Dr. LINDBERG. Yes, sir. That was for me a very helpful discussion. We have done our best on this. I should fall back and say that the general scheme of the need for an outreach project, which Dr. DeBakey and the panel brought to our attention, helped us enormously [now].

The scope with which they urged us to attack the problem was fiscally way, way above what we were actually able to get resources to do. We have however done a good job with the resources available to us.

There were about 80 projects. Maybe I could draw your attention to these displays. The first one shows the distribution in our country of persons with codes-that is to say, the persons who have signed up to use MEDLINE.

The dark area there, California, has got the largest number of codes, and the cross-hatched areas of New York and Washington is next. That was the state in 1985, when we started our more highpowered outreach effort.

Just grossly, if we look at 1991-I think-you can see the country has gotten much, much more dense in the places that have access to our system.

OUTREACH

There are still some areas, rural areas in particular, Wyoming, parts of the South, where they are not so dense, but we are making a lot of progress on it.

This display shows where we have formal outreach projects, little circles on the map. They weren't nonexistent in 1989, but they weren't very numerous.

The result of our outreach effort is that we now have 80 projects, pretty reasonably distributed across the U.S., which we show highlighted in yellow, the States that have had the most projects are the rural States that really have had a great increase in the number of physicians that have accessed the system.

The green dots indicate institutions that are offering courses which train physicians in the use of GRATEFUL MEĎ. I don't want to suggest to you we have covered the problem. Those may just be a one-year award, but at least they are giving some groups of doctors courses in how to use the systems.

The project site indicated by the green dots are specifically and almost solely aimed at minority problems, or treating minority patients. I can give you the details of what those entail. The general picture is, we are doing a lot more than what we were doing. The net result is we are increasing the number of doctors and particularly minorities in rural areas who have access to our systems. I can you some examples, if you like.

Mr. STOKES. Sure.

Dr. LINDBERG. The first one that comes to mind is in the Rio Grande area, where we have gone back to the system of librarian circuit rider, an incredible person. A lady that, inside three days, makes the circuit and visits the small towns and hospitals and trains them how to do their searches. We discussed that same kind of scheme with Dr. David Sacher, he visited us, wondering how that would fit into their ideas.

Meharry has its own outreach programs. With all the troubles they have, they feel they are fortunate and their obligation is to do their own outreach program. With that in mind, they send both students, and more particularly residents, out for periods of time in very rural areas.

The help they thought would be best would be if we would help them to equip those residents and their preceptors with computers and the ability to call back to Meharry and call to NLM and get their searches done, be modern and take that with them, even though they are residents, when they go to learn from the older doctors-we all know you learn a lot from the young students as well.

That is the help they thought we could give them. There is a comparable scheme at Interfaith Medical Center in Brooklyn. There are a set of toxicology programs I am quite proud of. I think the advice you gave me, Mr. Stokes, is that I ought to not ask the Congressmen, but should be asking the people doing this work, particularly in the black community, the directions we ought to choose, and we did.

One of them surprised me. That was the tremendous interest in the toxicology information system, which are actually very compli

cated, sophisticated, beyond many of us to really be familiar with, but they are particularly relevant to minorities because of exposure in jobs and exposure in neighborhoods with chemical dumps. Their view was that is a special interest, and you ought to lean into it. With that in mind, one of the people on our staff, Mel Spann has undertaken some training and meetings with a couple dozen people.

More important, there are seven sites at HBCUs where there are toxicology centers. One for doing research, but more important, how to train the people in those systems. If that works out well, we will repeat that. It looks like it is a good start.

This Loansome Doc for ordering reprints, it is of general use, but I think there is a special problem with minorities, which requires special attention. There is also another program at NLM which has started, essentially for engineers and computer scientists.

They are now interviewing candidates, and by January 1, will have about half a dozen undergraduates, but that is a start. They wil! spend 2 years alternating from their college programs and NLM, including full-time summer, and they will have preceptors at the black colleges.

We have had good response to it, we have good applicants, happily both men and women. So we will have our choices to make. We will have them in place by July. What we hope to gain from that— the people have always had students. What is new is this will be a long enough period so that they hope two things will happen:

One, that they will go for graduate degrees-I mean, students have always been in the labs, and they have always taken the best paying job that came along as soon as they could leave, and that is a shame, because some of the need for graduate degrees. We hope of those, some will stay in biomedicine. That is where we stand.

NLM EMPLOYMENT

Mr. STOKES. I appreciate that response. Obviously, there has been a great deal of sensitivity in that area. I am very appreciative of that.

We also talked last year about minority employees at your agency. As I recall, about a third of your employees were minorities out of, I think, 540, you had about 154, but one of the things we discussed at that time was the high concentration of minorities in the lower grades.

Have you been able to make any progress in terms of that problem?

Dr. LINDBERG. I think it is still roughly the same situation. It isn't probably so extreme in a way, in that in the range of GS 13 to 15, there are 73 persons and minorities and women are 55 percent.

Minorities alone are only 10 percent, so that isn't something to be terribly proud of. In SES, there are only six such persons, one is a woman and one is a minority. That is not disgraceful, but not as high as we would like it to be.