1965, and the regional branches of the National Library of Medicine to be created under S. 597? The regional libraries will be selected only after careful study of existing population groups and service patterns in centers showing concentration of research, education, and health practice information needs. This orientation is entirely compatible with that of the medical complexes which would be created by S. 596. The regional libraries would thus constitute a specialized information resource to be utilized by and to backstop the medical complexes when they are authorized. Special services would be provided to medical complexes upon request. As plans are developed for the medical complexes, which would be authorized by S. 596, close coordination will be effected with the developing medical library network, including the regional libraries, which would be authorized by S. 597. Regional "branches," which would be established only where no local or private medical libraries suitable for, or desirous of, undertaking a regional function exist, would be developed along the same lines. 3. Title II, part A, of S. 600 "The Higher Education Act of 1965," presently pending before the Education Subcommittee, deals with library resources. Maintenance of effort is required. Would not a similar provision be appropriate for section 397 of S. 597? In S. 600, the wording of title II, part A, calls for support for library resources over a 5-year period. Section 397 of S. 597 similarly calls for support over a 5-year period. S. 597 apparently envisions that support for medical library resources, of the type and magnitude discussed in the bill, should not be necessary beyond a 5-year period. The matching formula has been designed with this in mind. The formula calls for a high level of Federal funds (60 percent) for the first year and then decreasing for the subsequent 4 years, the idea being to encourage and enable the private medical libraries to gradually build up their own levels of expenditures for resources. Hon. LISTER HILL, AMERICAN SOCIETY OF BIOLOGICAL CHEMISTS, INC., Chairman, Committee on Labor and Public Welfare, DEAR SENATOR HILL: The bill S. 597 to create the "Medical Library Assistance Act of 1965" is indeed a landmark proposal. Its enactment and implementation will go a long way toward repairing and refurbishing a vital link in the communication chain which will facilitate fuller enjoyment by the people of this country of the fruits of the great advances our medical researches have made possible. Since 1945 public expenditures per year for health and medical services have increased more than fourfold, from $2.1 to $9 billion, while during the period from 1957 to 1964 Federal expenditures for medical research have increased from $229 million to somewhat more than $1 billion and support from the private sector has grown to an estimated $540 million per year. There have been during the same period significant increases in the numbers of physicians, dentists, nurses, and scientists engaged in biomedical research. The corresponding growth in the amount of publication generated through the efforts of all these people has enormously increased the total amount of information which must be conveyed effectively to all components of our health teams if the vital work supported in this way is to be made useful and meaningful to the people. An integral role in this process is played, not only by the libraries of our 87 medical schools but also by our more than 3,000 hospital libraries and the libraries of our other health related institutions (schools of dentistry, pharmacy, nursing, osteopathy, veterinary medicine, etc.). Your bill, sir, is clearly aimed at the entire complex and has far more than the limited goal of more or bigger libraries merely for their own sake. The Federal expenditures to date for medical libraries have indeed been meager and the fact that these facilities have lagged so far behind our enormously expanded research efforts has emphasized the weakness of the link labeled "library" in the communication chair. The President's Commission on Heart Disease, Cancer, and Stroke has wisely preceived this problem and has made some highly pertinent recommendations in this area. Your bill will go a long way to providing the essential authority for the Federal Government through its already pivotally located National Library of Medicine to improve the situation over the next 5 years and increase the effectiveness of public enjoyment of the health advances made possible by our impressive research accomplishments. I could easily cite the wealth of available statistics which further buttress the main thesis of this letter but they are, I am sure, already known to you. I would rather conclude, at this time, by urging your continuing, untiring efforts toward successful passage of this important bill. Please feel free to use this letter in any way which might be of assistance to you, the members of your committee, and your colleagues in the Senate. A substantially identical letter is going forward to Representative Oren Harris to whose House Committee on Interstate and Foreign Commerce a counterpart measure has been referred. Respectfully yours, ROBERT A. HARTE. GEORGETOWN UNIVERSITY, Washington, D.C., February 24, 1965. Hon. LISTER HILL, Washington, D.C. DEAR SENATOR HILL: I want to express my support and the wholehearted support of the faculty and student body of the Georgetown University School of Medicine for the bill S. 597. In the Federal program to upgrade medical education, in which your efforts have been so important, no item is more important than support for the libraries of the medical schools. These libraries are particularly important when they also serve university hospitals, schools of dentistry, and other training areas for the health professions. I know that you are well aware of the problem created by the increasing volume of important scientific medical literature. The medical center libraries are faced with rapidly developing obsolescence unless facilities can be constructed, people trained and new techniques developed for processing, storing and distributing information in the health sciences. Here at Georgetown University Medical Center, we are keenly aware of this problem. Indeed, we can provide a graphic demonstration of the urgency for action in the medical library field. The inadequacy of our library facilities threatens to reduce the effectiveness of our educational programs. In consultation with experts, we have now developed plans for a new library to serve the extraordinarily large population of a growing medical center: Medical students, dental students, nursing students, interns, resident physicians, full-time faculty of the three health-related schools of the university, the staffs of our affiliated hospitals, and the community of physicians and dentists. We are grateful for your efforts in this vital field, and I want to assure you that we stand ready to help you in any way that we can toward the passage of this proposed legislation. Chairman, Committee on Labor and Public Welfare, DEAR MR. CHAIRMAN: I am taking the liberty of enclosing for your information a copy of a letter I have received from Dean Fitz of the School of Medicine of the University of New Mexico. The dean is very much in favor of your proposal, S. 587, to provide a program of grants to assist in meeting the need for adequate medical library facilities and services. Sincerely yours, CLINTON P. ANDERSON. THE UNIVERSITY OF NEW MEXICO, Albuquerque, N. Mex., February 4, 1965. Hon. CLINTON P. ANDERSON, New Senate Building, Washington, D.C. DEAR SENATOR ANDERSON: Senator Lister Hill has recently introduced a bill, S. 597, to provide a program of grants to assist in meeting the need for adequate medical library facilities and services. I am strongly in favor of this bill. As a physician interested in medical education, I believe that adequate library resources are of the utmost importance to the effective practice of medicine and to medical education. As dean of a developing medical school, I can state without equivocation that the development of the library is perhaps the most critical single factor in the establishment of a new school. I hope you will see fit to support this legislation when it reaches the floor of the Senate. Best personal regards. Yours sincerely, REGINALD H. FITZ, M.D., Dean. CONGRESS OF THE UNITED STATES, Hon. LISTER HILL, Chairman, Senate Committee on Labor and Public Welfare, DEAR SENATOR HILL: A Constituent of mine, Dr. Sidney Curelop, a member of the New Hampshire Heart Association, has written the enclosed report on S. 597. I would appreciate having this statement made a part of your records and it would be most helpful having your views or those of your staff concerning this report. DEAR MR. CHAIRMAN: Richard R. Fernald, chairman of the board of directors of the New Hampshire Heart Association, wrote me a month or so ago regarding S. 597 and enclosed with his letter a report by the ad hoc committee to study medical library systems legislation. Dr. Curelop's remarks seem very much to the point, and I believe they may be of interest to your committee in connection with its consideration of the Medical Libraries bill. I should like to request, too, that they be made a part of the record of hearings. DEAR SENATOR COTTON: Enclosed you will find a report submitted, by request of this association's board of directors, from one of its members, Dr. Sidney Curelop, on Senate bill 597, relative to funds for medical libraries. The New Hampshire Heart Association's board of directors has urged its parent body, the American Heart Association, to take a strong favorable stand on S. 597. They have requested that I urge the same of you. At the same time, may I bring to your attention the significant observation made here by Dr. Curelop-that these funds can serve their greatest purpose if they are used also in improving the medical library services of community hospitals, when they can benefit the practicing physician. I would like to ask that you let the Association know of your position on this legislation. Sincerely, RICHARD R. FERNALD, Chairman, Board of Directors. REPORT TO THE BOARD OF DIRECTORS OF THE NEW HAMPSHIRE HEART ASSOCIATION BY THE AD HOC COMMITTEE TO STUDY MEDICAL LIBRARY SYSTEMS LEGISLATION The bill recently introduced by Senator Hill and Congressman Harris takes cognizance of the fact that growth of biomedical data has not been matched by a growth in facilities and techniques for dissemination of these fruits of research among scientists and practitioners. The purpose of the legislation is to improve the means of such dissemination. We recognize the importance of dissemination of such information among health scientists. However, we feel strongly that relatively less attention has been paid to increasing the flow of information to the practicing physician than to the individual engaged in medical or paramedical investigation. As a heart association in a relatively small and relatively rural State we wish to stress importance of improving the facilities for bringing information to the practicing physician. Improvement in techniques and facilities available in large medical center libraries is valuable and necessary. However, that is not the kind of medical library likely to be used by the great bulk of practicing physicians. They usually turn to their com munity hospital libraries for reference help. How often they are disappointed in this quest. The average community hospital library, or, certainly a large number of community hospital libraries, consists of haphazardly selected collections of partially or entirely unbound medical journals and obsolete or antiquated textbooks. Indexes are almost unknown unless the library is large enough to justify subscribing to the Index Medicus. In view of the enormous number of medical journals indexed therein very few community hospital libraries could justify such an expenditure or even the requisite shelf space. It must be emphasized that we are concerned with the 20, 30, or 40 journal collection supplemented by 40 or 50 selected reference works. Collections of journals and books of this magnitude would not be dignified by some medical librarians with the term "library.' However, it is important to realize that a properly indexed collection of the size indicated would be far better than what is presently available in many (and I feel safe in saying almost all) community hospital libraries. We should very strongly alert the American Heart Association to the fallacy of taking the advice of medical librarians at face value. Such individuals, by virtue of their training and experience, are incapable of understanding the true needs of the practicing physician, who snatches 10 or 15 minutes from his crushing daily schedule to seek information about a patient in his practice. The practicing physician wants some accurate information quickly. He does not require or perhaps need the kind of comprehensive bibliography that would be needed to satisfy a librarian or someone writing for publication. In an article which appeared in "Hospitals" of June 16, 1964, Mr. Scott Adams, the deputy director of the National Library of Medicine, had some interesting comments to make on hospital libraries. He pointed out the Dryer report on postgraduate education of physicians had paid very little attention to the matter of such conventional education media as books, journals, and libraries. In alluding to the size of hospital libraries he said that the joint committee on standards for hospital libraries required 1,000 volumes and a journal collection of at least 25. To him this seemed grossly inadequate and he spoke of a library collection of 5,000 volumes and 100 journals. However, in the paragraph which followed that allusion, he referred to a study of the interlibrary loans at the National Library of Medicine which demonstrated that the heaviest traffic was in three extremely well-known journals: The Journal of the American Medical Association, the British Medical Journal, and The Lancet. These three journals are so widely read that they certainly should be included in any hospital library collection. Yet they are apparently not available in many hospital libraries. Here again, we see evidence that many of the practicing physician's reference needs can be satisfied by the widely read journals which should be commonly available. This again is an indication that a much smaller number of journals than one which would satisfy a professional librarian would probably satisfy the practicing physician. On page 3 of S. 597, beginning on line 4 and continuing through line 9, we see the justification for the establishment of methods of indexing of small hospital collections which would be essential in the establishment of the kind of improved hospital library facilities we have in mind. The Index Medicus is now made by the MEDLARS computer. As a byproduct of this index it is now possible to make an index of any combination of journals which are contained in the master index. Such an index would be invaluable to the small hospital library. We strongly urge that the National Library of Medicine be requested to consider making such indexes with funds supplied by S. 597. A major obstacle to establishment of proper library facilities in community hospitals is the absence of a medical librarian. To the hospital administrators she often represents an unnecessary expenditure, or one which is difficult to justify to the board of trustees. Certainly a hospital library with a collection of a few hundred volumes and 20 or 30 journals cannot justify the maintenance of a full-time librarian. However, among the hospital volunteer corps there are frequently individuals who would be interested in such work. Under S. 597 the training of such people for parttime work as volunteer librarians could be carried out. Direct subsidy of parttime or full-time librarians would, of course be another possible approach. On page 3 of S. 597 on line 17 we see justification for support to biomedical, etientific publications. Lange publications of Los Altos, Calif., has so far published three editions of a little book called "Current Medical References." edited by Dr. Milton J. Chatton and Dr. Paul Sanazaro. This volume is a bibliography of medical articles which satisfy many if not most of the requirements of practicing physicians. R. 597 would justify the Government in supporting the subsidization or encouragement of such a project. It could perhaps be enlarged and perhaps published on a yearly basis. There could also be prepared subdivisions. A division dealing solely with cardiovascular diseases would be of particular interest to the American Heart Association. On page 11 of the bill, beginning with line 12. we see a section which should be reworded somewhat. As it presently stands, this section would simply permit the Surgeon General of the Public Health Service to establish fellowships to physicians for the kinds of medical and scientific activities which are now adequately subsidized elsewhere. This section should be made to refer specifically to work directly dealing with biochemical communications. All in all. I think this is a good piece of legislation and one which pays belated attention to an extremely important area of medical activity. COMMITTEE ON INTERIOR AND INSULAR AFFAIRS, T.S. SENATE. June 12, 1965. Ion LITER HILL. DEAK LISTER: I an. writing in support of S. 597 which would authorize funds to improve medical library facilities. I am sorry that I am unable to testify Personelly at the hearing a June 14 and 15 My own committee responsibilifor will take me on, of town or field hearing to evaluate progress under the Federal Water Pollution Contro. Art or the days when S. 597 is under een identfon Tom odysed by Dr. Kenneth B. Castleton, deal of the College of Medicine at the 'n verein of 1'l the one of the Srectost needs at the university medical center was planned, no 4 the time the medica modion Tihenry phom we made for the library No funds were available at that time, and it whapo nde mich hopomorsilahla leton the mirarit modi Show me the mail T'niversity of Trah whole o the lame mons com: distance from the medical center TESLA A ton smel en crowde Although the university hopes to build is the non- then i not contemplated that the new library wil + TOSOITE DUCreditation as a medical hosuit, whil has been constructed. Bhrors bn because of recent driveS 64 f. th. May hospita, the College nf The availability of 4777777 moeder. madis for money for both the medical cente Medicine is finding it dimenit to Federal funds on a matching grant 1 tar, pudambted? - make it much easier for the college to secure the remain bill, therefore most important. mones Passages of this n: StrOBS support. |