However, there are existing mechanisms through which Federal staff could help bridge the gap between research and service. For instance, there are funds available for conferences to facilitate person-to-person communication with the innovator, and for site visits when appropriate. There also are funds for special services, such as consultations. Much more communication of this kind is needed, and with participation provided for all categories of potential users of the innovation. Further, there are some funds available for the printing and wide dissemination of specially noteworthy project reports in order to achieve a rapid wider currency. To illustrate this last point, the Vocational Rehabilitation Administration invited HIRI to redo its final report on the research utilization study into an attractive 6 by 9 edition, and funded the printing of 4,000 copies.

The scientific community generally is not aware of the program problems, information needs, and concerns of the Federal agencies. Some of the suggestions already made with reference to identifying those needs and inviting the scientific community to contract for meeting them, appear relevent to this question too.

On the subject of the existing means of communication, a finding from the American Psychological Association's project on scientific information exchange (Menzel, H., American Psychologist, vol. 21, No. 11, November 1966) may be appropriate to quote here:

*** The possible relevance of a message to a man's work may not become apparent at the time it is first received, but only when that same message is repeated, sometimes more than once, or when it is put together with other information yet to be received, or when changes occur and needs come up in the course of the scientist's own future work.

In fact, not only an individual scientist, but an entire scientific community may for years turn its back on some already published and significant piece of work, until it is "brought home" by repetition, appearance in new media, rediscovery in new contexts, or other supplementary messages. Information must often be publicized repeatedly or through diverse channels before it will enter the stream of communications which will lead it to its ultimate user; and from the point of view of the consumer of information, it is frequently necessary to be exposed to the information repeatedly before it will make an impact * * *. Much of this crucial multiple exposure is brought about in informal ways, largely through contacts between individual scientists.

Before I turn to the fifth question, I would like to add something to the prepared written statement.

A person in one of the Federal agencies here in Washington yesterday told me the following: A Russian scientist had an invitation to visit some biomedical laboratories in this country and went from laboratory to laboratory to see what they were doing in his area of specialty. As he moved from one to another, he was very surprised to find that the people on up the line frequently did not know what he had learned down the line from the places he previously had visited. But by the time he finished visiting 15 laboratories in the United States, he knew more than most of his American counterparts did, who had not been spending much of their time visiting and seeing what the others were doing. As he pointed out, in Russia this could not happen. My friend in the Federal agency said, "Yes, by your tight controls, this particular thing would not happen, but you would not have as many things going on in 15 different places as we have."

So there are perhaps some advantages and disadvantages. I think we can capitalize on our advantages of free inquiry and diversity by more effective communication so that the people working in different

and diverse settings can more readily know what others are doing and can become effective consultants to each other.

As a matter of fact, we are proposing something of an innovation in this area in the field of emphysema. There is a hospital in California which has developed a rather strenuous exercise program for emphysema patients which appears to be quite effective. On the other hand, there is considerable difference of opinion in the medical field as to whether exercising someone who is gasping for breath is a good idea or whether it may not sometimes result in the "last gasp."

There is another well-known medical facility in New York City which likewise has been experimenting with special exercise programs for emphysema patients. The two programs are complementary but not identical. The institution in New York has used oxygen therapy and electrical stimulation, which the California group has not used. the California group has used conditioning exercises and relaxation exercises of a semiyoga type which the New York group has not used. Both of these, by the way, have published their findings in the appropriate medical literature.

In our own study, we are proposing first to go around the country and find out what is being done as a point of fact. We want to find out who knows about these two exercise programs. Then with the concurrence of the directors of the two institutions, we propose to get them together, along with consultants such as chest specialists and chest surgeons from public and private hospitals and in private practice. We plan to get all of these people together for a several-day conference to combine the best features of each program.

Senator HARRIS. Who is funding this study?

Dr. GLASER. This is at the moment a proposal. The Veterans' Administration has funded the California study. The Vocational Rehabilitation Administration (VRA) has funded the New York study. The one I am talking about is a proposal at the present time trying to apply what has already been learned.

Senator HARRIS. Whom would you be proposing it to?

Dr. GLASER. VRA.

After the new program has been developed and tested for its efficacy and some effort has been made to determine which features of the program contribute most to the improvement of the patients, this new program then will be disseminated by means of various strategies for getting it utilized. We will then propose to evaluate the efficacy of certain of these procedures. By an effort to bring together the best that is known in a given field and at the same time bring together the potential users from the beginning as consultants, we think the process of research utilization will be facilitated.

Now, to go back to the prepared statement

5. Are new, or additional, Federal institutions needed to further development and application of biomedical knowledge?

In my judgment, we do not need new or additional institutions to further development and application of knowledge. We do, however, need special components within each of the major Federal research grant agencies (and within the experimental, research and demonstration contract-awarding agencies) that would carry responsibility for what we might call "marketing" functions. These Federal agency components, such as NIMH's Applied Research Branch, and

OMPER's Division of Program Utilization, might work as facilitators and catalysts to help both the researchers and their own agency project officers to promote the application of research and demonstration findings among potential users.

There might be a place for a federally supported operation to serve as an information center regarding what Federal institution one should apply to when one wants to do research in a particular field. It would be something like a central computer that one could plug his problem into and get an answer, such as, "Take this one to VRA," or "Take this one to NIH." The more new Federal institutions are created, the more such a central agency might be helpful.

Again, I would like to depart from the prepared statement and add to my paper and read something else which I think would fit in here. I believe there is a need to reduce wasteful proliferation and fragmentation of research, demonstrations services, and research utilization efforts by developing better interagency exchanges to discuss policies and problems as well as projects already underway or needed to help fill gaps in knowledge. Agencies also could work out common as well as unique strategies for utilization of promising findings. The more complex our society becomes and the more specialized the focus of different groups, disciplines and agencies, the greater the need for system integration to relate the parts to the whole.

Returning to my written statement now there have been many expressions of concern in recent years about the relative lack of application (and applicability) of basic research findings. Some people who feel this way seem to have concluded that the consequence of this fact is that more applied research should be supported, and relatively less basic or pure research should be supported. There is another alternative I should like to lead into, keeping in mind that research always is a necessarily expensive method of investigation and that one has to be prepared for many tries which turn out to be failures.

It is conceivable that two reasons for the relative lack of applications of research findings stem from communication difficulties and from various types of resistance to social change. The chain of progression from conduct of research (such as a laboratory investigation) to actual value to society (as in a practical program) is a complex one. This is especially true in the biomedical field which involves special problems of control groups, limited number of cases, and need to evaluate side effects. The more complex the transition from research to utilization, the more it is desirable to increase the present support for exploratory and demonstration research in the area of research utilization. This appears to be a better alternative to achieve application than to reduce support for basic research. When a biochemist does some research in a rather restricted biochemical area, what opportunity does he have to communicate with people in related areas? Creative effort is needed to bring together biomedical research people and people from different disciplines, such as chemistry, physics, and engineering, who may have information pertaining to the problems of biology and medicine. Later, it may be valuable to bring these people together with various categories of appliers, such as physicians, nurses, perhaps professional practice psychologists, educators, physical therapists, and public health personnel.

Again departing from the paper, I would like to suggest that when an innovation appears to the practitioner there are generally four

questions that implicitly, if not explicitly, he tends to ask himself: One, is this innovation likely to be helpful? Second, might it be harmful? Are there some side effects which may negate its positive values? Third, is it practicable in terms of time, energy, money, and skill? And fourth, is it important enough for me as a private practice physician to change from what I have been doing and what I know how to do to this new procedure?

Thus, the development and application of biomedical knowledge can be facilitated if those engaged in research and demonstration projects would keep these four questions in mind with reference to the orientation and needs of the practitoners in the field.

In addition to the original five questions responded to herein, the subcommittee has expressed interest in two other questions directly related to our own research studies, namely:

(a) What have you found to be the major barriers to the dissemination and utilization of findings from research, experimental and demonstration projects funded by Federal agencies?

(b) What are some of the relatively effective ways of reducing or overcoming barriers and opening gateways to better dissemination and utilization of existing knowledge-in the biomedical and other fields directly concerned with human welfare?

The major barriers are inadequate communication, attitudinal resistances to new ideas or practices, lack of time and inclination to explore and master seemingly complex innovations when one can hardly keep abreast of established daily involvements and commitments, institutional inertia, need to assert the worth of what is now being done, sometimes lack of money to try the new technique, et cetera. The summary of suggestions for reducing those barriers suggested by the participants in the aforementioned Department of Labor seminar, "Putting Experimental, Research, and Demonstration Findings to Use," is reproduced herewith.

It represents the distillation of the thinking of this group of some 30 people, including myself and our associates, on how to reduce these barriers and get research utilized more effectively.

Senator HARRIS. Without objection, we will place that in the record. (The abstract referred to follows:)

EXHIBIT 2

SUMMARY OF SUGGESTIONS OF DEPARTMENT OF LABOR SEMINAR, "PUTTING EXPERIMENTAL RESEARCH AND DEMONSTRATION FINDINGS TO USE"

ABSTRACT AND SUMMARY

Every year the Federal government spends millions of dollars to finance experimental, demonstration, and research projects in one or another of the social sciences. Many of them produce valid and valuable findings on how to improve practices, techniques, services, and standards.

There is, however, a considerable gap between the best available knowledge in almost any given field and everyday practice. The quality of life in our society can be upgraded if that knowledge can be more widely disseminated, given greater impact, and more extensively applied. This seems particularly true with reference to knowledge in the areas of human resource development and utilization, design of human environments, and health-related knowledge.

Below are the principal ways to achieve this, recommended by participants in the seminar, Putting Experimental, Research and Demonstration Findings To Use. The participants were aware that not all suggestions are relevant to each

type of demonstration activity, that the degree of application and the emphases selected are closely linked to availablity of resources and to the particular program's key objectives, that many of the things suggested already are being done to some degree by some agencies, and that not all have been tested for efficacy.

1. Stimulate good research proposals by (a) streamlining grant and contract procedures, including providing a small planning stipend after approval of an informal proposal, and by (b) inviting and reaching out for submission of proposals in a given field to assure desired complementary studies and needed coverage of given subjects, not just waiting for proposals to be submitted.

2. Prepare and distribute to potential users comprehensive but succinct periodic reviews of the state of the art/knowledge in given fields. In these reviews, point up gaps which might be filled by Research and Demonstration (R & D) or Experimental and Demonstration (E & D) projects.

3. Ask and try to answer continuously, from inception to completion of a project, the questions of its aims and ultimate use of results. Whom is the demonstration intended to influence? What are the obstacles to the good use of results, and how can these obstacles be overcome? What criteria should be used to evaluate the results? When these questions have been tentatively answered, either before the project begins or at the start, bring in representatives of the identified program group who will be needed to implement the findings (in addition to requiring that each proposal include recommendations by the sponsor on how to implement the findings of his project). The representatives will meet with the project staff and funding agency program officer, for consultative reactions to the tentative answers. These persons may well be helpful with practical advice not only regarding possible improvement of the project, but also regarding appropriate ways of interesting potential users or colleagues in their own field.

4. Provide for continuous interaction between grantor or contractor and grantee, from the beginning of the project through the period of dissemination and efforts to apply results. This may imply more technical training for Washington agency staff; more staff devoted to keeping in contact with projects and stimulating use of results; better interagency coordination; development of a clearinghouse and data retrieval system similar to that of the Office of Education.

5. Provide in the project methodology a built-in component on reporting procedures and statistical data which would permit subsequent evaluation and utilization.

6. Summarize findings in separate, brief, nontechnical, and very readable reports, in addition to the full technical reports. Get criticisms of at least the summary reports from key representatives of potential users before they are put into final form. Then disseminate them widely to members of the various groups of potential consumers.

7. Conduct seminars in conjunction with site-visits, where potential users can discuss the innovation, perhaps see it and "feel" it as something alive, and consider its applicability to other situations. The participants could have small group discussions of ways to adopt and perhaps to improve the innovation. Give encouragement to each participant to tell about innovations in his own facility. Thus, each participant can become a giver as well as a receiver of information. 8. Replicate important demonstrations as a means of accumulating more experience and, through reaffirmation, making them more credible and impactful. 9. Identify and recruit key practitioners in various localities to apply the innovation to their own settings. Their example might be expected to foster adoption among others with whom they are influential. To facilitate application of the innovation, provide human links or change agents who are thoroughly familiar with it to serve as consultants to the institution which is interested in exploring, adopting or adapting the innovation.

10. Invite attention to the potential rewards of adopting the innovation-for example, winning approval from key persons or sources, gaining prestige, reducing costs, improving services-so that the potential user can identify them with his self-interest.

11. Obtain policy commitment from funding agencies to the idea that dissemination and utilization functions are an integral part of its research program. Implement this commitment by training agency program officers in these skills and providing each research-support operating division with a dissemination and utilization staff of its own, in addition to an overall Bureau or Office capability. This operating division staff would work with agency program