present a statement in support of Senate bill 597, the Medical Library Assistance Act, which was introduced in the Senate by the chairman of your full committee, Senator Lister Hill.

Before reading the American College of Physicians' statement, which was passed by the board of regents and also by the membership at a meeting, I would like to say, parenthetically, that I also have the honor of serving as president of the American Medical Writers Association, an organization of some 1,800 scientific writers in the medical field. It will interest the subcommittee to know that the AMWA has also endorsed the purposes of the proposed legislation.

For those present today who do not know of the American College of Physicians, I would like to take a moment to describe our society. The college, which is 50 years old this year, represents 12,400 specialists in internal medicine and related fields.

The allied fields previously are nonmedical fields. We have some dermatologists, psychologists, radiologists, this group of people. Our principal interest is the continuing education of physicians. To work toward this goal, the college sponsors 2 national and 25 regional meetings each year; it conducts 18 postgraduate courses and publishes the monthly Annals of Internal Medicine. These courses are 5-day extension courses at different medical schools around the country and publishes the monthly Annals of Internal Medicine, which at the present time goes to 15,000 subscribers each month.

The CHAIRMAN. How is your attendance at these meetings?

Dr. ROSENOW. The attendance at our most recent meeting in Chicago was over 5,000 doctors. The one in Philadelphia 2 years ago had 7,200 registration.

Our postgraduate courses average 100 per course so we have about 1,800 physicians per year registered in these courses. The total number of people who go to these regional meetings amount to about 2,500. Those are 1- or 2-day meetings. I cannot tell you how many read the Annals of Internal Medicine, but I am sure a substantial number do, because we get a lot of letters, both favorable and unfavorable.

To aid in maintaining high standards of medical practice, the college participates in the administration of the certifying agency for internists-the American Board of Internal Medicine-and, with other medical organizations, operates the Joint Commission on Accreditation of Hospitals and the Commission on Professional and Hospital Activities.

Included among our leadership are the physicians responsible for the training of a large percentage of our Nation's undergraduate and graduate physicians, obviously within their special field.

Because of its intense interest in the training of physicians and in the continuing education of internists, the American College of Physicians looks favorably on any Federal act that would improve medical library facilities.

We feel that S. 597, and its companion bill in the House of Representatives, provides realistic solutions to a growing problem of collecting and retaining information vitally important to the present and future practice of medicine. Parenthetically, and this is a personal opinion, it would seem to me that this act would make a substantial contribution toward solving the present problem but will need to be a continuing support program in order for us to keep abreast of the

rapidly expanding field of knowledge and the increasing number of physicians and the other allied health personnel.

The American College of Physicians supports the provisions of Senate bill 597 and commends Senator Lister Hill for sponsorship of the legislation.

Thank you very much.

The CHAIRMAN. Doctor, I was interested in what you had to say about your regional meetings. You feel that these regional libraries would be quite an asset, do you not?

Dr. ROSENOW. Yes, sir. Almost without exception it is a very interesting thing, Senator Hill, to look through our directory and see how many people are listed as having some kind of a teaching connection with a medical school in any town where there is a medical school, and also, we know that most of our members are active in the training of interns and residents and whenever they have to prepare a paper or anything for one of these meetings, they have to find things in the library that are not only useful for giving a paper, but that are also useful in their daily practice of medicine.

The CHAIRMAN. You feel, then, that this bill will definitely be a step forward?

Dr. ROSENOW. Yes, sir.

The CHAIRMAN. Doctor, what are the criteria for membership in the College of Physicians?

Dr. ROSENOW. A man must be a licensed physician, he must have spent a formal period of time getting training in internal medicine or one of these allied fields. He may become an associate member of a medical college-about 5 years out of medical school he is eligible to belong. Then he advances to fellowship or full membership upon passing his American Board of Internal Medicine examination, and doing other things. For example, he is required to either publish some papers or write up some case reports or thesis.

One of the interesting things is, it is required, if he writes up five case reports as a requirement, that he must attach to it a suitable bibliography and a discussion of the literature which pertains to these five cases.

He may not apply to become member of our college. He must be proposed by someone and seconded and endorsed by a Governor in each State and he is supported by the board of regents.

The CHAIRMAN. He must be nominated?"

Dr. ROSENOW. We do not make it too impossible. If he writes to me me and asks how to join, I send a proposal for him to give to somebody and ask to be nominated.

The CHAIRMAN. That is the democratic way to do it, is it not?
Dr. ROSENOW. That is what we think.

The CHAIRMAN. You have brought us another good statement, Doctor, and I want you to know we very much appreciate it. We are having some mighty good testimony for this bill. We certainly appreciate your contribution.

I may say I have a telegram here from Chicago which I shall read: I should like to join my colleagues here and in other medical centers throughout the country in urging the passage of the Medical Library Assistance Act. The need for improved communication in the biomedical sciences is urgent and the enactment of this bill should result in improved medical care for the Nation. H. STANLEY BENNETT, M.D.,

Dean, Division of Biological Sciences, University of Chicago.

Dr. Carleton B. Chapman, president, American Heart Association. Doctor, we welcome you back. You have been with us before and you are always most helpful.

STATEMENT OF CARLETON B. CHAPMAN, M.D., PRESIDENT, AMERICAN HEART ASSOCIATION; PROFESSOR OF INTERNAL MEDICINE, UNIVERSITY OF TEXAS, SOUTHWESTERN MEDICAL SCHOOL; ACCOMPANIED BY DR. GEORGE E. WAKERLIN, MEDICAL DIRECTOR, AMERICAN HEART ASSOCIATION

Dr. CHAPMAN. Thank you, sir.

I have brought with me also Dr. Wakerlin, who has been before you also, sir.

The CHAIRMAN. Dr. Wakerlin, we are delighted to have you with us again.

Proceed, sir.

Dr. CHAPMAN. I am Carleton B. Chapman, professor of medicine of the University of Texas, Southwestern Medical School, and currently president of the American Heart Association. Our board of directors has instructed me to testify in support of the proposed Medical Library Assistance Act of 1965-S. 597-very enthusiastically and with no qualifications or reservations. The board did, however, place certain emphases which I shall try to convey.

We are honored and pleased to have the opportunity to offer support for this very fine proposal. As a matter of fact, our first reaction to it was to wonder why it has been so long in coming. We have circulated the bill-and our reaction to it-among our 55 affiliate and 236 chapter heart associations. We have the assurance that the proposal has been brought to the attention of a large proportion of our 70,000 members (of whom half are physicians). We find no one who is opposed; quite on the contrary, support for it throughout our organization has been strong and outspoken.

The CHAIRMAN. Doctor, may I interrupt you there?

Dr. CHAPMAN. Yes, sir.

The CHAIRMAN. You have just made a statement that has been in my mind ever since these hearings started. That is, why we have not done something about these libraries before, why we waited so long.

Dr. CHAPMAN. I do not know, sir; we have a point or two to make about that later in our testimony.

The CHAIRMAN. I note we have a friend here with us, Dr. Warren. He has been a great advocate, a great champion.

Go ahead, sir.

Dr. CHAPMAN. The American Heart Association is primarily concerned with the control of diseases of the heart and blood vessels through research, education, and community program. Since 1948 the association has emphasized basic research in the belief that the most direct route to the attainment of its goals runs via the discovery of fundamental causative factors. This, in turn, involves laboratory research, investigation at the bedside, and field studies. We have supported and implemented work of this sort to the full extent of our resources, always placing the main emphasis on the support of people rather than on glittering glassware, laboratory chrome plate,

and electronic machinery. But, in the past few years, there has been growing up among us a considerable uneasiness that something was missing from our general approach to our goal. We began some time ago to recognize the fact that many of our applicants, often brilliant and capable people, were frequently not sufficiently aware of the background against which they were working. It was not-and is not-unusual for us to receive requests to support work that has already been done in other regions and in other countries. And while we see some merit in duplicating work for the purposes of checking and cross-checking, we see nothing but disadvantage in encouraging an investigatoryoung or old—to set out on a piece of research without first becoming something of an authority on what has gone before. We have seen investigators follow lines that have long since been disproved; we have seen them struggle along, using inadequate methods, despite the fact that a few hours in a good library would have placed much more powerful tools at their disposal; we have seen men work for months designing and perfect apparatus that was already in highly successful use in other laboratories. And we have sat in scientific audiences listening to brilliant young investigators proudly laying out the results of their studies, only to have someone rise, after the initial applause has died down, and say: "We entirely agree with these results; in fact, we did the same work and came to the same conclusions 10 years ago." There then follows the citing of a published reference to substantiate the claim and the young investigator retires, not in triumph but in hideous embarrassment.

But it is not a young man's discomfort that should concern us at such times. Unfortunately, he receives what he deserves. It is the harsh and troublesome fact that duplication of research in ignorance and without conscious plan is wasteful and expensive. It is expensive not only in dollars, but also in terms of scientific progress and intellectual effort.

We have no figures-no totals in dollars-to substantiate this burden. Records of this sort of investigative mishap are not usually kept; indeed, the people involved are usually ashamed of the fact and have no wish to advertise it. But the intangible cost to our Nation's research effort and progress must be staggering.

Equally intangible, but scarcely less important, is the handicap imposed on imaginative planning and synthesis of research results by incomplete knowledge of the scientific record. These are the processes by means of which the thinking and the discoveries of others are moulded and composed to yield new in sights and new direction of attack. And it is always, partly or entirely, through the medium of the written record that men's minds come into effective contact and begin to move off on independent new scientific errands. Many of us in the American Heart Association have begun to realize that we have, in the past, given insufficient weight to the necessity of studying the scientific record in depth as an indespensable forerunner to laboratory, bedside, or field studies. We have begun to appreciate the actual damage done when a young and inexperienced investigator is allowed, and even urged, to rush blindly into the laboratory without first having carefully and thoughtfully studied the relevant literature. We wish to stress our profound conviction that sound scholarship is nei

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