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-standiii<r   and   largely    uii-     tive.  Similarly  in  the  conununicatioii   of   health
                      spoken  obstacles   to   vigorous   Federal   participa-     knowledge,  it  can  and   must   develop   a   partner-
                      tion  in  this  process.  Federal  support  of   e(lue@-     ship    Nvhereby    scientific    and     communications
                      tion  many  form  has   been   viewed   darkly   because     skills  and  resources,  both   Federal   and   non-Fed-
                          ears  of  Federal  control  in  a  political  sense.
                      of f                                                         eral,  work  together  to  transmit  the   urgent   mes-
                                   eral   programs   of   public   information
                      Strong     Fed                                               -bages upon which health depends.
                                                           n   through    fear
                      have been treated with suspicio
                                                                                     The    Subcommittee    on    Communications     there-
                      of self-aggrandizement vii press agentry.
                                                                                   fore    recommends,    as    a    fundamental     policy
    rigli @                                                                                                                                              Ii
        t                          seeking  to  judge  broader   policy   mat-
                         Without
                                                                                   underlying   its   subsequent   specific    r@onuiaenda-
    nany@             ters  we   submit   that   in   the   communication   of
                                                                                   ions,  that  the   communications   functions   of   the
                                    ledge  these  fears   are   illusory   and     t
                      health know
                      irrelevant.  They  are   worse:   They   contribute   to     Public  Health  Service,  and   especially   those   re-
                                ry death and disability.                           lated  to  public   information   and   the   continuing
                      unnece,-zsa
                         In the  generation   of   health    knowledge,    the     education  of  the  health   professioiis,   be   recog-
                                                                                   nized   and   supported   on   a   scale    commensurate
                      Federal   Goi-emment     his     abundantly     deiiion-
                      strated  its  ability  to  stimulate  and  support  pro-     with  their  importance  as  a  major  we@ipoii  in  the
                      ductive  effort  without  stifling   control.   It   has     prevention and control of disease.


                                                                  Pu6lic InFormation
    [litt
                                                                                                                      -sors    of    strok@
                         The  public  has  an  almost  insatiable  tliint  for     ino, from  one or more precui
     met-,,                                                                        w
                      health     information.      LNeivspaper      readership       liy  don't  they  act  while  there  is  still   time?
    ,tronle,
                      studies   have   shown   that   health   articles   rank     Because  tliev  either  lack  the  information.  or  the
    iation.'.
                      high  both  in  number  of  readers  and  in   retention     information  has  been  presented  in  such   a   fasli-
                      of   information.   Every    major    daily    newspaper     ion that tliev lack  the  motivation  to  act  upon  it.
                                                                                                                 -e   much   greater    ind
                      has   at   least   one   column   devoted   to   health.       IVe must    therefore mak
                      News   which   suggests   a   scientific    breakthrough     more  iiii,,igiiiati@-e  use  of  existing  comnitinica-
                      is   given   front   page   prominence.   The    general     tions  media,  and  we  must  create  bold   new   chan-
                      interest  magazines  rarelv  go  to  press   without   a     iiels  of  information  to  close  the  alarming   (,rap
    seS.              substantial quota of health information.                     between   the   acquisition   of   research    knowledge
    er.                  Yet   the   public   remains    remarl,-ably    unin-     in  oui-  medical  centers  and  laboratories  tnd   its
                      formed,   or   remarkably   slow   to   act,   on   many     dissemination to  the  familv  physician  ai-id  to  the
                      matters  which  are  quite  literally   "of   life   and     general public.
                      death."   Part   of   the   problem   may   stem    from       IVe have i i-nioiiificeiit  and  exciting   storv   to
                      the shee
                               r   profusion   of    available    information,     tell.  Every   American   is   deeply   concerned   with
                      sometimes    contrtdictorT    and    frequently     half     the  preservation  of  his  own  health  ind   that   of
    inedi             true or halfhearted.                                         his  loved  ones,  yet  we  have  not  capitalized  upon
                         III 9,11 three  disease  fields  falling  within  our     that-concern.             IVemusttal,-etlieplungeintothe
                      Purview,  we  were  told   by   medical   experts   that     mainstream   of    modern    con-Lmtiiiications.    '""e
                      the  average  American  family  today   is   not   aware     must  use  the   advertising   and   promotional   tech-
                                                          ,tsures    necessary     niques  which  htve  been  so  successful  in   creating
                      Of the simple,
                                      fundamental me.
                      to   Protect   its   members   from   these    diseases.     a  demand  for  consumer  goods  to  create  a   similar
                      'ais   is   a    failure    of    commwiications.    The     demand  for  the  kiiowled(,Ye  which  will  save  thou-
                      @ronary-prone    middle-aged     male,     the     young     s,,iiids of precious lives.
                      @other  with  one  of  the  seven  danger   signals   of       'We   therefore   recommend   the   following    steps
                      Cancer
                              the  corporation  executive   who   is   suffer-     be taken:










                                     404                                   REPORT TO THE PRESTDENT
                                            STRENGTHENING PHS                                  There  is  a  desperate  sliort@ige   of   these   skilled
                                                                                                                                                        ce
                                                                                               specialists,   both   in   the   Public    Health    Serri
                                         INFORMATION SERVICES
                                                                                               and  in  medical  ceiiters,,ind  uiiii-ersities   throllgh
                                     IlTo believe the Public Ile,,tltli  Sei-i-ice  has  a     out the country.
                                     duty and ,t  responsibility  to  use  every  possible        '"7e tberp-fore   recommend   that   the   Office    of
                                     resource  to  bring  the  litest  health  information     Information   and   Publications   in   the   Office    of
                                     to  the  American  people.  In  a  matter  so  urgent     the  Surgeon  General  be   allocated   -,i   sp
                                                                                                                                              ocific ail.
                                     as the  prolongation  of  life  ,ind  the  prevention     nual sum of $1 million solely for these trqi
                                                                                                                                                     mile
                                     of needless disability  and  death,  we  must  insist     purposes:
                                     n  the  Iiizliest  priority  for   these   communica-
                                     upo                                                            a. A   grant   pi-ogrim   to   educational    iiistitu.
                                     tions activities.
                                                                                                     tioiis  for  the  development  of   pilot   training
                                     For  this  reason  we  recommend   that   the   funds
                                                                                                     programs in the field of medical cornm
                                     appropriated  for  the.  Office  of  Information  and           c,,ttions.   Such   grints   should   support    the
                                     Publications in  the.  Office  of  the  Surgeon  Gen-           development  of  t  core  ciii-riculiliti  the  Pay.
                                     eral  should  appear  as  ,t  budgetary  line   item.           nient  of  factilty,  ,ind  provision  of   stipends
                                     They  should  be  increased  by  $750,000  per   year           fortriiiiees.         Auiiii-ersity-,vliieliliisboth
                                     to finance such additional ictivities as:                       a  medicil  center  and   a   school   of   journal.
                                     a. Recruitment   and   inseri,ice   training   of    in-        ism  would  probablv  ,;erN,e   ,is   an   excellent
                                     formation  specialists,  selected   from   -,iiiioiig           setting   for   these   pilot    training    rograms
                                                                                                                                             1)
                                                                                                                                                                  at
                                     young   college   gr,,idiittes,   to   improve   dis-           in communications.
                                     seminatioii  of   health   iiifori-natioli   to   the          b. ProN,isioii  of  felloi%-sliips  for   the oii-tlie-       'di
                                     public.                                                         job  training  of  a   variety   of   personnel   in
                                     b. Creation  of  materials   for   free   public   serv-        the  (,ritlieriiiaiiid  writing  of  science  infor-
                                     ice  aniiouiicei))eiits  oii  health   for   use   by           )nation  materials.   -Alaiiy   of   these   fellows f@
                                     radio, TV, and ni@,t(,rtzines.                                  would be ti-,qiiied in  the  i-,-ii-ioiis  ,igencies
                                     C. Development    of    fact    books    oii    specific        of  the  Public  Heiltli  Sei-i-ice:  iiiiiiy  would
                                     health  topics,   siiminarizijir   present,   scieii-           be   trained   in   otii-   medical   centers    and
                                     tific  knowledge  for  the  use  of   reporters   and           large   research   institutions    throughout    the
                                     community leaders.
                                     d. Development   iiid    production    of    a    health        country.
                                                                                                In   iddition,   eve   recommend    that    the    Public
                                     yearbook, similar in scope and qtial         "     "D    Ifeiltli   Service    conduct    and    support    seminars
                                                                                  ' y
                                     the  Agriculture  Yearbook,  to   creite   a   series
                                                                                              and  other  methods  desi(,nied  to  (ril-e.   professional
                                     of   autliorititii-e   ,iiid   understandable    ref-                                         L-
                                                                                              scien@e   writers   the   bich-gi-otind   they   need    to
                                     erence volumes in ;pecific lieiltli topics.
                                     e. Assignment   of   in-riter-editors    to    accompany write icetir.,ttelv,                  and    clearly     On
                                     forei,-ii   PHS    missioiis    .iiid    to    report    health subjects.
                                     promptly   on   the   findings   iiid    exl3eriences      Science  writiii(r  is  a   Iiiglilv   developed   skill.
                                     of such missions.                                        The  popularization   of   such   scientific   fields   as.
                                     Assifniment   of   Nvritei-s   to   produce    prompt    iiiiele-tr  physics  and   space   has   been   brilliantly
                                     summary    reports    of    scientific    conferences    successful.   In   the   medical   field,   both    'Within
                                     in   forms   suit@ible   for    the    health    pro-    ind outside goi-eriimeiit. there has been a Pe-
                                     fessions.                                                sistent  reluctance  On  the  ptrt.  of  scientists   and,,
                                                                                               liysicians   to   take   professional    writers    behind
                                                                                              p
                                         TRAINING IN HEALTH                                                                                           and
                                                                                              the scenes oii a basis of mutual confidence
                                           COMMUNICATIONS                                     open t'loors to geiiuiiie understanding on  jn,,tttetl.,,@i
                                     Because  the  transmission   of   medical   iiifonna-    of  profound  interest  to  the  public.  As   it
                             tion  has  been  given   such   a   low   priority   in   our    medical   writin-   in    the    popular    media-
                             total  national  health  effort.,  we.  have   given   little    with  some   otitstaiidino,   exceptions   has   t
                             attention   to   the   recruitment   ,iiid    trtiniiig    of    to  be   fragmentary   ,iiid   often   misleading.
                             communications   specialists    in    the    health    field.    Public Health Serx-ice should take the






                                                                                   C O'@%      ICATIONS                                                            405
                                 edy na this condition, and  its  public  iiifor-                   other specialists, we will lack a  solid  scientific
     II Serv                       n o@ces should  be  authorized  and  eiicoiir-                   base  from  which  we  can  tailor  our  educational
                              @mat@io
                                                                                                    efforts toward motivating clianue in people.
     3throu                   @d to    do SO.                                                                                                 In
                                                                                                      IVe      therefore      recommend      that      the       Public
                                RESEARCH  CENTER  ON  HEALTH                                        Health   Service   be   provided    wi@tli    funds    to    initi-
                                               MOTIVATION                                                                                                          -rch
                                                                                                    ate the development of t Center for Resea
                                In     mounting     preventive      attacks      Upon      heart    in    Health    Motivation.     In     addition     to     specific
                                       cancer,   and   stroke,    we    face    the    difficult    behavioral     studies     directed     at      the      individual
                              c aller     of     changing     the     life     patterns      and    decisioiimaking     process     in     changing     patterns     of
                              habits     millions     of     people.     For     example,     it    living,   the   center    would    analyze    the    contents    of
                                                                      plilet    listino-     the    public     canipaian     materials     witli      reference      to
                              is fairly easy to put out ,' Pam
                              various    factors     which     predispose     ,Ln     individual    their    effectiveness     and     influence     upon     behavior,
                              iD  a  heart   attack,   but   it   is   extraordinarily   dif   -    and     it     would     hopefully      concentrate      particular
                                       get   that   individual    to    reduce    his    calorie
                              ficult to                                                             attention      upon      hard-to-remh       population       oroups
                                                up    cigarette    smoking,    or    to    limit
                              intake, to give                                                       which       reject       existing       educational       campaigns
                              the stress factors in his daily life.
                                                                                                    emphasing    iiidividu,@il    initiative     and     chances     in
                                Little  research    has    been    done    on     the     effec-
                                                                                                    livinc, pattern,,.
                          @@@,,'tivene-ss   of   the    virious    approaches    Nvhicli    have          tn
                                                                                                      It is estimated that $500,000 a 'vear                   for     5
                                       ed    to    chan-e    the     ingrained     habits     of
                              Rttempt                 C!
                                                                                                         s would be necessary to initiate the                    devel-
                              people.   Unless    this    important     research     is     con-    year
                                                                       sociologists                                                                  treh      Cei-ter.
                                                         scientists                          tnd    opment   of   suc-li    a    Motivational    Rese,
                              ducted by behavioral
                                                     Continuing Education of                        t6e   Healtk Professions
                                The     forward     sweep     of     medical     science     has    as   a   critical   problem   in    medicine    today,    is    not
                                                                                                                         sponsibility      of      anv      significant
                              brought   a   kind   of   "instant    obsolescence"    in    nied-    the primary  re
                              ical    knowledge.     Most     physicians     practiciiia     to-    segment of our national health resource.
                              day    received     their     medical     education     in     the       Nledical    schools,    the    logical     locus     for     the
                              1930's   and   1940's.   The   fact   that   they    ,ire    prac-    major     effort,     are      correctly      preoccupied      with
                              ticing   two   or   three   decades   later   poses   a   critical    undergraduate     education     first     and     research     see-
                              o@-tacle    to    the    delivery     of     up-to-date     health    ond.    Continuing    educations     if     it     receives     any
                              care.                                                                 attention   at   all,   must   settle   for   what   is   left   of
                                For    many    years,    lipservice    has    been    paid    in    already      inadequate      resources.       Similarly,       com-
                              the   medical   profession,   as    in    most    other    profes-    munity    hospitals    could    contribute    oreatly    to     the
                                                                                                                 g     education     of      community      physicians,
                              sions,    to    the    concept    of     continuing     education.    continuin
                                                                                                                                    o   care    for    the    patients.
                              But  the   facts   of   dtily   life   are   hard   to   overcome.    but their first job is t
     oped skiff,',
                                                                                                    Professional     societies     have     many     other      respon-
                                Alost     doctors     work     a     60-hour     week.      Even
      fields   as
                7@            their   free   time   is    never    truly    free.    Thev    are    sibilities.
     )rilliant'yl        t                                                                             Yet continuin-- education is a
                          .   deluged    with     paper,     rancriiia     from     professional
     til   within                                             m ID                                                                                                    a
                              journals   to    flyers    advertising    the    latest    medical      erat
                                                                                                                                                  ort,,   the    worlds
                              gimmick.     Among     the     papa     are     invitations     to    large
                                                                                                    of   science   and   prai   tice    will    spiral still     farther
                              attend     lectures,     seminars,      clinical      conferences.
                              Ilut   only    the    sui)ermotivated    or    the    semileisured    ap,,irt.  The gap between what                  is know@n   n@d__._
                                                                                                                                                          rder      and
                              are   able   to   respond   ofte.,i   eiiougli   to   keep    pace    what i
                              "litli their changing profession.                                     -I -ri rvl
                                                  ttest   single   obstacle   to   a    cohesive       The Pul
                                Thus tile gre,                                                                     lic  I-lealtli   Service   clearly   has   a   lead-
                              Program    of    continuing,    education    for     the     medi-    ership  role  to  play  in   helping   to   f   orge   a   national
                              Pal   profession   is   time.    The    second    is    dix-ersity    continuing    education    effort,    by    assisting    all    the
                                             ind   needs,   The   third   is   the   fact   that    available resources         in gi
                              Of interests,                                                                                            ving    due     attention     to
     ie lead                  'Olltilluiiig   education,   altliouc,,Ii   it    is    recognized    this problem.

                                          @5          27









                                406                                 REPORT TO THE PRESIDENT
                                  STRENGTHENING CONTINUING                             visual  materials  for  continuing  education  of   ti
                                      EDUCATION PROGRAMS                               health profession.
                                                                                         The   Public   Health   Service   Audiovisual    i,-
                                The  Subcommittee    recommends     that     appro-    cility,   located   at   the   Communicable    Di
                             priate units of  the  Public  Health  Service  be  pro-   Center  in  Atlanta,  Ga.,  on  a  small   scale,
                             vided with funds and authority to:                        ,tlre,,tdy  demonstrated   high   competence   ir
                                a. Stimulate    and    support    through    grants,   production  of  training   and   educational   11
                                  contracts   or   in   other   appropriate   ways,    rials, and in  the  collection  and  disserainati
                                  demonstration    projects     and     experiments    such materials produced elsewhere,
                                  directed   by    medical    schools,    community      11're therefore recommend that        the Publie,'@.
                                  hospitals,  professional  organizations  or   any    Health   Service   Audiovisual   Facility   be   eii-"
                                  appropriate  agency,   designed   to   make   im-    ],,irged in scope ind strengthened so thit it  rflay.,
                                  portant   scientific   knowledge   systematically    become  a  National  Afedical  Audiovisual  Cen-er".@,
                                  and   conveniently   available   to    practicing    To  this   end   we   recommend   the   following
                                  physicians.                                          cific steps:
                                b. Stimulate   and   support    research    projects        (a) The appropriation   of   $1.5   million    for
                                  designed   to   develop    new    and    improved           necessary   renovation   and    expansion    of
                                  methods   of   conducting    continuing    educa-           facilities.
                                  tion    programs,    including    experimentation          (b) Appropriation  of   $1..5   million   for   the
                                  with  various  media  (i.e.,  closed-  or   open-           first  year,  scaled  upward  to  $4.0  million
                                  circuit television,  etc.),  various  instruction           for the  fifth  year,  to  develop  an  iiitra.
                                  methods  (i.e.,  programed   instruction,   sen@-           mural program  ivliieli  -,vould  include  Pro-
                                  nars,  etc.),  and  various  means  of   evaluat-           duction,  experimental  use   and   evaluation
                                  ing  such  programs  in  terms  of  their  actual           of educational materials in  such  areas  as.'
                                  impact in upgrading medical practice;                       radio,  television,  motion   pictures,   pro-
                               C. Dissemiiiite ,ts widely as possible the       re-           crrlilled  instruction,  etc.;  research   and
                                  sults   of   experiments,   demonstrations    and           training pi-ocrranis  in  audiovisual  fields;
                                  other  projects  in  the  continuino-   education           international exchan     of   medical   motion
                                                                                                                    ge
                                  field,   whether   sponsored   by   the    Public           pictures; and other purposes.
                                  Health  Service  or  by  others,  so   that   all     (e)   Authorization   of   an   extramural   program
                                  interested   organizations   may   benefit   from           of  grants  ,ilid  fellowships  and  appropri-
                                  the experience of others.                                   ations  to  support  such  a  program,  begin-
                               d. Conduct    studies    and    demonstrations    in           ning at the level of  $1.5  million  per  year
                                  communications     technology     ind      educa-           ,ind rising to q million at the end  of  a  5-
                                  tional i-netliodology.                                      year  period:  such  ,i  pro,-Tam  would   en-
                              For   these   purposes   the   Subcommittee    recom-           able  the  center   to   support   selectively
                           mends  appropriations  of  $2  million  for  the   first           promising   projects   in   audiovisual   com-
                           year,  $4  million  for  the  second,  and  $6   million           munication   at   medical   schools,   conimu-
                           for the third.                                                     iiity hospitals, and other  institutions  and"
                                                                                              to assist, through training  grants  and  fel-
                                    A NATIONAL MEDICAL                                        lowships, in the  development  of  a  national
                                    AUDIOVISUAL FACILITY                                      cadre      of      medical      communications
                                                                                              specialists.
                             The  imaginative  use   of   new   communic,,itio   is
                                                                                       In  addition   to   the   program   outlined   abov(S
         T                 media  offers  the  best  hope  for   necessary   break-
                                                                                     the  Subcommittee  feels  that  the  Nttiolial   Aledi,
                           throughs   in    continuing    education.    The    Sub-
                                                                                     caf  Audiovisual   Facility   should   exert   iminedi-
                           committee  believes  that  in  addition  to  its   broad
                                                                                                                                      ica-
                           program   of   support    for    continuing    education  ate  and   strong   leadership   in   two   common
                           outlined    above,    the    Public    Health    Service  tioiis media of particularly high promise fO
                           should  also  take   leadership   in   producing,   dis-  continuing   education   of   the   health   prof@i-Or"
                           sominating,   and   promoting   the   use   of    audio-  These are, first, the field of closed-circuit tele




                                                               CO'%IA@--ICATION'S                                               407
                                  already    beiii-    used     sporadically, Health Service   in    reci,ititilicr    ,tiid    employing
                                  tetit,   by   medical   sclic>ols.   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     serviciii<r   @cific   user   needs    having    a    high
                            it  is  argued  that  the   system   would   be   working     priority.    Though    present     science     information
                            well if  it  only  -were  used.  A  typical  service  for     activities  niiy  @   praisenvortliv,   the   process   bl
                            abstracting    specialized    heart    information,     for   winch   they   are   organized   is   diffused   among   a
                            example,  may   draw   upon   the   contents   of   4.500     variet)r  of  relatively   esoteric   interests.
                            different journals.                                             Such  diffusion  is  to  be  expected  in  -,i  pr@urs'.
                            The  need  for  reviews   of   literature   in   special-     @A-Iiicli  emphasizes  the  support  ,iccording   to   thO
                            ized fields  is  met  witli  such  mono-raplis  as  those     objectives   of   individual   institutions   or   person'
                            on diet and -,atherosclerosis, sii-lokino,,  ,ind  Heart,     alities  rather   than   ,tceordiilg   to   common   needs                   c
                            disease,   and    the    hydrodynamics    of    pulsatile     ,iiidro-,ils.           EN-eiiiftliekeepersoftlieftindsare                   ag
                            flow.  In  recoomition   of   the   importance   Of   sci         t-                                           cannot
                                                                                    -     aware  of  priorities  in   Health   needs,   they                           ur
                            entific    conferences,    government     and     profes-     readily    distribute    fluids    according    to    such                   UE
                            sional   societies   support   a   constant   round    of     priorities  unless  the  dei-n,,iiid  for  sue]'  uses  's
                            meetings.    Publication    of     proceedings     covers     widely recoomized (57).
                            such  topics  as  evolution   of   the   ,itheroselerotic       -kt   the   same   time,   the   medical    c(
                            plaque,   thrombosis,   and   ei-nbolism.   A    bibliog-     cannot    escape    responsibility    for    the
                            rapliy  of  medical   translations,   supported   bN,   i     certtin    us6rs    of    biomedical    infornia
                            grant from the  -N',,ttioiial  Library  of  '@\fedicilie,     iiiarily practitioners, ,ire neglected
                                                    ,isin(,,,iwareiiess  as  well  as
                            is i step towird incre,                                       methods    of     information     ni,,in,,i(,Yen                     red  exte
                            an aid in searching.                                                                                                               iication,
                                                                                          tliour,h   the   original   objective   of    On
                                                                                                                                                               Sts   and
                                                                                          nonprofit   enterprise,   The    Institute    fc
                                                                                                                                                               grant,
                            Consultation                                                  vancement  of   '.\Iedic,,tl   Coiiii-nuiiicati(                             in@
                            -@c)t  the  letst  of  the   forms   of   assistance   is     provide    medical     information     to     practitiolie                   tem
                            consultation  in  person   or   by   telephone   N@.-itli     its   director,   Dr.   RichLrcl   Orr,   said   lie   cot
                            scliolars. Plivsicians   at    the    '-\I.D.    Anderson     obtain  little   support   for   this   purpose,                             opi









                                                                                           -NIL@-ICATI
                                                                                  C O',% 1.            ONS                                                          429
                                pll)]ic, Ilealtli Service, With            its   siil)staii-       I)iolooical   ,ictivity   cards   based    on    literature    o
      id sp                 Tile                                                                                                                                        f
                                                                      p@-ial               to      caii(,ei,   cl)eiiiotlieral)y,    for    prel)ai-iii(,    cancer
                        ti.,,] budget for grants, has t s
                                           iorities for            of                    iii-      chemotherapy    abstracts,     and     for     the     secondary
                        de,tenilille    pr
                                                                                                                  -ature described
                        forl-natioii    and    to    direct    attention    to     tli@            heart  litei                             above.      These      fenv
                                                  contracts   ,ind                 intramural      contracts    alone    exceeded    an    outlay    of    $3     million
                        priorities
                                                                                                   in 1 year.
                        proara@.
                               GRANTS AND CONTRACTS                                                         INTRAMURAL PROGRAMS
                                                                                                       A    superficial    study    of    the     science     information
                                 iuthority of the Public Health                       Service
                             The
                                      grants     in      support      of      con-Lmunication      programs        conducted        internally         by         various
                        10 employ
                                           I    information    was     clarified     by     a      health    a(reiieies    and    organizations     finds     a     v,.t-
                        of       bioiiiedica
                                           the    Comptroller    General,     iNla-rch     4,      riety    of     commendable,     discrete     enterprises     in     a
                        decision Of
                        1964.    Even    prior    to    that     decision,     grants     had      relatively      loose      relationship      to      one      another.
                        been   used    in    a    variety    of    experiments    and    mis-      Such    relations    as    are    found     tend     to     be     in-
                                   ilin-      in      science      information.       Lllajor      formal,    spontaneous,     and     voluntary,     as     befits     a
                        sions de,
                                                              abstracting            service@      freely functioning institution.
                        grants          went to  support
                        of     "Excerpta     '@\leclica"     and      "Biolocric-,il      Ab-          The    pi-ice    of    such     freedom,     unfortunately,     is
                        stmcts,@'      conferences,      symposia,       primarv       publi-      the     sacrifice     of     much     economy     of     money     and
                        cations,     ,t     hindbook     which     indexes     ejects      of      effort.     submersion     of     pi-ii-nary     needs     Lnd     ob-
                                                                                                   jectives,    iii(I    Iii-np    exploitation    of    the    technical
                        chemical     compounds      on      the      cardiovascular      svs-
      -e, ou                                                                                       potentialities      of      ,t      well-or(raiiized       information
                        tem,    and    trial    issues    of    a    cardiovascular    bibli-
      ,lion                                he    @'ational     Heart     Institute     grant-      system.   To illustrate, tile            preparation      of      ,iu-
                        ograpliy.          T
                        ed   $50,4'8    to    trip,    Institute    for    the    Advancement      tlioi-ity  lists  or  NN-oi-d  lists   for   use   in   various   iii-
      Ito               of    ,Ifedictl     Communication     for     training     in     the      dexiiig      s(.-lieiiies      frequently       proceeds       without
      ra                art    of    communications,    and    in     1963     it     granted      iiitet-cli-,iii-e       amon-       the       various       pro(yrims,
                        $54,280    to    improve    the    reaching    and    practice     of      -i-@iiitees,    or    contractors,    ,iltliou(rii     their     judg-
                        preventive medicine (,58).                                                 mciits    will    determine    the    compatibility     of     tlieii-
                          I,i(yeniotis     and      relatively      inexpensive      applica-      systems.       Sporadic       contracts        for        translations
                                                                                                   an
                        tions     of     modem     teclinolo,-y     supported     by     such          d     abstracts     iiiciir     needless      duplication      and
                        grants include  maometic             tapes,       which        repro-      expense.      Support      of      publications      proceeds       on
      iiig to           duce   the   sounds   of    the    heart    for    the    study    of      an  ad   hoe   basis   NN-itli   little   regard   to   the   desi,-ii
      Dr per@'          congenital    and    acquired    heart     disease,     and     video      of    a    total    information    system.     Little     lieed     is
      ,non ni           tapes,    wlikh    permit     repeated     viewing     of     fluoro-      (,ii-eii    to    the    fact    that    prooi-es,3i%-e     automation
      funds             scopi-@    images    of    heart     and     lun(ys     in     motion      of    libi-,irv     sei-i-ices     requires     editorial     cooperi-
      iev C             without    further    exposure    or    presence    of     he     pa-      tioii   ill   tiie   form   of   titles,    il)sti-acts,    and    key
        to  su          tient,                                                                     words.    There    is    little     insistence     thit     evaluative
                               for    use    in    diagnosis,    research,     and     train-
      ich uses          illg.  One      interdisciplinary      study,      supported       by      pi-oce(,Itiz,es     be     liuilt     into     information     experi-
                          grant, reviews exchanges between eng'                                    nients    and     even     l@     regird     for     the     contribu-
                                                                                       ineers
                                                                                                   tion    of     these     experiments     to     continuing     ediica-
                        @d     biologists     on     the      hydrodynamics      of      cir-
                        @ation of the blood.                                                       tion    of    the    practitioners    and    to    public    enliglit-
                          In    Years     to                                                       eiiineiit and encouragement.
                                           come,   it   is   assumed    that    the    flexi-
                        bilit                                                                                  ir   easier   to    criticize    this    condition    than
                             Y     of     the     grants     mechanism     may     be     em-          It is f,
                        PIOY@     extensively      to      support      biomedical      corn-      to     correct     it.     The     administrative,     legal,      and
                        roullications     and     continuing     education      for      sci-      psychological       barriers       to       coordinating        infor-
      )iie              !,tltists   and   pr
                                           aetitioners.     But,     as     noted      above,      iiiation   ,ictiA-ities   even   in   i   totalitarian   state    ,ire
                                                                  tture   is   less    likely      f
      for the       z,,, ,ie grints mechanism by its n,                                             orniidable    (,5.9)    :    How    much    more     difficult     is
                           se-N-e      indic                                                       the   tisk   in   ,iii   institution   which   stakes   its    scieii-
                                           ',Ited    needs    of    a    Federal     informa-
                               syst-n,     than     are      contracts      and      budgeted
                                                                                                   tific   I   ife   upon   f   ree(lom   to   experiment,   which    de-
      Lci be          '-'Programs,     For      example,      contracts      were      issued      peiids    wholly    oil    cooperation    -,iiid     persuasion     to
                        @.ior dei,eiopnlellt of    MEDL-A-RS,         for          developin-      obtain    acceptance    of    ,tiitliorit,,ttive    channel-,     itnd
      Ise.
















     7      l'i


                                                                                                                RESIDENT
                                      430                                        REPORT  TO  THE  P
                                                                                                                                  anded     information     in     the      fields    @;!*.'years
                                                                                                                for example, dem
                                      procedures    in    the    interest     of     economy,     priori-
                                                             liange          ofinforniation?           No       of   physics,   chemistry,   and   engineering    at    a    speed         ing   re
                                      ties, and effective exc
                                      iiidii,idiial reproof is warranted for the                  fla-svs       "Ind   on   a   scale   without    limit.    This    demand    for         guisti(
                                      in    the    biomedical     information     programs     of     the       information      continued,       under       postwar       c,.di.
                                                                                                                                                                                               Tjpc
                                      Nation.   As   Dean   Rtisk-   said   of   the    Bay    of    Pigs       tions,     in     development     of     unconventional      weap.
                                                                                                                                                                                           coune
                                      fiasco,   "There   is    something    in    it    for    everyone."       oiis,   nuclear    energy,    space    vehicles,    and    medical
                                                                                                                                                                                           Ter
                                      For   those    burdened    ivith    this    difficult    task    of       techniques.                                                                     Iin
                                                                                                                                                                                           Cil  an(
                                      coordinating     information,     there     should     be      less       In 1950   the      National      Science      Foundation       was         on    SC
                                      criticism     and     more     sympathy,      cooperation,      and       established.    Among    other    duties,     it     was     asked
                                                                                                                                                                                           policy
                                      support.                                                                  to   "bring   about   the   effective    coordination    of    the         the   Fe
                                      As   a   move   in    this    direction,    the    Public    Health       various     scientific     information      activities      within
                                      Service   ]its   established   a   focal    point    of    i-espon-       the     Federal     Government,     develop     new     or     im-
                                      sibility   in   the   office   of   the   Special   Assistant    to       proved     methods     for     miking     scientific      informa-         mittee
                                      the     Surzeon     General      for      Science      Information.                                                       e    of     scien-         cornpc
                                                                                                                tion available, foster the interchano,
                                      Af,,tiiy PHS     divisions      ,ilso      have      appointed      sci-  tific    information    among    scientists    in    the    United         the   F(
                                                                                                                                                                                           of   Vol
                                      enee    information    officers.    Several    of    the     recom-       States    iiid    foreign    countries,    and     provide     fi-
                                      mendatioiis     of     the      Surgeon      General's      Confer-       nancial support for tr,,iiisla                                             patibl
                                                                                                                                                   tion of     forei,@        sci-              The
                                      ence    on     Ifealth     Communications     (60)     have     met       ence,'l  as  well  -ts  to  "maintain   a   register   of   scien.
                                      with     ,L     conscientious     response.      New      functions                                                                                  tions
                                                                                                                tific    and     technical     personnel     in     the     United         searcl7
                                      have     been     defined,     new     programs      have      been       States" (61).
                                                                                                                                                                                           and    f
                                                                     itions,        tnd         ambitious
                                      developed  in  communi@                                                   Early   efforts    at    coordination    by    the    Office    of
                                                                                                                                                                                           the   in
                                      plans   for   the   future   have    been    dn,    ivn.    Similar
                                                                                                                Science     Information      Services      (OSIS)      of      the
                                      steps     by     the     Am@can;Nfedic,,il     Association     line       ',National      Science      Foundation      including      fonna-         respoi
                                      been    noted    Lbove,    Nevertheless,    the    '-\-nation    is                                             I        ii    on     Scien-              Ma@
                                                                                                                tion of .t Federal Advisory Counc                                          ments
                                      only    on    the    threshold    of    an     expanded     program
                                                                                                                tific    Information,     were     strengthened     by     est-ab-
                                      of    health     c-onuntinications     and     continuance     edu-                                                                                  Natio
                                                                                             t5                 lishment,    in    1959    of    the    Federal    Council     for
                                      c,,ttion.                                                                 Science    and    Technology.    composed    of    officers     of         tional
                                      It   is   to   be   expected,   moreover,    that    these    steps       policy    r,,ink    from    the     major     Government     agen-
                                        (y    in    the    direction    of    nitional    ,ind     world-
                                      will o                                                                    cies.    A     Presidential     task     force,     headed     by.
                                      wide developments.
                                                                                                                James   H.   Crtwford,   Jr.,    in    a    report    to    Jerome
                                      (An    exceptionally     co(,rpnt     review     of     the     in-       Ill'iesner    chairman    of    the    Council,    stated    that,
                                                                                          Icp
                                      formation     facilities,,ivailable      to      pharm.      -uticq
                                      firms   has   been   prepared   by   I%fr.   S.   T.   Zelter   for       As  one  of  the   many   agencies   supporting   R   &   D   (re'
                                                                                                                search   and   development)    the    Foundation    cannot    rea,
                                      the       Organization       for        Economic        Cooperation       sonably  be  e.,cpected  to  exercise   any   forceful   direction
                                      and      Development      Paris,      October      23,       1964.)
                                                                                                                of   other   agency   STINFO   (scientific   and   technical   In-
                                                                                                                formation)  policies and practices"  (62).
                                                     FEDERAL PLANS                                                                                                         uded
                                                                                                                The          Crawford          recommendations          incl
                                                                                                                                                      e   clearance   louses    to
                                      Conception      of      a      Federal      information      system       creation of Governmentwid
                                      had    its    origin    in    Thomas    Jefferson's    vision    of       detl    with    reports    on    current    research,     research
                                                                                                                results,      specialized      information      centers,       and
                                      a   university   and    in    the    Constitutional    ai-itlioritv
                                      of   Cono-ress   to    fix    standards    of    -weicrlits    ,ind       scientific meetings.  Th
                                                                                                                                                            dinated           ac@"
                                                                                                                                               e     report     also      proposed
                                      measures.    For    the    most    part,     the     svstem     has       referral center to provide "coor
                                                                                                                to     sp@ci,,tlized'inform,,Ltion     centers     and     service
                                      developed    informally;    much     of     it     is     regulated
                                      officiallv    by    the    Government    Printin(r    Office    and        Issuance    of    this    report    bad    been    preceded    by
                                                                                       in                                                                                  ional
                                      the    Joint    C4omi-nittee    on    Printing    but     otherwise       ,t   series    of    hearings    conducted    by    congress
                                                                                                                committees     notably      the      Senate      Committee      O@
                                      it   is   disciplined    on    a    voluntary    and    cooperative
                                      basis.                                                                    Government    Operations,    and    by    a    great    deal    01
                                                                                                                                                                                 e
                                      The    need     to     improve     interchange     of     wientific       scholarly    ,ictivity,    much     of     it     supported     by
                                                                                                                                                                                 pily
                                      information    intensified     25     years     ago.     Scientific       National       Science       Foundation.       (A        bibliogra
                                      and    technical     de@,clopiyient     of     nuclear     weapons,       on    handling    scientific    information    (63)    ill     tl'





                                      7-61   listed   1,121   items   without   includ-     of     "Unpublished"     literature     includes     informa,-
                            vears   195
                            ing  reference   to   coi-niiierciil   applications,   lin-     tion   presented   more   or   less   informally   at    meet-
                                      medical   records,   or   technical    writin(r.)     ill,,s,  reports  to  Goi-ei-iinient  agencies  such  as   the
                            guistics)                                                         p-
                    i       ljpon     revieiving    the    Crawford     report,     the     Food     and     Drug     Administration,      medical      or
                                         osed  that   the   Office   of   Science   and     clinical    records,    letters,    advertisements,     films,
                            Council prop              Secretariat   for    the    Coun-     and   unpublished    reports    of    research    which    in-
                            Technology, serviiig,,is
                                      r    the    President's    Advisory     Committee     clude    much    valuable    information    about    so-called
                            il  and  fo
                            oil   science   (Ind   Teclinolog-,N-,   provide   "general     negative   results.   Lack   of   such   a   facility    tends
                                      advance  but  not  control  or   dircTCiou"   for     to    delay    the    prompt    application    of     research
                            policy 9'Ll
     'ion of  th
                            the Federal information system (64).                            findings.  For example
     ies                              June,   the   Council    established    a    Com-          e   I   ol@q tkq@
                            Also,    in                                                                                          was known
     aw                               Scientific     and     Technical     Information,     industrial laboratory wh ch-
                            Inittee  on                                                                                                   ,t-,bg@her    to
      in
                            composed  of    science    information    specialists    in
                                                                                            p@t@h.                                               intention
      ol                                                                   the     task
                            the Federal agencies, to carry forivard                         of
                            Df  volunta                                                                                                 an        consumd-
                                      ry   coordination   of   effective    and    com-
                                                                                            ti  .   In   ignorance   of   this   finding,   a   pharmaceu-
                            patible information systems.                                 - Craig  ,
                                                                                            tical   company   used   the    chemical    as    t@s    l@ent
                            The   components   of   this   system    include    collec-
                                                                                            for     sulfanilamiLe@.gA!L@tiig_IQQ,!Laths     before     the
                            tions  of  documents,  facilities   for   analvzinlr   ,tnd
                                                                                            druo, w               @n.     This     proprietary      infor-
                            searching  the  collections  or  recall   iiig   documents,
                                                                                            mation    was    not    intentionally     concealed:     There
                            and   facilities   for    organizing    and    distributin-
     e Office  0                                                                      In    -,vas   simply   no   established   channel   for    circulat-
     S)  of   th            the   information   contained   in   the    documents    in     ing this information.
                            response to user needs.                                          A    clearinghouse    function,    to     evaluate,     pack-
                            Alajor   Federal   collections    of    scientific    docu-
                            ments  are  in  the  Libr,.irv  of   Congress   (LC),   the     age,      and      distribute      biomedical      information
                            Nationil A,,-,ricultur-,il T,ibi,,,ii-v (.\7-kT,), the          widely   but   selectively,   is   an   essential    component
                            tional Libi,,,ii-v of '.\Ie(liciiie        the      Science     of    an    effective    biomedical    information     system.
                            Information    Exchange    (SEI),    and     the     Clear-     The   National    Referril    Center    for    Science    pL@d
     ne                     inghotise   for   Federil    Scientific    and    Technical     Teclill@lp -estab-lish-e-d'-re-c'e-n't'ly-i-'n""'t'h-e--L'i"b'rary
     le,                                                                                             _cM
     to                     Information.                                                    of  Congress,  promises   to   be   useful   in   facilitating
                            The  first   three      collections      are       composed     access   to    present    sources    of    information.    But
     ,tted that. l'
                            mainly  of  reports   of   research   results   and   asso-     referrals  in  response  to  inquiries  do   not   serve   the
     R & D (@,4i-           ciated    information.    The    National    Library     of     purpose     of     announcements,      explanations,      wam-
     cannot  reA
                            Ifedicine   is   the   most   comprehensive   single   col-     ings,   cautions,   alerts,   alarms,   and   glad    tidinas.
     .ul directIO4?
                            lection    of    formal    biomedical    literature    any-      To   a   considerable   extent,   the   mass    media    have
                            where.   The   SIE   collection    consists    wholly    of     served    to    distribute    biomedical    information     in
       includ               reports  of  research  in  progress:  Its  main   task   is     popular    forms,    with    varying    degrees    of    accu-
                            to  enable  administrators   to   review   the   allocation     racy.   Their    participation,    along    with    the    Ad-
                            of  research  funds  and  activities,  but  it  is   useful     vertising  Council,  has been  creditable.                 But
                            a@   in   some   situations   for    advising    scientists     reporters   for   the   mass    media    ctn    not    perform
                            ,hat   others   are   undertaking   in   a   given   field.     the   task   of   collecting,   associating,   and    evaluat-
                            The   Clearinghouse   deals   entirely   in    unclassified     ing    information    about    diet,    exercise,     surgery,
                            technical    reports    issued    by    Government    agen.     drugs,   or   medication   for    selective    users,    espe-
                            "es:   It   announces   them,   distributes   notices    to     cially     scientists      and      health      practitioners.
                            'Pecialized   users   according   to    their    interests,     Groups   of   seliolars   are    needed    to    form    judg-
                            and pro@'ides copies oil request.                               iiiejits  upon  the  available  literature   and   to   direct
                            The   Federal   system   has   no   facility    with    re-     their    findings    through    strategic    channels.     For
                            IPO'Iiibil,t,   for   collecting   and   organizing    bio-     the  most  part,  such  a  service  is   available   in   some
                            medic I i
                                   Ilformation    which    does    not    appear     in     degree    only    through    universities     and     research
                                      literature.     This      neglected      category     institutions.











                      432                                                   REPORT TO THE PRESIDENT
                          Even without an  effective  clearinghouse  op-                              centers will be self-generating and  autonomous.                                                        r
                                                                                                                                                                                        communication
                      eration  for  biomedical   information,   various                                  As Jerome Wiesner said,
                      societies  and  institutions  have  formed  indi-                                  We   must    take    care    that    the    Government    information
                      vidual specialized information centers to collect                               svstems    not     oi,erwhelm     the     non-Government     activities,
                                                                                                      particularly   those   of   the   technical    societies    which    are                 evaluating
                      germane     documents     and     provide     a     focus     of      bio-                                                                                             In
                                                                                                      particularly   sensitive   to   the   needs   of    the    users.    The          is   easy    to    reco
                      medical      scholarship.       Afany       are       one-man       opera-      process of scientific coiuniunkation with its long                  tr"'
                      tions:     Others     are     supported     with      elaborate      rp-f-      dition    of    self-criticism    plays    an     Indispensable     ,le.          tures,   such        as
                      erence    facilities.    Eventually,     it     is     to     be     hoped      The   existence   of   a   healthy,   impartial   system    of    scien.          wh'   ch   will    prin
                      that  all  special  information  centers  will                          be      tiflc   communication   helps    assure    the    country    that    the       @-..instea-d  of   10   C(
                                                                                                      science   It   supports   is   valid.   The   first    scientific    in.
                      linked in a system which will enable them                               to                                                                                        .-quality.     In     o
                                                                                                      formation    panel    of    the     President's     Science     Advisory
                      share     resources     and     knowledge.     A     set     of     clear-      Committee    insisted    on    an    articulated,    rather    than    a          judgments          hing
                                                                                                      ce,traliz@     scientiflc     comniunication     system     to     ma             saving    of    I    or
                      inghouses     -would     be     a     logical     binding     force     in                                                                          in.
                                                                                                      tain    independent    avenues    of    scientific     criticism.     it          regular        postaL,(
                      such a system.                                                                  is   my   strong   belief   that   these   considerations   are    still
                          It    is    a    tribute    to     democratic     institutions     and      valid           (64).                                                             pe-dite        exchange
                                                                                                                                                                                        and      Palo      Alto
                      to      the      professional      dedication      of      those      con-         An    articulated     system     rather     than     a     controlled          worth          $200,000
                      cemed      that       a       remarkably       effective       information      system    satisfies    the    need    for     freedom     and     flexi.          neously     from     c(
                      system    for    science    as    a,     whole     already     has     de-      bility     and     still     provides      the      cooperation      and          picture        service?
                      veloped     in     an     informal     manner,     in     part      thanks      agreement        on        standards,         on         interchangeable          ,up     an     automate
                      to     the     Special     Libraries     Association      and      similar      parts,      ivhich      facilitates      exchange      of       informa-          on  tape  and   mic   i
                      bodies.   In    a    free    society,    moreover,    it    is    to    be      tion.      The       present       informal       system,       however,            tion     be     serve
                      expected        that@         many         specialized         information      stands in need of more articulation.                                           @j     viewer     which
                                                                                                                                                                                        particular         film
                                                                                                                                                                                        ,as  Putting   a   nicl
                                                                                 Information Costs
                                                                                                                                                                                             viewer         and
                                                                    ,,nificance     of      com-         Llleanwhile    it    is    possible    only    to    speculate     on
                          Considering the economic sic                                                                    2
                      municat.ion      techniques,      it       is       unfortunate       that      the    total    amounts    paid    to     finance     publication     of                                iv
                      there    is    not.    more     direct.     budgeting     and     account-      scientific      reports      in      professional      journals,      or
                      ability     of     these      activities      in      Government.      Al-      the     total     amount     of      conference      expenses      which                                0
                      though     the     Bureau     of     the     Budget     has      attempted      tire    allocated    to    travel,     to     operations,     and     to                            to pa
                                                                                                                                                                                                           total
                      to      encourage      accountability,      specific      charges      for      publication      of      proceedings.      Al>out      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
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                                                                                                                                                                !
                                                                                                                                                                !  ii@i
                                                                                                                                                                   @o;
                                                                                                                                                                I  I @i
                                                                                                                                                                .  7
                                                                                                                                                                i  @ili
      ,4                                                                                                                                                     .  I
                 e'.                                                                                                                                            ;  . i -Vi
                  r,








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                                 I
                   I       I1-   i
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