ther a luxury nor evidence of weakness. It is rather an utter necessity and the hallmark of the creative, successful researcher.

We immediately realized, when we began to study the proposed Assistance to Medical Libraries bill (S. 597) that implementation of it would go a long way to correct the dangerous imbalance that has developed in biomedical research; an imbalance created by a disproportionate emphasis on the test-tube method of answering questions; à distortion that has the effect of banishing forever any printed contribution that is more than a few months old. The proposed bill will also have the effect of converting many of our biomedical libraries from mere warehouses for books to active information centers; receiving, processing, and above all distributing knowledge in the biomedical field to those who need and use it. But we also realize that no matter how freely scientific literature is made available, the effort will be useless unless our researchers are willing to sit down and digest it. Such a willingness is hardly likely to be directly created by passing a law; but it will begin to develop when an appropriate climate is created. Much of this is the responsibility of our universities and directors of research but the proposed bill, if enacted, will be very influential in this direction. Such a move will provide eloquent evidence that our national leaders understand and accept the vital necessity to read and digest other men's views and results, as well as to labor in the laboratory with vigor and with wisdom.

So much, then, for the intangibles. We believe they are of paramount importance and resolutely resist the usual impression that because they are intangible they are also nebulous and unimportant.

I turn now to the first provision of the proposed bill which provides funds for constructing new facilities and renovating old ones. The abysmal physical plight of the Nation's medical libraries is such common knowledge that it hardly needs further elaboration. But it should be noted that the recent construction of a few very splendid medical libraries is only a small beginning. Our contact with medical schools and their libraries is a close and continuing one; and we have noted with increasing dismay and bewilderment the general neglect of such libraries by the medical schools themselves. They have used funds (their own and Federal funds) for other types of construction imaginatively and aggressively, but the gross inadequacy of library buildings and facilities has usually gone unrelieved as if it were a matter of lowest priority; an item which can safely be ignored indefinitely. Even where we have found efforts to relieve the inadequacies underway, we have often been amazed at the inadequacy of the efforts themselves; at the incredible lack of comprehension of the basic relation of medical libraries to medical research and education, especially at the student level. Documentation of this long neglected need is readly available and undoubtedly has been or will be presented to this subcommittee. But the facts that over half our medical school library buildings are more than 30 years old and that over half of them are filled far beyond their nominal capacities are certainly worth noting. It is also of interest that medical schools have for years been devoting about 1.5 percent of their incomes to their medical libraries and that the figure has almost, if not quite, kept pace with increasing income in recent years. But, in our minds, the figure has been much too low all along, and many of the deficien

cies in our medical educational system can logically be attributed in some measure to this fact. I believe I can say with almost universal agreement, in sum, that medical school libraries are undoubtedly the most neglected of all medical school facilities. This generalization, incidentally, includes their collections and operating budgets as well as their physical plants.

One should certainly note, in passing, that the plight of many medical libraries that are not parts of medical schools is likewise dismal. The American Heart Association depends in some measure on several such libraries and feels strongly that they should share in the use of Federal aid for upgrading facilities and services and for protection of their invaluable collections. We believe, in fact, that a good case can be made for increasing the amount of money to be made available for construction in the first 2 years. And we suggest that consideration be given to a flexible matching policy so that the Federal contribution might vary from 50 to 90 percent of the cost of construction, depending on circumstances. This is in line with our continuing concern that under a rigid one-to-one matching policy, the affluent institutions may be able to participate quite easily; but those with inadequate funds of their own, when the need for upgrading of facilities is often quite urgent, may be unable to participate at all.

We share in the strong general impression that adequately trained library personnel is grossly inadequate to meet the national need. We are especially impressed with the need for library personnel who are also conversant with medical subject matter and concepts. We support the request for training funds as stated and, in addition, hope that some consideration can be given to methods of inducing graduate physicians to consider becoming professional medical librarians. Some such move seems to us to be very much indicated and would, we believe, be an important step toward bringing physicians in both practice and research into more effective contact with the biomedical literature.

The proposal to establish special fellowships for creative literary work in the biomedical and social sciences is worthy in itself and should be supported, in our opinion, provided such fellowships cannot be more logically included in existing programs. They would not, however, meet the specific need for a mechanism to bring trained physicians into medical library work. We find the fellowship proposal of interest primarily in that it may serve as one means of attacking the growing need for better communication between the biomedical professions and the lay public. Such fellowships could, we believe, be made to provide suitable physicians with the necessary time and professional advice to enable them to turn out authoritative reports primarily designed for lay consumption. It might also make it possible for certain physicians to contribute communications in depth in fields, such as medical history, that tend to narrow the gap between medicine and the humanities.

Next to funds for construction, we regard the provision of the bill for improving and expanding basic resources to be the most fundamental. It would provide in some instances for much needed expansion of holdings, especially of periodicals. Perhaps more important, it would give small libraries the opportunity of building up microfilm or microcard collections covering items that are unpro

curable in the original. Runs of many important biomedical journals, for example, can often be acquired in this form at reasonable cost but are prohibitively expensive (or unprocurable) in the original. Such funds would also make it possible for libraries to expand their copying facilities so that most loans can be issued in copy instead of in the original. This system, now thoroughly tested in several centers, not only spares wear and tear on the original but provides the reader with a permanent copy for his own use. We also trust that funds under this provision could be used, when indicated, to bring salary scales of library workers to a reasonable level. In many instances they desert the library as soon as a betterpaid opening is available. We believe the descending scale of awards under this provision ($200,000 or 60 percent of annual operating expenses in the first year; 50 percent in the second; 40 percent in the third, and so on) to be wise and hope that it may serve to induce parent institutions gradually to increase the amounts allocated to their libraries.

The proposal to support research and development (sec. 396) in medical library science is especially important in view of rapid progress in storage and retrieval techniques, methods made mandatory by the explosive increase in publication of biomedical material. Also to be considered are improved methods of copying and transmission and other items. The American Heart Association regards the proposal (sec. 396) as a reasonable component of the larger plan to improve the Nation's medical library facilities.

The American Heart Association strongly approves the proposal of financial support for appropriate biomedical scientific publications (sec. 399) of a nonprofit nature. Certain needed scientific journals, particularly of a technical nature with relatively limited, but crucial, readership, not infrequently require financial assistance in the beginning years and in some instances, in subsequent years as well. Likewise, other significant scientific publications may never appear without financial subsidy. A recent example in the cardiovascular field is the Journal of Lipid Research (for biochemists and other investigators in atherosclerosis and related research) which was established with wisely expended Federal funds. Likewise, the proceedings of the 1964 Second National Conference on Cardiovascular Diseases and the summary of the conference are being published through joint support of the National Heart Institute, the heart disease control program, and the American Heart Association.

Since certain highly meritorious periodical publications may not achieve financial stability during the first 3 years, our association recommends that the restriction of grant support to 3 years be liberalized, certainly to 5, and possibly to 10 years.

The CHAIRMAN. You mean they might not achieve financial stability during the first 3 years?

Dr. CHAPMAN. Yes, sir, we feel they need some more stability in point of time and planning and so on.

Our last point, sir, relates to the regional medical library provision (sec. 398). We fully support the provision but urge that careful consideration be given, in its implementation, to existing medical library developments of a regional nature.

We note, for example, that the Medical Library Extension Service of the University of Wisconsin has been in successful operation since 1926. Similar services are provided by the University of Nebraska in its State. Most significant, however, is the fact that in both instances the service is not actually promoted or advertised owing to the fact that each is already operating to capacity (but on a very small scale). Similarly, the farsighted efforts of the Medical Library Center of New York should be studied and facilitated in implementing this provision of the bill.

Special consideratiioon should, we believe, be given to the library needs of the practicing physician. The Wisconsin and Nebraska operations are primarily devoted to meeting such needs. In some States, including Texas, State medical societies maintain special collections and facilities to serve the needs of practicing physicians which are not incidentally, always similar to those of the medical student or research worker. We believe that the experience of such units should be carefully studied and that any regional medical library plan should help them to expand and upgrade their operation. The services they render are indispensable and, in most instances, overtaxed. Whether or not such units join a regional library plan, or cooperate as an independent unit, should be optional.

In the last analysis, regional organization of medical library facilities is the only solution to the problems created by small collections, inadequate operating funds, and the costliness of modern bibliographic and copying machinery. The American Heart Association believes that the provision relating to regional medical libraries will greatly facilitate existing efforts at regionalization and considers it a wise and useful component of the bill.

In conclusion, the American Heart Association puts itself solidly on record as strongly favoring the Medical Library Assistance proposal (S. 597) virtually in its entirety. Even with careful consideration, we can find no serious fault with it. More positively, we believe it will make a contribution to the health of the Nation that is out of all proportion to the amount of money requested. Funds for construction and renovation, on a matching basis which should be negotiable within wide limits, are very urgent. So are funds for expansion of collections and services. Training funds are scarcely less important and we urge that some means of making the career of medical librarians attractive to physicians be earnestly sought. The use of funds for research in library and bibliographic techniques seems eminently sensible to us and we hope it will receive favorable consideration. We are especially impressed with the need for Federal funds in support of special types of medical publications. It is paradoxical that there is a sizable number of biomedical publications which, although of little commercial promise, are inordinately valuable scientifically. Finally we support the regionalization of medical library facilities as a logical and highly useful provision. And we again urge that in planning regional organizations, previously established units be considered and assisted; and that the library needs of practicing doctors, as well as other categories of physicians, be taken into account.

Finally, the American Heart Association finds that the tangible reasons for supporting the proposal (S. 597) are quite compelling but wishes, nevertheless, to place great emphasis on the intangible. We

believe that progress in biomedical research will be more effectively served by renewed emphasis on sound scholarship than by any other single action now open to us. The medical libraries assistance proposal (S. 597), if implemented, will be a giant stride in this direction. The CHAIRMAN. Doctor, you speak about the library needs of practicing doctors. Just as you have emphasized, it seems to me this is important, that doctors may have the benefit of these libraries. We should do all we can to encourage them to make the best possible use of these libraries and get the benefits therefrom. Is that not true?

Dr. CHAPMAN. We agree entirely, sir, and we find that if information is made available to them, they will usually call for it. This is certainly true in our own experience in distributing American Heart Association publications among practicing physicians.

The CHAIRMAN. I read an article in a medical magazine not long ago that a doctor graduating in 1920, if he did not pursue new knowledge very much, he would still be all right by 1940. But if he graduated in 1940, if he did not pursue his education, so to speak, seeking and gaining new knowledge, he would be out of date by 1950. If that be true between 1940 and 1950, what in the world would it be today between 1950 and 1965? There has been so much new knowledge acquired, is that not true?

Dr. CHAPMAN. Yes, sir, the doctor would be in a very difficult position without access to updated information at all times.

The CHAIRMAN. Doctor, you brought us another fine statement. You brought us a fine statement, you will remember, on the complexes, carrying out the De Bakey commission's report. Do you not think these complement each other?

Dr. CHAPMAN. Yes, sir; we feel it is necessary in any kind of medical advance to have readily available up-to-date information and it ought to be available on short notice. We believe this bill will accomplish this very important purpose.

The CHAIRMAN. In other words, if we increase library resources. we would contribute to the effectiveness of these regional complexes wouldn't we?

Dr. CHAPMAN. Yes, sir; I think it will contribute to medical effectiveness all across the board.

The CHAIRMAN. Dr. Wakerlin, we shall be glad to have you say anything you wish to, sir.

Mr. WAKERLIN. Mr. Chairman, I might make a few remarks, very, very briefly, by way of reiterating Dr. Chapman's comments.

I might say first of all that before becoming the director of the American Heart Association several years ago, I was a medical faculty member and department head for some 30 years. I have been a user of medical libraries from the time I was a medical student over 45 years ago.

The CHAIRMAN. Where did you graduate from?

Dr. WAKERLIN. Rush Medical College, the University of Chicago. Certainly there is need for expansion and for renovation of the physical facilities of many libraries. I have visited many of them. Some of them are really far behind in terms of their physical facilities. We need more training for librarians, more training facilities and opportunities available. As Dr. Chapman said, we certainly need to upgrade the status of medical librarians. One way to do this, in