources, research and development in medical library science, the support of biomedical publications, the support of special scholarly scientific projects, the establishment of regional medical libraries, and the establishment of regional branches of the National Library of Medicine. While the Bureau of the Budget recognizes the importance of the objectives of H.R. 3142, we note that there appears to be uncertainty as to the best future course of development of scientific-including biomedical-libraries in view of the rapid advances being made in techniques for the indexing, storage, and retrieval of information. This has led us to the following conclusions: 1. That a study should be undertaken of future biomedical library needs which takes full account of developing techniques for the improved handling of scientific information. The Office of Science and Technology has agreed to undertake such a study. 2. That it would be prudent to defer beginning a program of medical library construction until 1967 in order to allow time for completion of the above study and consideration of its implications on the facilities needs of medical libraries. 3. That the need for regional branches of the National Library of Medicine is not clear at the present time, and hence the provision of H.R. 3142 relating to the establishment of these branches constitutes a contingency authority for something which may or may not ultimately prove desirable. We believe that the optimum allocation of resources between national, regional, and local medical library facilities is a matter deserving close attention under the program of research and development grants authorized in this bill. The Bureau would further suggest that the separate authorizations for each of the bill's provisions may be unduly restrictive as further studies give a clearer indication of priorities among medical library needs. A combined appropriation ceiling would appear to offer greater latitude to direct funds in accordance with the priority of the objective. Subject to these considerations, enactment of this legislation would be consistent with the administration's objectives. Sincerely yours, PHILLIP S. HUGHES, Assistant Director for Legislative Reference. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Hon. OREN HARRIS, Chairman, Committee on Interstate and Foreign Commerce, May 5, 1965. Dear Mr. CHAIRMAN: This letter is in response to your request of February 15, 1965, for a report on H.R. 3142, a bill to amend the Public Health Service Act to provide for a program of grants to assist in meeting the need for adequate medical library services and facilities. The popular title of this bill is Medical Library Assistance Act of 1965. The bill would provide the basis for a coordinated attack on a number of serious, interrelated problems with which medical libraries are confronted today. The plight of the Nation's medical libraries is critical. During a period of intensive development of health research institutions, medical schools, and other medical facilities, support for medical libraries has been seriously neglected. The condition of medical libraries has steadily deteriorated under the pressures of rapid development of other programs and activities of medical institutions, most of which make increasing demands upon the medical library. In addition, the broadening base of medical research and practice, calling for literature from many ancillary fields, has added to the magnitude and complexity of medical literature. Medical libraries are cramped for space, critically deficient in trained manpower, deplorably inadequate in resources and desperately in need of new methods for handling the growing medical literature. A large-scale national effort is needed now to rehabilitate medical libraries. The President's Commission on Heart Disease, Cancer, and Stroke, reacting to this situation, stated "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 Commission recommended “That not less than $30 million per year for 5 years be authorized and appropriated to the National Library of Medicine for a program of grants and contracts to support improved medical library services in the United States including facilities, resources, training of personnel, secondary publications, and library and communications research" and "that broadly conceived legislation be initiated clearly authorizing the National Library of Medicine to assist medical libraries in the ways recommended." Enactment of this bill would be a major step in carrying out the Commission's recommendations. Facilities The bill would authorize the Surgeon General to make grants of up to 75 percent of the costs of constructing, renovating, expanding, or remodeling medical library facilities. In acting upon applications for grants, consideration would be given to the relative effectiveness of the proposed facilities in meeting demonstrated needs for additional or improved medical library services, and priority would be given to projects for construction of facilities for which the need is greatest. For these purposes, the bill would authorize appropriations not to exceed $10 million a year for a 5-year period beginning with fiscal year 1966. One of the most critical needs of medical libraries is for space in which to maintain their collections and to carry out their necessary day-to-day operations. The chronic shortage of shelf space precludes the acquisition of essential additional books and materials each year. Crowding obstructs and often completely prevents access to the volumes on hand. Working space for library staff's is so restricted as to be a real barrier to effective operations (many medical libraries are so crowded that there is not even space for desks for the staff), and many libraries lack the space for up-to-date processing and labor-saving equipment. The need for space is desperate and of great magnitude. However, in order to make the most effective use of the funds that will be available for this program, we believe that initiation of the construction program should be preceded by a study of the kinds of facilities which will be most suited for meeting present and future requirements in the light of rapid technological advances. To allow time for such a study, and at the same time achieve the full objective of the construction program envisaged by the bill, we recommend that this provision of the bill be amended to provide for a 4-year construction program, beginning with fiscal year 1967, with annual appropriation authorizations of $12.5 million. Training The bill would authorize the Surgeon General to make grants to assist in the training of medical librarians and other information specialists in the health sciences. Not to exceed $1 million a year would be authorized for 5 years, beginning with fiscal year 1966. Sums made available under this section shall be used by the Surgeon General to make grants (1) to individuals to enable them to accept traineeships and fellowships leading to postbaccalaureate academic degrees in the field of medical library science, in related fields pertaining to sciences related to health, or in the field of communications; (2) to individuals who are librarians or specialists in information on sciences related to health, to enable them to undergo intensive training or retraining to attain greater competence in their occupations (including competence in the fields of automatic data processing and retrieval); (3) to assist appropriate public and private nonprofit institutions in developing, expanding, and improving training programs in (medical) library science and the field of communications of information pertaining to sciences relating to health; and (4) to assist in the establishment of internship programs in medical libraries meeting standards prescribed by the Surgeon General. There is a critical shortage of professional personnel trained to meet the special needs of medical libraries and the medical community they serve. There are approximately 6,300 medical libraries in the country, staffed by only about 3,000 professionals. The annual attrition from this professional group is approximately 150. There is urgent need for specialized training over and above the general librarianship for professional persons to staff medical libraries. The type of professional needed to deal with the medical science communications problems is not being trained at the present time. Training programs must go beyond the basic, traditional training in library science and provide advanced training, specifically related to the communication needs of the medical community, with a heavy emphasis on the biomedical sciences, the existing patterns of communication in the medical community (including familiarity with the medical library system), and such specialties as systems engineering, linguistics, and the like as they relate particularly to medical communication. H.R. 3142 would authorize the kinds of training assistance particularly suited to the development of this specialized competence. Postbaccalaureate support of selected trainees and fellows in programs directly related to the problems of medical science is essential. Centers of excellence could be developed in which comprehensive interdisciplinary advanced training could be furnished persons preparing for careers in medical library science. This would require medical direction and leadership. Many of those presently staffing medical libraries need intensive specialized training in order to increase and update their competence. The training of biological scientists as information specialists and the training of scientists in information techniques in relation to medical problems also constitute important segments of a farsighted effort to upgrade the quality of service of medical libraries to the student, the investigator, and practitioner of the health profession. Internship programs in outstanding medical libraries would assist greatly in training of new librarians and in updating the skills and increasing the competency of persons already in the field. Resources The bill would authorize the Surgeon General to make grants of money, materials, or both to public or other nonprofit medical libraries and related scientific communication instrumentalities to expand and improve their basic medical library or related resources. Not to exceed $3 million a year would be authorized for these purposes for a 5-year period, beginning with fiscal year 1966. No grant in any year could exceed $200,000 or, if lesser, 60 percent of the annual operating expense of the library for the first year; 50 percent (or, if lesser, fivesixths of the first year grant) for the second year; 40 percent (or, if lesser, fourfifths of the second year grant) for the third year; 30 percent (or, if lesser threefourths of the third year grant) for the fourth year, and 20 percent (or, if lesser, two-thirds of the fourth year grant) for the fifth year. Grants could be used for (but not limited to) acquisition of books, journals, films and other materials; cataloging, binding, and other services and procedures for processing library resource materials for users of the library; acquisition of duplication devices, recording equipment, and other equipment to facilitate the use of the resources of the library by those it serves; and introduction of new technologies in medical librarianship. The medical library resource need is of great magnitude and so directly related to medical research, to the training of medical manpower, and the information essential to the practicing medical community that it requires special, intense attention immediately if fundamental responsibilities in the health area are to be fulfilled. Neglect of support of the resources of the Nation's medical libraries has been chronic and cumulative to the point where they now have only about half the books, journals, and other resources they need. In addition to these shortages, a larger majority of the medical libraries have large backlogs of tasks such as cataloging and indexing necessary for the effective use of the literature and are in critical need of new and additional types of equipment (such as photoduplication) to speed the processing of materials. Significant Federal assistance is essential to build up collection to minimum standards and to support necessary bibliographic apparatus. In this connection, it is important to note the vital role to be played by regional medical libraries to be established under another provision of this bill. These regional libraries will collect materials in depth and make their resources and services available to other medical libraries in a broad geographic area so that the resources of the amaller libraries can be limited to the most-used classes of materials. Even with the efficiency and economy which the regional medical library mechanism will foster, the need for basic resources is tremendous. The descending scale of Federal grant support for these essential resources would encourage the upward revision of medical library budgets over the 5-year period, and serve to stimulate substantial, continued institutional support for the medical library function in the future. Regional medical libraries The bill would add a new section 398 to the Public Health Service Act which would authorize the Surgeon General to make grants to existing public or other nonprofit medical libraries to enable them to serve as regional medical libraries for the geographical areas in which they are located. Not to exceed $2.5 million a year would be authorized to be appropriated for these purposes for a 5-year period beginning fiscal year 1966. Grants could be made only to medical libraries which agree to provide supportive services to other medical libraries in the region, provide free loan service to qualified users, and make available photoduplicated or facsimile copies of biomedical materials which qualified requestors may retain. Priority would be given to medical libraries having the greatest potential for fulfilling the needs for regional medical libraries. In determining priorities consideration would be given to such factors as the need for a regional medical library (assessed in terms of the levels of research, teaching, and medical activities of that library in relation to other medical library services in the region); and adequacy of the library (in terms of collections, personnel, equipment, and facilities) as a basis for a regional medical library; and the size and nature of the population to be served in the region in which the library is located. Grants under this section for basic resource materials could not exceed 50 percent of the library's annual operating expense for the preceding year (exclusive of Federal financial assistance under this bill). Construction, renovation, or expansion of the physical plant necessary for the carrying out of functions as a regional library would be authorized in the same manner and subject to the same terms as other construction grants authorized in the bill. Grants could also be used for equipment, staff, and services necessary for the functions of a regional medical library. Need for regionalization has become acute with the growth in the magnitude of the medical literature and the speed with which information is required. At present, the National Library of Medicine is serving as the "libraries' library" in meeting the needs for increasing amounts of material which local medical libraries do not have on their shelves. Assistance in meeting the need for basic library resources will help materially in relieving this problem, but it is neither economically feasible nor necessary for each medical library to seek to build its own collection to try to encompass even a sizable proportion of the whole of the medical literature. The development of a system of regional medical libraries, locally operated and controlled but with Federal assistance in the collection of materials in depth and of the equipment and staff necessary for an effective regional service, would do much to meet the needs of individual medical libraries in the region, and at the same time assure rapid, quality medical library service throughout the Nation. It would also contribute greatly to the effective utilization of scarce, skilled manpower, since the services and knowledge of highly qualified staff would be available throughout the region served. In some regions of the Nation there may be no medical library adequate to serve such area as a regional medical library. The bill would add a new section (sec. 378) to part H of title III of the Public Health Service Act (relating to the National Library of Medicine) which would authorize the Surgeon General in such cases to establish, as branches of the National Library of Medicine, regional libraries of medicine to serve the needs of such regions. Not to exceed $2 million annually would be authorized to be appropriated for this purpose for a 5-year period, beginning fiscal year 1966. Sums so appropriated would remain available until expended. We strongly endorse these complementary authorizations as providing the flexibility necessary for the most rapid and efficient deployment of medical library resources and services throughout the Nation. Special scientific projects The bill would add a new section 395 to the Public Health Service Act which would authorize not to exceed $500,000 a year for a 5-year period beginning with fiscal year 1966, to be used by the Surgeon General to assist, through awards to physicians and scientists, in the compilation of existing, or the writing of original, contributions relating to scientific, social, and cultural advancements in the sciences related to health which will facilitate the distribution and utilization of such knowledge and information. The Surgeon General would be authorized to make appropriate arrangements whereby the facilities of the National Library of Medicine and of other institutions would be made available in connection with the projects for which the awards are made. With the tremendous increase in the volume and complexity of the literature in the biomedical sciences there is an urgent need for preparation of critical reviews, articles, abstracts, and other compilations or original contributions of a high degree of excellence and reliability to make more readily available to the medical community knowledge of advancements in the medical sciences. Such reviews, by physicians and scientists of stature, can serve as one of the most important keys to the literature, by providing practitioners, teachers, scientists, students, and others with access to, and appropriate perspectives on, significant aspects of scientific developments. Research and development in medical library science and related fields The bill would add a new section 396 to the Public Health Service Act which would authorize appropriations of not to exceed $3 million a year for a 5-year period beginning with fiscal year 1966, for grants or contracts for research or investigations in the field of medical library science and related activities, and for the development of new techniques, systems, and equipment for processing, storing, retrieving, and distributing information pertaining to sciences related to health. The magnitude and diversity of the requirements of the Nation's corps of healthworkers for the information in the medical literature is tremendous. The information resources of the Nation's biomedical libraries must be made available to its corps of health practitioners, to researchers in the health fields, and to students being trained in the health professions, in ways which are commensurate with their urgency, variety, and volume. The volume and character of the published biomedical literature are such as to pose peculiar problems of storage, retrieval, and transmission of the information contained therein. The uses to which the information is put are of such vital importance in terms of the health needs of the Nation that the urgency of improving these aspects of its handling cannot be too strongly emphasized. Nearly all aspects of current medical library science need to be reassessed to develop more efficient skills and technologies. In addition, research is needed in related areas such as the uses of information by scientists. teachers, and practitioners and their searching techniques and attitudes; medical terminology and classification; machine indexing; graphic image storage and retrieval, and the like. Such research will not only provide answers to many immediate problems of medical information handling, it will also provide important guidelines for the future. Support of biomedical publications The bill would add a new section 399 to the Public Health Service Act which would authorize appropriations of not to exceed $1.5 million a year for a 5-year period beginning with fiscal year 1966 for grants or contracts with nonprofit institutions of higher education or individual scientists for support of nonprofit biomedical scientific publications and to procure the compilation, writing, editing, and publication of reviews, abstracts, indices, handbooks, bibliographies, and related matter pertaining to scientific works and scientific developments. No grant for support of any periodical publication could be made for more than 3 years. Effective access to the medical literature requires a variety of secondary publications, including abstracts, indices, handbooks, critical reviews, and the like. This is particularly true as the volume, magnitude, and complexity of the literature increases. The support authorized by this section would be limited in duration and could serve as a stimulus to the initiation and successful maintenance of a few carefully selected publications which have potential for making a special contribution to the biomedical community. National Medical Libraries Assistance Board The bill would provide that the Board of Regents of the National Library of Medicine shall constitute and serve as the National Medical Libraries Assist |