E'PRESIDENT'S COMMISSION ON HEART DISEASE, CANCER AND STROKE U 0 Mimi E P B E I D E N T A NATIONAL PROGRAM TO CONQUER HEART DISEASE, CANCER AND STROKE 'Volume II February, 1945 THE PRESIDENT'S COMMISSION ON HEART DISEASE, CANCER AND STROKE MEMBERSHIP OF THE COMMISSION Dr. Michael E. DeBakey, Chairmn Dr. Samuel Bellet Dr. Hugh H. Hussey Mr. Barry Bingham Mrs. Florence Mahoney Mr. John Mack Carter Dr. Charles W. Mayo Dr. R. @ Clark Dr. John Stirling Meyer Dr. Edward W. Dempsey Nlr. James F. Oates Dr. Sidney Farber Dr. E.'.Nf. Papper Dr. Marion Fay Dr. Howard A. Rusk Mr. Marion B. Folsom Dr. Paul W. Sanger Mr. Emerson Foote Gen. David Samoff Gen. Alfred M. Grueiither Dr. Helen B. Taussig Dr. Philip Handler Mrs. Harry S. Trun-tan Mr. Arthur Hanisch Dr. Irving S. Wright Dr. Frank L. Horsfall, Jr. Dr. Jane C. Wright Dr. J. Willis Hurst STAFF OF THE COMMISSION Dr. Abraham M. Lilienfeld, Staf Director Dr. Bayard Morrison .Mr. Stephen J. Ackerman Dr. Nemat 0. Borhani Mr. Horace G. Ogden Mr. Louis Carrese Mr. Marcus Rosenblum Dr. Maureen Henderson Dr. David Schottenfeld Dr. William L. Kissiek John D. Turner Mr. Lealon E. Martin Nfr. Daniel Zwick FOREWORD Volume I of the Report of the President's Commission on Heart Disease, Cancer and Stroke contains a summary of the dimensions of the problem, the national resources and needs, and the @cific recommendations for developing a national program to combat these diseases. The contents of volume 1 were derived from the reports of the Subcom- mittees of the Commission and from special reports on selected subject areas. The Subcommittee reports were prepared after each Subcommittee held a series of hearings at which testimony was obtained from experts and after the mem- bers of the Subcommittee had reviewed the special reports and other material. These Subcommittee reports and staff papers provide in greater detail the views and judgments of the Commission and some of the bases for such judg- ments. It was considered desirable to publish them as volume 2 of the Com- mission's Report, since the material has value for guiding programs and policies and for stimulating additional research. Much of the material represents fresh data, unavailable elsewhere. The special reports that were prepared for many of the Subcommittees are designated as source papers and follow the relevant Subcommittee report. State health departments, schools of all the health professions, municipal governments, nmrch institutions, hospitals, foundations, and voluntary or- ganizations will find in these pages support for their earnest aims. We believe that these reports and documents will strengthen the case for their present pro- grams and light the way to their fulfillment. We hope that the reports will stimulate health organizations to open new pathways of research and health practice. Despite the emphasis on Federal action and Federal financing, as might be expected in a report to the President, it will be obvious to the discern- ing reader that there are opportunities to move ahead on the recommended pro- grams at State and community levels. Indeed, many recommendations of the Commission are based upon exemplary action which has already occurred in many communities. In volume 1, we have already listed the many who have contributed their time and talent to the work of the Commission. There is little to add to these grateful acknowledgements except to note that the editorial services for volume 2 were performed by the Commission's Staff Director, Dr. Abraham Lilienfeld, and Marcus Rosenblum. Daniel M. Bailey reviewed the special report on li- bmries by the Subconunittee on Facilities. The staff of the National Library of Medicine assi@ in the preparation of the bibliographies; the citations in this volume conform to the system used by the National Library of Medicine. The design of volume 2 was contributed by the capable staff of the Government Printing Office. MICHAEL E. DFBAKEY, M.D., v CONTENTS Page Forword ----------------------------------------------------------- v Heart Disease: Report of the Subcommittee -------------------------------------- 1 Source Papers: The Magnitude of the Cardiovascular-Reiial Disease Problem --- 14 Congenital Heart Disease ------------------------------------ 48 Rheumatic Fever -------------------------------------------- 61 Arteriosclerosis --------------------------------------------- 74 Hypertensive Heart Disease ---------------------------------- 92 Cancer: Report of the Subcommittee -------------------------------------- 105 Source Papers: The M&6niitude of Cancer ------------------------------------ 118 Stroke: Report of the Subcommittee -------------------------------------- 129 Research: Report of the Subcommittee -------------------------------------- 138 Source Papers: Atherosclerosis: Current Concepts and Research Trends --------- 162 Essential Hypertension: Current Concepts and Research Trends-- 177 Cancer: Current Concepts and Research Trends ---------------- 185 Rehabilitation: Report of the Subcommittee -------------------------------------- 227 vii Page Manpower: 262 'Report of the Subcommittee -------------------------------------- 288 Appendix A------------------------------------------------ ILM Appendix B------------------------------------------------ 306 30S Appendix C------------------------------------------------ 315 Appendix D------------------------------------------------ 316 ------------- Bibliography ---------------------------------- Facilities: 321 Report of the Subcommittee ------------------------------------- Iiistitu'tiolls, A SurN-ey of Facilities ------- 341 Source Paper: Biomedical elopilig'.\Iedical Libraries --- Special Report: A Program for Dev 3 N Communications: 401 @port. of the Subcommittee ------------------------- 410 ig for the Biomedical Sciences ---- ation litindlii Source Paper: Inform Economics - and Cancer -------------- 440 Economic Costs of Cardiovascular I)ise-,Ises - 631 dical Research ----------------- onfereiice on the Economics of ,\le c E N 1 14 viii REPORT OF THE SUBCOMMITTEE ON COMMUNICATIONS SUBCOMMITTEE ON COMMUNICATIONS '.Nfr. E--8iERso.N FooTE Chairmn .,Nlr. B.@Rrty BI-@GIIAM .Nfr. JOI-1.@ CARTER Dr. R. LEE CLARK STAFF Dr. BAYARI) H. AfoRRiso--,, 'Nlr. @AL-IRCus ROSE-NBLUM Dr. AzR-tHA3.E 11. LiLiENF= CONSULTANT .Alr. AliKE GOR31A,-i REPORT OF @f edi THE SUBCOMMITTEE ON COMMUNICATIONS..,-. The prevention ,ind control of heart disease, Breakage of any link in this cliiin can nullify cancer, and stroke-tlie saviiig of a liuii-ian the strength of the others. Nearly every link life-begins not with the doctor, the hospital, or depends upon the right knowledge in the right the medical center. It begins with the indi- place at the right time. Coni-e@Iv, many i-idual himself. thousands of heart disease, cancer, ,in-d stroke He decides to go for a clieckup@itlier before deaths occur beeiii-,e of failures in the con,- syii,iptoms appear or ,it the eii-liest si(Y-n of t5 iyiunicatioii of lifesai-iiig knowledge to the po- trouble. Or lie decides not to. The decision, tential victim or to the physician who tm-its often made cisutilly or ei-e)i subconsciously, may add or subtract ,t decide from his life. him. '.Nf,,iiiy factors influence his decision. One is It is to these costly failures that the Subcom. his financiil condition. Another is the con- niittee oii Comiiiiiiiieitioiis li@is directed its prin. N-enieiice and accessibility of medical itteiition. cipal itteiitioii. IVe reco(riiize the vital impor. The most important factor is the stite of his tance of research coiiiiiiuiiicition-I)etween sci- knowledge about health iiiatten. entist and scientists We wliolelie@iiiedlv endorse Once he enters the medical orbit, his fate is the recommendations of other subcoiiimitte)es coneeniiiio, the need for st,rengtheiiiiia the med- i-.tiii subject, to m@iny wliims of cliince. If lie in is .i-ise enough to make his appointment sooii ical librirn- s steii-i and iddiiig to the electronic y enough, and if the physician lie chooses is cap,.ibilitv for liiiidliiitr research information. trained and equipped to detect. iii incipieiitIN. But we feel that the greatest impact oii death dangerous condition iiid make the proper re- and disability from heart di-,ease, cancer, ,ind ferral, and if his community is blessed ii-itli the stroke, iio\N-,.iiid in the vear-s immediately aliead) special slills and facilities his condition re- can be mide tliroiicrii intensive nationwide e@ffort quires -,iiid if he is ible and willing to follow n q to bring to the physician and the public 'he @l- tlirouo-ii the prescribed course of treatiiient-iii in ]air this happy conjunction of eirciiiiistaiiees-Iiis information tliev need tbout these diseases. It -,!-I Oubst life will be prolonged, his function unimpaired has been said that kiio%vled(,!e is power. in @,j ye II. or restored. health, it is the power of life and deat A Federal Mandate The Federal GoN-eniinelit, as described else- sources to support the transmission of medical where in this report, has been given a clear knowledge to its point. of ,ipplicatioii. mandate and substantial resources to support One point of application is the meeting PIIO o-a or the the generation of health knowledge through of physician and patient. Ynowled,,- biomedical research. The results of this policy laci o@it on'tlie part of the patient. brings then, too long. have been the great scientific advances that together in time or keeps them apart characterize our time. Knowledge or the lack of it, on the Part of the unter.- But knowledge unused is knowledge wisted. doctor detemiines the success of their enco .. Cal t of bioniedi And strangely, the Federal Goi-eriiment has not Clearly, this is the ultimate targe been oii-en a similar iiinndate tiid similar re- research. These are the prime audience 402 CO'@\LML'NICATIONS 403 both patient and physician for their done so by dea-elopiiig a pai-tnei@iip of Federal Equipping tioiis task: A process and iioii-Federal scientific resources in a system enr ,Ounter is a conimtinica of education and information. which promotes individual freedom and init,ia- There are long-standiiiols. hospi- -@arce topflicrit ci-eatii-e talent, in motion Pic- iiid, second. the ttires and television. It recognizes the scieii- iealtli a(rencie,,,; c,,ii-trid(re-tvpe t i i-y t projectors foi ific knowledge iieces& o rive coi-nplete, ac- especially -acy adaptable to private ciii .iiid .iutlienticity to health documentary own offices, - amiii(r and the impressive beginnings ,tl- ians in their it times progr asp, by pl'3?sic choosing. ready made at the Service's Communicable of their own -efore recomniend: Disease Center in ei-eatimcr -,t truly national ,We thei tion 6t tioii of million per medical audiovisual center. (a) That an appropri, initially, be made to the '-\national IVe therefore recommend that the Public year, Afpdic-,il Audiovisual Center for the spe- Health Seri-ice be ,tuthorized and that funds be cific purpose of developing. dis;-zeiiiiiiat- tppropri,,ited, to contract with professional tele- duction of twelve ,ind evaluating closed-circuit tele- vision producers for the pro ingi -rams on subjects vision proo of vitil 30-Minute documentary films eieli year of the interest to the health professions. highest quality, on subjects related to heart dis- (b) That an initial (ipproprifttion of -',l iiiil- ease, cancer, and stroke, and any other subjects lion per year be nude to the '-\-zttion-,il is may later be deemed desirable. Each film Aledical Audiovisual Center to produce should be budo-eted at or about the level of short films for use in cartrid(,e-tvpe pro- S150,000 to assure writing and production that n . i omote the. -,widespread will make the films competitive with the best of jectois, and to pr use of this promising new educational commercial television. This price should in- device by the medical profession. elude a sufficient number of prints to assure lu V, widespread use on local commercial television 10 asi TELEVISION outlets across the nation. The contract should .reas ro6: p focus the also provide for the full participation of the s The health world has been slow to @h and roducer and his organization in the marl,-eting awesome power of teleiisioii on specific healthp fields' of the films. The Public Health Service, in con- problems requiruig specific public uii(ler--taiid- ing and response. junction with non-Federal scientists and physi- Ily sidted for delivering cians designated by the Service, should have full The medium is idea rogram' control of the content of each film. The films clear visual information in dramatic and force- IT film, should be available for commercial sponsorship fW terms. The art of the documents true to science and at the same time challenging 'within a predetermined range of appropriate to the interest, is hi@ product classifications, excluding such obviously ahly developed. Commer- tble inappropriate sponsors as tobacco companies, cial television is cap, of r-eachino- an over- i- @helming majority of the American people, pliirmaceutictl firms, and the like. -ision is growing rapidly. In the Subcommittee's view, the potential of and edue, itional telev 11 eom,- Yef health documentari es have been few in television as a disseminator of health informa- !Ommu-, number, tion to the public can be realized only through )ns uneneii in quality, and generally drab 91n@ in presentation. It has been their quality, quality production of authoritative material, ind fel rather than their subjec 'hat it can be t niitter that has rele- made available in such a way t -hem to un,%ttract ,ationil gated t ive scheclulina- and viewed in prime television time by the widest doomed them to small audiences. Television possible audience. The method proposed, which producers areas aware as newspaper and maga- consists essentially of a Federal investment in mmunication talent, would cost about $1.8 mil- 2in,- editors of the tremendous public interest co in health. The products, with a few shining lion per year. Alternative methods, such as the exceptions, have simply been inferior in the governmental purchase of prime time, would rame @g"IY competitive world of commercial tele uch and result in the showing of in- cost as m 'Visioli. ferior products, with inevitably inferior results. The, Subconunittee recognizes the problems The impact of 12 first-class documentary films, faced by a Government agency like the Public each carrying a message of urgent importance 408 REPORT TO THE PRESIDENT for the protection of Axnerican families, would cut independent efforts to handle drug iiiforma- be immediate and oierwlielming. tion are responsible for mticli important ' @ 14.; 4 The Subcommittee further recommends that formation failing to reach those who need the Public Health Service be authorized, and most, ,tnd in view of the progressive increase it, that funds be appropriated to the National the consumption of medications and other Medical Audiovisual Center to support through chemical products, the Communications Sub. appropriate mechanisms, such as grants or con- committee endorses current proposals for the tra@ the development of effectiie television establishment in association with the National programing in the health field on the nation's Library of Afedicine, a national drug inforrna- educational television stations. The sum of $1 tioncle-,irin(,rliouse,serving,,tndsupportiilggov. million per year is recommended as a beginning emmental and nongovernmental drug informal figure. tion units. ETV programs reach school audiences at all IVe believe that the clearinghouse should be levels from primary school tlirouch college. In given authority and ev, entu,.tlly additional funds many communities, the ETV proor,,tm is viewed for proi-idiiia, c,!Ttnt-s to promote compatibility widely by the,,idult intellectual and civic leader- and cooperation among drug information unit& ship as well. It represents an excellent medium The clearinghouse should include full in for attracting young people to health careers, formation on the chemical structures ,tnd bio. for establishing and maintaining desirable logical properties of ,Lll known compotmds and health liabits,,,tnd for stimulating desirable com- the derivatives of such chemicals, with reoard munity-wide health activities. In many areas, for their cellular, environmental, ,Lnd social ef. ETV facilities can also be used for continuing fects. It should gitlier information from all alth professionals. The health reliable sources, including t]-io published litem. education of he potential of this growing educational force has ttire, conference proceedings, -oveminent re- scarcely been touched. ports and other records. Further, that the clearinghouse should produ@ both for oeneral A CLEARINGHOUSE FOR ,iiid specific users, annotated bibliographic-% DRUG INFORMATION systematic files of information on drugs in The Subcommittee recognizes the fact that forms suitable for replication, critical reviews,-i improper use of drugs is t(xlay an important compilations of evaluated data, judgmental re- cause of avoidable disease. Because the gaps sponses to individual inquiries, and other ap and wasteful duplication tssociated with pres- pi-opri,,tte information. Tke Promotion of Health The Subcommitee on Communications is well cancer, and stroke. As a, member of the Com- aware of the fact that its re,--onunendations mission stated early in its deliberations: range beyond the problems of heart. disease, can- NVe have a majority interest In personal disaster In eer, and stroke, if these problems are considered the unitLd States-and conversely a majority oPpot' narrowly. 111'e feel strongly that more effective tunity to help improve the health and prolong the Ufo of the U.S. population. transmission of health information to the pub- That Is because Tl percent of all U.S. deaths Rre. lie and the professions-whatever the r, ifi@ Pee ,,u,;@d by heart disease, cancer or stroke. subject may be-is essential to the saving of Secent.T-one percent Is a majority interest in any- human lives. ti"... IVe believe further that strengthening our People want information about heart diseaslh health communications resources i-nust iiieN7i- cancer, tnd stroke. If reliable information i! tably advance the crusade against heart disease, presented to them, they will act upon it. A-ad 101 lit CO,NA@ICATIONS 409 action will set in motion a chain of events accept this added challenge. And we strongly will sharply reduce the toll of these dis- recommend that the Federal Government ful- fill its responsibility to promote the health of communication is as funda- the nation throtiali strong and effntive com- tli as research itself. Weof tlip, iiiiiiiicitions programs. s Subw@ttee urge that the j%IR. E-,IERSo.N FoorE, ical science and medical practice b' idai Source Paper INFORMATION HANDLING FOR THE BIOMEDICAL SCIENCES: BACKGROUND AND POSSIBILITIES Evolution In the history of the race, as in the Iiisto physician ,iiid patient to cope with a dazzline ry of the individual medical communication be- .ind confusing array of knoivledo,,e, fact, and gins at home. Transfer of knowledge by nueleic OP'll'On- acids in the genes, imprinting of liabits, and And then as iioiv, the task of puttiii- this in- direct sensory observation, the pristine means of fori-nitioii into some rational order developed alone with the process of recording the infonna- learning the medical arts and sciences, remiin n the most elementary and probably most effective tion on stoiie, metal, papyrus, cl-,iv glass, and methods of communication even today. wood, Nvitli cliisel, pen, brush, stick, paint and ink. Concepts and teeliiiics have cli,,iiiaed, but PARENT TO CHILD the process of or(,aniziiicr and exchanging in- formation has remained constant and contin- As a child leinis from its pirent, the student tiotis. These clianc--res in concepts and technics of medicine learns from his preceptor. It is are ,L product of necessity, perception, invention, this tradition ritlier than sentimentality which nd acceptance. "The genius so-called is only It leads physicians to i-e-,,trd their teachers is that one who discerns the pattern of things with- parents" or the teacher to think of cl-,Ll iiig in the confusion of details a little sooner than practitioners as his "children." Personal ex- the ai-eraae iiian.11 perience ind personal conversations and is@i- itions continue to have ,i power that underlies INTERCHANGEABLE PARTS the influence of formal systems of information It is conventional to associate a startling turn c exchange: textbooks, unfurls, lil.)rarie.@,,iiid the %n@ co mass media. in the technology of communication witli a m- iiiercial failures ,t Bible assumed to liavp, been Nevertheless, personal experience has its limi- printed by Joli,,iiiii Gutenberg ,it '-\faiiiz late tat-ions. Such limitations may liii-e motivated the 15th ceiiturv. Gutenberg ,vas n t the fir-4 those who tried to encompass the living treasury 0 to use movable blocks of type. The had beeu'--',l of medical knowledge in the writinos attributed used earlier in Korea. But Gutenberg was to Imhotep, Hippocrates, and Avicenna, at dif - to exploit the phonetic alphabet of the Oel-i@ ferent stacres of human progress. EA-en in an- with movable letters. That fact, and the pr cient Egypt, Greece,,iiid Iran, the body of medi- Iccenti sion of the type in the '.Nfaiiiz Bible, cal knowledge challenged the ability of the @d( t5 the importance of Gutenberg's ,idop individual physician to contain in his own siiiill printing of the principle of interc-lia head all the medical kiioivled,,Te that his precep- standard parts, applied to the mantif,,t( toi-s could bequeath. Then, as now 7the.,;eareli for methods of man- rifles by Eli ll'liitiiey and used so sucO I information soualit to aid both in the manufacture of automobiles and aging medici 410 CO'.\I'-%IL'N'I CATIONS 411 il)le of eiiiployiiir iiitereliaiieable ri(,,Iit into iiiiiiil)til@itioiis. Such i circumstance Tile prilIC s is critical to the construction of led Cali-iii N. '.%Iooei-s to foi-iiitilate the law that -staiidii-d p,,' I - t a] information systems, as suo,- "IV]iere there is L penalty inipo--ed upon the rnodel-li nie(ilc tn bv efforts to establish standard noiiien- people who use information, the better the iii- gested Seattle iiid ,i universal system of chemical cod- formation system, the less it will be used." i,,g (L)). Tile fundamental relations of this Billings not oiilv elected to acquire the most principle to both the iiitellectu,-tl and technical comprehensive collection of medical literature elements of information management is a m,,t- on earth; as his cai-eei- coincided with t)ie first jortlieiiie of tliis.,tccount. floiveriii(, of periodical publications, 'ie ivas The technique of Gutenberg in producing quick to see the need for t monthly report on Standard interchangeable pieces of type did not new medical titles. In 1879@ lie established the immediately release a volume of literature. "Ilidex'-Nfedictis" and the following vear lie pro- other technical iniioi7ations were required, such duced the first volume of the first series of the as the i-otar.v press, papermaking machinery, "Index-C,,ttvlo,-tie" of the Librai-v of the Army casting of iiiet,,illic type, quick-dryin(r iiiks. and (3). Suroeoii Geiieral's Office u- especially the contributions of Faradtv, Henry, Since then, the historv of these publications and Nfaxwell to the electronia,-netic movement and compiiiioii works issued bv the American dazzlin I of precisel-% machined tools. -iN[edical Association has been t struggle to pro- fact, an A major retardant on the cultural side was vide an up-to-date ,ind effective guide to the the distrust of scientific thought, as opposed to volume of literature (4..5). II'lieii in 1955 the iig this in. I elations. So "Ilidex-Catalo,,Ue"' ceased publication in iiiid- itutlioiitai-iqn dogma or mystic rev develop4 surreptitious were many scientific studies that alphabet with the litli volume of its fourth Le informa.@ d results in cryptic forms series, the number of entries in the unpublished their authors recoi,de (Ylass, and intelligible onli to themselves. (The appre- b,,ickloo, of completed indexing exceeded the print and of t]) hensions it time seem to Iiiiger in the total number of entries published in four series laiized, but eDTtograpliy of some scientific ivriters tod-,iv.) in 'i 8 years (6). @ang Under these circumstances, the writin(y ,ind col- Lnd lection of medical literature teiided to be se- MEDLARS nd t questered in discrete enclaves which served as The need to cover more literature better and inN centers of medical learning, and the exeli,,in,e quicker prompted. a report to the National Li- Iled of information ,imong these centers was hap- brary of '@Nlediciiie Board of Regents, November :hings with-. bizard rather thtn free and systematic. 1957, which led to ,L proposal to the Council of sooner than Library Resources, April 1958, tliqt funds be THE OPEN SOCIETY provided to investigate the feasibility of mecli- @RTS America was the looical focus of a move- tniziiig the biblioaripliic process. Alechaniz,,t- Mel't counter to the Old World pattern. Bein tion of the index to current medical literature ,irtling turl 9 with a cord dependent at first on important medical litera- ("Index '.Nle(licus"), with support of a @nt o hive American physicians could easily @ the to the Department of Heilth, Education, and IV- el f are f rom the Council [,,tinz late -I*c of an ol)en system of medical knowledge. t not the a system, with a complete central deposi- was i SiF o@lird an electronic system for fa- iev had b was envisioned, in 1878, by John Shaw cilititing search and retrieval of i-nedical titles. I Funds all -e,- erg wasf t,,s7 who chose to call the Library of the interested in special bibliographies the Oceid on General@s Office (in the Department of Y), "The National Library of Medi- of the cardiovascular literature, enabled the li- brary to develop the computerized Ikledic,,tl Lit- (This term first became legal in 1956.) radoxically, the frontier tradition of Amer- erature Analysis ,tnd Retrieval System, @fED- disdaining precedent, also tends to dis- LARS. Today MEDLARS appears to have the scientist who examines the literature the technical potential for recording and dis- he does his experiments. He is not felt tributino- all scientific literature (7). There- orking as hard as the man who plunges fore, the present challenge to handling medical s REPORT TO THE PRESIDENT 412 information seems less technical than intellec- DISTRIBUTION OF CHEMICAL LITERATURE BYLANGUAGEOFORIGINALTEXT, 1963 tual and social. Can infon-nation scientists deiise effective plans for organizing knowledge? ',W, ill society ENGLISH NON-ENGLISH upport the information system and encourage s and reward its users? Such questions haunt the librarian who tries to match individual, impor- tung,te demands for infon-nation with the dis- orderly contents of the scientific literature. THE MATHEMATICS OF BABEL The following data offer some concept of the volume and variety of literature which the mod- ern information system may be expected to manage. Based on unpublished d3ta developed by Chemical Abstracts The rate of output of biomedical publications for the past 10 years has been fairly constant, to 3 million received betnveen 1800 and 1933 -years at 1.4 papers per man employed in bio- (9). medical research and den-elopnient, ,ind 1.4 per minority among scientists A productive project 1 to 2 years old (8). but the volume has writes the majority of the papers published. grown in proportion to the expansion of re- How still is this minority no one knows ex. search and development. In 1960, there ivere actlv, but it is probablv between 10 and 20 per- 5,800 biomedical serial publications. The total cent of the total (8). For that matter, a small number of papers covered in 1 vear bv "Index minority of journals carry the bulk of the cited -N@icus" wis 120,000 in 1960 and is expected literature (8. 10). to be 250,000 in 19t-O (7). -kltliougli the clieiii- Of the seriil publications founded after 1950, ical literature is estimated to double every 8.5 one-third died before 1960. The great majority years, the National Library of 'i%fedicine calcu- of those founded in that. period (80 percent) lates that the volume of biomedical literature were forei(,ii: As biomedical research increases doubles only every 25 years (9, 10). aiiioii(r scientists who do not ordinarily speak The Library estimates that it received 4 nail- En rlish, publication of scientific reports in for- lion titles between 1933 and 1963, in contrast ei(,ni laiigu,,i-es will expand, unless there are ill incentives for favoring English as R Spec TOTALNUMBER OF TITLES RECEIVED BY THE NATIONAL LIBRARY OF @,EDICINE common scientific laiiom,,i(re. kn unpublished IBM-lq33 1933-1963 zn study bv "'Chemical Abstracts" indicates that 7 - in the 3,eirs 1961-63. there was a sliolit, increase in the proportion of papers written originaDY - in Eiiolisli, composing not quite half of thO total. @The' proportion written originally in - Russian increased substantially, while InOd other non-English languages declined, rel 4 zn tively. 3 Secondary Publication z The current volume of biomedical literotu is not only ilide-.Ked; it is also ibstracted and t4, some decree translated. Approximately such secondary publication services, a third O.., 0 them American, are concerned with bion'P-d Iwo 1850 1"0 19 JD literature alone. The iiwi-kber of second,, CONNIUNICATIONS 413 PE RCEN TAG E OF 14, 275 U.S. B I OME DI CAL DC IN 891 JOURNALS CUMENTS services for all scientific ,tnd technical litera- ARS TRACTED OR INDEXED BY SEVERAL SERV CES t four times as large, (11). ture is abou a] total of bioinedicil abstracts is The annu l@oo An additional 700,000 titles are @000. 1 t e or indexed. ('@Nf,,tny documents are and some listecl or qb- Covered more than once, stra,cted ire strangers in the biomedical field.) There are 31 secondary sources in the United States for drug information alone (12). (In- trainural services of pharmaceutical companies 0 1 2 3 4 5 6 are not included in these estimates.) Of 882 journals carrying 14,334 papers cited COVERAGE By INDEX WEDICUS OF 14, 275 C)OCUMENTS by NIH grantees as products of their work. inmost all were processed by at least 1 of 13 N.t ar d y services, and the average proe- major secon essing was by more than 3 of the secoiidarv s. Two services, "Index '.\Iedicus"" publication fei-,itivnyi Zliui-n@,il: Biologicheskaya Khimiva@' (I@1) and the "Bibliouraphy of Ac,,riculture" (1@;). B.@ produces 100,000 ,tbstr,-wts a year. iBA'g), covered 94 percent of the articles (11). Its French counterpart, "Bulletin Siomtle- A 1961 study of the coverage of cardiovtscu- tique,@l cliinis to annotate 200,000 titles. '.Nfost lar, endocrine and psychopliirm,,icological lit- services in specialized categories produce fewer erature found that the combined efforts of -'Ex- than 10,000 or even fewer thin 1.000 abstracts a cerpta Meclica" (E.Nf), "Psychological Ab- year. stracts" (PA), "Chemical Abstracts" (CA). and "Biological Abstracts" (BA) covered TO Technical Reports percent, of the articles, all 1 to 14 years old. "Excerpt a 3fedica" alone covered 4--) percent. Ili addition to items in books and serial pub- the best of the four (13). lic,,itioiis, the biomedical literature in recent Forty percent of all the simple articles were years has been peopled with ,t new breed called covered by more than one of the four services the "technical report." Some such reports are speak cited. deemed iiieli-ible for formal publication be- in for. A study of coverage bv six services (E'-Nf, C, ere tuse of "]earth, degree of dettil, specialized BAg, CA, BA, PA, and I.Nf) found t svnimeti-i- language, oi- restricted interest," according to Lblishe4 Cal distribution. None covered 4 percent ,ind el-iteri,,t used by the Division of Biological te.s than allsixcoA-eredanotlier4percent. Abouti3per- Standards of the Public Health Service. An- cent of the s-,imple journals were covered bv no other ftctor is that the criteri,.t for revie-sv before were covered printiii- of tee]-iiiical reports diffet- sometimes ,nore than one service; 14 percent by five and 17 percent 'were covered by two; 24 from those for journal publication. Some are Percent were covered by three and 24 percent presented in preliminary form .it scientific con- by four. (11). ferences before ,L refined version is offered for On the average, the world's scientific journals formal publication. Some consist of author Bb- d@ are being covered four times over by U.S. ab- stricts, submitted for distribution at meetings, stracting-iiidexiiig services, but not -,ilnvavs for for publication with the proceedings, and these the Wne content. are regarded as seriously as -,t formal publica,- 1-@f indexes 145,000 documents a year (1963), tion. In 1962, 1,615 biomedical technical reports he t SAMP- number abstracted by the U.S.S.R. were identified, half from the Department of u@@f,erati,vnyi Zhum,,il: Biolooiya." The vari- Defense. The indexing services cover such re- 4)us Sections of ccexcerpta 3fedic,,i" total about ports only on t -,elective basis. A cleariiio,,Iiouse 90,000 abstracts a year. CA produces 163,000 in the Department of Conunerce has been desig- econdo,l abstracts a year, in contrast to 30,000 for "Re- n,%ted to annotuice and distribute all nonclassi- 414 REPORT TO THE PRESIDENT fip-d technical reports issued under Federal brtries in hospitals with i-nore than 400 auspices. was 2,657 books, in contrast to one r@ommellda. Sources of announcements of tecluiical pub- tion for more than 6,000 books and more tha lications include, "Technical Abstract Bulletin" 126 journals for the larger hospitals (16). Por, (TAB), issued by the Defense Docmneiitition hospitals -,vith more than 100 beds, one pro fes. uenter tDDC) ; "Nuclear Science Abstr-,i@" sioiial body recommends at least 1,000 boolm (NSA) of Atomic Energy Commission (AEC); published ii-it-Iiiii the past 10 years (17). "Technical Publications Announcements" The 3,192 hospitals with professional lib (TPA) of National Aeronautics and Space Ad- employed only 863 full-time personnel and ministration; and "Government Research Re- barely 3,000 part-time personnel (1,5). Despite ports" (GRR), Office of Tecluiical Services this sliorta(,re of tm, ined personnel, only 294 (OTS) of the Department of Commerce. Each have ,ttteiided the four institutes on hospital lists a separate category of documents for the librariansbip held since 1959 by the -American'. biomedical sciences. Hospital Asssociation. Technical reports usually are published with- A particular difficulty in this setting is the in a month. in contrast to journal ,trticles, ivhicli liospit,,il's tendency to coiifuse the separate call. usually take 6 to 8 months. In TAB, the laz iligs of the medical librii-ian, the iiiedic@il rec- from publication to announcement is 6 month@ ords librarian, -iiid the librarian who serves The American Documentation Institute, Li- the pttients (18). brary of Congress, provides a depositol-v for Doing their utmost with limited rewure@ papers, or port-ioiis thereof. which are @enied small libraries lein lieax-ily on the resources of formal publication because of lenotli or decree the.Nttional Librarv of Ifediciiie and other, of detail, provided they are recommended by i-najor depositories. @liey ]rate participated in@ the editor of a scientific journal ind iniiouneed an iiiterlibrir.N, loan svst4em to excliaiioe rela., tively rare documents, but the dei-naiids upon in the journal. this system, too, ire on the verge of a break.. LIBRARY SERVICE down. Interlibrary loans by the -National Libra@' Few inp-dical libraries today are much bet-ter of Nfedicine, which stocks 1 million volumes, in-' off than the scientists in nian,,t-in- the volume creased 82 percent from 1958 to 1961. The de-; of information ,ivail,,ible. The librarian is ex- maiid for such loans is expected toicceler,,tte as pected to stock or procure all documents re- .NIEDLAPTS expands its coveri-e from 2,200 quested, to prepare iiinouiieements and biblio(,Y- tn raphies, and to keep all this iiifonii,,itioii in lieit journals to 3,500 journals plus 5,000 books-' tially. Tliei-eissomeexpectttioiitliit@AIED.;@.-" order. As if this were not enough of ,t burden, ail ]I I'.4 LARS, instead of supplying bibliooTipbiesi,'., librarians ]rate been attacked for not proi-idiiia kvlletlier recurrent or on demand, ivill sin'P]Y@' answers instead of dociiments,,iiid for failiiiz to ly tapes to rectorial centers which will con- ,ilert scientists and practitioners to new iiiior- @UPP tn ciuct the seareliesiiid provide the bibliographies mation. Farfrombeing,-tbletoprovidetliere- to aiisnver the prospective -volume of requedg- search services in which they are trained, most The value of such biblioarapliies is suggested librarians are compelled to give most of their n - by i test, run of ,t prototype prepared fo@ cirdi- time to housekeeping and administrative duties. oi-,,tsetilar studies. Ini-'estioators in this fiel4 In 1962, oiilv two of every five hospitals with who are well read even by the standards of tho fewer than 99 beds reported han-iiig -,i profes- profession, found that 85 T)erceiit sional library, ,ind these bad ,in -ivert(,,e collec- eiiees pertinent to t r,,Ivpr@- in the liei tion of only 158 books. Of the total of 5,4-44 prototype biblio(, al)liv were new short-term non-Federal general hospitals reois- tlibiy,-h the average ,t(,e of the titl tered with the American Hospital Association, more than 6 i-noiitlis, aecDrdino, to an ur'P only 3 out of 5 had professional libri@,-, (15). lished study by Heriier and tl'ie Institute The average collection in professional li- Adi-anc--nient of Afedical Communications. CONI.\IU'-\'ICATIO-NS 415 methods of haiidlin- medical INTERDISCIPLINARY AND may sti-eii-tlieii iiifoi-iiiatioii in years to come, but Alooer's law, INTERNATIONAL COMMUNICATION cited aboN-e, will also operate. ve figures are a rotioli indication of The, ibo the diiiiells'Olis of biomedical literature. To tdd INVISIBLE COLLEGES AND all scientific and technical literature to Wo4iiedi- INFORMATION CENTERS ciii ,,-ritings would niultipIN. the number and Two ti picil and somewhat contradictory re- 'Vorietv Of publications bv a f,.ictoi, oil the or(lei, poiises ,ire heard from most scientists or prac- (I the coinplexitv of the information s of lo, ,in -n by ,i factor of 106 or more. Iiiiproi-e- titioiiel-s in-lieii tliev are asked ]low they obtain p,,tttp-l scientific information. (A) Sii-itio,: "I have. no nlents ill tile ,irts of medicine nen-ei-tlieless de- trouble. II'lieii I wish to know something, I pend more and more oil the sciences of clielii- ist ry, physics, enoineeriiig. and mathematics: kiio@v Ni-liei-e to look or NN-lioiii to call." (B) I)espei-ate: '@lloNN- call I cope with the quantity 3iost medical iiii--iolis todiv ,ire iiiterdiscipli- of information published?" It iiiav be al,,@ied that neither is sophisticated. One result of the ilitel@di-ccipliiiii-N iiiisizioll But both indicate a disposition to turn to per- has been ,i realization tli@it collillitililettlolls Ill any one subject are limited bv the qtialitv of so)ial ac@iiiiiiitiiices foi- information ratliei- than erves to the benvilcleriii(, jiiii-le of the formal liter,.i- scientific communications in oeiiei-al. This coii- ttil-e. -Neitlier is much help to the middleman ent s Coiiiiiiis- clusion was voiced bv the Pi-esid NV etardatioii ivliieli ol)seri-ed, lioze job is to help all users get the medical in- sion on'@Nfental P of foniiatioii they need. It is essential to support the foundations of rather, In the excliaii(,re of scientific and technical in- scientifle research in all fields. and to stluiiil.,ite tie communication of both needs and solutions inioiig in- formation, iN-ail-,il)le data indicate that scien- Testigators and clinician.-, Nvorking at every level tists spend se%,ei,.tl times is many hours at meet- upot (19). iii(rs or oil the telephone as they spend reidiiia break- Requirements of improved and accelerated coniiiiiiiii- the literature. EN-eii tlioti-li delays or frtistra- cations across the boundaries not only of disciplinary lines but of Natioiis can be met in part by vigorous tioiis in efforts to use the literature may be re- exploitation of conventional methods as well as new spoiisible foi- this relitix-e dependence oil coil- methods prompt exchaiiTe of unpublished sci- %-ei,sation, such conferences are not in themselves entific data and development of efficient, systematic iieces&irilv all economical method of exchanging retrieval of results of research is ur-ently need- kiiowled,re. The number of meetings alone ed Increased support for research in coinmuni- cation theory and technology must be provided if Nve seems extrai,agantlv high. The biomedical ileetiiigs in the Unit;d States and Canada listed are to make effective use of our scientific potential and traulate ne@, scientific knowledge into practice (19). by calendars published by the American Aledi- -egoing data offer a cal Association iiid others total more than 1 500 On a limited scale, the fol y@, sirnpi fair view of the pattern ,ind volume of biomed- ,t year, -,iiid these are slid to be only a fourth of ical information. But the dviiimics of coni- the number -,actually lie-Id. (21). municatioiis are not ,is easily described is the At the cutting edge of science, ,tmong families dimensions. There is some evidence that the of sl@ialists, such as those concentrating on -e will viral etiology of cancer, resort. to personal con- exponential growth of scientific literatui level out (8, 20). There is also considerable versatioiis, telephone calls, and occasional visits OPillion that the formal literature may be a rel- or conferences is understandable and justifiable. 4tivelY minor force in biomedical conimtinica- Such scientists need not,,iiid should not wait for tio @z n outpaced by the grapevine, the iiivisible publication of final results bv their colleagues. 4 colleges conferences, and specialized informa- It is ,t tribute to the camaraderie of science that @sted VI t"D" centers. The influence of cybernetics, tliev form and maintain associations for free exchange of information. At the same, time, ernployirlz computers, TV, microforms, photo unput @itutp, Prilite-rs ialized information grad- magnetic tapes, and long-line circuits, such sources of spec t'jons. REPORT TO TI-IE PRESIDENT 416 ually expand to include others outside the inti- have been supplemented by -,t network that radi. bey mate circle. ates and ricochets in all directions (24). But the Once a body of special infon-nation is solidly little has been said here of the shift of medical established and of wide enough concern, it is emphasis from treatment to cure or, still better, common for the iiot-so-invisible colle,,-e to set, to prevention; from specific single predispos- ing, provocative, precipitating, and perl)etuat. up a specialized information center, ,t focus for the stor,,ize of specialized knowledge to answer ing events to multifactorial processes; frora or anticipate geriiiiiie inquiries. discrete, isolated specialists to a multidiscipline e National Referral Center for Science and ary team; from sporadic clinical observations to Th Tecluiology, Library of Congress, has produced systematic genetic, clinical, epidemiologic, and to slied further light on the laboratory studies of individuals and of large its first directory opulations. And yet these conceptual changes number tnd distribution of such specialized in- p -ise the "pattern of things within formation centers. An early study of informa- radically rei tion centers (2@9) necessarily dod(res the duty of the confusion of details" (1) as envisaged in the idealizing their function ('-?3). But it. seems past. -,videly igreed that such centersire,,,i lo(rical de- Equally significant to the process of info rma- ons to the tion transfer has been the increasing ability to vice for mateliing specialized questi quantities of data in specialized fields. identify specific pathogenic -igents and condi- This all too liasty summation of the evolu- tions with names which are ilmost universally t,iontry changes in the teclinoloc,,y of medical understood and accepted, -,whether parasites, information transfer-from preceptor to man- chemicals, or forces of temperature, velocity, ual, journal, library, and information center- mass or electromagnetism. 71-ie terminology has given sparse attention to the concepts of medical knowledge. The concept of medical Of ,tnatoniy also is well established. Even the language of biochemistry and virology has be- communication has shifted from a private con come less occult tmoncr the specialists. Defini- i-ersation,,imong a hierarchy of physicians to,,in international, permanent, floating caucus of tion and precision of concepts are the intellee- scientists, practitioners, and laymen. Tile t,ual counterpart, of the svstem of standard pathways of information have opened up. interclianaeable parts used in the technology of Straight lines, from preceptor to ,tpprentice, information handling. Definitions and Assumptions ost e;zre;zious assumption is It is Nvidel tssumed that iiitereli,,iiiueable Perhaps the m y standard terms meaning the same in all ]an- that it is possible to frame and employ such a guages and disciplines, -ivill facilitate the flow disciplined IIn(,niage, but that is the faith of many "information scientists a cateoorY which of information, even though acliiei-einent of a ists, librar- standard language is slo-%v ,ind difficult. in this context includes docuinentql riters, and It may be assumed ,ilso that a technology ians, indexers, bibliocrraphers, w which links all the cities of the world with in- editors. succinctly, 28 stant information will accentuate the use of "Information" itself is defined@ 05) meaning assigned to data" The impli standard te@. Although undisciplined natural lano-,uaze will cation of this definition is to exclude transrnis' ver,,atio@@@ undoubtedly continue to prevail in common dis- siori.-4. random siomals: Casual con course and in much professional writing, its unsystematic records, and accidental collectiOn!@'.- automatic translation into standard disciplined or accumulations, not to mention noise aiid.@@ forms will be necessary if a network- of scientific dysplastic art. information is to operate satisfactorily. "Communication" may be conceived as CO L i-ICATIONS 417 information: it implies perception of formation than with -,vrong information or with ond Iillg on the part of both sender and no relevant information at &11. @eiver and exchange of information, but it A further assumption is that the flow of iii- not necessarily imply active response. In formation is screened and regulated at key points. These include the scientific colloquies, the function of the information facilitate delivery of the -message the medical societies, the medical schools, the that it is understood. professional journals, science writers, librarians rdiiiarily tells how the user inter- and other science information specialists, and in@age. But it ought not be the duty the directors of various mass media. information scientist to asstire, that the Publishers and TV producers in particular upon the information given. The be,- qre assumed to liive a responsibility, as well as fy the manifest in- @lm,vior of the user is something to be determined i rare opportunity, to satis his individual judgment in the context of terest of their clientele in health information c affairs: e.g., it is the information sci- (1,76). IVIiile it is incumbent upon professional who informs the practitioner of the cliar- journals and libraries to speed exchange of in- ter of a vaccination; administration of the formation ,imong scientists, and -while it is the Tamination may depend on the judgment of the prestin@ptive duty of medi@ schools, medical physiciani the decision of the patient, or the societies, and hospitals, in cooperation with requirements of law. This distinction may various voluntary and official health agencies, serve to disabuse information scientists of ap- to maintain and improve the competence, of the itioner, such enterprises require pretensions of messianic responsibility and to health pract icipat,e extraordinary expectations on the public sympathy and support. It is assiii-ned PsA of administrators. that the health sciences are best fostered iii a Such a concept of communication also an- societ,v where knowledge is widely difFused. swers the natural question: ll?liv bother 'with The mass media, including the carriers of ad- fresh messages for people who do not apply vertisiiicr ,tre among the most potent forces for what they already know? The task of motivat- coiiN-eviiic,- information or misinformation, as 'anda ing people to act is a responsibility for the com- the cise iiiiy be, for the improvement or im- )Iogy munity at large. Motives for action involve pairnieiit 6f the species. tomnion goals and aspirations. The basis for Th6 siie@'s 6r failures of such efforts are in- feeding information is the assumption that peo- fluenced materially by forces described in the ple may act more suitably with the right in- following paragraphs. ,)ti Impediments o@ Message Transmission The impedance factors iii message transmis- This model does not serve our present pur- SIOR usually cited are: A weak or confused sig- pose, however, except for its bearing on the Ila]; circuits insufficient to carry or distribute volume of in formation as it affects the entire cir- the load; receptors of insufficient sensitivity; or ciiit. Other factors discussed below are obsoles- the absence of a feedback to regulate the nature ceiiee, which concerns the speed and timing of or flow of the signal. transmission; accuracy and evaluation, which A signal may be confused by competition with are judgmental rather than physical factors in other louder or contradictory signals, or by the communications; language, related not only to P@llce of a mere multitude of signals. The the nature of the signal but to the nature of the Circuits may suffer from a short age of filtering or switching mechanisms. Human as well as mind; and a radical revision of "the pattern of PhYsical failings may impede reception and things within the confusion," a:ffecting the de- feedback. sign of the information system. 418 REPORT TO THE PRESIDENT FLOOD OR SCATTERED SHOWERS systematic interaction among sl@ialties, I-ari- jovE ous forms of Iiiikage and switching of itiforrna. vvhi( Most of the studies of biomedical information tion sources need to be developed (27). The ve promptly conclude that the mere volume of task of the information scientist may be one TI literature in itself is a major impeding factor. of building irrigation ditcl-ies to handle th victi To quote but one such study, runoff from scattered showers, rttlier than One nosi@ Science and technology can flourish only if each of dammiiig or channeling a flood (21). we scientist interacts with his colleagues and his predeces- sors, and only If every branch of science interacts with OBSOLESCENCE BY THE HOUR other branches of science; in this sense science must also remain unified If It is to remain effective let, The rapid obsolescence of medical infol'rna- even tioii is suggested by Survey data as Well as by because of the tremendous growth of the literature, that there Is danger of science fragmenting Into a mass of i-epprt,s of medical research. A study of inter- h&VE repetitious findings, or worse, Into conB!cting special- librtry loans by tlie'@\atioiial Library by ties that are not recognized as being mutually Incon- Of '@Nledi. sistent. This Is the e@nce of the "crisis in scientific ciiie found tliit 59.C; percent of the serial eXBX and technical Information." (27). publications requested ivere, less than 10 years re@p Faced with an overload of information, the old, 78.3 per@iit were less thin 20 years old, in receiver resorts to one or i-nore of the following and only 5.6 percent were i-nore than 40 years old actions. He may skip, ignore his mistakes, let a (29). 117'itJiout. iiiiplyiji(r that the More recent claii bacl-loo,, build up, select only important items, information is necessarily new, the fi(,,ures in- c-ons abbreviate the response, call for help, handle dicate that the reference, works in the physi- mati messages wholesale, or quit. These ,tctions are ciaii's boolcea-@ may not tell him all lie needs TI of ni also known as omission, error, queuing, filter- to know. ture ing, approximation, multiple channels, cliuiil-- A more dramatic fi,-tire, widely cited, is that treai ing, and escape (28). 90 percent of the plianiiiceuticals on the market today were unknown 20 years ago. A-,Iiii, it is join, Filt-erinn, or selection is in elementary action on the part of ill receivers. -ks Freud has not. implied that the ')O percent are necessarily CUP I pointed out, the art of for-ettiii- is more im- better than the durable 10 percent. -N-eveltlie, n tn portant than remembering: Otherwise the mind less, rapid and notable chances in the practice L- would be completely cluttered. 'Bie develot)- of i-nediciiie such is prophylaxis of rheumatic heart disease, exercise of stroke victims, and m ent of specialties in science is a filtering proc CN-tolocrical di,.i(niosis of cervical cancer have ess, an effort to select only items of information that are pertinent to a given discipline oi, iiiis- teiided to i-el)lac4e oldei- ii-iet-liods. Tliir-,e changes Sion. in clinical practice sotuid a clear cli,,Llleii,(,r6 to part In most discrete specialties, there does not I)i-acitiojiei-s to keep tip with the times, in pite tpl)ear to be -,in overload of information, des liv coiisultiii- current literature. The rise in U.S. fiiiidin- of biomedical re- the e@tieiiee noted above -%vitli the bibilool- zn. search and development, an increase, from $148 ral)liy of cardiovascular literature. IVithin a narrow specialty, the available work of the million ill 1950 to $890 million in 1961, has tuiquestioii,,tt)ly multiplied such cliiii,,es in clin- leading contributors is quietly located and studied, and if tn iuil,-nown comes tip with a ical practice. @@id realization of these medical has the adi-aiiees has been disturbiii- to tiiy practi- significant report, the (,rapevilie Soon tioiiers and some of their patients. IlThile word, often before formal publication. ordinarily they re@ooiiize it is wi.% to @lle'w Nevertheless, the task of dealing -,vitli the current volw-ne of medical literat novelty, to stay ivith tried and tested proce, ure remains dui-es, they cannot help but be teii-ipted by the critical for producers and users of iiiforma- fact that. many medical non-eltie-s of the past tion and above ill for the ii@ddleman, the in- -10 years, such as i-alviilar sur(rery, antibioticsp fon-nation scientist. The iisei- who ranges over n the great mass of literature sees oii]3- ,t limited, and steroids, have become established and re- biised sample, even thou,-Ii such stimtil,,ttino, sp@ted. Bet,Ni-eeii c-autioii and lwpe, they are browsing may be the road to Serendipity. For as badly torii as Hamlet. -@iid nothing can ie' CO-NLNRD.,ICATIONS 419 SO much as scientific inforinition become captble of supplying fresh information istin,,,uisli between geiiuiiie dis- promptly, in perspective, and well evaluated. ei-e clian(,Pls of fasl@oii. The present rate of research ,ind development they fear is tlitt they ni,,tv be is so far ahead of the reporting and evaluation ioii. Medical fashions in di,,i,-- that much scientific information is out-of-date ipted the flippant c4Diiuiiei@i that before it is in print. n@s have. Prcln ,in one imes have epidemics of statistics The time lag between the delivery of i report we somet epidemics of disease. Treatment and its publication ranges from a few months rather than &ISO May be a fashion as i-nuch as diaomosis, even to ,t few years. Secondary publication in- event to the extent of suraerT. The assertion variably takes a few months more. But the de- that 75 percent of the cancer victims might Ivy between the completion of the report and -eiy of an acceptable report usualli- is even h,,,ve their lives "saved meaniii(r "Proloii(red," delii by early diagnosis and preventive stirgetT, for long i- thin the (lelty in publication. In the example, has been slialen by data offered with process of announciii(y new information, there- es (30). fore, both the ivritiiig ,iiid publication phases .respect to manun,,iry sit Information is available to support the claim are too slow for the modem pace of obsolescence in behalf of sitr(,ery, but the quest ioii is, is the or for the scientific appraisal of the newest in- claim trtil3, scientific? In such -i situation the formation. conscientious physician needs evaluative infor- ma,tion rather than mei-e documents. FREE MARKET vs CARTEL: The uncertain scientific basis for other foimis THE PROCESS OF EVALUATION !.of medical practice is reflected in serious litera- It is considered by many that ,t critical step ture on acupuncture, the Chinese technique of in nian,,icrin(rscientific informationistoweed out treating ailments by putting needles in the false, frivolous, or foolish contributions, or coii- joints, and nioxibustion, known in the West as versely to select for publication only the si(,- cupping, a technique of drawiiio, blood to the -sisteiice of these. with a vacuum. The pei n.ificant and the sound. In other words, evalua,- practices in the Oi-ieiit may encourage curiosity tion and screening tre trumpeted as critical to informittioii handling (12), except amon(r those Ls to their value, but. ,i conclusive scientific ex- ZD who feel frustrated by obdurate critics and edi- periment has not validated these teeliiiies. tors (31). Arguments over dietary factors or the use of The evaluation system is both formal and in- ariticoagulants in heart disease offer another ex- formal. Evaluation begins in the author's ample of the need for scientific evaluation of struggle to select precise -%vords, proceeds with transient reports. Such arguments also illus- trate the volatility of scientific theories and the comments by his preceptors and reviewers, and tendency for fashion and discovery to be con concludes in the response of readers to his work, ifnotinthisgeneratioiitheniiialateroiie. The fu@'with one another. While such disputes are best settled bv experi- theme of critics of this process is that evaluation needs to be refined, to be more self-conscious raezt and careful accumulation of evident ,e a, desperate patient is seldom willing to wait for and critical 7and to exert more influence. t6 final verdict. Having seen first hand the At the same time it appears that, despite all practi i@ Ubiquitous achievements of modern science and nurdles and hazards presented by editors and @'@ITO]Ogy, he insists that something new be referees, the author who really tries can succeed l,r,e,l in having almost anything published and dis- ) especially when established methods are ow and unsatisfying Moreover, the possi- tributed. By this means the f ree market in sci- bBi @y that something new may actually be use- entific information tests a scientific work by the iui Is one that no practitioner cares to discount ancient rules of supply and demand. If the today. open market is indifferent, few copies will be But the physician will be handicapped in ap- read; if readers are respectful, the paper will be ply'ng 116'v methods unless information methods reproduced and broadcast. Apologists for this 420 REPORT TO THE PRESIDENT procedure ,issert that such freedom is necessary professional eminence; by reluctance to report to escape from liardeiiiiiz of the Iiiera lies. negative results, so called; and by Simple indif. with an epidemiolooical study of ference to publication. Under these circum. encephalitis (32) serves both as -,t warning stances, the common market for science inforrna. ,ig-,tinst restricting publication and as evidence tion suffers from a variety of political and of the futility of such restriction. L. L. Lums- psychological trade barriers. den was alone among 100 eminent colleagues in ascribing a St. Louis epidemic of encephalitis THE PATHOLOGY OF LANGUAGE to a mosquito i-ector. Altlioiicli his paper was Altl-iougli it is a truism that verbal skills are not published formally for 25 years, the rejected fundamental to the communications pro@ text was mimeographed and circulated ,imong current awareness of the health and patliol a select scientific underground until the f raved i ogy f lano--uaze is largely pragmatic or intu tive. -nized for the classic analysis @hat copy was reco, Achievement of verbal skills is an art rather it proved to be. than ,t science. Knowledge of the source of ver. A similar history ,itteiided a tlieoi-eticil and bil skills or their real nature is on the level of creative sttidv -.vliieli was r e(I bv P,-) iourii:tls L medical knowledge of malaria or typhoid fever before one old editor give it sl)@ice. lie 200 years ,i-o: The symptoms are obvious, but author predicted, on the basis of his theories, the agents and the biological process are m@ that biologists would find a free-living trepo- t-erious. neme and a simian reservoir of malaria. These It is possible that. psychological factors, such predictions were vindicated within ,t yet 3 if[ as fear, exhibitionism, greed, I)nit.,%Iity, sloven. Such incidents also indicate some hazards in Iiiiess, e-otisin, or libido may ]Handicap coltimu- evaluating factors of impedance or intensifica- nicitions more than ignorance of the rules of tion of biomedical communications. graii-im-,i.rorv@-ibul,,irT. Otlierwise,stylebooks. Dr. Richard Orr 5 director of the Institute for dictionaries. and teachers presumably would the Advancement of @ledical Communications, liiN-e fir wider effexts than we see. There are has ,isserted that many prized assumptions reasons to believe that many -,ood writers ap- about the process of information transfer @o not I)ai,ently learn their craft unconsciously by stand up under the test of experience. His ad- eclioiii- the style of books they read (341). But -%-ice is well warranted. Studies iiiidei-taleii to ,issess such issumptions are pathetically few. most authors who contribute to the scientific Illld technical literature seem untouched by any Meanwhile, demands for a free flow of literary iids. formation cannot be stilled bv a plea for tddi- The question, "Can we teich scientists to tional evaluative studies. Decisions to improve write well?@' is .inswei-ed by the question, "Do scientific communications must be tal,-en on the -,ve teacli scientists to -,vrite -,Yell ?" Despite the basis of temporary tssumptions, liowei-or uncer- fact that Eii,,,Iisli occupies a dispropolt-iolltte tain they may be. In this sense, each commu- amount of time in classrooms, article scientific nic,,itions procram is an ex eriment., and the r m p prose consistently fails to acliiei-e lucidity 0 quality of its assumptions is to be jud(reul less not to mention elegance. High by the superficial success of the communications Schools,. colle,-es, and pi-iblisililig coinl),,inies,,'P- program than by the discernible relation be- 1).Il.elltly are" social forces which either ]",I've tween those assumptions and the results. A free failed to cope with resistant psye-l'OlOt'liell market for science information should be the forces or leave been undermined bv more po,,,er, lo-ical response to the uncertainty of our as- ful social forces, such as the ltrn@ verbal iiibits siiiiiptioiis as well asin expression of confidence of peer groups or the pressure to publisll in in the experimental method. t at leisure in the competitive iast@ ,iiid repeii Nevertheless, free circulation of iinportqnt in- sti-ticr,,Ie for recognition. formation is restricted by considerations of na- The increase of research and development 111 oted tional security; by zealous protection of pro- cotuiti-ies which (lo n t favor En-lisli, as 11 0 in of the prietary interests; by rivalry in the contest for earlier, is claiming an increasing poitioll CONI'-\IL@-ICATIO@NS 421 i lititio litel'. title. oll@'etliieiitlv. today is none of the. I)Iiysictl, institutional, or Of S(' those V)10 1'e@t(I oii]@, Eiirlisli iiiaN expect to be i)sN (-Iiolo(yieal forces cited -.il)oN-e, but a historical restricted to a P"O(,rl'essivelY s'll',Ille" slllll.c@ Of t Ile Scott Adfij-ns, Deputy Director of the -Natioiiil Library of Medicine, recelit]3r stated -ittire. ter, le of iiitereliaiioe@il)le standard in an tddi-ess to the American Librar A--,socia- a Tile I)riiic'P y implies 'I suite laiiotia,e, prefei:-,LI)IN tioii (.Juli 1964) that iiiucli of the wirest ex- ill dominant in bioiiieclical I)i-es.@d ,il)otit information iiiioiig scientists re- Sil. AVIii(.Il is St par,.-i Ftl@ll (r I-ecise, consistent tel-iiiiiiolo N-: and suit,, fi-oiii the fact that tlieii- traditional tiolit, @GE literature; P ts of Nyords. How tlli@ priii - tidn- disciplines are i-noving into missioiis which ljcrelliell rderiv ,iri-a L- applied will depend oil the il)ilitN- draw upon a -,vide variety of scientific resources. ciple is to be essful studies of the I)i-oce@;-z of This pi@oce,%- was accelerated bv the @\Iiiili,,ittaii dezig" stlcc District, project and others with nailitai-v ,isso- inisterizioc' verbal skills and oil stieli @i(biiiiiist, iitive: t iiiost of the @ieii- ciati(-)iis, but it now extends also, if less desper- @i tive measures as iiitN, coll"e" world to the use of a standard -%-ocil)iilai-.N .atelv. to t wide variety of public health ,f vo _r_ -iiiis to be @eeii what mis@ions. 'O.'alllze d. It reiii, vel of neatly 01 eff ect, of contracts ivitli foi-eioll To illustrate. a scientist trained to recooiiize relay @ the fever ublisli Eii(,Ii@li text 01- of world- characteristics of cardiac tissues iiiav journals to P is, but ide ,,se of IIEDT,-'iPS tal)es. liai-(- t cozv gi-asl) of his subject. But if lie eii- One disadvintaae of the %-,t i@ietn of laii,-Ytia-e@ listlz in amission to sttidv dietarv. biomedical, eii%,lroiiiiien- 111i ,I sill(rle document into and -1-iral f@ictors as well as sociaf" is the need to translate suck 'fouroriTioreotlieriiiipoi,t-,iiitlaii(,tia,,es. AVIiile tal. @tn(i genetic influences oil cardiac tissues, he ,Ioven" demands. If different effects there MLY be some jtistifici@tioii for such diipli is @u@)ject to iieni )nlmu-@ se foi- ei-eariii,y seN-- are i.@sociited %A-itli different viruses oi, eni-iron- cation, tlierp, is far less excii P-ral English translations of one docwiieiit. aiiisli tll such men lie aiiiis to leani to distlii, Under aegis of the Oi-(ranizatioii foi- Economic (lifffreiices. In correlating various factors as Cooperation and I)ei-elopiiieiit. a Etirol@aii lie analyzes the tissues lie tries to acquire iie,"- Translations Center his been estzibli--zlie(I to --i%'e @rs ap-,,@. kii(.)-.@-ledo-e in a liost of uiifti@liar subjects. westerii\-atioiiskliowled,eofeasteriiEtiroi)eail sly by Sii-i,:!,irly the traditional hierarchies of subject mrareli and to make available translations 'lot But' of each coiii-entioiial discipline tend to otherwise obtainable. Various national a(,reii- niz ienfifiti, cies Opera, te in this activity. be -17,-tceiied by Nvord lists with a new range of by any MULTIDISCIPLINARY MISSIONS -\I"@@ioii ,iiid experiments desimiiecl to deal @ists in, Perhaps the most important storiii center in wit,. this ferment of biomedical information are -@zzed in the following section. )it,e tll@ the informal biomedical communications svsteiii -tion,ite Exper dity Or iments and Missions As Dr. James'@Nliller observed (28), there are INDEXING POLICY Only a limited number of things to be done with I:. the small card file on the desk of a scientists overload of information, but within the proe- :n catalogs, bibliographies, and directories an(. be described, there are m,,Liiy i-efinementc-. 5 in -,.-.'@e National Library of Alediciiie, there is For example, in the processes of queuiiig and -n..-..inion need to conceive of ,t pattern or sys- terr- -,f organization and to arrange the informa- filtering, or in storage and selection, there ,ire accordingly. Even wlip-ii information is @Y techniques of organizing or indexing (3-5) not pil@.-@. up in the order of arrival, some scheme is the iliforina tion so'as to simpli@, the process 'Of finding it (search and retrieval) (36). u sc- to find ,t specific itein. In a small eollec- ,is in 793-311) @65 28 ri 422 REPORT TO THE PRESIDENT tion, the search may be bt@ed upon free "%cia- A general theory ,is -,t logical fra rne'",ork of tion, such as a, "small Lwxk with t green cover events has been ,t driving force and -t PolverflA that cime in ibout 2 we@,@.i ago," or "the letter instrument in the physical sciences, exemplih,,. iiistein James asked about." lin i larger collection, the in the Nvorks of Gibbs, 1\Tewton, E and search will be related L@. dates, names, serial Bolir, as James Coiiqiit ]its demonstrated in 940 numbers, sizes, forms, a@-.,-ces, titles, or topics, essays collated under the title, n T-Tiiderstand. separately or collectively ing Science." Geiiertl theories in medicine,, t Numbers, dates, and a.-@5liabetical lists of au- pytho(,eiiie theory, the germ theory, ,ind most tliors are ai-nong the rti@.t familiar bases for recently the stress theory, have been producti organizing information. @iut not always the ,ilso7ifiiot,,ilwaysi-alid. Tlieliopeofconstruc@ easiest for the prospectus u.%r with only one iiig a (-,eiieral theory of beliia,ior, based on the subject on his mind. Fer ask a librarian for information concept, animates the studies of "Number 59-60045 in trip Library of Congress Miller and associates (37). In one sense, all catalog." Although tile.--: is a strong interest reasoning is deductiA-e iiisof ar,,is generalization ised on incomplete data (.,8). among scientists in ,tll r)-.@)licatiozis of certain a re b, -tutliors, their siNtrclies u@-.iilly concentrate on oack On the other ]laid, the pragmatic ippr or the inductive method, is relatively open, niore specific topics, such as tli@.-Tnal therapy. Because of the prime n,-,,l to organize topical inclined to allow events to define concepts, pat. teriis, or structures. information in ,iccessible 7)zitterlis, the tactic,,i] Such a contrast in strategy is exemplified in management of informat,:, n, Whether stored on cards, tapes, microfiche. ,r notes scribbled on two publications issued by the Public Health Service to facilitate the search for scientific the back of an envelope. ..;. less crucial in the biomedical field thin th(z @trateoT. (It is un- information. One, '@-Afedical Subject Headings," called likely, ]However, that a @.zle strategic topical IfeSH. frequently is assumed to be typical of pattern will rule the bi@-.--dicil sciences com- pletely. The current mil'-iple sympathetic if the Iiierareliieil structure of information (39), not preci tltliotigli it is ,ictually based on the literature sely compatible s--@emes of biomedical rather thin on classical concepts. TTnder 13 knowled(,e ]late (lemoiist:-fited persistent sur- main lieadiii(rs such ,is ,inatomical terms or. vital i,al'ues.) e5 I giiiisins, humanities, or communication IfeSH 0 PLATO VERSUS TOPSY i rran rres i-ai-ioiis subcate,, rie,3 ind terms or de- scriptoi-s. which in turn contain cross-reference& A fundamental differet.,:e of policy in tile To illustrate, under anatomical terms (A), nose strategy of planning an iii(I-xing.@i'steni is what ,ipp@,irs under three teories; parts of the Cl might be called the deduct;@-e versus the induc- body (-Al), musculos@-elet,,il system (A2), ,tnd ndexed tive method. The first sek"-4z to ,issign topics to respiratory si stem (A4). Nose is also i a prearranged set of cate,,,r)ries; the other de- under face (Al) ; iiid, in the other c,,ttegori -es categories from the topics encountered. -ided into ii-,isal septul rii (A2), (A4), it is subdii One is the hierarchic system, contrasted with the turbiiiates, iiasal mucosa, and iiasopll,'tryn so-called L@NITER.IF systc-rn. In practice, such These classifications provide ,t road map systems tend to approach -.,ne inotlier. storiiig and recovering information about t Herner has said thit "the phenomenon that nose. AfeSH is used primarily as a s ton for kele best characterizes modem (-Ir@umentation is the 44 Index @)fedicus." recurring denunciation and discovery of the In the introduction to MESH, '"'inifred need for context and resolution in index entries" - Sewell, subject ]leading specialist, stl On one hand, discrete terms inei-itably-- -'basic principles of assigning subject form clusters. Simultaneously, those who em- in medicine have not changed from bark on a program of rigid categorization are fortli in the first edition. IVe certain to encounter items that let the category i-iiiced of the value of using tii ideiitica au out of the bag. ity list for the indexing of periodic','Is ,rid tIll. 71@ 11 4i w i. f I t,II ! I i ;! .1Ii. . - - .- - 423 CO-NI-NIU-NICATIO'N@ ductioii of redundancy -,iii(I iiit(@ili('Iellee/ -ieiic(, re ks. Exl)ei , has led its to es in ipe(!ific practices and a sensory mechanisms, of redundancy and ititelli(yeiiee/seiisol@i iiiecli- discoiitiiiiiatioii of the Ilse But eve continue to aiiisiiis, the redact ion of gs Deduction of i-ediiii- eadiii(,s is directional sensoq mechanisms, the i rd sti e( dancy and intelligence Is or ectoi-s which serve to essence of i par Such a procedure, however puts ,i premium tictilar I),,il)ei- )9 the Division of Re-qearcli Grants on the abilitv of authors to select informative In contrast (lex with 6,700 main headings in titles and pertinent keywords. er, based upon the terms used RETRIEVAL VERSUS RELEVANCE in describing their work (40). Altliouali it is clear that the ait of iiidexiiir eriviiig index terms from titles to oi,-aiilziii, is the keN and finding scientific also as permutation or keyword are oroupecl Nviti information, iiidexiiic, is also i liui-nan and in- zn I t- I.. tellectii;il process. It ciii be facilitated but the system is never wliollv rel)lzt(,ed bv niacliiiierv. The tech- t like the editors r,qiits Index" find iilques of ilidexiiio, have subtle implications -%N-Iiieli suiiiiiion the ;I@ills of Iii(riier mathematics &needforc,,itegorc,.i treatment. and semantics (41). (1013 edition, the staff of the D' With the 1 In one study coiiipii-iii(y the success of i iiiecli- t their ion of Re,-zeareli Grants concluded tha aiiized system with a human sNsteiii based On system had proved "too rigid and cumbersome" s 3 x 5 cards, the ,idvaiit;i(re of the liuiyi,,in svsteiii and they therefore introduced i-nodifications. Was tlioiialit to lie with the superior qualitv of The more significant chances Nvere to o-roup re- m l@- 1: the Indexing. lated items as convenient categories An incidental fliidiii(r of this study, conducted Father thin as hierarchical classifications. The bv Cvril IV. Cleverdoii, College of Aeronautics, editors aim at compatibility with @\IeSH but @i-,,iiifoi-d. Cletclilev, Buck-s, England, was that have formed no hierarchical svstem to cover the there is an inverse relationship between rele- many descriptors which are needed to identify the work of grintees. vance and retrieval in a complex information s steiii. That is to say, the more narrowlv the In such a wordlist cross-references in them- y seirclier defines the information sought, in the selves tend to form categorical (ri-otipin(rs: foi- ?- r- interest of relevance, the fewer items will turn "ample, under "heavy metals," there is ,i coin- up, tii(I the more likely he will miss something. Plete list of the heavy metils preceded by "see Coiii@ei-,elv, if the information is defined broad- ly, the search Avill turn up a great many docu- Use of the keyAN-oi-d system has been eiicour- iiieiits Ni-li;lcli liaN-e no i-ele%--,iiice to the iiiqtiii-3-. i,ged by two developments. One is the shift, For example. an inquiry about the fimilies of noted above from disciplines into missions, a lieirt patients will turn up far more literature than one which asl@s for reports oil brothers and $bift 'which creates new categories of ,issoci,,t- tiorl. The other is electronic machinery which sisters of victims of coroiiai@y occlusion born in ,lakes it possible to set up all index au Kansas. In this dilenimi, uncertain whether to toiiiati- sacrifice relevance to retrieval or vice versa, the ""Yi the so-called pel-iiiuted index. Foi- exam- PI , giv iilvesti,-,,itor finds that the construction of the e Ll'i certain instructions and ,i title, such index and its subclttssifications, to provide the "Sensory mechanisms, the reduction of re- a machine may list 41,lidall(!y and intelli(rence," so-called depth of indexing, is as critical as the the te"ms',Ilpliabetica"lly as follo-%vs: f ramiii o- of the terms of search. The state of indexiiio- in general is indicated 'lltelligence/seiisory mechanisms, the reduc- by the fact that the tdoiioi-s of the Wheat-ley tioll of redundancy and Medal for Excellence in Indexing had to wait Ineclianisins the reduction of redwid,-tnee and several veai-s until they found a new book de- liltelligeiice/sensory' of the prize, late in 1964. servino RESTDENT 424 REPORT TO THE P BIBLIOGRAPHIES mniiy biomedical journals are published period- t-ional Counel evilly in ft serial publication called "Current undertaken t( Exploitation of an index for purposes of Contents." adopt wiifoi,i identifying sources of infoniiation about a given ing, abbreviii subject has been facilitated by the iutomition YSTEMS UNIVERSAL S but no such of the "Index -Aledicus" at the National Library Eugene Garfield, publisher of "Current Con- others. Herii of Nfediciiie. @IEDLARS, mentioned above, is te Ilar for3iis of i capable of printing out 50 recurring biblio,-- nts" and of ,i mechanized cit.,ition index (in Cal abstractiii r,,ipliies it ,i rate of 3 or 4 issues a day, -,Yitli@a contrast to the selective citation index proposed be used by iii periodicity ranging from 1 week to 6 months. by Tukey), is ,ilso a proponent of a Unified In. variety of pti It, can also print, out an ,iddition 22,500 special, dex to Science, originally proposed by Neurath write a variei -land each year Avitli (44! 45), as a meuis of org,.ii-Lizino, scientific in. biblio(,n-apliies oil deii n ',NIEDL-X.RS tapes, any rerioii-,tl iiifoi-iiiitioii formation in the er,,i of the "Biophvsicist, psy- ment. Thecoiiseii center may produce as many more biblio- cliccliemist, the litunan eii(rineer, the in-,tru. ineiitatioli scie m are perfectly ,crrapliies (7). litist, and the cosniobiologist.'@ stracts, gin-eii .AIEDLARS bibliographies -,vill not be anno- A coinp,,irtble proposal for a comprehensive telligent edit( tated, -,although it is technically possible for i scieiie4a information service has been advanced computer to produce ,innot,,ited bibliographies, bv Dr. Stafford IV,,trren, Special Assist,,tnt to recommended lie President, for.L\Ieiital Retardation. In com. INLESCO II- ,it some ,idditioiial cost, once the annotations t catioils, that j are coii-iposed by a human brain. In the juda- nlon with other proposals for handling science zn with the fill] iiieiit of many librarians, ,iiiiiot,,itions add con- information, the Warren plan offers the concept this advice of ,t siii(rie svstem of ,ill science information, siderably to -t biblio,-r,,iphv. To t de(rree tile-% I= many reduce, serve as,,i superficial review of the literature and with a ceiitril storehouse of abstracts and cita- abstracts. spare some readers the necessity of examinin(,, tioiis on tape, extensive use of microforiiis for L- . Ironically e each document. On the other liind, more spe- storage and duplication, ,iiid distribution of in abst,r-a ct i n o cifically iiiformative titles could reduce the need duplicate types and microfor.Tns to regional scien for annotations. libraries iiid to specialized information centers tists debt '.\Ieaii-,vliile, the capacity of '.\IEDLARS to for direct service to users. Like the @'ational on the journa produce bibliIomi-apliies has been limited by the Library of '.\Iediciiie, W,,trren's proposed Na- Engineers, oil number of trained personnel. One, informal tioiial Science Library would provide. extremely abstracts. T]i - iii hour limited service directly to individual scientists. -@,,&Pplications. test has indicated that ' \IEDI,@@RS in . tf@ns on the li@up -,Y@ic ,i@@aily cit,,iFi6ns as a team Both the Garfield ,tiid the Warren presentil- 3 -.S. The possi- tiolis emphasize the need to develop standard ,,iinino, librarians to utilize nomenclature and the importance of a compre- ieii@i\,e science index to meet interdisciplinary The manae, \IEDLARS in their searches offers all oppor- LI on witil needs. Gai-field has also advocated aovern- .0mm tunit.y for substantial economies in information c nieiital standards of literature searching, for Ili both situat handling. coi ipliance with Food and Drug Adii-iinistrs- Still another source of bibliographical infor- second lan@ the text fro, - iiiation is the citation index, Nvhich lists authors tion regulations, as an essential preliminary to 'n acceptance of a national dru-, information Second 1)artv. alphabetically in association with the papers service. with 1-9, 4-3). J. IV. Tukev, ivliieli have cited them (4 7@raP-ted or tra in the "Journal of Chemical Documentation," ABSTRACTING both, there January 1962, describes a citation index system rd usage. E Nvliicli would facilitate exploration of all litera- The volume and variety of abstracting serv' ices has been described eirlier. Such servicO :,@"!!Ilsliteratioi, ture pertinent to ,t specified topic, by repeatedly ,.--,@ruslichev, i ,%vei@e conceived originally as a i-nethod of reduc' -,winnowing the citations, elim' zell other vi inatii-i- those pa- @ i iiio, ,tiid corralling the lierd of scientific litP-rl" I -" " n Purthermor pers .vhicli are not of direct concern to the topic ttire. Todaytlieyirewidelyeonsideivdiolift"' specified. reached ,t state where steps must be taken biomedica ,@llslat'@n P. For purposes of browsiiia and alel-tin(r au- avoid chaos (41). In the field of cileiiiistr y ailtl "@4@idedl tliors to new titles, the tables of contents of physics, the --Vbsti-,ict-ing Board of the filter'," Inerea (ICSU) has eratiii@e bN, Aiiiei-icLii -iiid ]3ritisli pliysicists,,iiid coll,i@il of SciL@litific I iblislied pe tiolial al)st I,zl(,t air sel@N.i(.es to clieiiiists. 13tit such ,in interest is not evident in called "Cu: to (11(@oll ljlide, d'c,,il papers. A service to alert users Ill,ifol,ill oi, coiizzi@teiit s3,steiiis of index- the bioiiie i adopt o the avtil@ t)ility of specialized translated iii- bbre@-iatioii, (!Ii.@.,ifi(.,atioii, and translation, t 'EMS i,iiial steps been tal@eii bN. formation iiii(rlit be a consetitieiiee of the War- ]this undertaken to design iiio(.Iii- reii proposals, workiii(r tlii-ou(,rli affiliated iiifor- tn f "Current alterative, descriptive. and ei-iti- iiiatioii centers. ,ition inde@ to I)eriiiit one set of abstracts to Coordiiiition of scientific translation proi- index pri iv different sei-vii2es-ftyr a wide ects oil Cyo-,,ei-iiiiieiit contract is a function of of a Unifi be use v Of I)LIrpoiesi and to siil)dtie'tlie need to the '-\'atiojiil Science Foundation to the extent )secl by Ne v-itriet, ,, variety of ,il)stracts of the saiiie (locu- that counterpart funds are used awordino, to ing scient@ write the ternis of Public T,aw 480. The Foundation iophysicist r'leilt. ecoiiseiistis of most editors is that, author.,; also supports announcements by the Office of eer, the ii Tli capable of writiiio- their own ab- Technical Services of available transl,-ttions, are I)erfectlv tiobiologist streets, cri@'eli a set of ground miles iiid Ili ill- cl.,iqsified bv subject, and announcement of ,t compreli( sbeen adv t.1ligelit editor to discotiraae verbosity. It i- translations by private enterprise, issued by the reornmelided by various bodies, iiieludiii(r the Special Ijil)r,,iries Association at the, John Cre- .all Assistant v oil Scientific P"1)11- rir l,ibi-ai-y in Chicago. But there is no legal -ESCO ll'orkiiio- Part d,ition. In co@.'@ 1,@ handling scien catiolls, tlllt journals I)til)lisli -(iiitlioi@s' il)sti-.icts mechanism for coordinating translation serv- witli the full paper, but not maiiv have needed ices. public or private, beyond instruction to )ffersthe wneept @,ic,e iiiforniati '@' this advice (46). This procedure could iiiate- the '.\-,national Science Foundation to exert o@,@ rially reduce current pkvments for composing leadership. Under these circuniawices, per- )stracts and cit@'t- abstracts. suasion and cooperation determine how far microforms fo@r, Ironically enough, with all the effort invested such coordination can ao. distribution of in abstracting services. it appears that research rms to regionaf scientists depend far less on these sources than READING AND WRITING ormation cente " i on the journal papers ,ind their citations (.411). Considering the importance of verbal skills ike the National. s proposed Engineer---, on the other hand, appear to favor in communication, the effort given to improve N! abstracts. The varietv of texts. user needs. -,iiid this phase of (!oinniuliieitions in anv field of sci- 'rovidp, extremely iliza- applications, however discourages -eiier, i-idii,il scientists. 9 L- eiice is modest relative to expenditures on im- V@Lrren presenta-I tions on the future of .ibstract publications. pro\-eiiieiit of other processes, such as indexing len,elop sttndard TRANSLATIONS or translation. Projects undertaken so far, nce of ,t compre, however, include many that are promising and The management of abstracts has much in iiotenvortliv. For example, the National Heart interdisciplinary Ivocated govem-@ common with the mtiiao-ement of translations. Institute Iiiis issued a glossary to assist medical zn f In both situations, assuming the re searching, or author knows writers in using simple, lucid language (47). )ruc, Administr* a second language, it is preferable t,o receive The Public Health Service has employed pro- the text from the author rather than from a fessioiial science -%writers exclusively for the pur- preliminary tD, second party. In both. there is excessive dupli- pose of preparing reviews, such as one on the ruo- information catioli, with the same document bein,- qb- association of diet. with ,itherosclerosis. It also n aracted or translated by different services (11). conducts or supports seminars which offer sci- IG In both, there is a need for agreement on sttnd- ence writers an opportunity to draw @ly upon ard usage. Especially is this need evident in the information and advice of specialists in de- ,Lbstracting serv transliteration. For example, should it b Such serviw e veloping background information on new de- method of reduc-,' @rushchev, Hroosclieff, Kroosheff, or any of a velopuients in science. f scientific liters" dc)ull other variants. The National Tuberculosis Association ha-s fi- nsidered to have Furthermore, little is known about the needs ii,,tnced a science writer to %,ork- in a laboratory .0 for biomedical translations. Since the ICSU with a scientists a, project originated by the must be taken tO@ translation proaram began, there has been a Council for the Advancement of Science Writ- I of chemistry and decided increase in the citations of fore @ lit- ing (48). The council also promotes seminars @d of the Interns-' .1i, @t, @- @l. REPORT TO TI-IF, PRESIDENT 426 -the-job training pro- for technical documents) mal,-es it possible to ing a truncated "I for science, writers, on documents on cards or chips or transpar- graiiis, ,in(I ,iii annual briefing oil new horizons store generally availabl ill science. '@Nliiior projects of the council in- encies (microfiche) -svhicli in turn can be stored, tions, for use by clude ,t registry of science writers, a library,,,iiid retrieved, and reproduced by electromechanical pital libraries (53' ,,t bibliography. techniques (52), barring copyright restrictions A critical eleme The council was created by the'-N',,itional As- which could hamstring automation of scientific distribute microfo sociatioii of Science IVriters, which was org,,i- communications. Siichiiiacliiiiesmaybecla@d cluding core librai ilizecl to proi-note the qi-iality of science report- as speculative, experimental, or commercially relatively inexpeli iiig by popular i-nass media. The science writers available, as '.L%Iorton T-,iube has suggested. nient for enlargin,@ have done much to iiiiproi-e relations bet-%veeii Experimental machinery can read a docu. ing and printing i scientists -,iiid mass iiiedii reporters ,tiid liai-e ment, record the document in an electromag. demand. advised scieiitistsiiid physicians on effective use netic file, recall the document on request, and Experimental de of miss iiiedit, notably in the ii-iaiia(reiiieiit of aprint it out ,igain at ,t rate of 900 lines a minute, printing devices, u- press room for scientific meetings (49). In the speculative class is a machine that will clear image at Iii Other societies concerned -,vitli impron-emeiit listen to a question, ask the speaker to refine it, that would be att of biomedical writing include the Conference of and deliver the answer both orally and in print. laboratories, is pr, Biological Editors, whose stylebook (,50) has At ',,\Iassachusetts General Hospital, with the Public Health Public Health Service aid, iiurses and docto one of these match been -%videlv ,iccepted by professional journals, rs ,,iiid the -@n-ieric,,in.Niedic,,il IVritei-s kssoci,,ition, ,tre operating an experimental system which ies will answer COP -,vliicli numbers among its iiieiiil)er.--, many pliysi- permits a computer to exchange typewriter don: Immediate ,ii ei-,ins (lei-oted to writing,,iiid editiii(r. messages %vith 3--)O separate stations simulta- @nce works. The Public Health Service Ill-, "related funds record r- I , and report inioma- Only experience neously; to receive for ,i cotir@e to assist editors of deiit,,il jotinials tion; to request clarification of instructions; to -.Eno between wild I and to support a course in ivritin- for medical detect errors by the seiider and demand verifica- ments in inforiiiq st.udei,its. It conducts ,t monthly seminar for tion; and to issue reminders, cautions, or wa7- -World which excli, Avrite.rs,iii(I editors in its employ. And on rare in(,rs. lVben medication is prescribed, it can in- wliv c occasions ,t division or program invites ,t i-ioted stantly tell the doctor -,vliat it costs. ion sc@ editor to -,peak to a group of its ei-nplo3-ees. IVith such technical competence, demon- For the most part, however, trainin(, in -,vrit- str,,tted by the automation of the files of the So- 2n . able USE ing,,tnd editing is on-the-job rather than in-sery- ei,,il Security Administration, it is conceiv ice. Opportunities for special training in -,iii that, With tlle! '-N',Ition-,il Librar of '@Nledicine as ormati, y ,'Ic',Iclelllic setting are relatively few. '@\'o leo,,;S- a basis, the Government could maintain a d& het l,itioii specifically provides for support of appli- pository of all scientific literature (in microform ir i cations for career fellowships or traii-iiii(, crralits or on tape), index that literature, print out re- n o r.- tn atic for scientific -writing .iiid editinr. current bibliographies of special interest to ce ds inclti tain users, and deliver duplicate n-iicrofil@ ents or ot MICROFORMS AND BITS tapes to special information centers. forrnatic The full resources of this depository might access, ni Although it is generally a,-reed that human cliiplictted in -,i number of re but in o z' and social factors continue to be more critical keepiii(-r %%7itli the principle of 4 ties; assis@ to medical communications than the tecl-inology, o(,i-iii)liie duties and deceiitral reviews the dazzling ,tnd tantalizing potentials of the functions (.5--@)). And the disi Nrordlists, teciiiiolo,o-y call not be ianored. For example, to eiits could -be Licilit,,itect: ny itern I 0 Di @ tion, espe economize on the space occupied by much litera- store could ,iutoiiiaticilly idei Provide r, ttire, it is possible to print 50 pages or more on verse reactions associated iv questi in one small card and yet enlarge the type to acalls -,iiid print out a list of ill( readable size without loss of definition. Such ness information. ,I reduction in the size of -.i docuii-ieiit or a less To illustrate the versatility of the ilia Cutaneous dramatic one (most GoN-eriiiiieiit ,i-eiicies have NIFDLA in on a more coiiseri-atin-e b-,i Service n -Al agreed (.51) upon ,t stindard reduction of 18:1 capable, with a little i-epro(,r, iiiii(r, Of pi "iginated CoNr-\@.'ICATIO@NS 427 cited "Index ',\fedicus," based on 150 Cancer Institute7 Public Ifeiltli Service. Vi- trLin -allable Eii(rlisli-lan,-uage publica- rolo(rists in various institutions accepted assign- ,tlly aN t7 ts to inspect ,tllotted journals for articles oll., for use by general practitioners in hos- men on virolop,-, which they agree to review. Their (53). tal ibraries element in it system which would reviews are collected, reproduced, and distrib- critical croform copies of documents, in- uted to all participants, originally 120 in num- distribute mi, braries for i-emote outposts, is i ber. .,iuding cO@e ii relatively inexpensive and satisfactory instrii- For the anv,,treness of health professions in illirging microform copies for read- general, larae plans are in view. The Public ent for en ing and printing the text or any pirt of it on Health Service Suroeon General has said: st communities, the hospital should be the demand. For mo q FIperimental den-elopnient of several reading- pivotal agency for health communications. printing devices, capable of producin- ,L sharp Two major premises are agreed upon by many who at high niicqiific-,ition, at a price are working in this area: clear image 1. The community hospital will continue to take a that would be attractive to most libraries aP larger and larger central role In medical care pro- laboratories, is proceeding under contract witli grams, for good professional and economic reasons. the Public Health Service. A combination of 2. The community hospital will become increasingly one of these machines ,ind ,i handful of micro- important in health education for all types of health copies will answer a major need in communict- practitioners and the general public (54). typewriter tion: Immediate ,tnd eisv ,Lccess to esqentiil ref - Practitioners themselves receive an arsenal of s simulta- erence works. free plionoyrapli records, tapes, TV programs, -t inforina. Only experience and economics can draw the ridio broadcasts, and seminars, as well as lit- uctions; to line between Nvild faiitab-y ind pr,,tctical,.icliieve- erature, loaded -,vith miscellaneous medical in- id verifica. information handling todav. In ,i formation. inents in s or wam- world -which excliiii-es words ,ind vieivs across The "Journal of the American Medical Asso- I r_- l@ it can in- the seas by w,,iv of ,t satellite, the spectil,,ttions creation" cataloo-,s no less than 1,430 seminars for of information scieiiti.-zts ire relatively modest. the Nation's 150,000 physicians. The Arneri- e, demon- can L\Iedical Association proposes to accredit ; of the So- USER SERVICES institutions which offer approved programs for @onceivable Once information is collected and organized posto-raduate training. To retain standing in declicine as in the American Academy of General Practice, a atain a de- there rem,-tins the tisl, of delivering it selectively physician must complete 150 hours of approved microfom to users. Their requirements ,ind the uses @f postgraduate study every 3 years, and similar the information oti(rlit to determine the desian rint out re- u- standards are posed by various medical spe. @rest to cer- of an information svstem and services (41). ,ialties, societies, and hospitals. icrofilms or User needs include: Awareness, through ,tn- But as yet no system has been devised which nouncements or other publicity, ti-,iinin- in the @l provides the tired, overburdened practitioners ry might be use of information facilities as -svell as in the with the information they need to apply to a centers, in Sciences; ,iccess, not onlv to information in their specific patient at a given time, or which even own field but in otli@-I including browsina o [iziii,y bibli. L-1 P- makes it possible for them to obtain and absorb Portunities; assistance in search, including (ii- bil)liotliecai ZD the new information that is most important to on of docu- rectories, reviews, m,@intiils, compendia, triiis-, their regular practice. Some hopes are held tem in the lations, Nvordlists, guides, standard tables: and out for a desk-size film viewer described below. series of ad- Consultation, especially in the domain of prac- cific chemi. tice, to provide prolii'pt direct ,inswers to spe- Training Pific urgent questions. s aivilicr the Unfortunately for medical education, most Awcireness training films for practitioners are out of date, ie machines A spontaneous response to the need for ,in and resources for producing new ones are scant. is @DLARS ' awareness service is exemplified by the Virology There is no comprehensive program in any in- of publish- Alert originated eirlv in 1964 in the N,,ttion,,xl stitution for the review and selection of training REPORT TO TI-IE PRFSIDENT 428 films for medical practitioners, although the Hospital in Houston, for example, respond sev. Public Health Service Audiovisual Facility eral times a day to urgent requests by practicing performs its task of stocking, repairing, main- physicians, and they will arrange for addition, taining, and distributing medical films in an telephone lines to be plugged in, if nec@ry, exemplary manner. Resources for distributing to provide for ft conference with other. and showing training films are far better orga- specialists. p MS. nized than the production, assembly, and The foregoing examples are ,3, bare sampling evaluation of these valuable informational aids of the total science information projects sup. (,55). There is no formal biomedical program ported by licaltli,,i@encies, institutions, societi@ GRA for training users or information scientists in andbusinesses. Theexpenclituresforsuchserv. 'nie autlic information handling. ices, by the Department of Health, Educatjort, employ 9 Concern for practitioners as well as for scien- and IVelfare alone, including payments for page bioniedic costs of scientific papers contributed to profes. decision of t tists is expressed in a PHS contract with Long Island University to prepare a manual for sional journals by Public Health S 1964. Even ervice the care of chronic, d grantees, direct grants d con. nurses on illy ill patients. employees an an used in A PHS grant to Harvard to prepare an index tracts, and intramural activity, reach an annual iealiii to the medicinal uses of plants of Southeast total in excess of $28 million. possibly as much '.@@'Lyrants weni Asia and a grant to Utah State University to ,Ls $84 million, under -,a broad definition (.56). ';i "Excerpi produce a volume on the composition and nutri- -stracts,'7 con tive value of 5,300 forms of food are indicative Priorities of informational resources under development The influence of such an expenditure, out of to assist medical studies and practice. a total budget of more than ,t billion for scientific knowled-e and medical practice, will Search Assistance n be colored by the way it is directed toward Informational issistance is so ,Lbundant that serviciiiout 21/2 percent is al science information remain imprecise. of the PHS grant funds are spent on travel, their but it is not known -what part of this sum re- ACCOUNTABILITY lates to travel to scientific meetings. Publica- rary $2 to b(, tion costs are on the order of $20-$50 a printed Among the reasons is that it is difficult to page. Hemer found a cost range of from 6-4 9 ci agree on %vh,,it constitutes a proper charge to 10.4 cents a word. Some journals cha tei rgo. against science conununication. For example, authors $50 a page. ing to what extent are printing costs chargeable to On the basis of 15,000 papers a year @ting r a f rpm NIH-supported research th( scienceinformation? Traveltomeetings? Ad- it may be SI' ministi-,%tii-eoper,,itions? Atwhatpoint-areex- to put 5 sumed that about $3 million was paid periment tnd data collection overtaken by the these into print. Out-of-pocket costs for del t @iti process of comniimicatioii ? Are the creative tracts and t-rohslations may be nothing, if per, 'CS$ ion a and intellectual aspects of communication sep- formed by the author, but when such sem arable from nieclianictl and clerical services? are paid they are on the order of ',,25 In Ite@ ices Do the costs of s@irching for information count Outlays by the Department of Health, Fduc" the arc as charges for communication? Does one count tion, and Welfare for 1964: (fiscal year) WI' ry but ,is communication the costs of distributing in- estimated at $5,802,000 for publications; $12", our gr formation? Such questions ,ire likely to oceiii- 199,000 for bibliographic and reference serv'. arid degreE to the budget officer. ices; $4,842,000 for scientific meetings; intentions CO.Nn@-'ICATIO-NS 433 i(I ,Iutonorf, $7,06T,Ooo for research and development in opportunities to improve the quality of corninunications. life * * *11 (66). Lment into EVALUATION In the words of the Right I-Ion. J. Enoch rnment ac Powell, then Minister of Health for Great Deieties wl I,, evaluating outlays for communications, it Britain, "the progress of medical science and )f the usei is easy to recommend money-saiing expendi- the increase in outlay upon medical services with its I such as purchase of a copying machine must render this outlay more and more uneco- ridispensa turOsi int reproductions -for-l@nt a page nomic. On many fronts the progress of medical II system Which will pr country th no sacrifice of science consists not in doino, things more cheaply instead of 10 cents a page, with first scieul lity. In other eirctunstances, however, ,tnd simply than before but in discovering corn- Science A qua nts hinge on uncertain values. Will the plex and difficult tliinc,,s to do which previously jed, rather judgme n system ti saving of 1 or 2 days justify airmail instead of could not be done at all. On these fronts medi tific critici lar postage? Is it worth $20,000 to ex- cine is buying life at an ever-increasing margi- regu ldemtions i re a pedite exchange of messages between Bethesda nal cost." @d Palo Alto with a, teletypewriter? Is it At the same time, the cost-benefit school can tha: worth $200.000 to send documents instanti- aratie that there is a chance the one neglected eed neously from coast to coast by a, Iona-distance volume may contain the one bit of information ture senrice? Is it worth $ZI5 million to set -which will more than repay the years of cost coo Pic ini up an automated system of science ,ibstracts of its maintenance. Aforeover, this cost is shared nge of inform& tapeandmicrofoi-ms? Willcont;nuingedu- for the purposes of an entire information sys- on system, however, cation be served bv a desk-size sound movie tem: It is not a "loss leader" in a department ition. viewer which will enable a physician to see a store. particular film (in cartridge form) as easily CONSTRUCTION COSTS as putting a nickel in a slot, at a charge of $400 per viewer and $L)o per film cartridge? Is it A core librarv of 100,000 volumes (67) at $45 worth $20 million a year to broadcast popular a square foot ly to speculate would cost more than a million dol- .-,ce publication of.@ but authoritative and accurate information on lars to build (68). Although technological in- c,nal journals, or:, reducing heart disease? genuity may reduce this cost, the development which Cost studies of libraries indicate that it takes of the technology Nvill require considerable in- ,e expenses $1 a year to pay simply for the storage of a vestment. perations, and to book: The total outlay of university libraries In the feasibility report on automation of the A-bout 21/2 percent in dollars is about equal to the number of Library of Congress, the survey committee rec- spent on tmve@ volumes in their collection (6,5). It costs the ommended an appropriation of $'i5o,000 to de- 0 rt f this sum library $2 to borrow 9, book- and $2 to lend it velop specifications for partitl automation of ectin,-s. Publi@: out (29). the Library,,with an investment estimated even- $2@-,-50 a printed.. The holdin(r charge of a book. if compared to tually to reach from $50 to $70 million (52). range of from & 5-percent interest charge on capital, is equiv- An information center in a hospital would re- e journals r-hargl,' aleiit to valuing the aN-em, ge book at $20. Is it quire space for lectures, publishing activities, worth a dollar a ear to maintain a $5 book in and broadcasting, as well as for search and !rs a year result y 'q the stacks on the odd chance that it will be re- reading. Broadcasting facilities alone would @ch, it may be 0. quested once in 5 or 10 years? cost on the order of a million dollars for closed i was pa cl to pq@, Such considerations force reliance on the circuit television, including auditorium, sl- - )cket costs for or Principle that "the fundamental determinant of age, and studios at $30 a square foot, and equip- be nothingi if the dimension and character of our effort in ment at $250@000. en such serNioel wh @edical services and medical research is not and These facilities, the library and the broadcast- ler of $25 an iteO:@ of Health, B 'IV cannot be the arcane formula of cost-benefit eco- ing studio, -,ire only two components of a center 10@ie- theory but the set of values around which that could be operated to@ support continuing (fiscal year) @e build our great national purposes and the medical education. Other facilities would in- publications; ,,ncl reference vlgor and degree to -,vhich we pursue these na- clude a film exchange and viewing room; a de- ific meetings t'ollal intentions in the context of the needs and pot for reference slides, tapes, and radiographs; ORT TO THE PRESIDENT 434 REP t,,,tpes would ,Ilso increase I workshop; and demonstration tion of master an audiovisiia s. Considering that a medical schools Iiglitly. The figures given, flierefore, laboratorie students entering, needs a short-term appear to be rock bottom. On the Other ]land. vith 64 gener,,tl-special hospital of from 350 to 500 beds the present resources of i-nedic,,tl filii-is, once e'ral. for-teaching, there are enough hospitals of that uated and carefully -,elected, can possibly Pro. size to accommodate twice the present number vide pro,-rams ,it, figures ,ts low :is tlio% gi,r of medical schools. '-Nfucli interest is ei-iiieed in 8-inillimeter fi@ The total cost of coi -Lic isti -tion for ,i national with -,ouiid to be exhibited simply by insert, biomedical communications system may be c-,il- ing a cartridge or cassette in a viewer and etilated by ,tssuming v total of information f,,i- pressing ,t button. The viewer costs cilities based on 150 major medical centers, present, -,vitli negligible i-nainten,,ince and berinniiig ivitli medical schools with tetcliiiir ,ttion charges. In volume production it n hospitals. -@ssiiii-iin(- that such ,t --,vstem Nvould I less. The cassette costs less than $3 ar entirely from the gToiuid iits a @t. not have to be built film may be printed at 6 ce uT), a 10-y e,,ir capital outlay of $,Ioo million, or fore, educational filii-is ,tt. $15 each in the 8-mini. $30 million a ve,,tr, -svould ,it least approach f ul- nieter size are a practical possibility in such fillment of the need. This stiiii stands in the cartridges. They may be used more than loo perspective of annual outlays of more than $30 times each for is i-n-,iiiy as 30 viewers it -,i time. billion in the United States for health services, One may coiitempl,,ite,.i c,,i:Lilogtie of 10,000 basic including more than @ billion spent. by the medical films, at ,t cost averaging $10,000 eaeN Federal Government. or $100 million for production, built up over,. a period of 10 years, for vieaving .it 19000 St&. OPERATING COSTS tions, costing in tottl $500,000 for equipment, I,il)rary operations in a ii-iedical ceiitei- .vitli bookiiier I)riiits out of 100 distribution centers, -,it least acore librarv -%votild cost not less than -,vitti .t stock of film c,@tt4es costin(y $150,000 $100,000 a @,ir. -%-iiotlier $100,000 might. be at $15 a cassette. spent on collecting documents. The total costs of the information proff= The costs of broad@,istiii- are elastic, but they in each center are likely to oiersliadow such may be expected to niii not less tli,,t@n $50,000 i audiovisual services. Bloomquist (67) reported yetr for closed-circuit television on an iiiter- the busiest medical school library provided rriit,tent schedule. A unit coi-nposed of 144 half- more than 10,000 hours of student issistaiice in hour pro-rams in 36 ,veel,-s 4 a -week, cdsts,,iboiit ,t year. If to this workload one adds a, program S20,000 to produce. oii ,in extremely modest of continuing ekluc,,ttion for practitioners, alert- scale. IVitli an investment, of $16,000 in tape, ing services for scientists, and health education good for about 100 pa.@s, or ,tbout $1.40 per for the public, even the medical school library half hour, the entire unit may @ broadcast at -.i %vith the present maximum of 11 professional cost of $15 ,t half hour, including tklulici"lll employees %vould need more help. Considering salaries, recording, ,tnd ,imortizatioii, if the cost that the medical school libraries at the nipdian of the studio ,tiid equipment is ,tlloc,.it-ecl oii the have only three prof essiolial employees and pa@ basis of 50 -,veek-s ,t veftr. 40 hours t Nveek (69). them a median salary of $6,000, the number of IA'itli ,t production budget of 1,;140 for each such professionals in the information sciences half-hour proor,.im, it is obvious that Holly- ,ind their average salaries may be expected to wood standards -.vould not If the ad- double. vice of experienced producers is to be lieeded-. The human charges for science iiifor,,,atioil, the ini-estiiieiit of time .iii(I talent in the ori(r- for, the training and employment of teacher in,,il production could materially exceed the librariaiis writers, editors, searchers, tralisla- fimii-e ('iveii. which is based oii tli rs, and audiovisual teaiiis e full-time tors, indexe Services of one teacher li,,ilf-tijiie services of it the most costly, ,is well ,is the i-nost in-iport-qllt' orrnlt 0 producer/(Iirector, two c-,iiiiera men at sl.50 an component of the biomedical in liotir,,,iiidoiilv,,2,500forirtiiidprops. Reteii- system. COM'@%ITJNICATIONS 435 onclusion biomedical communications of - deiit's Science Advisory Committee to take in- ore a true picture than a strob- formation seriously and to compose. informative aph which arrests Niagara titles (27). ossible to capture the fluid and Such small improvements are not separable ts of the informal biomedical- from a grand design. The writing of a title These pages are aimed at has its impact on the structure of an index and formation pr es. The pro- the performance of a clearinghouse. Each con- and sultation at in information center is dependent ttion based on research o data and experiment, and the on such resources as MEDLARS and a film s of evaluating, categorizing, collecting, library. searching, recalling, reviewing, packag- Opportunities for improving the handling of g@ St tributing, and assimil,,itin this inf orm,,t - science information unfold from hour to hour (70). Given the backing of the medical com- don. If there has been undue emphasis on libraries, munity and the taxpayer, science information a services can provide scientists, practitioners, on mass media, on automation, on language, on @'t user needs, the asymmetry was and the public with instruments of intelligence reearch, or on 0 not intended. The process as i whole was the ,ts productive in their way as the electron @cro- object in view. graph, electrocardiograms, or radiotracers. In ble to avoid, if only by inipli@,t- an age when a message travels around the world it is impossi in a second, it is unthinkable that it should take tion, a bias in ftvor of one kind of remedv or months or even years for physicians and their another. There are many proposals for improv- patients to learn essential medical truths. ing the svstem, from the grand design of the Cmwford report to the basic ple.-t of the Presi- MARCUs ROSE.NBLU31. Re@erences :)orted 10) GOTTSCHALK, C. M. and DESMOND, W. F. World- @vided' (1) SH.&HN-, BFN. The shape of content. Cambridge, Alass., Harvard University Press, 1960. p. 28. wide census of scientific and technical serials. nce Amer. Doc. 14: 188-194, 1963. (2) National Research Council. Committee on Nlod- ern '.Nlethods of Handling Chemical Informa- (11) ORP. R. H. and others. Reference retrieval tools: biomedical abstracting and indexing services. tion. Survey of chemical notation systems, by 1. Hunsberger and others. Washington, Fed. Proe 23 (5, pt. 1) : 1165, 1964. 19G4. (.LNRC Publication N'o. 1150.) (12) SpRi.NG, W. C., Jr. and Ho-;icxER, F., Jr. Drug John Shaw Billings: 1838-1913. (3) ROGERS, F. B. information for the biomedical community. Library J. 88: 262'1-2624, 1963. Bethesda, @ld., institute for Advancement of Medical Communication, 1963. (4) BRODILA-,, ESRELLE. The development of medical (13 bibliography. Baltimore, '.%Iedical Library As- ORR, R. H. and CRou@ E. M. Secondary publi- cation in cardiovascular, endocrine, and psycho- sociation, 1954. - pharmacologic research. Amer. Doc. 13: 97- @viFRED. Atherton Seidel: an apl)re- (5) SEWELL, Wi 203, 1962. ciation (1878-IM). Amer. Doc. 13: 123-124, (14) U.S. Library of Congress. Science and Tech- 1962. nology Division. Guide to world's abstracting The National Library of Medicine index meeban- and Indexing service In science and technology. Washington, 1963. (National Federation of cting and Indexing Services Be- Science Abstra al Library of Medicine. The MED- port No. 109 LARS story at the National Library of Medi- (1-5) GiEsLE@ R. H. and YAST, H. T. A survey of cur- cine. Washington, 1963. rent hospital library resources. Hospitals 38: PRICE, D. J. i)E S. Little science, big science. 53--54, June 16, 1964. New York, Columbia University Press, 1963. (16) Committee on Hospital Library Architecture. U-8- LNational Library of Medicine. Annual re- Planning the hospital library. New York, Washington, 1964. United Hospital Fund of New York, 1957. port, 1963 ! ! ii@i @o; I I @i . 7 i @ili ,4 . I e'. ; . i -Vi r, 436 REPORT TO THE PRESIDENT (17) @oint Comniittee on Standards for Hospital Li- (36) HFRNER, SAUL. Methods of organizing inforrat. baries. Hospital libraries: objectives and tion for storage and searching. Amer. standards. Chicago, American Library Asso- 13: 3-14, 1962. ciation, 1953. (37) MILLER, J. G. Toward a general theory for the (18) ADANig, SCOTT. Hospital libraries: undeveloped behavioral sciences. Amer. Psychologist 10, base for continuing education. Hospitals 38: 513-531, 1955. 52-53. June 16, 1964. (38) COHEN, @ll. R. A preface to logic. New York, (19) U.S. President's Panel on Mental Retardation. Holt, 1944. A proposed program for national action to com- (39) U.S. National Library of Medicine. Medical Bub. bat mental retardation. Washington, 1962. ject headings. 2d ed. Washington, U.S. Public p. 19-20, U46. Health Service, 19M. (20) BAlt-HILLEL, YEROSH@ Is information retriev- (40) U.S. National Institutes of Health. Division Of al approaching a crisis? Amer. Doc. 14: 95-98, Research Grants. Medical and health related 1963. (Also see: I-etters to the Editor. Ibid., sciences thesaurus. W@ington, 1963. 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