DEPARTMENT OF HEALTH & HUMAN SERVICES

Public Health Service



Office of the Assistant Secretary
for Health
Washington DC 20201

April 14, 1982

Ms. Gloria Ruby
Office of Technology Assessment
600 Pennsylvania Avenue, S.E.
Washington, D.C.   20003

Dear Ms. Ruby:

I am pleased to have the opportunity to comment on the OTA draft
report entitled MEDLARS AND HEALTH INFORMATION POLICY, dated
March 1982.  My response is based on my knowledge of the National
Library of Medicine, and my experience as a practicing surgeon
as well as my responsibilities as Surgeon General of the U.S.
Public Health Service.

Overall, the report presents a comprehensive discussion of the
history of Library, its development of modern communication
and information systems, and gives special attention to the public/
private sector issues involved in scientific information handling.
Yet the overall tone of the report is unfortunate.  Despite
statements indicating that the National Library of Medicine
provides high quality, important services and products at
reasonable prices, the report seems reluctant to draw the con-
clusion that NLM deserves strong support as a public health enter-
prise.  NLM serves as a vital national resource for health care
delivery, public health, medical research, and health professional
education.  It should have a stronger endorsement from OTA on the
basis of the factual content of this report alone.

Furthermore, I believe that statements like the one appearing on
page 6, paragraph 3,  draw incorrect conclusions.   The statement
"Most private data base producers and private information services
take exception to the dominant role of NLM in the creation and
distribution of health-related bibliographic information," is
erroneous.  In fact, only one large foreign-owned private data
base producer and one U.S. vendor have taken exception to NLM's
role in this regard; they may be motivated by self-serving
interests.  This narrow viewpoint has been generalized to give a
misleading impression.

In addition, I note some misrepresentations concerning the scope
and usefulness of INDEX MEDICUS and the MEDLARS system.   It is
not true that MEDLIARS slights diseases prevalent in the southern
hemisphere and public health information needed in developing


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countries.  Neither is it true that the medical vocabulary needed
to retrieve information from MEDLINE is too complex to serve the
needs of family physicians.  It is my experience that family
practitioners fully understand and commonly use the terminology
used by the rest of the medical community.  You may wish to
re-examine such statements before publication.

More specific comments and suggestions will be forthcoming from
the National Institutes of Health and the National Library of
Medicine.

It is my understanding that this revised draft represents a great
improvement over earlier drafts.  Thank you for sharing it with
me at this time.

Sincerely yours,

C. Everett Koop, M.D.
Surgeon General