The CHAIRMAN. Yes; it is going to be housed at the hospital, but will be a new medical school, as I understand from what I read about it in the New York Times, is that correct? Mr. MEYERHOFF. Yes. And as such, there are a large number of resources, and as I pointed out, even though the resources are large, there is still a great need for additional material. But in our case, a separate agency is highly desirable because we can consolidate, for example, some of these older journals in one place. They do not need to be in all six of these medical school libraries. Since we have a daily delivery service, we can provide materials within 12 to 24 hours, whenever it is called for. Senator JAVITS. Now, you would, as I understand it, therefore, make or provide very flexible arrangements so that the Surgeon General could conceivably contract with a library like your own to make it into a regional medical library, either entirely or by your adding to services and facilities in such a way as to give it a practical effect of a regional medical library, is that correct? Mr. MEYERHOFF. That is my understanding of the bill. SATELLITE LIBRARIES Senator JAVITS. Also, would you believe that an organization like your own could undertake to have satellites so that, for example, you could not only cover New York City, but because of your management techniques as well as your properties and, because it is such a congested region, you might conceivably have branches which would be your tributaries, but could serve the practical purpose of a regional medical library in other areas which are satellite to New York City? Mr. MEYERHOFF. This could be done. Actually, our service area includes northern New Jersey, Westchester County, going out to Long Island. Senator JAVITS. And that could be extended beyond that? Mr. MEYERHOFF. Yes. Senator JAVITS. Do you think that would be much more economical than establishing new medical libraries on a regional basis? Mr. MEYERHOFF. Well, ours is a new medical library. Ours is a separate institution that is supported by the medical schools and medical institutions in the city. Now, this differs in an area where resources may be very scarce to begin with. You may fix on one library and build this up into a regional resource. MAINTENANCE EFFORT Senator JAVITS. Now, do you not think we also have to be careful that we do not substitute the Government for the people who are doing it now? In other words, we want to preserve everything we have, including, for example, the support of an installation like your own, by the medical schools, at the same time that we build upon that rather than just have the U.S. Government take their place? Would you agree with that? Mr. MEYERHOFF. Senator, the establishment of our center has been a very difficult-has been very difficult financially. It took nearly 5 years to accumulate the basic funds for the acquisition of the building alone from various private foundations in order to get this started. 49-825-65-7 We have to rely entirely on the contributions of our members and this limits our budget tremendously. As it is, each of the medical schools are funding this by $10,000 apiece, and they find this a great burden. As far as the membership of hospitals in our area, the fee is limited to $2,000 a year. Most hospital find it impossible to put that much money into an additional library facility. Senator JAVITS. But nonetheless, they are doing it, right? Mr. MEYERHOFF. Some of them are doing it. Senator JAVITS. They may find it impossible, but they are doing it. Mr. MEYERHOFF. Not the hospitals. Senator JAVITS. Well, those who are supporting you are doing it. They got you to where you are? Mr. MEYERHOFF. That is true. PAYMENT OF FEES Senator JAVITS. It was not the easiest but you got there. We do not want to sacrifice the initiative. One other question: The medical profession is supposed to be a place where people earn a lot of money. What about the payment of fees for the use of your facility. Is that done? Mr. MEYERHOFF. Of course. Senator JAVITS. It is done? Mr. MEYERHOFF. Yes. Senator JAVITS. And do you feel that the fee schedule is fair— one apportioned to the fact that doctors have pretty good incomes from their practice and that the patients really pay the bill? Mr. MEYERHOFF. It is the institutions that pay us, it is not any individual doctor. Senator JAVITS. Well, would it be feasible to get fees from doctors who use your services? Mr. MEYERHOFF. I do not believe so. Senator JAVITS. Why not? Mr. MEYERHOFF. I think most of the demand for this kind of service is generated through institutions-hospitals, medical schools-in which physicians work. Most of these requests come from-they come through the established libraries. I think this would be extremely difficult to handle, to try to ask from a physician, for example, who is giving his time in a clinic and is pursuing some research, that he should be paying an extra fee because he happens to need a journal or book in order to pursue his research in patient care. Senator JAVITS. Are we to assume, then, that the practicing physician who earns fees does not do any looking into journals? Mr. MEYERHOFF. Oh, yes, he does. Senator JAVITS. Why should he not pay a fee? His patient is paying him. Well, in any case, this is a creative area for thought, is it not? MAINTENANCE OF EFFORT Senator JAVITS. Well, one other question: In order to avoid letting hospitals and medical schools, and I can speak very freely on this because I am a contributor just like my colleagues here, in order to avoid their getting off the hook if the Federal Government gets into this business, do you not think we have to think about a membership schedule for them in the regional library so that they do not withdraw their contributions from a situation like yours, but continue it in order to use it? Mr. MEYERHOFF. Well, I am a little puzzled, because why should the library and the services that the library gives be separated from the support that medical schools get from the Federal Government in general? Physicians are not asked to support the medical schools, for example, and the hospitals in which they serve, with specific contributions. Senator JAVITS. You are asking me that question. I think I can answer it. Even though the Federal Government does help support medical schools, and should, I think there is something to be said for their paying to an effort of this character and then they will be on the ball to see that it is run right and not wasteful and they can do it much better than we. Well, we shall deal with that, but I just wanted to get your view. Thank you. The CHAIRMAN. You are saying, where your treasury is, there is your heart also, right? We would be interested in knowing how much did your physical structure, your building, cost you? Mr. MEYERHOFF. The physical building? The building was acquired-the building cost $900,000 and we made a payment on it of $450,000. There are still two mortgages riding on it. The CHAIRMAN. You still owe $450,000 on it? Mr. MEYERHOFF. Yes, sir. The CHAIRMAN. You had to make some expenditure, did you not, to accommodate it to your use? Mr. MEYERHOFF. Yes; to convert the 20,000 square feet for library purposes cost about $300,000. The CHAIRMAN. Was that all you had to expend to accommodate it to your use? Mr. MEYERHOFF. We had some other expenditures. The building was not in a good state. We had to put a new roof on and new boilers and that cost another $120,000. The CHAIRMAN. Do you have any other expenses with reference to the physical structure? Mr. MEYERHOFF. That is about it. The CHAIRMAN. Senator Pell? Senator PELL, No. The CHAIRMAN. Senator Javits? Senator JAVITS. I have just one other question. I have been directing my questions more at maintenance. I can appreciate the difference between establishing such a facility where I think Federal help would be most desired, and maintaining it, where I would like to see it as cooperatively maintained by those who use it as possible. I wish to make that very clear. Would you agree in principle? Mr. MEYERHOFF. Yes; I do. The CHAIRMAN. I want to thank you very much, sir. We appreciate your statement very, very much. Thank you, sir. Dr. Stafford Warren, anything you would like to add? STATEMENT OF DR. STAFFORD WARREN Dr. WARREN. Sir, I have a statement in preparation which I would like to put in the record later in the day, if I might. The CHAIRMAN. We shall be very happy to have that statement appear in full in the record. (The prepared statement of Dr. Warren follows:) PREPARED STATEMENT OF DR. STAFFORD L. WARREN Hon. LISTER HILL. Chairman, Senate Committee on Labor and Public Welfare, I am Stafford L. Warren, M.D., former dean of medicine and vice chancellor of the health sciences emeritus at the University of California at Los Angeles. I appreciate very much the opportunity and privilege of being invited to present some brief comments to you and your committee this morning. I consider this to be an historic occasion and of great importance to all of us in the biomedical fields and to science generally. Others have spoken here on the organization and academic aspects of S. 597. It is timely to speak of the users of the scientific literature *** the scholar and the student who will benefit by S. 597. As a former dean of medicine, the problem of making the medical and scientific literature available to the faculty and students in the biomedical disciplines became more and more difficult as the literature proliferated and as the number of scholars and students steadily grew over the last decade. As you have heard, every librarian worth his salt wants the world's literature on his shelves. For each, however, there has always been the lesser goal within the practical limits of his budget and space. He has had to put up with such statements as "This is good enough" or "This is all that is possible now." Few medical libraries are considered to be even adequate. Fortunately this situation does not need to remain, for with the passage of this bill, it soon will be possible for any and every scholar and student in any field of biology and medicine in any educational or research or industrial situation to have access to the world's scientific journal literature in citation and facsimile through his own biomedical library *** not only access but rapid and comprehensive search and a printout of the bibliography which he needs made in one fell swoop of the computer in which the citations are filed. As a practicing user of card catalogs and indexes over a 45-year period, I can testify to a well-know observation that about half the time over those years spent in searching the literature has been spent in physical exercise in the stacks and in searching indexes and card catalogs. This is work which is done just to find the materials and before any useful reading is accomplished. Medlars can now do this for us and better and more quickly. Like any anxious close friend of the family, I have watched the gradual movement of the National Library of Medicine into the frontier of computer technology. The inception was long ago, the gestation period fraught with difficulty, but at last, in January 1963, the Medlars computer began to compose and print out the Index Medicus and then bibliography on demand. No one could have been more delighted than our staff recently when 39 references on P.K.U. research were delivered promptly by Medlars out of the 140,000 citations then in the file accumulated since January 1963. The remarkable thing was that the newest reference was issued only 6 weeks previously. I would hope that sufficient budget is always provided in succeeding years for building up the computer file with all of the biomedical literature instead of just the "most important journals" as is presently the case. Comprehensive search is very important to the investigator and there must be, therefore, no gaps in the central file. To spread this facility nationwide, by means of a network of Medlars, regional units to which access by all of those needing to use it is a relatively inexpensive maneuver. The librarian is at long last in his "hey day" for he (or she) can serve the professional needs of the student and scholar in a professionally satisfying manner, letting the computer do the legwork. There is still a lot to do in training new librarians, in refining the methods, in constructing and organizing the network, and so on, but the day of achievement is here and now. I, for one, consider it to be one of the scientific breakthroughs of this era since it is a new and fundamental tool in the quick, accurate, and comprehensive communication of research findings and knowledge generally. It is the beginning of what we all know and expect to be the pattern for all of the literature *** a pattern which will assist scholarly work in every field, and everywhere. While this achievement has taken considerable time and many hands in many ventures, both academic and industrial, the leadership and sensitivity and dedication of Senator Lister Hill and his conferees in Congress has been particularly significant, for without their perception and action the National Library of Medicine might have remained just another splendid library. By passage of S. 597 the holdings and services of the National Library of Medicine can be extended to all through the network. I pay tribute also to the quick response by the many key administrators in the Department of HEW in support of the program every step of the way. From the viewpoint of the scholar and student, the library is the one place where the past and present meet and it is in this setting that "learning and teaching" are also brought together. In medicine particularly the use of books, computers and medical skills contribute to the health of our Nation in a manner which no other discipline can claim. This purpose requires a vigorous library system for achievement. The price is small for the dividends to be derived from this investment. Without any doubts and with great confidence of their complete support, I urge the passage of S. 597 on behalf of scholars and students in the biomedical disciplines everywhere. Sincerely yours, STAFFORD L. WARREN, M.D., Vice Chancellor of the Health Sciences Emeritus, The CHAIRMAN. Does anybody else have anything he wants to add? Senator PELL. No; I just apologize for not being here earlier. I would just like to state my strong support of the bill and congratulate the chairman on his progress in this field. The CHAIRMAN. We realized you had another committee where you wanted to be. We were sorry you were not with us. At this point I will insert in the record communications and various material. QUESTIONS FROM THE SUBCOMMITTEE ON HEALTH OF THE SENATE COMMITTEE ON LABOR AND PUBLIC WELFARE, ON JUNE 15, 1965, TO THE DEPARTMENT OF HEALTH, EDUCATION, Aand Welfare, IN RESPECT TO S. 597, THE MEDICAL LIBRARY ASSISTANCE ACT OF 1965 JUNE 17, 1965. 1. How many regional branches of the National Library of Medicine are contemplated? As the word "branches" is employed in S. 597, there are no definite or immediate plans for such extension units of the National Library of Medicine. It is understood that the provision for such branches (sec. 3. pt. H, of title III of the PHS Act) is included simply to backstop the plan to establish regional libraries across the country in selected geographic areas. The regional libraries, in accordance with the terms of the bill, would be established in cooperation with and through existing medical libraries of excellence. Federal grants-inaid would be used to support the Federal portion of such operations. Such regional libraries therefore, of course, would not be branches of NLM, any more than any other institution receiving a Federal grant is a unit of the Federal Government. The provision for NLM branches, which as such necessarily would be Federal establishments, would be used only where there were no local and private medical libraries suitable for, or desirous of, being enlarged to serve a regional function. It is contemplated that 8 or 10 regional libraries would be supported with grants-in-aid, over a 5-year period, in selected geographic areas across the country. 2. What coordination is contemplated between the medical complexes which will be created by S. 596, the heart disease, cancer, and stroke amendments of |