MEDLARS and Health Information Policy

September 1982

NTIS order #PB83-168658
Library of Congress Catalog Card Number 82-600639

For sale by the Superintendent of Documents,

U.S. Government Printing Office, Washington, D.C. 20402
MEDLARS AND HEALTH INFORMATION POLICY

ERRATA SHEET

Page

11. column 2, last para. , line 3 --- . . (36) instead of (142)

14. Table 2, column 2 . . . . . Total records in data base instead of Total records at

data base

15. column 2. line 6 . . . . . more comprehensive instead of comprehensive

15. column 2, 3rd para., line 4 ● **** fuller description instead of full

description

19. Figure 2, 1st circle .-. . commercial users 12% instead of commercial users

11%: 2nd circle . . . . . commercial users 11% instead of commercial users 12%

21. column 1 3rd para., line 5 . . . trained instead of training

27. column 1, 1st para., line 5 . . . . . (77) instead of (75)

27. column 2, footnote, line 1 . . . . . (77) instead of (75)

28. column 1, 2nd para., line 11 . . . . . American Public Health Association, “Report

of the Ad Hoc Committee on Medical Care Terminology,” unpublished, 1966-67

instead Of (105)

41. Table 9, column 1 . . . . . Major relevance to health care instead of Major

relevance health care

51. column 2, 2nd para.. line 14 . . . . . (12,21 ,29,96,118) instead of (96, 12,29,21)

53. column 1, 3rd para., line 10 . . . . . data that are of interest instead of data

that is not of interes — — t

54. column 2. 3rd para. line 5 . . . . . (40) instead of (49)

55. column 2, 2nd para., line 8 . . . . . (168) instead of (66)

56. column 2, line 2 . . . add (137) after service

57. column 2, 3rd para., line 10 . . . . add (55) after practices

59. column 1. 1st para., line 15 . . . . . (168) instead of (66)

61. column 2, 2nd para., line 2 . . . . . use fee rate instead of use fee ratio

65. column 2. line 3 . . . . as will be discussed further instead of as will be

66.

79.

92.

98.

102.

103.

104.

105.

106.

107.

110.

114.

139.

139.

139.

discussed

column 1 3rd para., line 6 and 7 ..... - there are no simple answers instead of

there is no simple answer

column 1 . 2nd para., line 10 . . . . . the other private instead of the other

column 2, 2nd para., line 7 . . . . . U.S. Congress House Report 1026 accompanying

The Medical Library Assistance Act of 1965 instead of (78)

column 2, 4th para., line 14 . . . . . (91) instead of (94)

column 2. 5th para., line 4 --0-- add (125) after technology

column 2, 2nd para. , line 2 ● -O*. add (96) after NCLIS

column 1. 4th para., line 9 ----- for complete 1981 data instead of for

complete data

column 2, line 4 . . . . . (129) instead of (14)

column 1, 2nd para., line 4 . . . . . (63) instead of (11)

column 1. 4th para. line 4 . . . . (25) instead of (125)

column 2, line 4 . . . . . (167) instead of (166)

column 1. line 6 . . . . . (96) instead of (97)

column 2, line 25 ● ea. . Jonathan Ruby instead of Johnathan Ruby

column 2, line 29 ---- - Charles W. Sargent instead of Charles W. Sergeant

column 2, line 36 ● **. - Thomas Jefferson University instead of University of

Pennsylvania Medical School
Preface

Accessible information is fundamental to the success of activities to improve the

health of the population. With the increasing growth of the health literature, however,

it is more and more difficult to locate needed information.

Both governmental and private sector organizations create computerized healthrelated data bases and provide access to them. Government-sponsored health-related bibliographic information is predominantly created and disseminated by the National Library

of Medicine’s (NLM) computerized system, MEDLARS. One of NLM’s legislative mandates is to “aid the dissemination and exchange of scientific and other information important to the progress of medicine and the public health” (Public Law 84-941).

The House Interstate and Foreign Commerce Committee requested OTA to examine

MEDLARS’ performance as part of a larger OTA study, Strategies for Medical Technology Assessment. The Senate Labor and Human Resources Committee then requested

OTA to explore the relationship between NLM and the private sector in creating and

disseminating health-related information by means of computerized bibliographic retrieval

systems.

This technical memorandum analyzes the arguments for and against NLM’s creation and dissemination of health-related bibliographic information. It provides information designed to help Congress in decisions regarding the appropriate mix of NLM

and private sector activities that might serve the public interest most efficiently.

A principal finding is that in most respects MEDLARS is an efficient system for

disseminating health-related bibliographic information. In regard to the relationship of

NLM and the private information sector, OTA’s main findings are: 1) that there are

insufficient empirical data to decide, on purely technical grounds, the most efficient

and effective configuration of public and private bibliographic activities; and 2) that

rapid developments in the computer and communications fields may, in the not too

distant future, profoundly alter the effects of current decisions.

This study was guided by an advisory panel chaired by Dr. Robert Hayes. In addition, a large number of academics in the health and information fields, practicing health

professionals and information specialists, and public and private information providers

were consulted. We are grateful for their contributions.

Director

,., Ill
Advisory Panel for Strategies for Medical Technology Assessment

Lester Breslow, Panel Chairman

School of Public Health, University of California, Los Angeles

Morris Cohen

Director of Technology Assessment

Kaiser-Permanente Medical Group

Richard Cooper

Williams & Connolly, Inc.

D. V. d’Arbeloff

Chairman and Chief Executive Officer

Millipore Corp.

Harvey Fineberg

Harvard School of Public Health

Jerome D. Frank

The Henry Phipps Psychiatric Clinic

The Johns Hopkins Hospital

William Goffman

School of Library Science

Case Western Reserve University

Leon Greene

Vice President

New Product Technology

Smith, Kline & French Laboratories, Inc.

David B. Homer

Orthopedic Surgeon

Stanley B. Jones

F.

Vice President

Blue Cross/Blue Shield Association

Wilfrid Lancaster

Graduate School of Library and

lnformation Science

University of Illinois

Louise B. Russell

Senior Fellow

The Brookings Institution

Herbert Semmel

President

Consumer Coalition for Health

Robert M. Veatch

Kennedy Institute of Ethics

Georgetown University

Richard W. Vilter

American College of Physicians

College of Medicine

University of Cincinnati

Kenneth E. Warner

School of Public Health

University of Michigan

Richard N. Watkins

Staff Physician

Group Health Cooperative

Carol Weiss

Graduate School of Education

Harvard University

Kerr L. White

Deputy Director for Health Sciences

Rockefeller Foundation

iv
OTA Project Staff —MEDLARS and Health Information Policy

H. David Banta, Assistant Director, OTA

Health and Life Sciences Division

Clyde J. Behney, Health Program Manager

Bryan Luce, Project Director for Strategies for Medical Technology Assessment

Gloria Ruby, Study Director

Dale A. Carlson, Analyst

John C. Langenbrunner, Analyst

Kerry Britten Kemp, Editor and Writer

Virginia Cwalina, Administrative Assistant

Mary E. Harvey, Secretary

Pamela J. Simerly, Secretary

Nancy L. Kenney, Secretary’

Lorraine G. Ferris, Secretary’

Michael P. Hughes*

Principal Contractors

Jose-Marie Griffiths, King Research Associates

Tefko Saracevic, Case Western Reserve University

Richard Solomon, Massachusetts Institute of Technology

Ithiel de Sola Pool, Massachusetts Institute of Technology

Patricia Woolf, Princeton University

OTA Publishing Staff

John C. Holmes, Publishing Officer

John Bergling Kathie S. Boss Debra M. Datcher Joe Henson

‘Until September 1981.

ZUntiI January 1982.

● Contract personnel.
Advisory Panel for MEDLARS and Health Information Policy

Robert Hayes, Chairperson

Dean, Graduate School of Library and Information

University of California, Los Angeles

Science,

Robert L. Chartrand, ex officio

Senior Specialist in Information Policy

and Technology

Congressional Research Service

Robert Cheshier

Director

Cleveland Health Sciences Library

Don Detmer

University of Wisconsin Medical School

Donald Dunn

Department of Engineering

Economic Systems

Stanford University

Rashi Fein, ex officio

Center for Community Health and

Medical Care

Harvard Medical School

Morton David Goldberg

Schwab, Goldberg, Price & Dannay

William N. Hubbard, Jr.

President

The Upjohn Co.

Lee Hyde

Assistant Director

Kingsport Family Practice Center

Kingsport, Term.

Edward Kennedy

President

BIOSIS

F. Wilfrid Lancaster

University of Illinois

Davis McCarn

Director

Computerized Bibliographic Services

The H. W. Wilson Co.

Judith Messerle

Medical Information Center

St. Joseph Hospital

Alton, Ill.

Christopher A. Meyer, ex officio

Senior Attorney Office of General Counsel

U.S. Copyright Office

Barbara Quint

Head, Reference Services

Rand Corp.

Roger Summit

President

DIALOG Information Services, Inc.

Robert Wedgeworth

Executive Director

American Library Association

Carol Weiss

Graduate School of Education

Harvard University

Gloria Werner

Biomedical Library

University of California, Los Angeles

Kerr L. White

Deputy Director of Health Sciences

Rockefeller Foundation
Contents

Chapter Page

1. INTRODUCTION AND BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

History, Objectives, and Scope of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Background for the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Organization of the Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. MEDLARS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Development of MEDLARS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Current Status of MEDLARS ....,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data Bases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Leasing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

On-Line Services Users and Uses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The Future of MEDLARS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Current Standing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. MEDLARS: SYSTEM-RELATED ISSUES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Subject Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Literature Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methodological Merit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. PRIVATE SECTOR HEALTH INFORMATION SYSTEMS . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Historical Origins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data Bases Relevant to Health Sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BIOSIS PREVIEWS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

EXCERPTA MEDICA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IRL LIFE SCIENCES COLLECTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SCISEARCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Commercial Search Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bibliographic Retrieval Services, Latham, N.Y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DIALOG Information Services, Inc., Palo Alto, Calif.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

System Development Corp., Santa Monica, Calif. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. PUBLIC AND PRIVATE INFORMATION SECTORS: ELEMENTS OF

CURRENT DOMESTIC POLICY ISSUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Historical Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The Appropriate Role of Government in Information Activities:

Major Underlying Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Allocation of Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Effects of Government Involvement in Information Activities on the

Private Information Sector . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pricing of Information Products and Services, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. MEDLARS AND PRIVATE HEALTH INFORMATION SYSTEMS:

DISCUSSION OF DOMESTIC POLICY ISSUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Range of NLM’s Computerized Products and Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Data Bases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

On-Line Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“3

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vii
Chapter Page

Pricing Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

Fees for Leasing Data Base Tapes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72

On-Line Service Charges. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Differential Pricing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

Research and Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Final Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Appendixes

A. The National Library of Medicine: Organization and Activities . . . . . . . . . . . . . . . . . . . . . . . 83

B. U.S. Information Policies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

C. MEDLARS Evaluations: AReview of the Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

D. Development of Computerized Biomedical Bibliographic Retrieval Systems . . . . . . . . . . . . . 109

E.

F.

G.

H.

I.

J

K.

MEDLINE: Technical-Processes . . . . . . . . . . . . . . . .. . . . . . . . . . . . .. ~. . . . . . . . . . . . . . . . . . . 111

Public Sector/Private Sector Task Force of the National Commission on Libraries

and Information Science: Principles and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

AGRICOLA and ERIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116

Future Information Technologies: Implications for Biomedical Retrieval Systems . . . . . . . . 120

Issues in International Access to MEDLARS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

Health Program Advisory Committee and Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . 138

Acronyms, Abbreviations, and Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

List of Tables

Table No. Page

1.

2.

3.

4.

5.

6.

7.

8.

9.

100

11.

12.

NLM Databases, Fiscal Year 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

NLM Data Bases and Updates, Fiscal Year 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

MEDLARS:Usage of NLM Data Bases During September 1981 . . . . . . . . . . . . . . . . . . . . . . . 15

MEDLARS: Number of Domestic Institutions On-Line by Region and Type,

September 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Summary Comparison of the Functional Capabilities of

MEDLARS II and MEDLARS III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Excerpta Medica Abstract Journals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

IRL Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

On-Line Connect Hour Rates for Selected Health-Related Data Bases, Spring 1982, . . . . . 40

BRS: Selected Health-Related Data Bases Available On-Line, March 1982 . . . . . . . . . . . . . . 41

DIALOG: Selected Health-Related Data Bases Available On-Line, April 1982 . . . . . . . . . . 43

SDC: Selected Health-Related Data Bases Available On-Line, March 1982 . . . . . . . . . . . . . 44

Selected Databases Distributed by NTIS, December 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

A-1.

A-2.

A-3.

A-4,

A-5.

A-6.

A-7.

A-8.

A-9.

c-1.

G-1.

NLM Appropriations, 1970-82, ~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

NLM Staff, Fiscal Years 1975-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Medical Library Assistance Act Authorizations and Appropriations,

Fiscal Years 1975-82. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Medical Library Assistance Act: Distribution of Funds Among Grant Programs,

Fiscal Years 1980-82. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Medical Library Assistance Act: Resource Grants, Fiscal Years 1971-82. . . . . . . . . . . . . . . 92

Medical Library Assistance Act: Training Grants, Fiscal Years 1971-82 . . . . . . . . . . . . . . . 93

Medical Library Assistance Act: Research Grants, Fiscal Years 1971-82 . . . . . . . . . . . . . . . 95

Medical Library Assistance Act: Special Scientific Project Grants, Fiscal Years 1971-82. 95

Medical Library Assistance Act: Publication Grants, Fiscal Years 1971-82. . . . . . . . . . . . . 96

MEDLINE’s Coverage of Selected Topics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108

ERIC Clearinghouses and Operating Organizations, 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

I-1. Foreign Centers’ Access to MEDLARS, March 1982 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

. . . Vill
List of Figures

List of Figures Page

l. MEDLARS: Number of Domestic and Foreign Institutions On-Line, 1971-81 . . . . . . . . . . . 18

2. MEDLARS: Percent of Searches and Connect Hours by User Categories,

Fiscal Year 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

3. MEDLARS: Use of MEDLINE and HEALTH On-Line Data Bases by Connect Hours

by User Categories, Fiscal Year 1981 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

4. MEDLARS: Number of On-Line Searches Performed, 1972-81 . . . . . . . . . . . . . . . . . . . . . . . . 20

A-l. National Library of Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

A-2. Representative NLM Services, 1970-81 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

A-3. Medical Library Assistance Act Appropriations and Regional Medical Library Program

Budget Current and Constant Dollars, Fiscal Years 1971-81 . . . . . . . . . . . . . . . . . . . . . . . . . 90

A-4. Distribution of Resource Grants, Fiscal Years 1971-78 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92

ix
Chapter 1

Introduction and Background
Chapter 1

Introduction and Background

The significance of information to society is becoming increasingly apparent with advances in

technology. Most nations today realize that they

must be able to obtain and efficiently process information vital to national life. They must especially be able to do this with respect to health information. The transfer of scientific information

to researchers who require it in the conduct of

their investigations and to practitioners of health

care is essential for the health of the American

people.

The National Library of Medicine (NLM, or the

Library) is the Nation’s—and in many respects the

world’ s—principal resource for the collection, organization, and retrieval of scientific literature in

the health and biomedical fields. Its efforts complement the Nation’s investment in biomedical

and other health-related research, and in medical

education. NLM’s purpose, as expressed in the National Library of Medicine Act (Public Law

84-941), is “to assist the advancement of medical

and related sciences, and to aid the dissemination

and exchange of scientific and other information

important to the progress of medicine and to the

public health.”

NLM is a complex organization that performs

diverse and far-reaching activities, extending well

beyond what is customarily considered as traditional librarianship. (See app. A for a description

of NLM, including its organization, appropriations and staffing, and intramural and extramural

activities. ) It has funded grant programs that have

enhanced the collections of academic health center

and community hospital libraries, promoted library consortia, and supported the research and

development of computer applications to medicine as well as to information science. The Library

has also supported the development of a national

system of regional medical libraries, which links

NLM and local libraries.

HISTORY, OBJECTIVES, AND SCOPE OF THE STUDY

Two congressional requests to OTA prompted

this study. While expressing different concerns,

the two are complementary. The first request was

part of a larger request from the House Interstate

and Foreign Commerce Committee for a study addressing the techniques and methods available for

assessing medical technologies. * The committee

specifically asked OTA to examine the performance of MEDLARS, particularly the performance

of its major biomedical data base MEDLINE, in

disseminating health-related bibliographic information. * * The second request, from the Sen-

*See OTA’S study Strategies for Medical Technology Assessment

(117).

● *Since the inception of NLM’s computerized system, the terms

MEDLARS and MEDLINE have had a number of definitions. The

most recent definitions and those used throughout this technical

memorandum follow. MEDLARS (Medical Literature Analysis and

Retrieval System), NLM’s computerized retrieval and technical processing system, is a complex IBM multiprocessing system that maintains data files, provides on-line retrieval services and produces computer-photocomposed publications. MEDLINE (MEDLARS on-line)

is the largest and most extensively used of NLM’s data bases.

ate Labor and Human Resources Committee, resulted from interest in issues raised in an OTA

staff paper on NLM and from hearings on reauthorization of the Medical Library Assistance

Act held in April 1981. It asked that OTA explore

the Government’s role in the creation and the distribution of health-related information by means

of computerized bibliographic retrieval systems.

Thus, this technical memorandum has two objectives. The major objective is to examine NLM’s

role in the creation and distribution of computerized health-related bibliographic information in

light of the private sector’s presence in this field

and the public interest. NLM’s role with respect

to the transfer of bibliographic information is not

a unique issue, but is part of a growing concern

and discussion about the Government’s role in the

creation and the dissemination of all types and

forms of information. * —

*This issue is but one of many national and international policy

issues. App. B provides a contextual setting for the specific infor-

(continued on next page)

3
4

The second objective, which stems from the

House Interstate and Foreign Commerce Committee request, is to examine MEDLARS’ effectiveness

in disseminating bibliographic health-related information. Part of the response to that request

is contained in the OTA staff paper “The National

Library of Medicine” (116) and in the OTA report

Strategies for Medical Technology Assessment

(117). This technical memorandum analyzes three

(continued from p. 3)

mation policy issues of interest by briefly reviewing the history, current standing, and future prospects of domestic information policy

and describing the relationship between domestic and international

information policy.

BACKGROUND FOR THE STUDY

One of the mandated functions of NLM is the

collection and preservation of health-related

primary library materials, such as books, periodicals, prints, films, and recordings. Another mandated function is to organize the primary literature

and publish and make available indexes, catalogs,

and bibliographies—i.e., secondary literature—in

order to locate relevant primary literature.

Although both the public and private sectors

have a long history of providing bibliographic

biomedical information products and services— .

secondary literature—the Library of the

Office of the Army’s Surgeon General, the forerunner of NLM, began the first printed index to

the biomedical literature in 1879 with Index

Medicus. The index, which primarily contains

references to published journal articles, was

prepared manually until 1964, when MEDLARS

mechanized the processing and printing functions.

The index records were put into machine-readable

form, thereby expediting the production of the

printed Index Medicus and making these records

usable as a machine-readable data base. Thus, in

1964, NLM started the first large-scale, computerbased, retrospective search service available to the

general public. In 1966, as a result of research in

both the public and private sectors, Lockheed Information Systems (now DIALOG Information

Services, Inc.), a commercial firm, made available

system relevant issues: 1) the subject content of

the literature cited in the MEDLARS data bases,

in particular MEDLINE; 2) the coverage of the

nonserial literature in the MEDLARS data bases,

in particular MEDLINE; and 3) the evaluation of

the methodology and statistics used in the literature cited in the MEDLARS data bases. OTA

was not requested to, and has not attempted to,

analyze the effectiveness of private sector computerized bibliographic health-related information

products and services. Nonetheless, the issue of

assessing the adequacy of methodological design

and statistical analysis in cited literature pertains

to all health-related data bases.

the first on-line search service on a regular production basis. *

Today, the data tape used for the printing of

Index Medicus and other NLM printed publications is also used as the source of data for the data

base MEDLINE. Subsets of the MEDLINE data

base are incorporated into some of the other data

bases that are now available on-line at NLM. In

addition to producing data bases and data base

products, NLM now provides direct on-line machine searching of the contents of the data bases

to the information and health communities. The

Library is connected by a complex telecommunications network to more than 1,800 terminals in

institutions in the United States and abroad. It also

leases tapes of its data bases to two commercial

U.S. firms which disseminate the information online from their computer to their customers. Organizations in a number of foreign countries also

lease some of the data bases.

Worldwide, Index Medicus has been the

primary means for access to medical information

for more than 100 years. In the past 17 years,

MEDLARS has likewise achieved an impressive

● With on-line access, a person at a computer terminal can carry

on a dialog with the computer and direct it to locate information,

retrieve it, and provide it either at the terminal or in printed form

for mailing to the requestor.
5

reputation. By providing on-line access to its

bibliographic data bases, MEDLARS has made

NLM’s resources more accessible operationally

and geographically to almost all segments of the

biomedical community. Furthermore, NLM has

sought to maintain a coverage of the biomedical

literature that includes subjects of current interest,

and the Library now serves a diverse constituency including many health science disciplines outside of traditional medicine.

There are, however, two current issues that

challenge NLM and MEDLARS. One issue is how

to establish a suitable equilibrium between

MEDLARS and the changing needs of its users.

Although the scope of MEDLARS data bases is

limited, the quantity of knowledge in traditional

biomedical subjects is increasing. Furthermore,

much current biomedical research is interdisciplinary, and the present concept of health is broad

and information pertaining to health can be found

in journals in fields such as law and economics

that are historically not the Library’s province.

Moreover, health-related information is often

found in a form, such as technical reports and

speeches, that is not cited in MEDLINE.

The expansion of the biomedical literature base

has been accompanied by rapid progress in the

application of computer and communications

technologies to information systems, and a

tremendous increase in the volume and ease with

which information can be accessed. In order to

assist the selection process for the health professional who uses the information that is retrieved

and to provide a modicum of quality control, the

scientific merit of literary material requires more

and more scrutiny. One suggestion is that data

base producers such as NLM assume some of the

responsibility for assessing the evaluative

methodology and statistical analysis used in the

documents cited in bibliographic data bases.

The problem of accommodating user needs and

MEDLARS’ limitations is compounded because

of the lack of comprehensive data on MEDLARS

users. Although there is information available on

the location of the terminals with access to

MEDLARS by type of institution, information on

the ultimate users of the information is sparse and

insufficient for defining specific segments of the

user population. (System issues are discussed in

ch. 3.)

The second and more pressing problem facing

NLM is its role in the creation and distribution

of computerized health-related bibliographic information through MEDLARS. Not only NLM

but for-profit and not-for-profit organizations in

the private sector create health-related bibliographic data bases; such organizations include

BIOSIS (formerly Biosciences Information Service), Excerpta Medica, Information Retrieval,

Ltd., and the Institute for Scientific Information.

In addition, biomedical data bases produced by

both the public and private sectors are vended by

three commercial organizations—Bibliographic

Retrieval Services, DIALOG Information Services, Inc., and System Development Corp. Nonetheless, health-related computerized bibliographic

information is predominantly created and disseminated by NLM through MEDLARS. At issue is

whether NLM’s computerized bibliographic products and services and the products and services

of the private sector substitute for or complement

each other and whether NLM’s leading portion

in the biomedical information field is hindering

the growth of the private information sector.

Some members of the information community, and some members of the commercial sector

of the private information industry, have become

increasingly concerned about NLM’s dominant

role in the field. Because the industry is

heterogeneous and composed of a variety of firms,

it does not have one position regarding all of

NLM’s computerized bibliographic activities. Individual firms have particular opinions about

NLM’s activities depending on their perspectives.

Overall, the industry’s concerns are with respect

to NLM’s preparation of computerized bibliographic health-related data bases, NLM’s charges

to commercial information services and foreign

centers for leasing the data tapes, NLM’s provision of direct on-line access to its data bases, and

NLM’s pricing of direct on-line access to the data

bases. NLM’s pricing of access appears to be the

issue of paramount concern at this time. For the

most part, prices are significantly lower than those

charged by the private sector for access to healthrelated bibliographic information. (These issues

are discussed in ch. 6.)
6

Historically, public policy has held that NLM’s

position in the creation and dissemination of

health-related bibliographic information is in the

best interests of the public’s health and well-being.

Policy concerning the Library has been closely tied

to biomedical research policy. The political environment in this regard appears to be changing.

Although Government-sponsored biomedical research still appears to be of major interest, recent

announcements from the Office of Management

and Budget stress the importance of increased

private participation in Government information

activities and the need for “full cost recovery”

(undefined) of Government-sponsored information products and services. The Library’s role in

providing computerized health-related bibliographic information may be reduced if such suggestions are implemented.

This OTA analysis focuses on current NLM

issues as they relate to national information

policy. These issues have direct importance for

institutional and individual users of health-related

bibliographic data bases, NLM, private sector

producers of health-related data bases, and private

information retrieval services (vendors). The

issues are also significant for foreign data base

producers and information retrieval services, both

governmental and private, and for foreign institutional and individual users of health-related bibliographic data bases. Because the issues are

similar to those concerning other Federal information activities, their resolution also has implications for Federal and non-Federal organizations

that create and distribute Government-sponsored

information, private sector information enterprises, foreign information organizations, and all

users of Government-sponsored information.

This report’s emphasis on current issues of

necessity gives inadequate attention to the future

ORGANIZATION OF THE REPORT

Chapter 2 describes the development, current

status and future plans for MEDLARS’ data bases

and on-line services. System issues related to the

effectiveness of MEDLARS in disseminating bibeffects of new and emerging technologies on biomedical bibliographic retrieval systems. Current

issues result in part from technologies now in use.

Evolving computer and communications technologies are still only in the early stages of development, and indications are that they will be much

more powerful and varied in the future. With expected dramatic changes in data base creation and

access, some current issues may diminish in importance or disappear, and quite different ones

may arise and require consideration.

But it is not possible to know with any degree

of certainty which technologies will be adopted

and which issues will become significant. Social,

political, and economic forces, as well as technological forces, are instrumental in determining the

development and utilization of any innovation.

Indeed, the way decisions are made about current issues may affect which new and emerging

technologies are implemented. This underscores

the need for flexibility in public policy.

There are indications that in the future there

will be more distributive means of disseminating

information than are utilized at present. * Indeed,

NLM administrators think that the technologies

will be available in the next 5 to 7 years; they are

making long-range plans in line with this thinking. Currently, NLM is experimenting with making one of its data bases available for distributive

searching in 1 or 2 years. Thus, future technologies and their possible effects on biomedical bibliographic retrieval systems are discussed briefly

in this study (see app. H).

*A distributive data-processing system is one which uses multiple small computers to process all or portions of a data base. The

small computers can be widely separated and may be linked by telecommunications lines to each other and to a large computer.

Idiographic health-related information are discussed

in chapter 3. Chapter 4 is a brief description of

private sector health-related data bases and commercial information services. The next chapter,
7

chapter 5, discusses the considerations underly- ucts and services. That chapter also considers the

ing the current debate on the appropriate role of effect of new technologies on present issues. There

the Government in information transfer. Final- are 11 appendixes included—both for reference

ly, chapter 6 analyzes the domestic and interna- and, in some cases, for expanding ideas and issues

tional implications of changing the range and pric- contained within the body of this report.

ing structure of MEDLARS computerized prod98-76L O - 82 - 2
Chapter 2

MEDLARS
Chapter 2

MEDLARS

INTRODUCTION*

The dramatic rise in the number and types of

biomedical primary publications, such as books,

journals, and technical reports, often makes direct

access to this literature difficult and confusing. Increasingly, secondary publications, including indexes, bibliographies, abstracts, and catalogs,

serve as important elements in information transfer by directing users to primary sources. Development and use of computerized bibliographic information systems have further facilitated access

to the growing body of primary health-related information publications.

The National Library of Medicine (NLM or the

Library) has been in the forefront of this field and

*Information in this chapter was obtained primarily from NLM

staff and NLM publications.

DEVELOPMENT OF MEDLARS

The development of MEDLARS parallels the

evolution in medical bibliography that began in

the 1950’s with the first attempt to apply computer technologies to information processing. (See

app. D for a general description of the development of computerized biomedical bibliographic

retrieval systems. ) The system’s first data base,

MEDLINE, was a byproduct of the computerized

production of the printed Index Medicus. One of

the earliest accomplishments of NLM’s predecessor, the Library of the Army’s Surgeon General, is attributed to John Shaw Billings and

Robert Fletcher, who together began the first

monthly index of the world’s periodical medical

literature in 1879 (74).

The early history of Index Medicus was marked

by severe financial deficits, frequent changes in

sponsorship, and the commitment of a few dedicated individuals and organizations. The Army

Medical Museum and Library, the successor to

the Surgeon General’s Library, struggled to keep

the index afloat despite financial problems until

pioneered the “first large-scale library-based reference retrieval system” for health-related information (34). Since its inception, MEDLARS has

become more sophisticated, accessible, and inclusive; and MEDLARS II, the Library’s current system, is utilized more than any other system by

health communities in the United States and

abroad.

This chapter describes the development of

MEDLARS, its current operations, and its projected future operations, providing information

for the discussion of system issues in chapter 3

and for the analysis of public/private issues in

chapter 6. As requested by Congress, the primary

focus of the discussion is on MEDLINE,

MEDLARS’S major biomedical bibliographic data

base.

1899, when the publication failed. It was then revived for 3 years as Bibliographic Medica by a

group of French physicians. In 1903, the Carnegie

Foundation undertook its financial sponsorship,

with Fletcher as chief editor. In 1927, Index

Medicus was merged with a similar index produced by the American Medical Association, and

its circulation quickly increased sixfold, though

it continued to lose $25,000 to $50,000 annually.

In 1960, NLM assumed responsibility for publishing Index Medicus monthly, and the American

Medical Association began the annual Cumulated

lndex Medicus (CIM). In 1965, with the advent

of computer applications to publishing, the American Medical Association turned CIM over to

NLM (74).

lndex Medicus continues to provide physicians

and other health professionals the major access

to biomedical literature worldwide (142). Published monthly, lndex Medicus cites articles from

2,600 biomedical periodicals published in 36 languages. NLM endeavors to include references to

11
12

published articles in periodicals “judged to be of

greatest potential use to the international biomedical community” (35). In 1879, Billings’ and

Fletcher’s index cited some 20,000 articles. One

hundred years later, Index Medicus adds citations

of about 220,000 articles annually, and about

6,000 biomedical institutions subscribe to it each

year (36).

By the late 1950’s, NLM recognized that the exponential growth in biomedical literature required

revision of the manual procedures for preparing

Index Medicus and other publications. With the

aid of a $73,800 grant from the Council on Library

Resources in 1960, the Library developed a mechanized process that improved the method of preparing citations for publication.

In 1964, a true computerized system,

MEDLARS, was put in place. The system was

developed between August 1961 and December

1963, by the General Electric Corp., under contract to NLM. MEDLARS cost $3 million, some

of which was supplied, at the recommendation

of the National Advisory Heart Council, by the

National Heart Institute. The new system improved the quality of the printed Index Medicus,

enlarged its size, and decreased the time required

for its printing by using the first computer-driven

photocomposing device, Graphic Arts Composing Equipment (GRACE). The research and development of GRACE by the Photon Corp. was

sponsored by NLM. The new technology represented a significant advance in the technology of

computer typesetting (3). It also allowed for an

increase in the number of articles that could be

included in Index Medicus and in the number of

subject terms assigned to each article. A module

supporting the production of NLM’s published

catalog and its catalog cards was added in 1965.

MEDLARS was used to produce all of NLM’s publications from 1964 to 1975.

It was evident to NLM that the data base prepared for lndex Medicus could be used for

machine searching. In 1964, therefore, the Library

began a batch computer operation. Users of

MEDLARS would telephone, mail their requests,

or make personal visits to the Library and other

selected sites, and trained search analysts would

access the system for the designated information.

However, there was no direct interaction between

the searchers and the computer, the process was

expensive, and the time between the submission

of a request and receipt of the resulting bibliography ranged from 3 to 6 weeks.

In 1968, NLM began planning a more advanced, on-line automated support system to create new files and allow on-line formulation of

searches. The specification and test of the logic

of the search was to be done on-line, but the actual searching were to be done later in the batch

mode. Meanwhile, in cooperation with the System

Development Corp. (SDC), NLM was experimenting with an on-line bibliographic retrieval

system. This system, AIM-TWX (Abridged Index

Medicus via the Teletypewriter Exchange Network), used an abridged data base consisting of

5 years of citations from the 100 most important

English-language journals in clinical medicine. The

system became operational in May 1970, and was

so successful that by November of the same year

over 80 institutions were using it. AIM-TWX ran

on SDC’s IBM 360/67 computer. Telecommunications enabling remote access were provided via

the TWX network (then part of the American

Telephone & Telegraph Co. but subsequently

transferred to the Western Union Corp.).

But the new MEDLARS, MEDLARS II, took

more than 6 years to be completed. The original

contractor could not fulfill its obligations, and a

contract was negotiated with SDC. As an intermediate solution, SDC merged the old MEDLARS

I with the already successful on-line retrieval system AIM-TWX and put MEDLINE

(MEDLARS On-line) service in place in October

1971. * Because the communications facilities provided via the TWX network were disproportionately high in cost, NLM contracted with Tymshare, Inc., in 1971, to provide data communications services for MEDLINE. The MEDLINE data

base included citations from 1,000 to 1,200 journals for the current year and the previous 3 years.

The completely new MEDLARS II, which finally

became operational in January 1975, is the system

now in place. The computer was successfully connected to TYMNET, a telecommunications network, in 1977.

*Currently, the term MEDLINE is mainly used to describe the

data base and not the service.
CURRENT STATUS OF MEDLARS

NLM is continuously refining MEDLARS II to

extend its capabilities. The system has evolved

into a complex multiprocessing system that maintains data files, provides on-line retrieval services,

and produces computer-photocomposed publications. The main computer facility is located in the

NLM building in Bethesda, Md.; a second facility for processing searches is at the State University of New York (SUNY), Albany. In September

1980, NLM enlarged its computer capacity twofold with the transfer of an IBM 370/168 multiprocessor system from the National Institutes of

Health’s (NIH) Division of Computer Research

and Technology.

Commercial firms and the Government cooperate in providing telecommunications to NLM’s

computerized data bases through a “complex arrangement of lease lines, public dial-up switched

circuits, commercial telecommunications networks, and the U.S. Government-sponsored research network (ARPANET)” (134). TELENET

and TYMNET are the principal commercial networks and carry 80 percent of the on-line traffic.

Data Bases

General Description

MEDLARS II contains almost 20 data bases.

The machine-readable data tape that is the source

of data for MEDLINE is used to produce Index

Medicus and other publications including the

Abridged Index Medicus, Health Science Serials,

National Library of Medicine Audiovisuals Catalog, lists of citations in specialized biomedical

fields (termed recurring bibliographies), and individual bibliographic searches considered to be

of general interest. Table 1 lists the scope and date

of initiation of NLM’s current on-line data bases.

Most of the data bases, like MEDLINE, are bibliographic, and contain references to the primary

journal literature (monographs, serials, etc.); a

few contain numeric or representational information.

Some of the data bases–MEDLINE, CATLINE,

AVLINE, HISTLINE, SERLINE, and SDILINE–

are created and maintained solely by NLM.

Table 1 .—NLM Data Bases, Fiscal Year 1981

Data base and scope Date initiated

AVLINE (AudioVisuals on-Line) —citations and

abstracts to about 10,000 health science

audio-visuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . February 1976

BIOETHICS LINE (Bioethics on- Line)— 13,000

references to materials on bioethical topics . March 1978

CANCERLIT (Cancer Literature) –285,000

references dealing with various aspects

of cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . July 1974

CANCERPROJ (Cancer research PROJects)—

20,000 descriptions of ongoing cancer

research projects . . . . . . . . . . . . . . . . . . . . . November 1975

CATLINE (CATalog on-LINE)-300,000

references to books and serials cataloged at

NLM since 1965 . . . . . . . . . . . . . . . . . . . . . . . . . . . September 1973

CHEMLINE (CHEMical dictionary on-LINE)–

a file of some 1,000,000 names for chemical

substances, representing 500,000 unique

compounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . May 1974

CLINPROT (CLINical cancer PROTocols)—

summaries of clinical investigations of new

anticancer agents and treatment techniques . . February 1976

EPILEPSY LINE (EPILEP’SY on-LINE)—contains

about 25,000 references and abstracts to

articles on epilepsy . . . . . . . . . . . . . . . . . . . . . . . . January 1976

HEALTH (HEALTH Planning and

Administration) —contains about 200,000

references to literature on health planning,

organization, financing, management,

manpower, and related subjects . . . . . . . . . . . . November 1978

HISTLINE (HISTory of Medicine on-LINE)–

some 48,000 references to articles,

monographs, symposia, and other publications

dealing with the history of medicine and

related sciences . . . . . . . . . . . . . . . . . August 1978

MEDLEARN—computer-assisted instruction

program which teaches the novice user

how to search the NLM on-line system . . . . . . . November 1976

MEDLINE (MEDLARS on-LINE) –600,000

references to biomedical journal articles

published in the current and 2 preceding

years. An English abstract, if published with

the article, is frequently included . . . . . . . . . . . . October 1971

Back files that total some 2,700,000 references

MED 66. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . November 1975

MED 69. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . December 1974

MED 72 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . May 1975

MED 75. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . December 1977

On-line

MED 77. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . December 1979

MED 79. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . December 1981

MeSH Vocabulary File (Medical Subject

Headings Vocabulary File)—an on-line

vocabulary file of the 14,000 medical subject

headings that are used for subject cataloging,

and also approximately 20,000 chemical

records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . April 1974

NAF (Name Authority file) -an authority list of

125,000 personal names, series names,

corporate names and series decision

records . . . . . . . . . . . . . . . . . . . . . . September 1973

POPLINE (POPulation information on-LINE)–

about 80,000 citations and abstracts to

journal articles, monographs, and technical

reports in the field of population. . . . . . . . . . March 1980
14

Table 1 .—NLM Data Bases,

Fiscal Year 1981 —continued

Center for Population and Family Health at Columbia University. And RTECS is an on-line

Data base and scope Date initiated

RTECS (Registry of Toxic Effects of Chemical

Substances)—an annual compilation of

toxicity data for approximately 50,000

substances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . July 1977

SDILINE (Selective Dissemination of

Information on-LINE)-references to the

most current month of MEDLINE of

approximately 20,000 citations. . . . . . . . . . . . . . . October 1972

SERLINE (SERials on-LINE’)-bibliographic

information for about 38,000 serial titles,

including all journals which are on order or

cataloged for the NLM collection . . . . . . . . . . . . November 1977

TDB (Toxicology Data Bank) —contains chemical,

pharmacological, and toxicological

information and data on approximately

3,500 substances . . . . . . . . . . . . . . . . . . . . . . . . . . July 1977

TOXLINE (Toxicology Information on-LINE)–

a collection of about 600,000 references from

the last 6 years on published human and

animal toxicity studies, effects of

environmental chemicals and pollutants and

adverse drug reactions . . . . . . . . . . . . . . . . . . . . . April 1974

Contains 660,000 references to older materials

TOXBACK 65 ...., . . . . . . . . . . . . . . . . . . . . . . . . . . . September 1980

TOXBACK 74—on-line . . . . . . . . . . . . . . . . . . . . . . . . September 1980

SOURCE: National Library of Medicine.

MEDLEARN, MeSH and NAF, which are basically support files, are also products of the Library. The other data bases are supported or produced in collaboration with various institutions.

BIOETHICSLINE is produced in cooperation with

the Kennedy Institute of Ethics, Center for Bioethics at Georgetown University. CANCERLIT,

CANCERPROJ, and CLINPROT are sponsored

by the National Cancer Institute of NIH.

HEALTH is produced in cooperation with the

American Hospital Association and the Health

Resources Administration. POPLINE is produced

in cooperation with the Population Information

Program of Johns Hopkins University and the

Table 2.—NLM Data Bases and

searchable version of a publication prepared by

the National Institute for Occupational Safety and

Health. CHEMLINE is created by NLM’s Toxicology Information Program in collaboration with

Chemical Abstracts Service. TOXLINE contains

secondary information from Chemical Abstracts

Service, BIOSIS (formerly Biosciences Information Service), the American Society of Hospital

Pharmacists, the Environmental Protection Agency, Oak Ridge National Laboratory, the now

defunct Smithsonian Science Information Exchange (SSIE) data base, the Hayes File on Pesticides, and a Toxicity Bibliography produced by

NLM. *

MEDLINE

MEDLINE, with its related back files (MEDLINE

from 1966 to 1977), is the largest data base in

MEDLARS and is, by far, the most extensively

used (see tables 2 and 3). The literature indexed

for MEDLINE contains not only information on

the science and practice of medicine and public

health, but also on bioengineering, bioethics, and

● At this writing, May 1982, NLM offers EPILEPSYLINE, a bibliographic data base produced by the National Institute of Neurological

and Communicative Disorders and Stroke (NINCDS) of NIH from

abstracts generated by the private firm, Excerpta Medica. Excerpta

Medica provides NINCDS with computer tapes under a contract,

at the cost of the tape. The data base is expected to be available

through Bibliographic Retrieval Services (BRS) in the very near

future, and thereafter will no longer be accessible through NLM.

Use of EPILEPSYLINE is funded by NINCDS, and is rather low

(fewer than 40 hours per month on average). Both NINCDS and

NLM believe the data base will find a larger audience through BRS

(159).

Updates, Fiscal Year 1981

Average number of

Total records at records added Frequency of

Data base data basea

per update updating

MEDLINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 638,374 22,000 Monthly

On-line and backfiles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,631,463

TOXLINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562,130 12,800 Monthly

On-line and backfiles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,225,013

CHEMLINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 506,271 7,300 Every 2 months

CATLINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333,800 260 Weekly

CANCERLIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269,672 3,100 Monthly

HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186,999 2,500 Monthly

aDoe~ not inCludethe 116,u0 retrospective records added JUIY to September 1981,

SOURCE: National Library of Medicine.
15

Table 3.—MEDLARS: Usage of NLM Data Bases

During September 1981

Data base Number of hours

MEDLINE . . . . . . . . . . . . . . . . . . . . . . . . . 5,565

MED 77. . . . . . . . . . . . . . . . . . . . . . . . . . . 968

CATLINE . . . . . . . . . . . . . . . . . . . . . . . . . 919

TOXLINE . . . . . . . . . . . . . . . . . . . . . . . . . 826

CANCERLIT . . . . . . . . . . . . . . . . . . . . . . . 398

MEDLEARN . . . . . . . . . . . . . . . . . . . . . . . 389

HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . 318

CHEMLINE . . . . . . . . . . . . . . . . . . . . . . . . 285

SERLINE . . . . . . . . . . . . . . . . . . . . . . . . . 162

POPLINE . . . . . . . . . . . . . . . . . . . . . . . . . 161

TAB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160

SDILINE . . . . . . . . . . . . . . . . . . . . . . . . . . 149

AVLINE . . . . . . . . . . . . . . . . . . . . . . . . . . . 137

RTECS . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

MeSH VOCABULARY. . . . . . . . . . . . . . . 86

TOXBACK 74.... . . . . . . . . . . . . . . . . . . 70

NAME AUTHORITY . . . . . . . . . . . . . . . . 42

HISTLINE . . . . . . . . . . . . . . . . . . . . . . . . . 38

EPILEPSY . . . . . . . . . . . . . . . . . . . . . . . . . 34

BIOETHICSLINE . . . . . . . . . . . . . . . . . . . 31

CANCERPROJ . . . . . . . . . . . . . . . . . . . . . 31

CLINPROT . . . . . . . . . . . . . . . . . . . . . . . . 17

STORESEARCH . . . . . . . . . . . . . . . . . . . 2

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,882

SOURCE: National Library of Medicine

many other health-related disciplines. The intent

is to provide references to the most useful biomedical literature from the most significant biomedical

journals. Author abstracts are included for about

47 percent of the articles cited. Literature selection, thesaurus maintenance, and indexing are

three MEDLINE-related activities that require subject matter knowledge. MEDLINE’s ability to provide relevant bibliographic references depends on

the performance of these activities.

Literature Selection.—Literature selection is

used as a quality filter for the indexed biomedical

literature database. About 95 percent of the citations in MEDLINE are those selected for the

printed Index Medicus; the remaining 5 percent

include citations from the Index to Dental Literature, the Internatiortal Nursing Index, and a limited number of nonserial publications. Although

NLM chooses which journals are to be indexed

for Index Medicus it has no formal influence on

journal selection for the other indexes.

The selection process is highly structured and

involves a critical review of the literature by a

panel of expert consultants. Journals preselected

on the basis of scientific merit and relevance to

NLM objectives. The number of serials indexed

for Index Medicus is low in relation to the

Library’s collection: only 2,664 of the more than

20,000 serials collectedly the Library were indexed in 1981; the number of articles indexed that

same year was 273,750. (See app. E for a comprehensive discussion of literature selection.)

Medical Subject Headings (MeSH).-Central to

the development of MEDLINE is its controlled vocabulary, MeSH, a list of subject headings consisting of over 14,000 terms used in the indexing

process to characterize an article’s content. One

way to retrieve citations to articles in Index

Medicus and MEDLINE is by using these terms.

Catalogers also use the MeSH terms to catalog

books and other documents in NLM’s collection.

AVLINE, BIOETHICS, CATLINE, HEALTH,

MeSH, POPLINE, and SDILINE are also “MeSH”-

searchable data bases.

MeSH is arranged alphabetically and categorically. The 15 categories are subdivided, and arranged in a hierarchical manner, to show relationships between broader and narrower terms. The

terms are constantly being updated to reflect

changes in knowledge and practice. As of 1981,

there were 9,OOO major terms and 5,OOO minor

terms in the MeSH terminology. Both major and

minor terms are used to describe articles cited in

MEDLINE: only major descriptors are used to

describe articles in Index Medicus. When an indexer assigns a minor descriptor for on-line

searching in MEDLINE, the computer assigns the

appropriate major descriptor under which the

citation will appear in lndex Medicus. The MeSH

vocabulary is also used by catalogers in libraries

throughout the world as subject descriptors for

books and monographs.

MEDLINE can be searched not only by the controlled MeSH vocabulary, but also by using any

word contained in the title of an article, or in the

abstract when included. (For a full description of

MeSH, see app. E.)

Indexing. -Subject indexing is a disciplined, intellectually demanding activity that requires consistency and accuracy in assigning subject headings to articles. In part, the effectiveness and reliability of a bibliographic retrieval system are built

on the reliability of its data bases, which is deter-
mined by the indexing quality of its records. Indexers assign MeSH headings to describe an article’s contents (indexing) on the basis of their orientation, training and judgment of the article’s major

and minor points and the headings’ congruence

with the subjects discussed in the article. They

may modify the MeSH headings with one or more

subheadings.

An article may be indexed exhaustively (indepth) and assigned about 10 MeSH terms, or not

exhaustively (nondepth) and assigned approximately 5 MeSH terms, depending on the length

and content of the article. All the articles in most

of the journals covered by Index Medicus are indexed. In some journals, however, only selected

articles are indexed; that is, since some journals

carry health-related articles only occasionally,

indexers are instructed to scan these journals and

index only relevant articles.

Articles are indexed not only by NLM staff, but

also by commercial contractors and by centers in

foreign countries with which NLM has quid pro

quo bilateral agreements. (See app. A for a more

complete description of NLM’s international activities. ) Of the 273,000 articles indexed for Index

Medicus in fiscal year 1981, NLM staff indexed

70,000 (26 percent), four U.S. commercial contractors indexed 52,000 (19 percent), foreign centers indexed 28,000 (10 percent) and U.S. commercial contractors indexed 123,000 (45 percent) for

the foreign centers. Initially, all of the foreign

centers did their own indexing. Currently, centers

in the United Kingdom, France, Sweden, West

Germany, South Africa, and the Pan American

Health Organization Library in Brazil all have indexers on their staffs.

NLM exercises a considerable degree of quality control over the indexing process. In addition

to requiring high educational standards for indexers, it provides them with a formal training course

and continuous contact with able and experienced

indexers, NLM revisors, who monitor the proficiency of all indexers. The Library also periodically updates training, and employs computerized

validation routines and proofreading at a number

of stages during the indexing process. (See app.

E for a technical description of indexing. )

Leasing

NLM leases 12 of its data bases through the National Technical Information Service (NTIS) of

the Department of Commerce. Payments from

these leases are turned over to the U.S. Treasury

after NTIS deducts a brokerage fee. As of January

1982, Bibliographic Retrieval Services (BRS) and

DIALOG Information Services, Inc. (DIALOG)

had signed such agreements with the Library.

Until January 1982, the MEDLINE tape was leased

to a subscriber at $50,000 for the first year and

$30,000 for each subsequent year. Other MEDLARS

data tapes were leased at different fee levels. NLM

has established the leasing charges and arranged

for and negotiated the agreements. NTIS, which

acts as an accounting broker, receives payments

from the leases and returns these revenues to the

U.S. Treasury after taking a 10-percent brokerage fee; in the case of some data files such as

CHEMLINE, NTIS pays royalties to the organizations that compile some of or all of the data file.

As of January 1982, the MEDLINE data base

tape is leased on a fixed fee plus a use fee basis. There is a use fee of $4.00 per on-line connect hour and $0.01 per off-line printed citation

for MEDLINE and MEDLINE back files, with a

minimum fee of $20,000. After the $20,000 minimum is met, the use fees of $4.00 per on-line connect hour and $0.01 per off-line printed citation

continue in effect. NTIS continues to serve as

NLM’s broker.

On-Line Services Users and Uses

In fiscal year 1981, NLM conducted over 2

million on-line searches, fully one-third of all such

searches performed in the United States (165). In

fiscal year 1977, 754 domestic institutions had

direct access to MEDLARS. By 1981, this figure

had grown to almost 1,550 domestic on-line centers. Users now include the major medical school

libraries, over 700 hospital libraries, and libraries

in pharmaceutical and other commercial firms (see

table 4) and centers in 13 foreign countries. In all,

there are more than 1,890 domestic and foreign

institutions with direct access to NLM’s data bases
17

Table 4.—MEDLARS: Number of Domestic Institutions On-Line by Region and Type, September 1981

Type of Institution

Other Foundation

Medical Allied university Other Hospital/ Society Information

Region school health college library clinic Research Association Commercial agency Other Total

01 9 3 2 1 45 3 0 21 0 2 86

02 14 7 7 3 55 13 4 82 4 2 191

03 7 5 1 1 35 8 3 28 3 2 93

04 15 4 4 5 51 57 10 44 11 16 217

05 7 5 4 0 104 7 3 35 1 5 175

06 17 10 9 2 52 8 2 12 1 2 115

07 14 9 8 2 95 4 9 36 4 0 181

08 10 8 4 1 54 4 3 15 0 3 102

09 14 10 5 0 43 7 4 19 3 3 108

10 2 4 3 3 37 5 2 2 0 2 60

11 12 5 10 2 113 11 5 34 10 7 209

Total 125 70 57 20 684 127 45 328 37 44 1,537

September 1979a

Total 120 NA 91 NA 400 93 NA 273 NA 34 1,011

(see fig. 1). Many other institutions, including

3,OOO to 4,OOO hospital libraries in the United

States, provide indirect access to MEDLARS by

referring requests to facilities with on-line terminals for searching.

Although NLM does not collect data on the individual users of its services, some information

is available on institutions with direct access to

MEDLARS. In fiscal year 1981, the Library ran

2.02 million search requests. Of these, 32 percent

came from hospital on-line centers, 21 percent

from medical schools, and 12 percent from commercial firms (see fig. 2). Hospitals, more than

any other type of institution, have direct access

to MEDLARS. In 1981, they were the largest users

of MEDLARS as measured by both the number

of searches requested (32 percent) and the number

of computer connect hours (34 percent). Medical

schools ranked second, with 21 percent of searches

and 17 percent of computer connect hours. Hospitals and medical schools also ranked first and

second, respectively, in their utilization of the

MEDLINE and HEALTH data bases (see fig. 3).

There are 328 domestic commercial firms with

direct access to MEDLARS. Commercial firms are

the third highest user group in the utilization of

all MEDLARS data bases, as measured by searches performed (11 percent), and the fourth highest

when measured by number of connect hours utilized (12 percent) (see fig. 2). Ten percent of the

MEDLINE connect hours are used by commercial

firms (see fig. 3). These firms tend to use

CHEMLINE and TOXLINE more often than

MEDLINE and utilize an estimated 30 percent of

the total connect hours to TOXLINE.

There are no recent nationwide data on the ultimate users (i.e., end users) of MEDLARS data

bases. Most studies of MEDLARS users have

design limitations, are dated, or have been conducted on an institutional, local, or regional base.

They indicate that a variety of health professionals, including students, request searches for

a variety of reasons (see app. C). For example,

a survey conducted by NLM in 1975 found that

41 percent of MEDLARS end users were physicians, 19 percent were nonphysician scientists, 10

percent were librarians, 10 percent were students,

and 20 percent were reported as “other” (85). Preliminary results from a survey of hospital on-line

centers, mainly located in New England, indicate

that slightly more than one-half of search requests

are from nonphysician health providers, including

nurses, ancillary service providers, and administrators. Searches are requested to aid in providing patient care, preparing presentations and

journal articles, and planning new services and

purchasing equipment (50).
18

Figure l.—MEDLARS: Number of Domestic and Foreign Institutions On-Line, 1971=81

aFigureg d. not include users with TOXLINE file access only; therefore figures are lower than actual.

SOURCE: National Library of Medicine.

Searching and Retrieval

MEDLARS II allows for direct communication

with the computer in on-line, interactive fashion.

That is, the user can carry on a “dialog” with the

computer, refining the search by typing in successive questions until the needed references are identified. An on-line search usually takes 10 to 15

minutes. (See app. E for a description of searching methodology. )

The references can be either printed at the time

the search is entered (on-line) or printed during

the offpeak hours (off-line) and mailed to the requester from NLM or SUNY the next morning.

(Searches can also be formulated on-line and then

stored in the computer for reference and later use. )

The number of on-line searches more than doubled from 1977 to 1981 (see fig. 4).

For the most part, trained search analysts,

termed intermediary users, perform searches. Although an untrained individual can perform

searches, the current system, like most others currently in use, is not designed for it. NLM is investigating methods to make the system more cordial to users without library or information

systems training (64).

It is generally agreed that an ideal search requires that a trained searcher have a reference interview with the person requesting information
19

Figure 2.—MEDLARS: Percent of Searches and Connect Hours by User Categories, Fiscal Year 1981

Commercial

11 ”/0

Hospitals

32°10

Medical

schools /

21 “/0

Hospitals

34 ”/0

Figure 3.—MEDLARS: Use of MEDLiNE and HEALTH On-Line Data Bases by Connect Hours

by User Categories, Fiscal Year 1981

MEDLINE

Allied Health

3%

HEALTH

\

SOURCE: National Library of Medlclne
20 —.. ——. .—-. — — ——

Figure 4.—MEDLARS: Number of On-Line Searches Performed, 1972-81

1,500,000 [

1,434,539

1,400,000

1,300,000

1,200,000

1,100,000

1,000,000

900,000

800,000

700,000

600,000

500,000

400,000

300,000

200,000

100,000

0

1,250,372

288,233

662,195

498,424

1 3

1972 1973 1974 1975 1976 1977 1978 1979 1980 1981

Fiscal years

SOURCE. National Library of Medlctne

to determine the purpose of the request, the requests are conducted

sources the requester has consulted, the facets of in a wide variation in

the subject the requester wants emphasized or results.

eliminated, new terms in the field the requester

in this manner, resulting

the quality of searching

can supply, and the character and volume-of the Aggregate data on how search requests are

retrieval the requester expects. Requesters are made are not available, but there appears to be

often familiar with such information from their variation from library to library, mainly because

own experience and from previous consultation of differences in populations served. For examwith written sources. It appears that not all search pie, the New York Academy of Medicine Library
21

estimates that more than 80 percent of its searches are requested by telephone or mail. Most of

its other inquiries are by telephone. The reference

room of NLM estimates that about sO percent of

its research requests are made in person, while the

Biomedical Library at the University of California at Los Angeles, an academic health science

center library, reports that over 80 percent of its

requests are made in person.

User Training

NLM has developed an on-line training course

in MEDLARS for information specialists who act

as intermediary searchers for end users. The first

courses, held in the mid-1960’s, initially trained

analysts in batch searching techniques during a

rigorous 8-month session; this was later decreased

to 2 months. With the introduction of interactive

on-line searching in October 1971, the need for

lengthy training decreased, and the training program was shortened to 3 weeks. The current

search training program lasts only 1 week. Before

attending the formal l-week course, a searcher

must complete MEDLEARN, the Library’s computer-assisted instruction program.

The l-week training course, normally held

either at NLM or at the Regional Medical Library

in Los Angeles or Omaha, is comprehensive and

includes didactic instruction in system mechanics,

Boolean logic, search formulation, controlled

vocabulary searching, free text searching, the

scope and content of the MEDLARS data bases,

special system capabilities, as well as hands-on

experience at the terminal. The training course is

set up in a modular fashion, in order to assist

searchers who need more complex and more comprehensive training. Additional training is available after the initial class, and many searchers

return for a l-week advanced training course.

NLM also teaches abridged update/review

courses.

During fiscal year 1981, 942 search analysts

were trained in 43 initial and advanced training

classes at NLM, UCLA, the University of Nebraska, and in the field. This is more than triple the

number (254 analysts) training in 1977.

As noted previously, more than 1,890 domestic

and foreign institutions now have direct access to

MEDLARS via NLM. New institutions have been

admitted to the MEDLARS network, as computer

capacity permits, on a priority basis. Priority

standing is given to direct patient care facilities,

health professional education institutions, organizations primarily engaged in health protection

activities, and Federal and State health agencies.

As a condition of obtaining access to MEDLARS,

an organization is required to send at least one

person to attend the formal l-week initial training program. Salaries and other expenses during

training must be paid by the sponsoring organization.

In the past few years, more hospitals/clinics and

commercial institutions have obtained direct access to MEDLARS. As a result, the character of

the student population has become more heterogeneous. The original analysts were experienced

librarians from large medical schools, hospitals,

research institutions, and Federal agencies, resulting in a fairly homogeneous class. Today, the

varying levels of expertise represented in the

classes have stimulated NLM to experiment with

new training methods and curricula.

Notwithstanding the mandatory searcher training program, there is some opinion that searcher

variability may well be the weakest link in the

entire system. The MEDLARS system may be too

complex to be understood in a l-week course by

one who has little background in information systems or medicine and biology. Since there are

neither entry nor exit standards for trainees, there

is no control over the level of expertise of those

who attend the sessions. The trainees’ difficulty

is mainly in the complexity of the subject, the data

base content, and the thesaurus. NLM training

provides searchers with highly technical skills, yet

the knowledge base grows ever more complex,

and thus, so must searchers’ skills. In addition,

once a terminal is acquired by an institution or

organization, anyone can use it.

The interactive process between the searcher

and requester is critical to identifying relevant

citations in the data base. Inexperienced and poorly trained searchers cannot respond adequately

to such a need. Searchers must meet the needs of

practicing physicians who tend to use MEDLARS

to obtain information related to clinical problems.
22

These physicians, often not accomplished researchers, are also the ones most in need of guidance to ask the right questions. The critical point is

whether the searcher really understands what the

user wants. Such issues become more important

as NLM extends MEDLARS throughout the hospital community. At many places in the Nation, including the University of Virginia, a concerted effort has been made to upgrade the skills of librarians in community hospitals remote from major

medical centers and large resource libraries, so

that they may adequately conduct search interviews with physicians and forward information

requests to resource libraries.

There are some observers who suggest that

problems with retrieving information from the

system may not be particularly attributable to the

searcher, and they point to an evaluation study

of MEDLARS’ on-line process conducted in 1978-

79 (156). That study concluded that the type of

training (formal or informal) had no statistically

significant effect on search performance, and suggested that in some areas improving search effectiveness may be more a matter of system redesign

than of training or retraining. The study also

found the predominant reason searchers elected

to use one system over another was that the system they elected offered access to more of the data

bases that they needed. In addition, searchers

tended to prefer the system they had learned first.

Searchers were also influenced by the range of a

system’s capabilities.

User Services

In addition to providing search training, NLM

supports the users of MEDLARS in numerous

ways. In order to facilitate interaction between

NLM and user institutions, a professional library

staff member is assigned to a user service desk at

NLM to receive telephone calls and respond to

problems which users are having with the system.

In addition, information about the system is

transmitted to enrolled users by newsletters and

other forms of communication. When a new

MeSH is published, and when new on-line data

bases are added to MEDLARS, the regional medical libraries update the training of the searchers

in their regions. Searchers also have access to the

NLM Technical Bulletin and Users Manual and

may contact a more experienced searcher for assistance.

On-Line Access Charges

NLM began charging users in the United States

for access to its data bases in April 1973. The

prices have increased a number of times over the

years. As of January 1, 1982, computer connect

time for all data bases, except CHEMLINE,

TOXLINE, TOXBACK 65, and TOXBACK 74,

is $22.00 per hour of prime time (10:00 a.m. to

5:00 p.m. EST) and $15.00 per hour of nonprime

time. The price for printing a page of citations

off-line is $0.15. The price of CHEMLINE is

$101.00 for each hour of prime time and $94.oo

for each hour of nonprime time, with a charge

of $0.45 for each page printed off-line. TOXLINE

and its backfiles are priced at $52.00 per hour of

prime computer time and $45.00 per hour of nonprime time, with a charge of $0.35 for each page

printed off-line.

CHEMLINE, TOXLINE, TOXBACK 65, and

TOXBACK 74 are priced to include the royalty

charges paid to the organizations that provide information for them (e.g., Chemical Abstract Service, BIOSIS, and the American Society of Hospital Pharmacists). Foreign centers establish their

own rates.

NTIS serves as a collection agent for NLM. In

1980, roughly $2 million in charges were paid by

domestic user institutions in on-line access charges.

NTIS paid 70 percent of this sum to contractors

supplying NLM with telecommunication systems

and additional computer capacity; 20 percent of

the charges went for billing, collection, mailing,

and postage; 10 percent was returned to the

Treasury.
23

THE FUTURE OF MEDLARS

Current Standing

The developmental efforts of NLM that led to

MEDLARS II promoted the development of online systems by both the public and private sectors. The private sector took the opportunity and

studied the NLM system: “Tests and analyses of

the system and its use had a significant impact

on information science researchers and helped

guide their thinking along new lines” (165). NLM

had acted in the traditional role of Government

by demonstrating the application of novel and

potential technologies that require large and longterm investments not typically assumed by private

industry,

Many of the on-line information services that

were formed in the wake of NLM’s developmental efforts have since revised and expanded their

search capabilities more rapidly than NLM, and

MEDLARS II is no longer a state-of-the-art system.

In May 1980, the Director of NLM established

a MEDLARS III Task Force to plan for NLM’s

future automation needs. The Library’s computer

experts are troubled that the functional life span

of the MEDLARS II software is only 3 or 4 more

years. All software eventually becomes “fragile”

because of the continuous modifications required.

The search services MEDLARS II provides are not

as sophisticated as those available on other online systems.

More important, many of NLM’s internal operations are now carried out through a combination of manual techniques and separate automated

systems, and the Library is finding it difficult to

continue providing quality services without enlarging its staff. Since such an increase is not likely

in the immediate future, NLM hopes that more

and improved automation of internal functions

will prove compensatory. New techniques for

computerizing internal library functions are available and in use in other libraries.

The MEDLARS III Task Force completed the

conceptual framework and the functional analysis

of MEDLARS III in September 1980. The systems

development plan was completed in September

1981. Currently, a systems analysis is under way,

with a request for a proposal to design and implement MEDLARS III expected in 1982. The new

system is expected to be completed incrementally between 1983 and 1985. The system analysis

and systems development plan are being prepared

by NLM staff supplemented by specialists from

the private sector. Current plans for the design

and implementation of MEDLARS III are that

both tasks be carried out by a commercial firm

under contract.

MEDLARS III is a line item in the NIH/NLM

budget and is expected to cost $6 million. The

functional analysis component cost $1 million; the

design, scheduled for 1982, is expected to cost $2

million; the design and implementation, scheduled

for the year after, will be funded at $2 million;

and the installation, scheduled for the last year,

is funded at $1 million.

The MEDLARS III Task Force was advised by

experts and consultants from both the health sciences library community and the general information systems community in both its analysis of

the Library’s needs and in its formulation of functions to be incorporated into MEDLARS III. The

task force expects that MEDLARS III “when implemented [will] represent a significant transition

from a partially automated, loosely integrated set

of functions [characteristic of MEDLARS II] to

a highly automated, tightly integrated system that

is responsive to the needs of many” of its potential users (104). This statement reflects the pace

at which technological advancements are moving in this field.

Generally, MEDLARS III is expected to improve NLM’s internal and external capabilities.

It will automate and improve: 1) the acquisition

of biomedical literature; 2) the creation, maintenance, and distribution of bibliographic records;

3) the retrieval of bibliographic information;

4) inventory control; and 5) the delivery of primary documents (i. e., interlibrary loans). Some

of these processes are now automated, whereas

others are essentially manual. MEDLARS III will

not perform functions that are purely commercial and available from private vendors, such as

98-764 0 - 82 - 3
24

putting the user’s own private files on-line for

searching.

Improvements in MEDLARS’ retrieval capabilities will result from the construction of an integrated data base that permits a single search access to the bibliographic data bases currently in

the system. There will be other features in

MEDLARS III to assist and simplify a search analyst’s efforts. It will adhere to standards for forming search strategies now being established by the

Council of Library Resources’ Committee on ManMachine Interface.

MEDLARS III is designed to build on MEDLARS

II, permitting the incorporation of new technology and allowing for incremental implementation.

For example, NLM has a contract to explore the

initial phase of on-line indexing. As soon as this

indexing is achieved, it can be incorporated into

the old system until MEDLARS III is ready. Much

of the new system will not be at the leading edge

of computer technology, but will update the current capabilities of MEDLARS II and incorporate

newly established or developing technologies.

Electronic mass storage and distribution of textbook material is being studied at the Lister Hill

National Center for Biomedical Communications,

and an experimental retrieval language, CITE

(Current Information Transfer in English), which

should make the system more accessible to an untrained searcher, is under development at NLM.

The plans do allow some latitude for examining new and undeveloped innovations. One innovation that could be considered for MEDLARS

111 is a natural-language approach to computers

(i.e., involving the use of standard English) that

was developed at Beth Israel Hospital in Boston,

under a research grant from NLM. This approach

has been very successful in a limited system, and

NLM is considering funding a feasibility study for

enlarging the system to include all the hospitals

in the Boston area, hoping that the results may

be applicable to MEDLARS III. The purpose of

using natural language is to make the system

easier for untrained people to use. A comparison

of features between MEDLARS II and MEDLARS

III is presented in table 5.

At the same time that MEDLARS III is evolving, NLM administrators are considering the fuTable 5.—Summary Comparison of the Functional

Capabilities of MEDLARS II and MEDLARS Ill

MEDLARS II

Retrieva/: Highly automated, oriented towards the technically

trained search analyst.

Technica/ Processing—Leve/ of Automation: Many critical

functions such as serials processing, indexing, catalog

maintenance, circulation, and an interlibrary loan are essentially under manual control.

Record and Fi/e Creation and Maintenance: Currently

automated functions have deficiencies which include

duplicate redundant record creation, maintenance, and

searching; inclusion of nonauthoritative bibliographic data;

and incompatibility between NLM files and with other national library data files such as the Library of Congress,

Ohio College Library Center.

Card Cata/og: Manually controlled; difficult to maintain

up-to-date.

Network Access and /nterface: On-line access to NLM

records is available only for the retrieval. Only limited access to capabilities such as record creation and maintenance. No capabilities to provide for local records creation.

Regional Medical Library Document Delivery System: Manual

system for processing requests, maintenance activity and

administrative controls for almost 1,000,000 requests per

year.

MEDLARS Ill

Retrieva/: Enhanced user aids with natural English-like language queries will benefit not only the trained searcher,

but will enable health practitioner users to access the system directly and effectively for many queries.

Technica/ Processing—Level of Automation: These functions

will be more completely automated and integrated.

Record and Fi/e Creation and Maintenance: Will be based on

the concept of a master machine-readable record for each

bibliographic entity and processing unit. Record structure

will be based on the Library of Congress MARC record. Ail

bibliographic elements will comply with established

standards.

Card Catalog: Fully computerized and available on-line

through MEDLINE network to users all over the United

States.

Network Access and /nterface: Users will have access to national locator information and the retrieval system files. The

system will be capable of interfacing on-line with other

automated systems to provide data for support of local

processing, or to permit distributed processing of NLM records in local systems.

Regiona/ Medica/ Library Document De/ivery System: Fully

automated system for generating and routing requests.

Fully computerized management control of traffic including

fiscal and program control.

SOURCE: National Library of Medicine.

ture of health information transfer. The technology and the times may warrant the introduction

of more distributed kinds of arrangements for the

provision of data base information (see app. I),

and NLM has undertaken a limited experiment

with the Toxicology Data Bank to test this hypothesis (33).
Chapter 3

MEDLARS: System- Related Issues
Chapter 3

MEDLARS: System-Related Issues

INTRODUCTION

The only full-scale effort to review the effectiveness of the MEDLARS service was conducted in

1966-67, before the system was available on-line.

At that time, very little was found to be critically wrong with the system (75). The study was conducted on an earlier version of MEDLARS, in essence examining a system vastly different from

that in place today. (See app. C for a review of

evaluative studies of MEDLARS. ) A comparable

examination of MEDLARS at this time would require a much greater effort and may be

unwarranted.

From a review of the literature, interviews with

trained users of the system, consultation with experts, and statistics on system utilization (see ch.

2), OTA finds that MEDLARS, in general, is effective in disseminating health information, using

the traditional criteria of recall and precision. *

*Recall refers to the ability of an information system to retrieve

“relevant” documents; i.e., documents of value in relation to an information need that prompted the request for an on-line search. I%

cision refers to the system’s ability to hold back “nonrelevant” docSUBJECT COVERAGE

The National Library of Medicine (NLM or the

Library), like other organizations responsible for

collecting and organizing biomedical literature

and for providing information services, is faced

with the difficult issue of delineating the field of

biomedicine. Over and above the tremendous

growth in the quantity of published biomedical

literature, the boundaries of traditional medicine

as a field of practice and research are continuously

expanding to encompass new disciplines. Many

disciplines are fragmented and becoming more

and more specialized, and new interdisciplinary

fields are created in the pursuit of scientific

knowledge.

The fields crucial to the health of the Nation’s

people have become so numerous and diverse that

The system does not retrieve information as efficiently as is possible with available technologies,

but its retrieval and other capabilities will be enhanced when its successor, MEDLARS III, is

developed.

OTA has reported on issues concerning

MEDLARS’ effectiveness in disseminating bibliographic health information in part in the staff

paper “The National Library of Medicine” (116)

and in part in the OTA report Strategies for

Medical Technology Assessment (117). This

chapter considers three system issues: 1) the subject content of the literature cited in the

MEDLARS data bases, in particular MEDLINE;

2) the coverage of nonserial literature in the

MEDLARS data bases, in particular MEDLINE;

and 3) the evaluation of the methodological design

of articles in literature cited in the MEDLARS data

bases.

uments (75). These two measurements are considered to provide

(by implication) an estimate of a system’s ability to satisfy the information needs of its users.

discriminating between those central and those

peripheral to health depends on one’s point of

view. Conventionalists maintain that the basic

medical sciences and clinical medicine disciplines

are at the core of health and should remain the

primary focus of the Library’s efforts. Others—

who consider that social, psychological, and environmental factors influence health, or who are

interested in the application of research findings

or in the organization of health services and its

effect on health—disagree. They propose that

areas such as behavioral medicine, technology

assessment, primary care, family medicine, and

health services research are equally important, but

are receiving insufficient or delayed attention by

the Library for its collections and in its products

and services such as MEDLARS.

2 7
28

NLM has tried to be responsive to all users and

has expanded its subject coverage beyond the

fields historically associated with biomedicine. In

1879, Billings classified the citations in Index

Medicus into 14 categories, one of which,

jurisprudence, may be considered outside the

medical model. In 1973, there were 81 fields or

disciplines used to classify lndex Medicus citations, with many new entrants from disciplines

outside the basic sciences and clinical specialties

of medicine (31).

One example of NLM’s efforts to expand subject coverage is in its coverage of the health services literature. In 1966, NLM, at the request of

the American Public Health Association (APHA),

began to broaden its selection of journals and to

expand its set of subject headings to index health

services literature. APHA established a committee to advise NLM “in its efforts to improve the

analysis, storage, and retrieval of literature pertinent to . . . medical care organization and financing” (105).

This effort, while important, was apparently

insufficient. A 1976 report by the House Committee on Interstate and Foreign Commerce found

that NLM had not adequately served the information needs of those concerned with health care

delivery and health services research, and that attempts to retrieve information in the fields related

to health care delivery had not been entirely satisfactory because of deficiencies in the vocabulary

used for indexing and cataloging (149). The report

did, however, commend the Library as “a world

leader in library services for medical sciences and

biomedical research” (149).

NLM renewed its efforts to become a primary

source of information to professionals in health

services research and health care delivery by convening additional advisory groups, entering cooperative arrangements with the American Hospital

Association, and continuing to expand its vocabulary and the number of journals indexed for

MEDLARS concerning health care delivery and

health services research.

By 1977, 58 serial titles, recommended by organizations and individuals in health care management, economics, law, and manpower, had been

added to MEDLINE. The Library was also adding

indexing terms to its medical subject headings

(MeSH) vocabulary: 150 by 1977, and an additional 50 to 100 in 1978. A 1977 House Interstate

and Foreign Commerce Committee report congratulated NLM for making “substantial progress”

in handling health care literature (148). By November 1978, the Library had established a distinct data base, HEALTH, that contained references to literature on health planning, organization, financing, management, manpower, and

related subjects. The American Hospital Association assists with the updating of the data base.

The Library also began a collaborative effort

about 5 years ago with the National Health Planning Information Center (NHPIC). In 1979,

NHPIC started working with the Library to

develop a common terminology, so that NHPIC’s

data base could be included in NLM’s HEALTH

data base. Serials from NHPIC’s data base have

been included in HEALTH since 1979. It is expected that by the end of 1982, the nonserial

literature in NHPIC’s data base back to 1975 will

be indexed according to MeSH and will be available on HEALTH. While terms are continually

added to MeSH, health services researchers and

planners find some information retrieval problems

that mainly stem from an absence of clear definitions and distinctions among indexing terms and

from the inconsistent application of terms by

NLM indexers in preparing HEALTH (24). Both

factors are normal indicators of a relatively new

and changing field.

Coverage of health care literature will probably

remain a problem for NLM, because relevant articles and literature appear in so many diverse

publications and reports. Selectively indexing

more journals alone from law, management, and

public affairs would be exceedingly difficult and

expensive. Furthermore, NLM’s experience with

selectively indexing health planning administration journals since 1976 indicates a skewed

distribution for the selected articles: a very few

serial titles contain the vast majority of the relevant material. Improved coverage would require

reviewing a larger number of journals containing

few relevant articles per issue (24).

NLM continues its attempts to improve the subject coverage of many other new and emerging
29

fields. The Library is now concentrating on improving the literature collection and the MeSH

vocabulary for the psychological and sociological

aspects of medicine. But, according to certain

observers and users, some other fields essential

LITERATURE COVERAGE

An issue closely related to the issue of changes

in the character of the content of biomedical

literature is that of changes in the type and form

of the literature. The format for presenting information often varies among disciplines. For example, in addition to books and serial publications,

the health care literature, perhaps more than the

literature in other biomedical disciplines, often includes unpublished technical reports, project descriptions, speeches, and presentations that are

referred to as “fugitive literature” or “grey

literature.” All biomedical fields have seen a rapid

growth in such literature in recent years. Strictly

speaking, “fugitive” or “grey” literature is not subject to publishing and reviewing channels because

of length, degree of detail, specialized language,

or restricted interest, according to Public Health

Service criteria (76). The term has also been used

to refer to literature so widely dispersed in so

many sources that it is difficult to find, or to literature that appears in channels not normally expected (e.g., an article on palliative care in Architectural Forum) (76).

Indexing services have traditionally covered the

“fugitive” or “grey” literature only selectively,

with NLM being no exception. MEDLINE, the

largest and most extensively used data base in

MEDLARS, concentrates on journal literature: 5

percent of its citations were from other literature,

primarily proceedings of conferences and symposia. As of January 1982, MEDLINE included

references only to journal literature. CATLINE,

which includes citations for all post-1801 printed

books and serials, contains citations for many

published proceedings and theses as well as monographs. As noted in the previous section, by the

end of 1982, NLM’s HEALTH data base will include the nonserial literature in NHPIC’s data base

back to 1975, indexed according to MeSH.

to health such as primary care are being overlooked by NLM. Because similar objections are

being raised about NLM’s coverage of the nonserial literature, these two issues will be considered

in the discussion section of this chapter.

As this country’s biggest generator of information, the Federal Government through its various

agencies and contractors uses technical reports

and other unpublished documents as a means of

communicating research and development progress. In many cases, such literature is the only

communication link from the time a research project is initiated until its results have been formally published in a book or journal. The results of

many research projects are of current interest

only, or serve exclusively as a tool for furthering

a more comprehensive research effort. In the latter case, results may never be published, making

the “fugitive literature” the only source of information (152). Some believe that if information is

worthwhile, it will in time be published in a journal, particularly if the information is about

biomedical research. Others disagree with this

view.

The intent of Congress over the years, however,

has been to see that the professional and taxpaying publics receive information benefits from the

technical missions that it authorizes (3). As a

result, the clearinghouse function—to evaluate,

package, and distribute unpublished biomedical

information widely but selectively-has been used

increasingly as a response to the information explosion phenomenon over the last decade. Clearinghouses typically identify, select, acquire, process, and store documents and other materials

while providing “locator tools, ” such as indexes,

to this collection. In the United States, there are

41 clearinghouses with a health focus, the majority

funded by the Department of Health and Human

Services (DHHS) (12).

The Government Printing Office releases about

10,000 Government reports annually. The ultimate processor and repository of federally spon-
30

sored scientific research, development, and titles, comes from DHHS, indicating a substantechnical reports is the National Technical Infor- tial flow in health-related information to NTIS.

mation Service (NTIS) of the Department of Com- Furthermore, NTIS has created working relationmerce. It has its own bibliographic data base ships for the computerized preprocessing of docu-

(NTIS) that is available from commercial infor- mants with at least three entities within DHHS:

mation services. About 10 percent of the NTIS the National Cancer Institute, Project Share Cleardocument collection, which exceeds 1.2 million inghouse, and NHPIC.

METHODOLOGICAL MERIT

The expansion in biomedical publication and

the diversification of biomedicine in subject and

format has been accomplished, as noted earlier,

by a technological revolution. With massive increases in the storage capabilities of computers

and improvements in communications systems,

the volumes of information and data that can be

accessed are overwhelming. A problem that is

becoming more and more significant is that of “information overload” and the need for readers of

the literature to separate the wheat from the chaff.

The concept of quality filtering, which was first

introduced by Etzioni in 1964 (47), has received

attention from a number of investigators (119,136,

157) and at international] conferences (30,124).

The methodological design and the statistical

analysis used in many articles, even in prestigious

journals, may be questionable. For example, of

67 clinical trials reported in 1979 and 1980 in the

British MedicalJournal, Journal of the American

Medical Association, Lancet, and The New EnglandJournalof Medicine, only 12 percent reported

on the statistical power of the investigation (39).

It appears that journal editors who have acted

as information gatekeepers of the scientific community are unable to continue filling this role—

in part because of the growing complexity of scientific literature, in part because of the climbing

standards of statistical adequacy. Journal editors

have been considered winnowers of the scientific

literature, “who, with the aid of peer review, sift

the finest grains to assure that studies published

in the scientific literature are well designed and

scientifically and ethically sound and that the findings are valid and thoroughly explicated and that

the work constitutes a true contribution to scientific knowledge” (44).

The referee system used in the process of selecting articles by journals is also open to question.

It has been shown, for example, that the concurrence between two referees of each of some SOO

papers submitted to The New EngZandJournal of

Medicine was only slightly better than chance

(67). In addition, the cost of the referee process

in the review of journal articles is high because

of the need for input from subject experts (123).

It has been suggested that NLM, in preparing

its data bases for MEDLARS, assist with the

gatekeeper role by describing articles as to adequacy and appropriateness of the statistical and

epidemiological aspects of the articles’ experimental design and analysis. NLM currently performs

some quality control in the selection of materials

for the Library’s collection and in the process of

selecting literature to be indexed for Index

Medicus and MEDLINE. However, the selection

is based on the scientific merit of the journal as

a whole and not on the quantitative accuracy of

specific articles, although the merit of individual

articles contributes to the choice of the literature.

Rigorous evaluation by NLM of the quantitative methodology used in specific articles would

be extremely costly: it would require an increase

in the Library’s funding as well as an effort to

locate and hire of personnel with the requisite expertise, neither of which seems realistic at a time

of fiscal retrenchment. Further, it would delay the

entry of references to published material into the

bibliography (Index Medicus or MEDLINE). According to NLM, quality control of journal articles by the Library also “would unquestionably

involve substantial debate about some articles

where statistical issues are themselves unsettled

among experts. Finally, the filtering of published
31

articles puts the Government in the position of

a scientific censor, with all the unpleasant implications of Big Brotherism and excessive ‘regulation’ “

(98).

The most advantageous points in the library

process and elsewhere for filtering the literature

are unknown and warrant serious investigation.

NLM could well serve as the catalyst for research

DISCUSSION

Expanding the limits of MEDLARS with respect

to the subject scope and type of literature covered

in its data bases has been discussed in the past,

but the funding to accomplish this goal was not

forthcoming (65). NLM must operate within financial and personnel constraints. If it remains

necessary to contain the perimeters of MEDLARS,

a reordering of selection priorities might be conceivable in light of the changing boundaries of the

biomedical field and other fields that benefit the

public health. But the lack of general agreement

as to the relative health contributions of each field

is a serious deterrent.

The issue of defining the fields of relevance to

health is not unique to NLM; it has been debated

in many forums over the years. The issue remains

unresolved because virtually every aspect of

human culture has some relevance to health. The

burden of defining the fields essential to health

cannot be assumed by NLM, but the issue is of

importance to the Library because its mandate is

open to interpretation. As noted in the Library’s

originating legislation, the purpose of NLM is to

“assist the advancement of medical and related

sciences and to aid the dissemination and exchange of scientific and other information important to the progress of medicine and the public

health” (Public Law 84-941).

Thus, it would be helpful to the users of

MEDLARS if NLM’s Board of Regents, within the

limits of the statutory language, were to define

precisely the scope of subjects and type of literature to be included in the Library’s collection

and products. Although information on NLM’s

policy concerning subject coverage and literature

coverage is available, the policy is not known by

in this area, which is certainly germane to its mission. For the time being, NLM could provide minimal guidance to users by providing simple indications about articles (e.g., whether an article has

data arrays in such formats as tables and graphs)

without making any definitive value judgment as

to their merit, or by refining the use of its present methodological subject headings.

all MEDLARS users. Those interested in fields

outside the basic sciences and clinical medicine are

sometimes uncertain about the dimensions of the

MEDLARS data bases, and some users are not

always sure about the definitiveness of their search

results. A more interactive mode of communication among the library, librarians and other information specialists, and the ultimate user would

enhance the understanding of the situation. Another party at interest is the private sector of the

information industry, where perceived inadequate

communication about the limits of NLM’s data

bases and NLM’s plans for their modification affects operational and investment decisions (166).

MEDLARS cannot technically or financially

cover all aspects of all health-related fields, or

comprehensively cover all literature, published or

“fugitive, “ in all health-related fields. Nonetheless,

members of various health fields, particularly in

new and emerging areas, have expressed a need

for better bibliographic access to information of

interest. NLM has assisted some professional organizations in the development of new bibliographic products. For example, the Library currently cooperates in the production of the Family Medicine Literature Index (FAMLI), an index

to the international literature in family medicine.

NLM decided against increasing the coverage of

family medicine magazines to be indexed for Index Medicus and for the MEDLARS data bases

or creating a special list of the journals. Instead,

NLM prepares a recurring bibliography on family

medicine from the data base which produces Index Medicus. The bibliography is incorporated

into FAMLI and supplemented by the publishers

with references to non-index Medicus journals,
32

which are indexed by the FAMLI staff, using

MeSH and additional family medicine subject

headings (52).

The FAMLI model is one of many that NLM

could use for assisting health-related professional

organizations improve bibliographic access to the

literature in their specific fields. A Library policy

that would permit the leasing of part of the

MEDLINE data base and would permit the reproduction of the data base tape would be a way of

developing new data bases of specialized interest.

The publishers could then supplement MEDLARS

data bases with information they deemed necessary, perhaps including “fugitive literature” citations or additional information subject headings

in their subject fields.

The problem of constructing MEDLARS data

bases in response to user needs is compounded

by the absence of sufficient reliable data with

which to construct a user profile. NLM is moving to obtain more data on its institutional user

community in its new pricing policy, which requires the payment of a use fee every time one

of its data bases is accessed through a commercial information service or a foreign center that

leases MEDLARS tapes (see ch. 2). At present,

it collects data only on institutions that access its

data bases directly through NLM and State University of New York (Albany) computers. NLM

needs information about the individual user. For

example, data on the end user’s profession would

be helpful in developing data bases more truly

reflective of user needs. Even so, the nature and

needs of the user community are changeable, and

potential users are difficult to identify.

If MEDLARS data bases were to include an

assessment of the methods and statistics used in

the articles it cited, the system would be extended

beyond its current capabilities. Although the issue

of assessment reflects users’ needs, it is not specific

to MEDLARS data bases only, but is important

to all health-related data bases. As noted previously, it may be appropriate for NLM to use its research capabilities to explore this problem.

NLM has already started research on one method of filtering information in the construction of

its Hepatitis Knowledge Base. The contents of the

data base are not bibliographic references, but are

reviewed and evaluated data and information synthesized by a consensus of experts and periodically

reexamined and updated. Another type of valuable research is the current critical appraisal of

the methodological subject headings in MeSH

(83). More explorations into the area of quality

filtering would continue NLM’s leadership role as

well as benefit the field of biomedical communication and the health of the country.

The diversity of demands by specialized groups

will continue to strain NLM’s ability to acquire

and organize needed scientific literature in a manner acceptable to all users, and comments on system limitations can be expected to persist. Balanced against such comments should be an acknowledgment of the success of MEDLARS—as

measured by many factors, including its continued

wide use and the vending of many of its data bases

in the offerings of commercial information services.
Chapter 4

Private Sector Health

Information Systems
Chapter 4

Private Sector Health Information Systems

INTRODUCTION

The growth and accomplishments of the private

sector information industry in the past two

decades are dramatic. In the area of information

systems, there has been a tremendous increase in

computerized data bases and on-line searching

capabilities. Health-related bibliographic information is now available from not-for-profit institutions and for-profit corporations that are either

devoted solely to information activities or operating as a division of a diversified conglomerate.

Some private sector organizations index and

abstract biomedical and other health-related literature and produce printed indexes and computerized data bases. Other private sector firms, known

as information services or vendors, sell on-line access to data bases usually leased from a variety

of data-base producers in the public and private

sectors. Still other firms-Bibliographic Retrieval

Services and the Institute for Scientific Information—provide on-line searching of their own data

HISTORICAL ORIGINS

The historical origins of the private sector

abstracting and indexing services, often referred

to as secondary services, are rooted in the professional or learned societies that flourished in the

19th century. Although these services began with

manually produced print products, the majority

today produce a machine-readable product or

data base as well. Many of the data base producers in the scientific and biomedical field remained in the not-for-profit sector, others were

purchased by for-profit firms, and still others were

initially profitmaking enterprises.

In almost all cases, public support in varying

degrees was made available to the organizations

—either to assist in the planning for conversion

from manual to machine production of their products, or to assist in the development of new, large

data bases. For example, BIOSIS (formerly Biosciences Information Service) and Chemical Abbases, just as the National Library of Medicine

(NLM or the Library) does for the data bases it

produces.

When data bases are leased, vendors often add

information to them, or provide a unique language of commands (software) that makes data

bases from several producers compatible. Thus,

through a single vendor, a user can efficiently

retrieve information from a variety of bases.

This chapter describes the various bibliographic

health-related information products that are available from the private sector in order to provide

background information for the discussion of

domestic policy issues in chapter 6. Owing to the

nature of the congressional requests for this OTA

study, system issues such as quality of private sector data bases and effectiveness of services are not

considered.

stracts Service both received support from the National Science Foundation, and Excerpta Medica

received grants and contracts from the Public

Health Service.

Private on-line services originated later than

many of the private scientific and biomedical data

bases, but also are an example of Government and

private sector interaction. Much of the original

development of information search services (vendors) as they exist today was sponsored in a notfor-profit environment, predominantly through

the Government’s research and development expenditures. Usually, the services had been fully

tried and tested before they were incorporated into

private sector products and services.

Indeed, two of the three major commercial bibliographic services in the United States, DIALOG

Information Services, Inc. (DIALOG) and System

35
36

Development Corp. (SDC), were recipients of

Government contracts. Lockheed Missiles &

Space Co. (formerly DIALOG’s parent company)

“developed its commercial activity on a foundation of Government service contracts from the Office of Education (ERIC), National Technical Information Service (NTIS), and the National

Agricultural Library” (18). In return, the Government received an expanded work force and needed

expertise. The third major commercial bibliographic service, Bibliographic Retrieval Services

(BRS), was initially part of a State university system. Thus, the public sector, as well as private

capital and individual initiative, was instrumental in stimulating the extraordinary growth of the

information industry.

DATA BASES RELEVANT TO HEALTH SCIENCES

A compendium of data bases, including those

in life sciences, chemistry, and social sciences relevant to biomedical research or health services can

be found in various directories, such as ComputerReadable Data Bases: A Directory and SourceBIOSIS PREVIEWS

BIOSIS PREVIEWS is a large international bibliographic data base covering the most frequently consulted journals in the life sciences, and is

therefore of significant relevance to biomedical

research and clinical medicine. It is produced by

BIOSIS, a not-for-profit organization founded in

1926 to serve the information needs of the life

sciences community. The journals BIOSIS

PREVIEWS covers focus on basic research in the

life sciences.

BIOSIS PREVIEWS is produced in connection

with and corresponds in coverage to the printed

versions of Biological Abstracts (BA) and

Biological Abstracts/RRM (BA/RRM). BA, the

larger, is an important bibliographic indexing and

abstracting source covering primary research journals in the life sciences; BA/RRM is an analogous

service covering reports, reviews, meetings, and

books. BIOSIS PREVIEWS provides references to

research literature in the life sciences, including

agriculture, biochemistry, bioengineering, biophysics, ecology, experimental medicine, microbiology, and pharmacology.

Essentially all of the journal literature of

original research in the life sciences is included.

In 1981, 9,143 scientific journals from 116 countries were screened for inclusion, as well as books,

monographs, meetings and conference proceedbook (167). Certain data bases–BIOSIS PREVIEWS, EXCERPTA MEDICA, IRL LIFE SCIENCES COLLECTION, and SCISEARCH, whose

contents focus on the basic biological sciences and

clinical medicine—are described in this section.

ings, semipopular journals, research communications, and symposia. Journals comprised solely of

articles on the life sciences are covered completely: every article and review is abstracted and indexed. Journals covering other sciences—physics,

chemistry, and related topics—are screened for

articles relevant to life sciences, and these articles

are indexed and abstracted. Each article referenced

counts as one citation (or “record”).

Approximately 3 million records dating from

1969 are available on BIOSIS PREVIEWS. In

1982, BIOSIS will add 14,584 records from BA

and 16,668 records from BA/RRM per month. BA

and BA/RRM are updated twice a month. In

1981, more than 300,000 records were added;

315,000 will be added by the end of 1982. The

citations and/or abstracts are keyed directly on

computer tapes, which are mailed to vendors and

are available to users approximately 5 weeks

before the printed versions of BA and BA/RRM

are available. Since December 1, 1980, abstract

text from July 1, 1976, to the present is included

to accompany BIOSIS PREVIEWS; these consist

of English language summaries from BA. As of

April 1982, access to BIOSIS PREVIEWS is provided by three commercial on-line search services

in the United States and a total of 10 on-line services worldwide. There are also three off-line search
37

services in the United States and 11 outside the

United States with access to BIOSIS PREVIEWS.

BIOSIS is operated by a board consisting of the

President of BIOSIS and 12 rotating trustees who

serve maximum terms of 6 years. Board members

are chosen to represent the Federation of American Societies for Experimental Biology, the

American Institute of Biological Sciences, the

American Association for the Advancement of

Science, the National Academy of Sciences, and

a changing group of disciplinary societies.

In 1982, BIOSIS charges commercial search

services $5,000 per year (plus the cost of 48 tape

EXCERPTA MEDICA

Excerpta Medica is an information retrieval

service that provides descriptive indexes of biomedical and clinical literature. Sixty percent of

its records include abstracts of the primary literature. Excerpta Medica was begun in 1946 as

an independent not-for-profit foundation with

some grant support from the U.S. and Netherlands’ Governments. In 1971, Excerpta Medica

was acquired by a private Dutch company, Elsevier-NDU, a major scientific publisher. Excerpta

Medica now publishes two indexes of bibliographic references to the drug literature, 43 journals containing abstracts of articles published in

the primary journal literature (see table 6), and

6 “core” journals containing abstracts of the most

recent literature in discrete clinical specialties from

the 43 specialty abstract journals.

A combination of professional, part-time, and

volunteer abstracters and indexers—all practicing physicians—screen approximately 400,000 articles from over 3,5oo journals each year to produce EXCERPTA MEDICA (or EMBASE), a computerized data base of references to 240,000 articles per year; of these, 150,000 are abstracted

for the 43 specialty journals. The data base is updated weekly.

EXCERPTA MEDICA was designed by and is

addressed to clinicians, as well as to research

scientists. All indexing is done by practicing physicians who also select, approve, modify, and in

some cases rewrite abstracts of articles. By screening 3,5oo journals and reports of scientific symposia worldwide, EXCERPTA MEDICA covers

reels at $17.50 each) for the current file of BIOSIS

PREVIEWS, and $6,600 per year (plus the cost

of 24 tape reels at $17.50 each) for the abstract

text package. In addition, BIOSIS charges the

services $20.00 per connect hour in on-line usage

royalties. Commercial search services are charged

for off-line prints of BIOSIS PREVIEWS only if

their charges exceed $0.10 per citation. They are

also charged $0.09 for each abstract text printed

off-line. Commercial search services include

BIOSIS royalty and printing charges and their online fees in their user charges.

Table 6.—Excerpta Medica Abstract Journals

Anatomy, Anthropology, Embryology, and Histology

Anesthesiology

Arthritis and Rheumatism

Biophysics, Bio-engineering, and Medical Instrumentation

Cancer

Cardiovascular Diseases and Cardiovascular Surgery

Chest Diseases, Thoracic Surgery, and Tuberculosis

Clinical Biochemistry

Dermatology and Venereology

Developmental Biology and Teratology

Drug Dependence

Endocrinology

Environmental Health and Pollution Control

Epilepsy

Forensic Science Abstracts

Gastroenterology

General Pathology and Pathological Anatomy

Gerontology and Geriatrics

Health Economics and Hospital Management

Hematology

Human Genetics

Immunology, Serology, and Transplantation

Internal Medicine

Leprosy and Related Subjects

Microbiology: Bacteriology, Mycology, and Parasitology

Neurology and Neurosurgery

Nuclear Medicine

Obstetrics and Gynecology

Occupational Health and Industrial Medicine

Ophthalmology

Orthopedic Surgery

Oto-, Rhino-, Laryngology

Pediatrics and Pediatric Surgery

Pharmacology and Toxicology

Physiology

Plastic Surgery

Psychiatry

Public Health, Social Medicine, and Hygiene

Radiology

Rehabilitation and Physical Medicine

Surgery

Urology and Nephrology

Virology

SOURCE: Excerpta Medic@ 1982.
38

the foreign, especially European, literature very

thoroughly, and provides English abstracts. The

Drug Literature Index and Adverse Reactions

Titles are considered to be especially thorough;

for drug-oriented searches of the literature, Excerpta Medica’s DRUGDOC provides very comprehensive and complete bibliographies. These are

deemed to be especially useful in their coverage

of drug testing conducted in countries other than

the United States.

Each of Excerpta Medica’s abstract journals is

produced under the supervision of one or more

section editors who are practicing medical specialists in the Amsterdam area. Each section also

has an International Editorial Board that does not

IRL LIFE SCIENCES COLLECTION

Information Retrieval, Ltd. (IRL) is an independent, privately owned British company providing 17 abstracting services covering discrete

areas in biological and medical sciences (see table

7). It began in 1966, with the publication of

Table 7.-IRL Abstracts

Animal Behavior

Biochemistry Abstracts

Part 1: Biological Membranes

Part 2: Nucleic Acids

Part 3: Amino-Acids, Peptides, and Proteins

Calcified Tissue Abstracts

Chemoreception Abstracts

Ecology Abstracts

Entomology Abstracts

Genetics Abstracts

Immunology Abstracts

Microbiology Abstracts

Section A: Industrial and Applied Microbiology

Section B: Bacteriology

Section C: Algology, Mycology, and Protozoology

Toxicology Abstracts

Virology Abstracts

SOURCE: Information Retrieval, Ltd., 19S1.

SCISEARCH

meet, but whose members are said to be available

to provide advice on problems that occasionally

arise in journal selection, classification, and terminology. A Board of Chief Editors coordinates

the work of the section editors, and acts as liaison

with the two executive chief editors, who are

responsible for organization and management.

Two million records have been entered in

EXCERPTA MEDICA since 1967. The data base

is vended through DIALOG on a user fee basis,

i.e., Excerpta Medica charges DIALOG a royalty

each time a DIALOG customer accesses EXCERPTA

MEDICA. DIALOG offers worldwide access to

EXCERPTA MEDICA records entered since 1975,

and is responsible for setting user fees.

Microbiology Abstracts, and has grown steadily. IRL prides itself on complete and timely coverage of journals in its specialty areas, and on inclusion of books, conference proceedings, reports,

patents, and the “fugitive” or “grey” literature

(advertisements, announcements, unpublished

and privately published reports). IRL currently

screens 5,OOO periodicals; its data base contains

approximately 440,000 records entered since

January 1978. The average growth has been

110,000 records per year, and the data base is updated weekly.

IRL products provide global coverage (less than

37 percent of its sources are of U.S. origin) and

full abstracts in English or foreign language

sources. The quality of indexing is controlled by

having all indexing and abstracting done in-house

by university graduates in the life sciences. The

IRL LIFE SCIENCES COLLECTION is available

on-line in the United States and worldwide

through DIALOG.

SCISEARCH is a multidisciplinary biblio- assortment of services and publications designed

graphic data base prepared by the Institute for to provide a comprehensive and coordinated inScientific Information (ISI), a private for-profit formation discovery and retrieval system. These

company located in Philadelphia. ISI markets an include a weekly early alert journal (Current Con-
39

tents); a selective information dissemination service (Automatic Subject Citation Alert); and a

document dissemination service (Original Article

Text Service). It also produces three comprehensive on-line interdisciplinary data bases: Science

Citation Index (SCI) (available on-line as

SCISEARCH); Social Sciences Citation Index

(available on-line as SOCIAL SCISEARCH), and

Arts and Humanities Citation Index (also available in on-line).

SCI consists of four separate but related indexes: Citation Index, Source Index, Permuterm

Subject Index, and Corporate lndex. Citation Index is arranged alphabetically by cited author. A

reference entry contains the primary author’s

name, the year the cited item was published, and

an abbreviated name of the publication with its

volume and page number. The source items citing

a particular reference are arranged alphabetically by source author immediately under each

reference item. Source Index is similar to an

author index with the full citations—author, titles

of article and journal, date of issue—to all source

references. Permuterm Subject Index is an index

in which all significant title words of the source

items are permuted, forming all possible pairs of

terms. Primary terms are arranged alphabetically,

and all the co-terms occurring with a particular

primary term are listed alphabetically under that

term. Corporate hdex lists source authors by both

geographic location and organizational affiliation.

SCIand SCISEARCH identify articles but do not

provide abstracts.

SCI’s coverage of over 3,000 journals is based

on a principle which is different from that of other

scientific retrieval services: the concept of citation

indexing. Citation searching assumes that if a particular article or set of articles or author has

material directly relevant to the subject of interest,

COMMERCIAL SEARCH SERVICES

In the private sector, the major on-line biomedical and health information search services are

BRS, DIALOG, and SDC. They acquire data

bases from a number of

producers, both profit

sources: private sector

and nonprofit, and

then other articles or authors citing that material

are also likely to be relevant. (This is also known

as “forward” searching. (Shepard's Citations, a

commonly used legal reference, uses this principie. ) A citation index is a structured list of all the

citations in a collection of documents.

Citation indexing takes advantage of the builtin linkages between documents provided by author’s citations by listing together all items with

common citations, and thus provides multidisciplinary searching capabilities. Thus, SCISEARCH

is complementary to data bases built along traditional disciplinary lines.

SCISEARCH can trace a scientific idea forward

in time, i.e., from an earlier cited article to a later

citing article. It is based solely on the scientist to

author’s decisions to reference other articles. Since

the intellectual intervention of human abstracters

or indexers is not required, SCISEARCH reflects

scientists’ research practices and their own vocabularies. Because SCI is based on citation indexing, significant items of information other than

journal articles can also be retrieved. They include

technical reports, patents, and material published

in books or the popular press—in fact, any item

that is cited by the author. This citation feature

also alerts users to relevant materials, including

historical articles, that may have been written long

before SCI was produced, and before other (alternative) data bases were accessible via computerized searches.

SCISEARCH contains approximately 3 million

records and is updated biweekly. It is available

on-line from 1974 to the present through DIALOG.

It is priced differently to and by each search service, depending on the year accessed and on whether or not the on-line user is a subscriber to the

printed version of SCI.

Government organizations, such as NLM, NTIS,

and the National Agricultural Library, and offer

their users the ability to search them with a single

software system. Table 8 is a listing of prices to

users for selected data bases.

98-764 0 - 82 - G
—

40

Table 8.—On-Line Connect Hour Ratesa for Selected

Health-Related Data Bases, Spring 1982

Data base BRS DIALOG NLM SD C

B!OSIS PREVIEWS . . . . . $41-55 $43-58 $65

CA SEARCH . . . . . . . . . . . 40-54 49-64 68

EXCERPTA MEDICA . . . . 55-70

IRL LIFE SCIENCES

COLLECTION . . . . . . . . 30-54

MEDLINE . . . . . . . . . . . . . 19 20-35 $15-22

SCISEARCH . . . . . . . . . . . 50-65b

150-165C

HEALTH . . . . . . . . . . . . . . 20-35 15-22

ENVIROLINE . . . . . . . . . . 61-75 63-78 90

TOXLINE . . . . . . . . . . . . . . 45-52

CHEMLINE . . . . . . . . . . . . 94-101

AGRICOLA . . . . . . . . . . . . 18-32 20-35 40

NTIS . . . . . . . . . . . . . . . . . 24-38 25-40 45

aprice~ are not directly comparable. Some information sewices maY vend ‘he

same data base but the data base may span different periods of time. The telecommunications costs also vary, as does the office printing and other costs.

For more specific information see tables 9, 10, and 11.

bSubscribers.

cNonsubscribers.

SOURCE: BRS, DIALOG, NLM, SDC, 1982.

Each of the vendors offers a different package

of software capabilities to its users. All major

capabilities offered by the NLM MEDLARS II system are duplicated in the commercial search services. However, because of the intense competition

in the information industry, the search services

revise and expand their capabilities more rapidly

than NLM. Their users can, for example, search

whole data bases on phrases they compose themselves by asking for words to be in a certain proximity to one another. They can review their search

strategies on the holdings of all or any group of

data bases from one search service without having to reenter terms in one data base after another. They can order documents retrieved in

on-line searches. They can put their own private

files on-line for searching on the vendor’s software. As noted in chapter 2, the plans for

MEDLARS III include the acquisition of functions

now available on commercial search services, except for the purely commercial ones, such as putting a user’s private files on-line for searching.

Samples of the capabilities specific to each search

service are included in the following descriptions.

Bibliographic Retrieval Services,

Latham, N.Y.

BRS initially focused specifically on the biomedical data bases, but it has since broadened its

coverage by adding ones in science, business, and

technology. The company now offers over 50 files

on-line.

BRS began as the Biomedical Communications

Network (BCN) at the State University of New

York (Albany). BCN provided on-line access to

nine data bases, including MEDLINE and BIOSIS

PREVIEWS, to large universities and medical

schools primarily in the Northeast. State funding

for the project was withdrawn in 1975, and BRS

was formed as a not-for-profit concern the following year, It was incorporated in May 1976 as a

for-profit corporation. In 1980, BRS was purchased by Indian Head, Inc., a subsidiary of the

Dutch company, Thyssen-Bornemisza.

User Profile

In the biomedical area, BRS estimates indicate

that its users can be categorized by type of institution: 55 percent academic; 18 percent corporate

industrial; 15 percent governmental (including the

U.S. National Institutes of Health and 30 Veterans

Administration hospitals); 6 percent miscellaneous

(including public and State libraries). In terms of

individuals, BRS estimates that 90 to 95 percent

of its activity is handled by trained intermediaries

(librarians or searchers) and that the remaining

5 to 10 percent is done by academic investigators

in science. For 1980, BRS estimates that physicians

comprised no more than 1 to 2 percent of its

trained searchers. The number of users is considered proprietary information. Passwords are

issued to both individuals and organizations.

Health-related data bases offered by BRS are listed

in table 9.

costs

The BRS rate for searching the MEDLINE data

base is $15 per hour, excluding telecommunications charges and the NLM $4 per hour royalty

charge. The costs for accessing all other BRS data

bases are shown in table 9. BRS’ on-line connect

hour rates depend on the number of hours of

searching in 1 year. Users subscribe according to

their projected use at the following rates. Any

royalties which are charged by the data base producer are added to these subscription fees.
—

41

Table 9.—BRS: Selected Health-Related Data Bases Available On-Line,

March 1982

On-line connect time Off-line print

rate per houra

rate per

Data base Minimum Maximum citation

Major relevance health care

BIOSIS PREVIEWS . . . . . . . . . . . . . . . . . . . . . . . $41

CA SEARCH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

MEDLINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

MEDIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

PRE-MED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Relevant to some specialties and interests

AGRICOLA (CAIN). . . . . . . . . . . . . . . . . . . . . . . . 18

DISSERTATION ABSTRACTS . . . . . . . . . . . . . . 24

DRUG INFO AND ALCOHOL USE/ABUSE . . . 21

ENVIROLINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

URIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

NIMH (NCMH) . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

NTIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

POLLUTION ABSTRACTS . . . . . . . . . . . . . . . . . 51

PSYCHOLOGICAL ABSTRACTS . . . . . . . . . . . . 46

SSIE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

$55

54

15

19

35

30

32

45

35

75

35

30

38

65

60

60

—

$0.10

0.10 —

—

0.05

0.10

0.05

0.10

—

0.10

aconnecttimeco~t~ in~l”der~yalties paid to data base supp~ers, but do not include telecommunications cOsts 0f$5to$7

per connect hour.

SOURCE’ Bibliographic Retrieval Services, 1982

BRS On-Line Rates, February 1982

Annual

Number of annual subscription Cost per computer

connect hours payment connect hour

25 $ 750 $30

60 1,500 25

120 2,400 20

240 3,800 16

User Training

New users are introduced to the entire BRS system in a l-day training session, which costs $35

for subscribers and $55 for nonsubscribers. BRS

has a special l-day training session for MEDLARS,

which costs $5O, and similar sessions for other

data bases. Approximately 300 training sessions

are conducted each year. The sessions are held

in major U.S. metropolitan a reason a monthly

or bimonthly basis, and in other on site locations

at the request of users or potential customers.

Value-Added Services

BRS has also created a file called PRE-MED that

updates the primary English-language medical

journals weekly with bibliographic citations not

yet available on MEDLINE. BRS also carries the

full text of all 16 of the journals from the

American Chemical Society.

BRS places a particular emphasis on marketing

a Private-file Service. Users can mail them

machine-readable files of their own data—library

catalogs, academic departmental publications

lists, etc.—and BRS will put the data on its computers and offer on-line retrieval with its software

at a competitive price. If the information is not

currently machine-readable, BRS offers a number

of options from a preprogrammed microcomputer

for local input to a direct on-line data input program. BRS also offers electronic messaging for

communication among groups of users and an

electronic newsletter capability.

DIALOG Information Services, Inc.,

Palo Alto, Calif.

In 1966, DIALOG Information Services

(DIALOG), then a subsidiary of the Lockheed

Missiles & Space Co., developed the first on-line

retrieval system that went beyond the demonstration stage to regular production (18). This system,

also called DIALOG, is the basis for systems currently in operation at several Government agencies, including the National Aeronautics and

Space Administration and the Justice Department.

The system has been commercially available since
42

1972, and now provides access to over 120 data

bases for 10,000 users in 40 countries (18). Six of

its data bases are of major relevance to health and

biomedicine.

Initially, DIALOG focused on education and

science, but it now offers data bases covering

business, social science, and the humanities. The

company is expanding DIALOG’s health coverage: INTERNATIONAL PHARMACEUTICAL

ABSTRACTS and EXCERPTA MEDICA were

added in 1975; MEDLINE was added in 1981; and

NLM’s TOXLINE and HEALTH data bases are expected to be added in the near future. This firm

is the largest commercial vendor of on-line biomedical bibliographic information in the world.

User Profile

The DIALOG system has over 10,000 users.

It is company policy not to disclose specific information about users because of competition

with other vendors. “Users” in this case means

“passwords” and is roughly equivalent to

organizations. However, some complex organizations and institutions may have several libraries

or information centers with terminals and thus

have several passwords.

costs

DIALOG’s access charges are displayed in table

10. A number of discounts are available, all based

on monthly usage levels. The maximum discount

of $15 per hour is available for a guaranteed usage

of 80 hours per month.

Like BRS, DIALOG bases its prices at least in

part, on a projected market value of each data

base and service. Market value is determined by

the nature of the data base, the user population

(e.g., financial communities are likely to pay more

for a service than academic users), and competitors’ prices.

User Training

DIALOG makes its services available to potential users by conducting 1,2oo training sessions

in 100 U.S. metropolitan areas and other sites at

customer request. These consist of a general

n/z-day training session for use of the entire

DIALOG system, augmented by specialized training sessions for a half-day each on EXCERPTA

MEDICA, on MEDLINE, and on BIOSIS. The

charge is $65 for the general training session

(which includes on-line practice) and $25 for the

specialized sessions. These courses are attended

mostly by librarians or specialized on-line searchers in universities, and in increasing numbers by

physicians and scientists (end users).

All DIALOG data bases are completely on-line.

Unlike NLM or BRS, DIALOG does not put

earlier years of data bases into backfiles for offline processing; DIALOG puts them into backfiles

for on-line processing. DIALOG also offers a

private file service. The company’s DIALORDER

system covers more on-line ordering sources than

any other vendor. The company also carries electronic newsletters and on-line directories.

System Development Corp.,

Santa Monica, Calif.

SDC was established as a not-for-profit company in 1956 as part of the Rand Corp., a consulting firm established after World War II to provide research services to the Air Force. SDC initially trained operators and programmers for the

SAGE early warning system. SDC became a freestanding, for-profit corporation in 1968. It has

been involved with biomedical and health services

data bases since 1968, when it assisted NLM in

developing ELHILL, the software package for

MEDLARS. SDC modified the ELHILL software

for the ORBIT package it now uses. The company

was purchased by the Burroughs Corp. in 1980.

It has more than 80 data bases that provide

coverage of information in many areas of knowledge.

User Profile

There is no systematic information available

about SDC users in the biomedical/health services

area, but an estimated 15 to 20 percent of its total

business is in the medical area. Of SDC’s total

customer population, an estimated 60 to 65 percent are from private business and industry, 15

to 20 percent from Government agencies, and the

remaining 15 to 25 percent from academic institu-
43

Table 10.—DIALOG: Selected Health-Related Data Bases Available On-Line,

April 1982

On-line connect time

rate per houra Off-line print

rate per

Data base Minimum b Maximum full report

Major relevance to health care

BIOSIS PREVIEWS

(1969 to present). . . . . . . . . . . . . . . . . . . . . . . . . . .

CA SEARCH

(1967 to present). . . . . . . . . . . . . . . . . . . . . . . . . . .

EXCERPTA MEDICA

(1974 to present). . . . . . . . . . . . . . . . . . . . . . . . . . .

HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IRL LIFE SCIENCES COLLECTION . . . . . . . . . . . . .

MEDLINE

(1966 to present). . . . . . . . . . . . . . . . . . . . . . . . . . .

SCISEARCH

(1970 to present)

(subscribers) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(nonsubscribers) . . . . . . . . . . . . . . . . . . . . . . . . .

Relevant to some specialties and interests

AGRICOLA

(1979 to present). . . . . . . . . . . . . . . . . . . . . . . . . . .

CHEMNAME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CHILD ABUSE AND NEGLECT . . . . . . . . . . . . . . . .

COMPREHENSIVE DISSERTATION INDEX . . . . . .

ENVIROLINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ENVIRONMENT BIBLIOGRAPHY . . . . . . . . . . . . . .

FOODS ADLIBRA. . . . . . . . . . . . . . . . . . . . . . . . . . . .

FOODS ADLIBRA . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INTERNATIONAL PHARMACEUTICAL

ABSTRACTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NTIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PHARMACEUTICAL NEWS INDEX . . . . . . . . . . . . .

POLLUTION ABSTRACTS . . . . . . . . . . . . . . . . . . . . .

POPULATION BIBLIOGRAPHY . . . . . . . . . . . . . . . .

PSYCHOINFO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$43

49

55

20

30

20

50

150

20

115

20

40

63

45

40

40

35

25

80

58

40

50

$58

64

70

35

45

35

65

165

35

130

35

55

78

60

55

55

50

40

95

73

55

65

$0.15

0.20

0.20

0.15

0.15

0.15

0.15

0.25

0.10

0.20

0.10

0.12

0.15

0.15

0.10

0.10

0.15

0.10

0.30

0.20

0.10

0.10

aconnect time ~ate~ include royalties paid to cfata base suppliers, but do not include telecommunications costs of ~ per

connect hour.

bMinimum connect time rate applies for users with adiscount contract.

SOURCE: DIALOG Information Services, Inc. 1982.

tions. At the present time, SDC is persuaded that

the majority of its users in the biomedical area

are from pharmaceutical firms, with very few

from academic or medical institutions. SDC hopes

to attract a larger portion of the health and

biomedical consumer market when it adds

MEDLINE and TOXLINE, partly in response to

requests from customers and reports from field

representatives.

costs

Three of the SDC offerings have annual subscriptions for the printed indexes produced from

each data base, but SDC has no subscription

costs, startup fees, or monthly minimums of its

own. Discounts are available to users for more

than 5 hours of connect time each month, to a

maximum discount of $2o for 140 hours per

month. SDC’s charges are shown in table 11.

User Training

SDC holds regular training sessions for new

users in major cities. Approximately 125 sessions

are held each year in 18 locations. Users are taught

the basic techniques of the ORBIT software system by professional instructors. New-user training sessions last 1%-days and cost $150 per person; this fee is credited back to the account of the

user. The session includes a training package, online practice, and 3 hours of computer time. There

are additional half-day seminar sessions for life

sciences data bases, at $5O per session. In addition, custom-designed classes are available at the
—

44

Table 11 .—SDC: Selected Health-Related Data Bases Available On-Line,

March 1982

On-line connect time Off-line print

Data base rate per houra

rate per citation

Major relevance to health care

BIOSIS PREVIEWS

(1969 to present) . . . . . . . . . . . . . . . . . . . . . . .

RINGDOCC

(1964 to present) . . . . . . . . . . . . . . . . . . . . . . .

CA SEARCH

(1967 to present) . . . . . . . . . . . . . . . . . . . . . . .

Relevant to some specialities and interests

AGRICOLA

(1978 to present) . . . . . . . . . . . . . . . . . . . . . . .

CHEMDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ENVIROLINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NTIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PESTDOC c

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

PSYCINFO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SAFETY SCIENCE ABSTRACTS . . . . . . . . . . . .

SPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SSIE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

VETDOC C 

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$65b

100

68

40

125

90

45

100

65

75

85

110

100

$0.10-0.25

0.13

0.20

0.06

0.25

0.20

0.10

0.13

0.10

0.15

0.15

0.25

0.13

aconnect time co~t~ include royalties paid to database suppliers, but do not include telecommunications costs of~hour

bSDCal~oha~adi~count plan that app~estoa~ accounts that use SDC’ssystem, ORBIT, foratleast 5hoursin agiven ‘onth

The discount is applied in steps dependent upon the number of connect hours used in agiven month on ail data bases, CRINGDOC pEsTDOc and VETDCIC require ayearly subscription to the printed journal from DeWent publications before

they can be accessed on SDC. These subscriptions costs as of 1981 were:

PESTDOC $11,275/yr

RINGDOC 30,3501yr

VETDOC 7,6251yr

SOURCE: Systems Development Corp. 1982

customer’s location on request, at a cost of $450

plus the trainer’s travel costs.

Value-Added Services

SDC has recently developed advanced crossfile searching capabilities for its ORBIT software

comparable to that used by DIALOG and BRS.

Users can create their own thesaurus of terms by

browsing through lists of terms in one data base

and carrying those lists over into other bases. If

a searcher finds a particularly interesting citation

in one file, he or she can command the system

to enter the terms appearing in that citation into

their search strategy automatically. Searchers

more familiar with softwares other than ORBIT

can rename commands and have those changes

automatically executed whenever they enter their

password. SDC also developed the first on-line

ordering system, the Electronic Maildrop, whereby users can place an order for an original document at their terminal.
Chapter 5

Public and Private Information

Sectors: Elements of Current

Domestic Policy Issues
Public and

Chapter 5

Private Information

Sectors: Elements of Current

Domestic Policy Issues

INTRODUCTION

The Federal Government has had a longstanding role in the creation and distribution of information goods and services. At the same time, the

private sector has participated extensively in

Government information matters. For example,

all through American history, the Government

has had a significant role in publishing, yet the

main publishing activities in this country have

been private. The role of the Government has

been neither to overwhelm or to restrict, but

rather to encourage private information activities.

Interactions between the private and public sectors are and have been dynamic but often discordant, requiring continuous renegotiation. In

recent years, the growing reliance of society on

information and the increase in the number and

type of information products, services, and

resources have heightened the tension between the

two sectors.

There are fundamental philosophical differences

underlying the discord. One philosophy is that

the Government’s role should be restricted in information activities and that information is best

managed and distributed in the marketplace by

having many non-Government information

sources. The other philosophy recognizes the

economic value of information, but in addition

is concerned with its social value and impact (125).

As a result of the philosophical differences, agreement as to the proper role of Government has

proven elusive.

After 2 years of deliberations, a task force of

the National Commission on Libraries and Information Sciences (NCLIS) completed a thoughtful

study setting forth general principles concerning

the role of the public and private sectors in

Government information activities. The NCLIS

task force is “in favor of open access to information generated by the Federal Government; in

favor of reliance on the libraries and private sector organizations (both for-profit and not-forprofit) to make readily available information that

can be distributed by the Federal Government; in

favor of a leadership role for Government rather

than a management role; and in favor of limiting

direct Government intervention in the marketplace” (96). (See app. F for a complete listing of

principles and recommendations of the NCLIS

Public Sector/Private Sector Task Force. )

This chapter presents primary considerations

for examining future as well as present national

information issues and the specific issues concerning the National Library of Medicine’s (NLM or

the Library) creation and provision of computerized bibliographic information. The considerations are the Government’s role in the allocation

of resources to information development and

distribution, and the effect on the private information sector of the Government’s involvement

in allocative activities. The influence of the

Government’s pricing policies is of particular importance. Because a historical perspective is

needed to understand Government information

activities, the chapter includes a brief section on

the history of public and private sector involvement in health information policy.

47
48

DEFINITIONS

Except where explicitly stated otherwise, OTA

uses the definitions of the NCLIS Public Sector/

Private Sector Task Force (96):

Public Sector—This term . . . includes Government and, more specifically, Federal Government. Agencies, like public libraries or public

universities that are entirely tax-supported, even

though non-Governmental in character, are included.

HISTORICAL PERSPECTIVE

Health information has a somewhat different

policy history than that of other science and technology information. Studies and activities in the

late 1950’s and early 1960’s that dealt with improving scientific and technical information either

implicitly or explicitly treated health information

in a different manner from other information both

in their general considerations and when addressing public/private sector issues. After the mid1960’s, most information policy studies and activities, including those dealing with public/private sector issues, were not discipline oriented,

and, thus, did not consider science information

by itself.

In addition to being allied to information policy, health information policy has been and is now

strongly tied to health policy, particularly that of

biomedical research and medical education. In the

past decade, health information policy has come

to be increasingly associated with policy toward

health services delivery, behavioral research, and

Federal payment for biomedical, behavioral, and

health services research.

Many Federal actions and publicly sponsored

studies of health information communication or

health issues testify to the perception that health

information is singular, and requires public support to assure its production and dissemination

in the interest of the Nation’s health. A comprehensive review of the roles of the public and

private sectors in health information policy is

beyond the scope of this report: the following

selected studies and legislative and executive actions exemplify the public position.

Private Sector—This term . . . includes private enterprises, for-profit and not-for-profit, as

well as organizations such as professional societies and trade associations, hybrids that are joint

Government/private enterprises, and organizations such as privately supported libraries and

universities (even though they may be subsidized

by public funds).

Perhaps the strongest indications of the attitude

of both the executive and congressional branches

of the Government toward health information are

the passage of the National Library of Medicine

Act in 1956 (Public Law 84-941), which established NLM, and the continued appropriation of

funds for the Library’s operations. (See app. A

for a discussion of the legislation.) The National

Library of Medicine Act was passed without opposition. Witnesses from the Government and the

medical profession unanimously supported it as

a most important contribution to biomedical research and the national welfare. The White House

was convinced that the Library would serve as

the best resource for the production and dissemination of biomedical information (13). NLM

was placed under the auspices of the Public Health

Service both to foster contact with programs in

biomedical research and to assist the Library with

providing access to information about scientific

advances to the health community.

NLM began to assume its official role as a national resource at the start of a period of governmental examination of the importance of research

and development (R&D) in the sciences. The 1958

Baker report (122) was the first of a series of

studies of information handling that arose from

concern with American science and technology

after the launching of the Soviet satellite Sputnik

I in 1957. It implicitly separated health from other

scientific information in its recommendations.

One result of the report was the establishment of

the Office of Science Information Service in the

National Science Foundation. The office was
49

given congressional and Presidential authority to

assume leadership in coordinating scientific (excluding medical) information activities within the

Government and between the public and private

sectors. For the most part, private information

services at the time of the report were in the notfor-profit sector of the industry.

During this period, the Subcommittee on Reorganization and International Organization of

the Senate Committee on Government Operations

was deeply involved in studying the management

of scientific and technical information, and from

1960 to 1962, the subcommittee released a number

of documents on various aspects of the issue. As

the major supporter of scientific and technical

R&D, the Government was perceived as having

the major responsibility for information. The little attention the subcommittee paid to the private

sector consisted of urging scientific and technical

professional and trade societies to “meet their own

challenges head-on and not wait upon Government to do so” (147).

Although the subcommittee was very concerned with the transmission of all categories of

scientific and technical information, it had a

stronger interest in biomedical information. The

stimulation of the not-for-profit organizations in

the private sector was a small part of the subcommittee’s interest, but interaction between the

public and private sector was looked on favorably. Although the greatest emphasis was put

on the Government’s responsibility for biomedical

communications, Senator Humphrey was interested in public/private cooperation and pointed

to the publication of the annual Cumulative Index (which at that time was published by the

American Medical Association based on NLM’s

monthly Index Medicus) as a fine example of collaboration between the two sectors (147).

In 1962, the Surgeon General’s Conference on

Health Communications emphasized the Public

Health Service’s responsibility in improving the

communication of biomedical research (138). A

major recommendation was that the Public Health

Service should “give technical libraries support

for their present activities and make funds available so they can use, experiment, and broaden

their role in meeting the needs of users, including

scientists, health practitioners, health educators,

and science writers. ”

In 1962-63, at the request of the National Institutes of Health, the National Academy of

Sciences/National Research Council conducted a

study of biomedical research communications

problems (111). The report recommended that the

biomedical community continue managing its

own communications. Although it conjectured

that the growth in biomedical research would require public funding of some information modalities, it stressed the need for scientific control of

the communications process. The report differentiated the conduct and location of biomedical

research from other scientific and technical

research, and suggested that the type of communication used for other types of scientific research

might not be appropriate for biomedical research.

It singled out NLM as “the central resource for

the network of biomedical libraries and information services and as the major indexing service in

the biomedical field . . . and the hub of the entire document retrieval component of the biomedical communication complex” and urged its continued support by the biomedical community in

its future development. It also urged support in

the form of direct grants in aid in the short term

to upgrade local biomedical academic libraries.

A similar and even stronger position was taken

by the President’s Commission on Heart Disease,

Cancer, and Stroke in its report of 1964 and its

source papers of 1965 (121). The report dealt at

length on the needs for improved health communications, and advised that this should be accomplished through existing libraries throughout

the country. The report noted that as a result of

the explosion in biomedical research “the continued and accelerated generation of scientific

knowledge will become increasingly an exercise

in futility” without an improvement in the library

school base, as medical libraries were essential for

advancing health knowledge, health education,

and health practice. It emphasized the vital need

for Government leadership in providing assistance

to medical libraries to assist researchers and practitioners in fulfilling their information needs, and

recommended strengthening NLM and bolstering

the Nation’s medical school libraries. It suggested
50

establishing a library network based on existing

libraries with centralized responsibility in the

NLM, building on its acknowledged capabilities,

including that of MEDLARS. This report provided

a primary impetus for the passage of the Medical

Library Assistance Act of 1965 (Public Law

89-241), which incorporated many of its recommendations. (See app. A for a discussion of the

legislation.)

Further expressions of congressional and executive interest in public support of health information and NLM are found in the transfer of the

Public Health Audiovisual Facility to NLM in

1967. The same year, the Toxicology Information

program was assigned to NLM, and the next year,

the Lister Hill National Center for Biomedical

Communications was set up as part of NLM.

The uniqueness of the Government’s involvement in health information was later underscored

in a report on scientific and technical communication sponsored by the National Academy of

Sciences and the National Academy of Engineering (95). One of the 1969 report’s recommendations was that steps should be taken to upgrade

and stimulate the initiation of privately operated

information services, which would then serve as

component elements in information programs

with Government services. The report explicitly

excluded NLM from this recommendation, thereby acknowledging the need for Governmentfunded health information services.

More recent studies of information policy deal

with broad issues that overlap disciplines, such

as privacy, Government management of data

processing, and the need for a national information policy (see app. B). Thus, few studies base

their considerations on health as distinct from

other disciplines. Health policy studies that consider information issues and health information

studies focus on such issues as quality filters for

biomedical information, means of informing the

public of biomedical advances, and means of increasing the efficiency of the Government’s management of health information; they do not consider the Government’s role in providing health

information to any degree.

Government activities in health information

have been concentrated mainly in the areas of

establishing health-related clearinghouses and

other types of information organizations, attempting to establish a coordinated Health Information

System based on primary data, appropriating

funds under the National Library of Medicine Act,

and reauthorizing and appropriating funds for the

Medical Library Assistance Act. At many of the

hearings regarding these two acts, there was considerable questioning with respect to the Library’s

cost recovery practices for its information goods

and services, but little attention was paid to the

appropriate role of the Library in providing information goods and services.

Thus, public policy regarding the degree of

Government involvement in health information

activities in general, and in NLM in particular,

has persisted essentially as enunciated 25 years

ago. In the past few years, however, there have

been definite indications that this policy is being

reconsidered. The section of this chapter entitled

“NLM’s Pricing Policies” addresses the proposed

policy changes.

THE APPROPRIATE ROLE OF GOVERNMENT IN INFORMATION

ACTIVITIES: MAJOR UNDERLYING CONSIDERATIONS

Introduction that the “Government should not compete with

In this Nation, there is a clear preference that its citizens” and that it is “the general policy of

the private sector produce and offer goods and the Government to rely on competitive private

provide services. This is underscored in OMB Cir- enterprise to supply the products and services it

needs” (emphasis added). cular A-76 (1979) (49), which sets policies for the

acquisition of industrial products and services The complexity of the issue is illustrated by the

needed by the Government. The circular states policy precepts which form the foundation of the
51

general policy. As stated in OMB Circular A-76,

the three “equally valid policy precepts” are:

1) to rely on the private sector, because “the

Government’s business is not to be in business;”

2) to retain certain Government functions inhouse, because certain functions are “so intimately

related to the public interest as to mandate performance by Federal employees;” and 3) to aim

for economy and employ rigorous cost comparisons when deciding how work should be done.

Thus, drawing the line between those Government activities which supplement or promote

private efforts and those which abridge private

enterprise is difficult. Economic considerations are

of some help in identifying appropriate Government activities. This section discusses the Government’s role in the allocation of resources to information development and distribution, and the

attendant consideration of the effects of the

Government’s involvement in information activities on the private information sector, particularly the effects of the pricing of Government

products and services.

Allocation of Resources

Economic Theory

In general, the market mechanism for the allocation of resources has proven to be effective, and

in the United States, most goods are produced and

bought and sold in the marketplace. There are

several reasons why Government itself assumes

the functions of allocating resources and distributing certain goods and services. One reason

lies in the nature of the goods and services: some

goods and services are available to everyone if

they are available at all. No one can be excluded

from the service. Services such as national defense

have the property of nonexclusivity. Such services

can be provided more efficiently by nonmarketing

techniques. Other examples are public health

measures to reduce contagious diseases, such as

eradication of the anopheles mosquito that carries malaria. Goods and services with this property of nonexclusivity are termed “pure public

goods” by economists.

Another possible justification for governmental allocation is the presence of positive externalities—i. e., the total social benefit from a good or

service may be greater than the sum of the benefits

to separate individuals. For example, the social

benefit from the research that resulted in the

development of the polio vaccine was far greater

than the sum of the benefits to the individual researchers and firms that participated in the experimentation or to the people who received the

vaccine. The research yielded benefits external to

those separate individuals. The society as a whole

gained added benefit from the reduction of a

major health problem. In such cases, Government

funding of the research may be considered appropriate in order that society reap more of the

potential benefits.

Although there are other economic reasons that

justify the Government’s provision and distribution of goods and services, the two just discussed

are the most pertinent to the issues of this OTA

study. The allocation of resources by the Government is based on both social and economic values.

Regardless of the justification for its involvement,

the Government “may provide a good or

directly or it may purchase the good or

from the private or public sector.

Allocation of Resources to Information

Development and Distribution

service

service

One reason it has been difficult to clearly define

the role of the Government in information activities is that economic theory concerning the

allocation of resources has significant limitations,

although it provides many useful explanations.

Economic theory does not always conform nicely with reality. Another reason is the lack of

general agreement as to the nature of information.

Information can be conceived of in two ways:

some understand it to mean the content of communication, while others equate it with the medium of communication. This difference is seen

in the characteristics that are attributed to information (96,12,29,21):

●

●

●

Information is an intangible.

Information can benefit an individual recipient and/or society as a whole; it is not

exclusive.

Information is not depleted by use; if one person uses it, this does not mean that another

person will not be able to use it. The value
52

●

●

●

●

●

●

of the information may decline, however,

even if the information itself does not change.

Information can be possessed by more than

one person at the same time.

Information cannot be easily packaged in

well-defined units.

Information can be made available in many

media, such as books, documents, journal articles, bibliographic references, videotapes.

These forms have many of the same characteristics as other goods and services.

Information is marketable and maybe profitable. It has value as a capital resource, as

an essential tool for decisionmaking, and as

a means for the better management of tangible resources (118).

The price of information bears little relationship to the costs of making copies available.

The cost of the first copy is likely to be a very

large part of the total cost of production and

the reproduction costs are relatively minor

(96).

The value of information increases as the

amount of data involved and as the degree

of organization of those data increases (96).

When information is viewed as a medium or

conduit, it does not possess the characteristic of

nonexclusivity, the common characteristic of a

pure public good. One reason for the Government

to create or distribute information is that it is a

public good. However, most Government information activities are conducted because of the

presence of externalities. For example, when the

Government provides information about impending typhoons or hurricanes, not only do the people in the path of the storm benefit from the information, but society as a whole benefits from

the reduction or prevention of a disaster.

Externalities from a particular good or service

are not always similarly perceived by all members

of society. In the United States, the Government

provides an extensive crop-reporting service that

is invaluable for agricultural markets. The Government also gathers statistics forecasting total

production (gross national product) which, in

turn, are used by private firms and trade associations to forecast their sales in order to plan production schedules and major long-term investments. Some would contend that the Government

is not justified in providing access to such information in either case because the benefits of the

service to society at large are not greater than that

of the sum of the benefits to separate individuals.

Others would argue that such benefits, in the long

run, are greater to the society as a whole than to

the individuals.

The problem is complicated by the extreme

variety in the content and medium of information. The responsibility for creating and disseminating information may rest with the Government or the private sector depending on its content and/or media. Because of considerations of

public good or externalities, which are influenced

by societal values, the Government maybe justified in certain information activities.

On the other hand, the long history of the private sector in publishing activities and the growth

and development of the commercial information

field in the last two decades give evidence that

much information can be successfully provided

and allocated by the market. But private enterprise is, and of necessity must be, selective in the

information it provides, in order to stay in business. The market may not operate successfully for

all types of information, particularly highly technical and esoteric materials. Such materials may

not have a large enough audience to be profitable

for a commercial firm to market, although the information is or may be essential for the common

good. They may or may not be of sufficient interest to nonprofit professional associations.

Effects of Government Involvement in

Information Activities on the Private

Information Sector

Introduction

Where one draws the line separating competitive from complementary activities of the public

and private sectors depends on one’s philosophical

orientation. Some believe that certain Government activities amount to unfair competition with

the private sector, while others do not. There are

areas where the private and public sectors are in

competition (e.g., both are involved in providing

postal services, education, and weather information). In most cases, prices that the Government
53

charges for these services are zero or very low.

Some have interpreted this as unfair competition.

In the current dialog among the sectors involved

in information activities, the term “unfair competition” is not used in the legal sense. The laws

that govern competitive activities apply only to

private actions, and the Federal and State Governments are deemed to be immune from their prohibitions. The term “unfair competition” is used

in the sense that prices for Government-sponsored

information products are often subsidized, resulting in unfair price competition.

Regardless of definitional distinctions, the

presence of the Government in the information

market does influence the private information sector. Because the two sectors are not subject to the

same laws, conflicts between Government and private activities are accentuated.

Market Segmentation

In evaluating whether or not the Government

is competing unfairly with the private sector, the

boundaries of the market for the information good

or service under consideration need to be defined.

In general, products and services that differ compete in discrete markets. For the most part, the

Government does not offer the same product or

service as private industry. A Government-provided information product, for instance, may contain data that is not of interest to a limited market

or may not be of immediate interest. In addition,

the Government may make information goods or

services available to populations or areas that

private firms would not find profitable to serve.

In some cases, however, Government information goods and services are similar to ones produced by the private sector.

Assessing whether or not information products

and services are competing in different markets

depends not only on the specific characteristics

of the product or service, but also on the substitutability of one product or service for another

in the market. For example, the mail, the telephone, and the telegram can be considered as

substitutes for one another and as such are competing in the same market. In reality, the substitution may be imprecise, and these three communication modalities can be considered as operating

in three distinct markets. Geographic distribution

may be another factor in considering substitutability and market segmentation. The services provided by one telephone company may be similar

to those provided by another. But if one telephone

company is serving a more circumscribed area

than another, the two companies can be considered as operating in discrete markets.

Segmentation may also occur when there are

different types of buyers for the product or service. For example, the users of health-related information can be conveniently divided into

students, teachers, investigators, practitioners of

various categories, managers, administrators,

planners and policy analysts, the Government,

health-related industries, publishing and communications industries, recipients of health-related

services, and the general public. The markets are

quite discrete, and the buyers in different markets

may be willing to pay different prices (65).

The Information Market

Information transfer is in an area where market

and institutional imperfections exist (125). Factors leading to market inefficiencies include

economies of scale, economies of scope, and structural and price barriers that prevent entry into a

market (21). Information goods and services are

often produced with significant economies of scale

due either to extremely high startup costs or fixed

costs or to the existence of decreasing unit costs—

or both.

The situation is even more complex because information production and distribution also leads

to economies of scope. Since doing so is often less

expensive, most information organizations usually

produce more than one product or offer more

than one service: e.g., a telephone company usually offers long distance as well as local call service,

or the publisher of a printed abstract journal may

offer the same information in a computerized data

base (21).

Structural and pricing barriers that may impede

the entry of new firms into the field include the

“lack of availability of major resources because

of uniqueness, geography, and so forth; lack of

competition because of low pricing and Government regulatory restrictions that exclude addi-
54

tional firms from certain markets; and market

restrictions caused by the advantages of scale

economies” (21). Other factors, including the difficulty of determining market demand and uncertainties about the value of information, may also

bring about imperfections in information markets.

Lave believes that as a result of the above factors,

the private sector may tend to undersupply information, particularly information that is needed

by and valuable to a small number of users (80).

Government and the Information Market

The Government both corrects and causes imperfections in the information market. The inefficiencies in the market provide a rationale for a

Government role in information activities (80).

Some of the inefficiencies in the market, however,

are the result of Government participation.

The Government enters the market when the

externalities are important enough that the market

cannot provide an efficient outcome and the economies of scale required to produce or distribute

a product or service are such that the Government

is about the only organization that has sufficient

resources to do so. The Government can also correct market imperfections by subsidizing the

private sector to provide the information (80).

When the Government undertakes the production and distribution of information, it may have

the power to affect the market price. Most

Government organizations price their goods and

services at zero or a low price. In addition, the

Government often has the advantage in the marketplace of prestige. There is a perception on the

part of some users that Government-sponsored

information goods and services are reliable (168).

Thus, because of the low price and/or perceived

quality of Government-sponsored information

goods and services, some buyers will favor these

goods and services over those that are produced

or disseminated by commercial firms. Hence, new

entrants may be dissuaded from entering the information market, and if the Government enters

an established market, others may leave.

Pricing of Information Products

and Services

Introduction

When the Government participates in the development and provision of certain information

products and services, the questions are whether,

when, and what to charge users for such products

and services. What rates should an agency charge

to best serve the public purposes for which the

agency was created? What rates should an agency charge that will not stifle the growth and

development of the private information sector?

Although the library tradition is that ideally all

information should be made freely available to

all, some libraries have always charged for some

services. Many first introduced fees with the advent of computer-based reference services (49).

Most services allocated by the public sector are

mixed with private benefits. It has been suggested

that user fees be instituted when the following

conditions obtain (92):

●

●

●

●

Units of service can be defined and measured,

and the fees related to benefits received in an

equitable fashion.

Individual users can be identified, and ownership rights defined: that is, at least some of

the benefits are private.

Fees can be enforced and nonpayers excluded

at a reasonable cost.

Charging users is not contrary to other, overriding social objectives: in particular, the

distributional consequences of fees must be

acceptable.

Practically, user reactions to fees must also be

considered, and the following ideas for setting fees

have been put forth (9o):

●

●

New fees should be for new services, not

those which have previously been free.

The fee should be closely associated with the

service for which it is paid, and should be

a simple function of the quantity of use, so

that the consumer can make a rational decision about how much to spend.
55

● The highest amount consistent with the purpose of the public activity should be charged.

As long as the institution is going to incur

the political and economic costs of introducing fees, it is better to get full payment, not

just the illusion of it.

Computer-based services fit most of the principles noted above. They differ from services

traditionally offered in libraries, are relatively expensive, are tailored to individual needs, are obtained from an outside source (a vendor) who

charges the library, and are easily identifiable and

provided at the user’s request.

Methods of Pricing Information Goods

and Services

When the true costs of a good or service are

known, average cost pricing or marginal cost pricing can be used as the pricing method. The costs

of an information good or service are the generation of the information or the collection and

organization of information; the design and development of the product or the service; the

maintenance of the operation, including the equipment, rent, utilities and space (fixed costs); the

handling of requests; the reproduction of materials; and the distribution of the good or service.

In the information field, average cost pricing

is used to recover fixed costs and those associated

with the handling of requests, the reproduction

of materials and the distribution of the product

and the service (72). Creation costs have not been

included in calculating average costs for most information products and services. The creation

costs of Government-sponsored computerized

bibliographic data bases have been subsidized by

the taxpayer. The creation costs of privately produced computerized bibliographic data bases have

been in almost all cases subsidized by a companion print product. But because of usage and

technological changes in the information market,

some adjustment in cost calculations may have

to be made for the increasing use of data bases

and the decreasing use of print products.

When the true cost of a good or product is not

available, formula pricing or target pricing is used.

In formula pricing the manufacturing cost is multiplied by a predetermined factor. For example,

books are often priced at five or six times the cost

of printing. Target pricing is based on estimating

the volume of demand and determining in advance a price that will yield a desired rate of return

on the total cost (12).

Some information services charge different

prices to different buyers for the same product or

service for reasons not associated with costs. A

problem with this pricing strategy—price discrimination—is the possibility that a buyer who

bought the product at a lower price might resell

it to others at a price lower than that charged by

the first seller. Another pricing strategy not based

solely on costs is pricing to achieve an objective

and not necessarily to recover the costs of a particular product.

Pricing Practices of the Private Sector

Generally, the for-profit sector of the information industry depends on venture capital or profits from other products or services to initiate a

new service or product (12). The price to the user

of the product or service is not solely based on

costs, but is usually established according to the

perceived value of the product or the service to

the user (66).

The information industry views itself as a

“niche” industry in which each firm operates in

a particular segment of the market. A firm carves

out a portion of the market where it sees a need

for its product or service and then develops the

market for its specialized service or product (66).

The two current commercial vendors of NLM’s

data bases—DIALOG Information Services, Inc.

(DIALOG) and Bibliographic Retrieval Services

(BRS)–view themselves in this light. When BRS

was established as a for-profit venture in 1976,

it targeted the academic and medical library communities, high-volume users of biomedical data

bases, as its market segment. The two principal

organizers of BRS, Janet Egeland and Ron Quake,

came from the (former) State University of New

York (SUNY) Albany Biomedical Communications Network (BCN), a nonprofit agency. Using

SUNY Albany computers, BCN served large universities and medical schools from the East Coast

to Chicago during the late 1960’s until 1975, when

State funding for the project was withdrawn. At
56

that time, BCN made available MEDLARS and

eight other data bases: BIOSIS PREVIEWS,

CHEMICAL ABSTRACTS, CAIN (now known

as AGRICOLA from the National Agricultural

Library), ERIC, INSPEC, NTIS, PSYCHOLOGICAL ABSTRACTS, and INFORM.

When first formed, BRS contacted members of

its delineated market to determine the services

they wanted and the price they would be willing

to pay. The company then and now establishes

prices on the market demand for the service and

adjusts the service to the established price. Since

its founding, BRS has added other types of data

bases and expanded its market interests, particularly in the area of the corporate community

(46).

DIALOG terms itself a service bureau industry

specializing in bibliographic retrieval service for

institutions. The company, which started as an

internally funded R&D project of Lockheed Missiles Space Co. in 1961, made on-line services

commercially available to the general public in

1972. It initially sold access to data bases in education and science, but now it includes data bases

in many fields including health. DIALOG’s pricing includes both cost and market value elements.

Calculations of average cost are based on the

following cost categories: royalties, telecommunication, equipment leasing, storage, loading

and updating of data bases, documentation, facilities, personnel, and various overhead figures.

DIALOG does not do rigorous market surveys

before marketing a new data base, but has experience in estimating the market demand at

various price levels for a new product.

In determining market value, the nature of the

data base and its general potential of appeal to

a mass market are taken into consideration. The

segment of the market the data base will appeal

to is also influential in establishing a price—e.g.,

financial market is more likely to accept a higher

price than an academic community. DIALOG also

examines what competitors are charging for a

similar service. The value of the data bases to the

mass market and/or market segment is balanced

against the calculated cost, and a price determination is made after a profit is also factored in.

However, if the market value appears to be lower

than anticipated costs, the decision is made not

to provide the service.

Government Pricing of Information Goods and

Services: Federal Policy and Practices

Currently in Force

The Federal Government has no set policy for

pricing the information goods and services it provides. Authority for pricing stems from enabling

legislation and the Office of Management and

Budget’s (OMB) directives, with departmental

policies serving as a secondary source. Enabling

legislation is the principal authority governing

charges. Such authority is possessed by only a few

agencies, such as NLM and the National Aeronautics and Space Administration. Other authorities governing charges are title V of the 1952 Independent Offices Appropriations Act (31 U.S.C.

483a) and OMB Circular A-25 (1959) (48).

Title V of the Independent Offices Appropriations Act requires that the Government set prices

to recover as fully as possible the entire costs of

providing a service, taking into account the public

good and the benefit to the user. Indirect costs

that benefit the public at large, rather than the

purchase of specific services provided, cannot be

included in the authorized fee.

OMB Circular A-25 requires that a reasonable

charge should be made to each identifiable recipient of a Government service from which the

recipient derives a special benefit. The identifiable

recipient of a Government service who derives a

special benefit above and beyond what the public

at large received from the service should be

charged, so that the Government recovers the full

cost of rendering the service. Exceptions are allowed when the recipient is engaging in a nonprofit activity designed for the public safety,

health, or welfare and when payment of full costs

would not be in the best interest of the program.

The circular prohibits Government agencies from

charging more than the cost recovery level, since

it limits the charge to the services’ total cost and

not the “value” of the services to the recipient.

Although both title V of the Independent Offices Appropriations Act and OMB Circular A-25

are concerned with setting prices for Government
57

services in general—and not specifically information services—more and more, the policies are

being applied to information products and services. Owing to their lack of specificity, interpretation of these two authorities is very difficult, and

despite two Supreme Court cases, the questions

of who and how much should be charged remain

unclear. Indeed, in 1979 the General Accounting

Office (GAO) recommended “that OMB should

work with the executive departments to clarify

the circular to state clearly when charges should

be made and the manner in which full costs should

be recovered” (55).

Operational considerations are also involved

in setting Government prices. In general, an agency operating under a fixed budget will not attempt

to recover costs in excess of its budget regardless

of demand. A disincentive to increased productivity occurs because production costs and billing and accounting costs come from appropriated

funds, but in most cases any funds collected by

an agency are returned to the U.S. Treasury. The

type of information good and service also influences the pricing practices of a federally funded

information organization, and the organization

usually has different criteria in establishing a price

for a primary (e.g., a technical report), a secondary (e.g., a computer search of bibliographic information), or a tertiary information product or

service (71).

As a result of the vagueness and variety of the

laws and regulations governing pricing, a Federal

information organization has many pricing options available. Government organizations are not

established to raise revenues and therefore choose

their pricing strategy on bases other than economic considerations.

The mission of the organization is a major factor in a Federal information organization’s determination of the amount of costs and the categories

of costs they want to recover. King (71) concludes

that the Government has three goals in providing

scientific and technical information: 1) assuring

the distribution of the results of federally funded

research or federally collected information; 2) supplying an agency and its grantees and contractors

with the information they require for their mission; and 3) providing a particular community

(i.e., health or education) with information,

regardless of the origin of the information or the

recipient’s funding source.

Social utility of the information provided is

another major factor in pricing. When the Government assumes the responsibility of allocating

resources for the development and distribution of

information, its pricing philosophy is premised

on the societal benefit that information development and distribution bestows. Distributing information free would at first glance appear to

realize the greatest social benefit, but there are

costs to the Government associated with the development and distribution of information which

reduce the net value to society. Thus, calculating

a price which stimulates the greatest use of an information good or service, but discourages frivolous use, is another purpose of pricing (71).

The cost categories and methods used to calculate costs vary widely among federally funded

information organizations, but in no case is there

an attempt to recover the costs of creating information. The most frequent method of costing bibliographic computer searches, computer data

searches, bibliographic data bases, and bibliographies is using fixed costs and costs associated

with reproduction and distribution (71).

Considering the variety of methods used and

the different aims of pricing, it is not surprising

to find inconsistent pricing practices among

Government information organizations. In 1979,

GAO found that information organizations that

provided scientific and technical information in

five Government agencies in general were not

functioning in accord with title V of the Independent Offices Appropriations Act and OMB Circular

A-25 in their pricing practices.

In its analysis, GAO did not distinguish between those programs that have enabling legislation regarding pricing and those that do not, nor

between data bases and on-line service. It reported

that, for the most part, the agencies providing

scientific and technical bibliographic services did

not charge for providing such services, were inconsistent in applying cost recovery policies when

charges were made, recovered less than 15 percent of the costs associated with user services, and
58

did not equitably recover the costs of bibliographic data services suppplied to private organizations for commercial purposes. GAO attributes the inconsistent practices partly to the ambiguity of OMB Circular A-25.

Many of GAO’s findings have been confirmed

in other studies. A survey, released in 1981, of

24 human services clearinghouses that are partially or totally supported by Government funds

found that 9 recovered no costs through user fees,

and 14 recovered some (12). An exception was

the National Technical Information Service

(NTIS), which is required by law to be selfsustaining.

A 1980 analysis of 111 federally funded information organizations found that 43 percent did

not charge their users for information services and

products (71). Further, charging practices varied

with the agency, the size of the organization’s

budget, the type of operating organization, and

the type of service or product. The product and

service most often charged for are books (42 percent), nonprint media (44 percent), computer bibliographic searches (39 percent), and computer

data searches (41 percent). Thirty percent of the

information agencies funded by the Federal Government charged user fees for their bibliographic

data bases.

A Changing Emphasis in Federal Pricing Policy

for Information Goods and Services:

“Full Cost Recovery”

At this time, the pricing of data base tapes and

bibliographic computer searches by a Federal information organization falls under the authority

of the organization’s enabling legislation, title V

of the Independent Offices Appropriations Act

and OMB Circular A-25. As just noted, the OMB

Circular A-25 calls for instituting charges that

should recover the “full costs” of rendering a service, but the vagueness of the language has left it

open to considerable interpretation. In the past

2 years, OMB has emphasized full cost recovery

in further directives, again without defining the

term.

In June 1980, an OMB draft circular, “Improved

Management and Dissemination of Federal Information, ” was issued for comment. One of its requirements was that information made available

through other than the depository library information system be provided at a price that would

recover all costs to the Government associated

with disseminating that information—including

printing, processing, and retention—but excluding

the costs associated with the production or creation of the information. The circular was not

issued in final form, because OMB felt that the

new administration coming into office in January

1981 should set policy, and because some of its

requirements are incorporated in the Paperwork

Reduction Act (Public Law 96-511) of December

1980.

In the Reagan administration, the issue of recovering costs of information products and services has become an increasingly important one (7).

In April 1981, OMB Bulletin 81-16 imposed a

moratorium on the production and dissemination

of certain audiovisuals and publications and called

for recovering the costs of production through use

fees. In fall 1980, the Government halted the production of many agency publications.

Of more direct interest is OMB Memorandum

81-14 released in September 1981. In implementing the 1980 Paperwork Reduction Act,

OMB has requested that all Federal information

centers be evaluated. Memorandum 81-14 sets

forth criteria to be used in the evaluation by

departments and agencies. One criterion is

whether or not the information organization

prices its products and services in order to recover

their full cost. Officials at OMB recognize that

“full costs” are not defined in the memorandum,

but suggest that if full cost recovery for information goods and services were required, the definition would be flexible and would vary according

to the specific case (7).

Also of interest is an unsuccessfully offered

amendment to the 1981 Senate bill, S. 800, which

reauthorized the Medical Library Assistance Act.

The amendment would have required NLM to recover the full costs of products and services sold

to domestic profitmaking institutions and foreign

private users. NLM products and services sold to

a nonprofit institution were exempt from full cost

recovery only as long as the institution did not

provide information services to profitmaking institutions. Full costs were defined as “the direct
59

and indirect costs (including overhead) applying

cost accounting principles associated with: (i) the

administrative and intellectual preparation of information products; (ii) the creation and maintenance of systems for the storage, retrieval, and

dissemination of these products: (iii) the storage

and retrieval of these products; and (iv) the

dissemination of these products in whatever

form. ” Neither the 1982 Senate bill (S. 2311) nor

the 1982 House bill (H. R. 6247) which propose

reauthorization of the Medical Library Assistance

Act consider full cost recovery.

The increased emphasis on full cost recovery

results from a number of causes, including reductions in Federal expenditures and expectations that

users of all Government products and services pay

for the cost of the product or service. At the same

time, members of the private information sector

have become more insistent that the Government

recover the costs of its information goods and

services. The Information Industry Association,

which speaks for many private sector firms in the

field, has said that “provision of subsidized information services by Government at low prices

(or no cost at all) is blocking and delaying the

ability of the market economy in information to

deliver low-priced information to everyone” (66).

On the other hand, some experts contend that

the imposition of a full cost recovery policy on

information products and services will limit an

individual’s choice by limiting financial access.

Many, particularly the library community, feel

that some social benefits of information will be

lost under this policy and that full cost recovery

would have “long lasting and deleterious effects

upon equal access to Federal information for both

the private and public sectors” (8).

The implications of instituting a full cost recovery policy for Government goods and services are not fully understood. Although full cost

recovery appears to be a simple and straightforward calculation, the principle is nebulous and

“must rely ultimately on arbitrary and economically indefensible accounting conventions” (21).

The term full costs has not been defined with any

degree of precision, and there are various notions

of the cost categories to be included in calculating

the full costs of information goods and services

and the allocation of such costs (80). The problem is particularly difficult with respect to joint

products, i.e., when more than one product is produced with the same resources.

Some observers believe that the expected increased revenues to the Government resulting

from a full cost recovery policy might not

materialize. The increased price that would be

charged under a full cost requirement might result

in a fall in quantity of goods and services sold and

might lead to a loss of economies of scale, and

the “alleged full cost price would fail to produce

revenues equal to costs as it is intended to do”

(21). A lower price may have benefits to the supplier—the Government—in the form of increased

revenues, and benefits to the user in the form of

lower prices.

A recent notion of including creation costs (i.e.,

the costs of creating information products and

services) in a full cost recovery calculation may

increase the price of Government-sponsored information products and services sharply. Perhaps

even more than other cost categories associated

with the production and the distribution of information goods, the costs associated with creating

information goods are ill-defined. But the issue

is acute because of pricing practices in the private

information sector. Until now, private firms for

the most part have not included creation costs in

the leasing fees for their data base tapes but have

absorbed the costs by overpricing the print products associated with the data base. It is questionable how long this practice can persist with

changes in user patterns from print products to

computerized information. If private firms include

creation costs in costing their data bases, they may

be put at further price disadvantage with respect

to Government-sponsored computerized information products and services.

The copyright law also affects the principle of

“full cost” recovery, primarily as it applies to the

sale of print material and the leasing of tapes of

the data bases, but not to the provision of on-line

access to data bases.

The 1976 Copyrights Act (Public Law 94-533)

provides no protection for any product—be it a

report, data base tape, or geologic map—pro-
.

60

duced by Government employees on Government

time. Such works are considered to be in the

public domain; any domestic individual can copy

them and sell them to anyone else.

A full cost recovery policy assumes OMB can

establish a formula based on accounting principles

to determine an appropriate price for Government

documents, magnetic tapes, etc. Simply stated,

such a formula would divide an agency’s budget

by the number of products sold in the year prior

to instituting full cost recovery, yielding a per

product price. The price would equal the average

cost. The example below is purely hypothetical,

because it assumes that the agency is producing

only one product and not performing any other

functions. It therefore does not account for the

problem of allocating costs between products and

among products and services.

If an agency’s budget is $22,ooo and it produces

one report that is sold to 22 customers in year 1,

in year 2, following the adoption of a full cost

recovery policy, the agency will charge each customer $1,000 for the report. Because Government

products are not protected by copyright laws

against domestic copying, a single entrepreneur

could buy one copy of the agency’s report for

$1,000, duplicate it, and sell it to the other 21 interested customers, or any interested customers,

for less than the Government’s price. The private

entrepreneur’s price could be lower because it does

not include the high costs of creating and developing the product. As a result of the lower price of

the private sector, the agency might lose its market

for the product. Thus, in order to ensure full cost

recovery, an agency would have to charge its first

customer the full cost of production, in this case

$22,000.

Theoretically, such a scenario is possible now,

without an established full cost recovery policy.

But because of subsidies, the Government price

is less than the price a business could charge if

it chose to reproduce Government products. Full

cost recovery policy may effectively drive the

Government out of the distribution business.

The effects of a full cost recovery policy could

be mitigated if there were a clause in an agency’s

licensing or purchase agreement with a private

firm that prohibited resale of its print or computer

tapes product. It is not clear, however, whether

such a restriction is enforceable. Since there is no

copyright on Government products, the Government may not have the power in legal terms to

hold buyers of its products to such a contract.

Such a clause currently exists in NLM’s licensing

agreement for MEDLARS data tapes, which are

priced much higher than others in the Government. It has not been challenged to date.

Thus, it appears that full cost recovery and

other pricing principles for Government information products and services need a fuller and more

comprehensive examination if all their ramifications are to be identified. There may be no one

pricing formula that represents the correct price

for all Government products and services, or for

that matter for any one product or service.

NLM’s Pricing Policies*

Introduction.—In almost all respects, NLM’s

pricing of its products and services is consistent

with the National Library of Medicine Act, title

V of the Independent Offices Appropriations Act,

and OMB Circular A-25, congressional opinion,

as expressed in hearings and reports, and the opinion of NLM’s Board of Regents.

The National Library of Medicine Act authorizes the Secretary of Health and Human Services

with the advice of NLM’s Board of Regents to

make publications, facilities, or services available:

1) without charge as a public service; or 2) on a

loan, exchange, or charge basis; or 3) in appropriate circumstances, under contract arrangements made with a public or any nonprofit

agency, organization, or institution. The purpose

of this authorization is to advance the legislative

mandate of the Library of making scientific and

other information readily available in order to

promote the Nation’s health. Because the act offers the Secretary of Health and Human Services

alternatives in setting charges, the Library has

been able to be responsive to changing needs and

has modified its pricing policies and practices from

time to time.

*Specific prices for MEDLARS products and services are reported

in ch, 2.

k
61

OMB Circular A-25 exempts Federal agencies

from recovering the full costs of services when the

recipient is engaging in a nonprofit activity designed for the public safety, health or welfare, or

when payment of the full fee by a State, local,

or nonprofit group would not be in the interest

of the program. According to NLM officials, only

3 percent of MEDLARS users do not meet one or

both of these conditions (56).

NLM has modified in its pricing policies over

the years. The Library’s initial free Carnegie

library tradition of not charging for any of its

products or services was changed with the advent

and extraordinary growth of MEDLARS, which

created a new and relatively expensive category

of library activities. When the Board of Regents

decided it was necessary to recover some of the

Library’s costs, it determined that the taxpayer

should be responsible for basic library products

and services but that other costs, particularly

those associated with the new computerized products and services, should be borne, at least in part,

by the user. The Library recognized that its appropriations could not support the entire costs of

NLM’s planned communications network, and so

had its on-line system designed keeping in mind

that it would recover a portion of the costs

associated with providing its services from the

users of the services (33).

The Library’s policy in charging users has been

relatively consistent. It is based on four assumptions that have varied only slightly from time to

time. They are: 1) the biomedical community of

users should share the cost of on-line services with

NLM; 2) NLM should support the generation costs

of building the data base and the users should pay

the costs of accessing the system; 3) all users

should have equal access to NLM services and all

sectors of the user community should be charged

the same amount for NLM’s products and services; and 4) charges are imposed to provide a

degree of management control over the rate of the

system’s growth and to make the service as independent as possible of NLM’s appropriations

(101).

Data Bases.—The NLM Board of Regents

reversed a 1965 policy decision to withhold the

sale of MEDLARS tapes for profitmaking purposes in 1970 on the basis that MEDLARS was

no longer experimental and that OMB Circular

A-25 required agencies to recover all or part of

their costs by sales in developing products of commercial value (45). A fixed fee was established

based on the dollar value of services performed

by foreign centers in exchange for access to

MEDLINE and other considerations.

In January 1982, the pricing structure was

changed. The Board of Regents at their October

1981 meeting resolved to “endorse a change from

a fixed fee for the MEDLARS tapes to a use fee

rate structure” (102). The use fee has the advantage of providing information on data base use

as well as serving a revenue purpose. The Board

also recommended that it “continue to delegate

to the NLM Director authority to adjust price

structures in response to changing situations”

(102).

Most other Government data base tapes are

also leased on a use fee ratio structure. Characteristically, Federal agencies turn their data base

tapes over to NTIS without charge. NTIS is then

responsible for marketing the data bases, distributing tapes to customers, and establishing a

price for their provision. The price of each data

base is established by calculating its direct costs

to NTIS, including management and marketing,

and NTIS’ fixed costs. If a new product or service is to be launched, NTIS considers the anticipated market value in its calculations. (See

app. G for a discussion of AGRICOLA and ERIC,

two data bases distributed by NTIS. )

On-Line Access Charges.—On-line access to

MEDLINE was provided without charge from

1971 to 1973. User charges were adopted as a

means of “ensuring that available NLM resources

could continue to provide equal access to

MEDLINE services, enabling the Library to sustain the quality and the performance of the system

by an appropriate degree of control of the system

and making it possible for the continued increase

in numbers of outside users to be largely independent of NLM appropriations” (99).

In 1975, on-line access charges for all

MEDLARS data bases, except TOXLINE and

CHEMLINE, were raised. Later that year, a dif-
62

ferential connect hour rate between prime and

nonprime hours for all MEDLARS data bases was

imposed in order to strengthen management controls over the use of the Library’s computer system

by more evenly distributing the workload, which

was overburdening during peak hours. It was projected that usage would shift from prime time to

nonprime time if the rate were lower during that

period. The rates were raised as a means of attaining full cost recovery of those costs associated

with NLM’s provision of on-line services “outside

the walls of the Library, ” such as telecommunications costs and backup computer costs. In 1980,

connect hour rates to CHEMLINE, TOXLINE,

and TOXBACK were raised to reflect increased

royalty charges.

In October 1, 1981, on the advice of the NLM

Board of Regents, connect hour rates charges for

all domestic users were raised again, and comparable rates for foreign centers were established

as of January 1982. The price per page printed

is the same as before, because NLM calculated that

the Library is recovering all costs for this process

at this time (33). But the cost calculations for the

new charges are very different from those used

before. The Library redefined accessing costs to

mean everything associated with on-line access

to the data bases. Thus, an additional $1 million

was added to the costs attributed to on-line services by including such items as overhead costs,

computer costs related to the service, and the costs

of managing the system. These latter costs were

not included previously because they are appropriated costs.

Congressional Actions.—The House and Senate

Appropriations Committees regularly review

NLM’s pricing policies and charges before they

are formally adopted, and have agreed with them

for the most part in the past. In 1974, Representative Flood expressed interest in putting

MEDLARS on a more self-sustaining basis. Both

committees have also expressed concern about the

effects of cost sharing on the dissemination of

health information, particularly to small institutions, and repeatedly have questioned NLM’s Director on this issue (150,151).

Because the enabling legislation for NLM does

not need periodic renewal, the responsible authorizing committees have historically not been involved with the Library’s pricing practices. As

previously noted, however, in 1981 the Senate

Committee on Labor and Human Resources considered an amendment to the Medical Library

Assistance Act (S. 800) that would have required

the Library to recover the full costs of its products

and services from profitmaking institutions.

Although the amendment was defeated, NLM

is attempting to respond to the requests for full

cost recovery expressed in it, by OMB, and by

members of the commercial information sector.

The Director of NLM established a task force as

early as April 1981 to develop a system which

would capture and allocate on a regularly prescribed basis all costs associated with NLM information services.

In the fall of 1981, NLM increased charges for

on-line access to MEDLARS data bases and designed a new pricing strategy for the MEDLINE

data base tapes. The Library maintains that it

made both modifications to accommodate the

public and private demands for change while

maintaining its policy positions. At its October

1981 meeting, the Board of Regents reaffirmed its

position against a differential pricing structure and

for “equal access and equal charges for all users”

(101). (The issue of differential pricing is discussed

in ch. 6.) It also said “the cost of building data

bases and housing them should be the Governmental responsibility of NLM, but accessing the

system should be paid by the users” at full cost

(101).
4

Chapter 6

MEDLARS and Private Health

Information Systems: Discussion

of Domestic Policy Issues
Chapter 6

MEDLARS and Private Health

Information Systems: Discussion

of Domestic Policy Issues

Advances in the application of computer and

communications technologies to information

transfer have focused attention on on-line systems

in the public dialog concerning the Government’s

role in the creation and dissemination of information goods and services. Recently, the National

Library or Medicine (NLM or the Library) has figured prominently in the debate. One view is that

the achievements of its computerized bibliographic system, MEDLARS, indicate that NLM

is fulfilling its mandate to create and disseminate

health-related information. Another view is that

MEDLARS’ success prevents the growth of private

sector organizations that create health-related data

bases and commercial firms that vend on-line access to health-related data bases.

This chapter examines two sets of issues. One

set concerns the range of NLM’s computerized

products and services. The Library regards

MEDLARS as an extension of its library functions,

while others say MEDLARS does not fall within

traditional library functions and is an inappropriate NLM activity.

The second set of issues pertains to the pricing

of NLM’s computerized bibliographic products

and services, specifically, NLM’s fees for leasing

NLM data base tapes and NLM’s charges for online access to its data bases. NLM’s position is that

its pricing policies aid in the dissemination of

health information to all who seek it; others argue

that MEDLARS’ subsidized prices give NLM a

competitive edge over private sector firms and

that NLM should recover the “full costs” of its

computerized products and services. The debate

concerning full costs remains active, although it

appears that NLM is moving toward recovering

the full costs of its computerized products and

services. Nevertheless, as will be discussed, the

definition of full costs is open to various interpretations.

The issues examined in this chapter are considered within a general framework of the Government’s role in the allocation of resources to information development and distribution; the effect

of the Government’s involvement in information

activities on certain segments of the private information sector, and the health community; and the

historic role of the Government in health information activities (see ch. 5). Specific criteria used

to examine the issues are product differentiation,

historic precedence, the presence of positive externalities (the social benefits received from a

product or service exceed the sum of the benefits

received by separate individuals), Governmental

costs, present or potential private sector involvement, the effects of private sector participation

on the creation and dissemination of computerized

bibliographic health-related information, and international implications. (International issues are

discussed in app. I.)

Although the analysis in this chapter focuses

on current issues, that focus is not at all intended

to minimize the importance of new and emerging technologies on biomedical information policy. Current issues are likely to be altered by

changes in computing and communications technologies. Thus, the analysis in this chapter should

be considered in the context of information concerning future information technologies. (These

technologies are discussed in app. H.)

65
66

RANGE OF NLM’S COMPUTERIZED PRODUCTS AND SERVICES

Data Bases

MEDLARS, NLM’s computerized bibliographic

retrieval and technical processing system, includes

MEDLINE (NLM’s original data base) and many

other health-related data bases. The rationale for

NLM’s creating or maintaining data bases varies

from data base to data base, because of their diversity. (See ch. 2 for a detailed description of

MEDLINE and, NLM’s other health-related data

bases. ) MEDLINE is the focus of this chapter’s discussion. For the most part, the other health-related

data bases are used to illustrate specific points:

it is not possible to generalize about them and it

is beyond the scope of this report to assess individual ones.

The immediate concern with NLM’s creating

and making available health-related data bases

arises from the claim that NLM is competing with

the private sector’s creation of such bases. Basic

to the concern is the relation of NLM’s healthrelated data bases to those created by the private

sector. Do these data bases provide identical, similar, or complementary information? Can one

base be substituted for another?

It is generally accepted that MEDLINE and

“similar” health-related data bases do not duplicate one another, but that there is a degree of

overlap. Overlap in coverage can occur at two

levels. Journal overlap occurs when two or more

data bases contain articles from the same journal. Journal article overlap occurs when two or

more data bases contain citations of the same article from the same journal. Journal overlap does

not necessarily indicate journal article overlap

(112), because different data bases may include

citations of different articles from the same journal. Moreover, the contents of the same article

are often analyzed differently for different data

bases in order to meet user needs. For example,

an article on the biologic differences between two

stages of a particular cancer can lend itself to a

variety of analytic approaches centered on basic

biologic processes, or on diagnostic techniques,

or on chemical analysis, or on clinical manifestations of the disease.

EXCERPTA MEDICA and BIOSIS PREVIEWS

are the data bases that appear to be the most

similar to MEDLINE in subject coverage, but the

extent of overlap among them has not been accurately determined. An early study comparing

the results of searches on biological, medical, and

veterinary subjects in EXCERPTA MEDICA and

MEDLARS data bases reports that of the 226

relevant references retrieved from EXCERPTA

MEDICA data bases and 467 relevant references

retrieved from MEDLARS data bases, only 94

references (or 13.6 percent) were found in both

secondary sources. The authors’ tentative conclusion is that the systems complement each other,

since if one system answers a question poorly, the

other system answers it well (154).

A similar conclusion is reached in a later study

that compared the two on-line search files as they

existed in 1978 (19). An estimated 42 percent of

the on-line MEDLINE file was covered also by the

EXCERPTA MEDICA file and about 31 percent

of the EXCERPTA MEDICA file was covered by

the MEDLINE file. The methodology employed

an author search: a search using indexing terms

might have disclosed a different degree of overlap.

The author concludes that “given the relatively

large numbers of unique records contributed by

each file, they are clearly complementary services

and any comprehensive search should make use

of both files” (19).

MEDLINE and BIOSIS PREVIEWS were included in an analysis of 14 major scientific and

technical data bases for both journal and journal

article overlap.1 Among all the 14 data bases,

there was approximately 20 percent journal

overlap, and among these journals there was 23

percent journal article overlap—i.e., only 4.6 percent of all the articles in all the journals cited in

any one data base were cited in more than one

data base. The authors concluded that the amount

of overlap was much less extensive than they

IT. C. Bearman and W, A. Kunberger, A Study of Coverage Overlap Among Fourteen Major Science and Technology Abstracting

and kkxing Services (Philadelphia: National Federation of Abstracting and Indexing Services, February 1977).
67

hypothesized before the study began. In any

event, overlap is often useful, particularly when

comprehensive retrieval is important, and

MEDLINE and BIOSIS PREVIEWS have been

used successfully in such a complementary fashion.

The data bases differ in other ways, including

the professional fields of interest and focus of each

of their abstracting and indexing services. For example, MEDLINE includes journals in nursing,

dentistry, and allied health fields; EXCERPTA

MEDICA does not. On the other hand,

EXCERPTA MEDICA includes materials related

to other health-related disciplines not found in

MEDLINE, as do BIOSIS and the other healthrelated bases. The bases also differ in their

coverage of English language publications. Sixtyfive percent of the journals indexed for MEDLINE

are in English, 60 percent of the journals indexed

for BIOSIS are in English, and 50 percent of the

journals indexed for EXCERPTA MEDICA are in

English. Other differences include the percentage

of abstracts in each data base.

There are few rigorous studies of overlap concerning other NLM health-related bases and

“similar” data bases created by the private sector. One analysis of toxicology information abstracting and indexing services found that each

service contributes somewhat differently in terms

of scope of coverage and type of coverage, and

that no one service is comprehensive or exhaustive

in the field (112). The study points out the advantages of diversity of biomedical data bases and

printed products, particularly in the toxicology

and chemical fields.

Product differentiation, however, does not

completely negate the possibility of substitutability among health-related data bases or printed indexes and abstracts, and at this time, there are

no hard data on the extent to which the existence

of one influences the use of another. Some claim

that libraries with limited budgets, such as hospital libraries, choose MEDLINE instead of “similar”

data bases on the basis of price alone. Others

claim that price is only one criteria and that hospital libraries choose MEDLINE instead of similar data bases because the literature cited in

MEDLINE is more relevant to their needs: the

practitioner who uses the hospital library will

choose MEDLINE over other data bases because

its content and scope are more related to clinical

medicine (155).

The little evidence currently available suggests

that the citations in MEDLINE, and other NLM

health-related data bases, do not duplicate those

available in any one base currently created by the

private sector, and that the availability of a diversity of biomedical data bases may be advantageous. It is on this basis that the following

arguments for and against NLM’s creating and

making available MEDLINE, and other healthrelated bases, are presented.

NLM created MEDLINE as a result of the computerized production of Index Medicus, and the

medical and information communities throughout

the world perceive this data base as an extension

of the printed publication. * The printed index has

a long and respected history, and is used worldwide: of the 5,888 copies sold in 1981, 2,623 were

sold abroad. MEDLINE is also used extensively

overseas. Foreign centers obtained access to the

data base just shortly after it became available in

the mid-1960’s through quid pro quo arrangements (see app. I). In this country and abroad,

the medical and scientific communities depend

heavily on Index Medicus and MEDLINE and,

with few exceptions, support their continued

production.

The historic relationship between Index

Medicus and MEDLINE in conduction with NLM’s

legislative mandate to publish and make available

“catalogs, indexes and bibliographies . . . to the

material it collects” (Public Law 84-941) is an important argument in favor of NLM’s continuing

to create and make available MEDLINE. The argument is strengthened by the joint production

of the two products. Index Medicus a n d

MEDLINE are tied together by the production

process, as the computer tape which is accessed

in MEDLINE serves as a vehicle for the production of Index Medicus and derivative products.

Indeed, the computerization process that results

in MEDLINE is the least expensive way of producing Index Medicus.

*There is little, if any, expressed interest in NLM’s discontinuing

the creation of Index A4eul”cus.
68 —

The presence of social benefits (externalities—

see ch. 5) is another criterion by which to assess

NLM’s continued creation of MEDLINE and other

health-related data bases. Insofar as it is believed

that the general public health requires expenditures for information products and services which

individuals will not incur for their own benefit,

Government provision of such information may

be necessary. More specifically, if MEDLINE and

NLM’s other bases provide information to physicians, researchers, and other health professionals

that results in an improvement in the health of

various members of the general public, society

may want the information created and disseminated, even if the physicians, researchers, and

other health professionals do not perceive that

they get enough benefit from the information to

pay the price of buying it on the private market.

In considering how far such conditions exist for

MEDLINE and NLM’s other health-related data

bases, it is assumed that some of the primary literature cited in the data bases contains information

that results in an improvement in health. But do

secondary sources, which refer to the primary literature, contain information that is needed to protect the general public’s health? They would appear to, since the primary literature is voluminous, scattered in increasing numbers of journals,

and virtually inaccessible without a well-constructed index (see app. D). Thus, secondary information is considered to have social value because it “leads to the use of primary information

and can reduce costs of identifying and locating

information for the Government and other users”

(71).

The more significant questions are whether

MEDLINE and NLM’s other data bases cite the

primary literature that contains information to improve health, and whether the citations are readily

available to institutions and individuals that

benefit the public’s health. There is no simple

answer to the questions. It is likely that the public

receives the most immediate benefit indirectly

from information that is available to practicing

physicians and other health practitioners.

MEDLINE contains references to literature in

many fields that contribute to the science and

practice of medicine and public health, with an

emphasis on the basic medical sciences and clinical

medicine, While there is evidence that MEDLINE

is responsive to the needs of practitioners (24),

there are practitioners who suggest its responsiveness could be improved.

Because of subject content, subject headings

used in analyzing articles, and the organization

of the headings, searchers do not always easily

retrieve references to the literature that physicians

practicing in patient care disciplines and settings

find useful. This is not to say that Index

Medicus/MEDLINE is not used by practicing

physicians and other health practitioners providing patient care. Indeed, it is the most used

secondary source of all bibliographic biomedical

sources (135), and there is extensive anecdotal and

indirect evidence of its use by patient care practitioners.

On the other hand, information required by

biomedical researchers is identified and organized

in MEDLINE for easy retrieval. If one believes that

biomedical research benefits the general public

health, then one may very well believe that NLM

is justified in producing MEDLINE. Indeed, Congress established NLM to “aid the dissemination

of scientific information important to the progress

of medicine and to the public health” (emphasis

added) (Public Law 84-941).

NLM’s other health-related bases require individual evaluation with respect to the presence

of social benefits. Each contains citations of

literature that varies in form and content: a few

of the data bases contain numeric or representational data. The category of user varies from data

base to data base as well. For instance, TOXLINE

contains references to information that has an immediate, or delayed, beneficial effect on the public

health. But 50 percent of its usage, as measured

by connect hours, is by commercial firms, including drug companies. It could be argued that

commercial enterprises receive enough personal

benefits from the information they receive to pay

the cost of buying it on the market.

The same reasoning can be applied to

CHEMLINE, which receives 50 percent of its usage

from commercial firms, but not to HEALTH,

POPLINE, BIOETHICSLINE, and other bases.

For example, only 1 percent of the approximately 318 hours of HEALTH usage in 1981 was by
69

commercial firms, while 80 percent was by

hospitals, allied health and medical schools, and

research institutions. Whether such users receive

sufficient personal benefits from the information

to pay for it on the market at current levels of

usage is in doubt.

Related to the above discussion of social

benefits is the Government’s allocation of

resources to health-related research, since the

Government funds research because of the social

benefits derived from its findings. The Government supports more than so percent of the biomedical research conducted in the United States,

and over the years has noted the importance of

organizing and disseminating the results of

biomedical experimentation. (See the discussion

of the history of health information in ch. 5.) It

sometimes pays charges to professional journals

to publish research results, and it has developed

and maintains an organizing tool, Index

Medicus/MEDLINE, for accessing the literature

on Government-sponsored and other research. If

the Library were to stop producing these bibliographic sources, it could be argued that meeting

the goals and objectives of the Government’s biomedical research policy would be made more

difficult.

On the premise stated above, as Government

decreases its funding for a type of research, its

justification in sponsoring the results of that

research is weakened. To illustrate, HEALTH is

a data base that centers on the health services

research and health care delivery literature. The

appropriations for two of the major Federal organizations that sponsor health services research,

the Office of Research and Demonstrations and

the National Center for Health Services Research

in the Department of Health and Human Services,

decreased from $69 million in 1980 to $40 million

in 1982. Should the Government, therefore, decrease or discontinue its support of HEALTH?

The issue is extremely complicated and must

be measured against other criteria. The data base

is used by hospital administrators and health practitioners as well as health services researchers. As

Government expenditures for health care continue

to increase annually at enormous rates, and to the

extent that health service research suggests ways

to contain health care costs, the rationale for Government sponsorship of access to this information

is strengthened.

The private sector might be inclined to create

MEDLINE and NLM’s other health-related data

bases with the same degree of consistency, quality, and comprehensiveness as NLM has. But the

desire or lack of desire of the private sector to do

so is purely speculative. At the present time, no

established private concern has expressed an inclination to undertake the creation and maintenance of MEDLINE. It would be difficult for a

private concern to rationalize the expenditure of

money required to create and maintain the data

base, since it requires the acquisition of a large

collection, library staff to index and process the

collection, and other capital-intensive equipment

and facilities. Nonetheless, venture capital is available for many information activities. The possibility exists that if NLM were to announce now that

it would cease the publication of Index Medicus/

MEDLINE in 5 years or so, some organizations

might be interested in the project (137).

However, there might be potential disadvantages associated with private sector creation of

MEDLINE, including the potential risk of not

being able to follow through on the proposed substitute system. There would be no assurances of

continuity, quality, and comprehensiveness. It is

doubtful that another organization could establish

a relationship similar to the one the Library has

with the medical, research, and library communities. The interaction is of great value in developing and maintaining the quality of Index Medicus/

MEDLINE in areas such as developing medical

subject headings (see app. E).

If Index Medicus/MEDLINE were to be produced by the for-profit sector, the data base might

not be as comprehensive. MEDLINE contains

rarely used citations to articles in journals with

low circulation and citations of possible future

use. For-profit firms tend to be more selective and

utilitarian in their operations, and might concentrate on common information and information of

immediate use. The uncertainty of future demand

may limit the information to be preserved by the

for-profit sector, although the potential societal

value of the rarely used information makes its

preservation important.
70

Finally, the price to the user of Index Medicus/

MEDLINE might be higher if it were prepared by

a private firm. The implications of higher prices

are discussed below in the section entitled “Pricing Issues. ”

It is not possible to generalize when speculating

about the private sector’s inclination to create and

make available NLM’s other health-related data

bases, because of their number and the diversity

of their contents. However, the number of records

in NLM’s other bases and usage are low compared

with MEDLINE (see ch. 2) and they may or may

not be profitable for a private firm to create.

In September 1981, users interacted with

MEDLINE for more than 5,500 hours, but they

used TOXLINE, the next most utilized data base,

for only 826 hours during the same period and

CHEMLINE for only 285 hours. Nonetheless, in

fiscal year 1981, with the NLM user charges then

in effect, NLM recovered 110 percent of its accessing and tape costs associated with providing online access to TOXLINE and 75 percent of its accessing and tape costs associated with providing

on-line access to CHEMLINE. If NLM’s 1982 user

charges had been in effect, NLM would have recovered 126 percent of its accessing and tape costs

associated with providing on-line access to

TOXLINE and 126 percent of its accessing and

tape costs associated with providing such access

to CHEMLINE (56).

In September 1981, BIOETHICSLINE and

CANCERPROJ received only 31 hours of usage

each and would not recover costs with such usage.

But some data bases may reach a wider audience

if produced by the private sector. For-profit enterprises generally have much more sophisticated

marketing technique than the Government. Data

base size and current usage are only two of many

factors to consider in determining if a data base

would bring in revenues. A few others include the

availability of source material, the costs of production, and the possible publication of a print

product from the data tapes. The last is essential,

because data bases are not profitable currently

unless produced along with a hard copy publication. Each of the factors varies with the individual

MEDLARS data base.

If the commercial sector were to find it profitable to produce some of NLM’s data bases, NLM

might be responsible for creating and distributing

only those bases that do not meet the market test.

In that case, there is a chance that a perception

might develop that NLM is creating and distributing data bases of little value.

On-Line Services

In addition to creating MEDLINE and other

bases, NLM provides on-line access to them. Although the service is relatively new with respect

to other NLM operations, it is a very visible activity and is associated with NLM’s history and leadership role in bibliographic retrieval systems both

here and abroad. It was established before commercial services provided on-line access to NLM’s

or to most other health-related data bases.

Currently, two commercial information services (vendors) —DIALOG Information Services,

Inc. (DIALOG) and Bibliographic Retrieval Services (BRS)—lease the tapes of MEDLINE and a

few other NLM health-related bases and vend online access to them. Are NLM, DIALOG, and BRS

providing services in the same market? If NLM’s

on-line services are sufficiently different from

those offered by the private sector, they may be

operating in different markets. It is generally recognized that the private sector search services, as

a result of better services and advanced software,

are more efficient than those currently available

from NLM (see ch. 4). It is not clear that NLM

and private information services are different

enough to conclude that the services are operating

in different and discrete markets.

Another way of defining discrete markets is by

the types of users being served by similar products

or services. The markets are discrete if the users

are sufficiently dissimilar. On this premise, there

is some, but inconclusive, evidence that NLM and

DIALOG, one of the private information services

that sells access to NLM data bases, are providing

services in different markets. As measured by connect hours, the majority of users that have online access to MEDLINE through NLM are in hospitals (40 percent) and academic institutions (19
71

percent). Although the exact figures are proprietary, there are indications that a large percentage of users that access MEDLINE through

DIALOG are in commercial organizations. There

is some overlap, since 10 percent of the users that

access MEDLINE through NLM are commercial

organizations, and 28 percent of DIALOG users

are in academic and other nonprofit institutions.

Nonetheless, DIALOG appears to be providing

services to a market different from that of the

Library. However, NLM and BRS appear to be

serving the same market, as the majority of BRS

users (55 percent) are in medical schools and academic institutions. But the boundaries of the

markets are not necessarily firm and might shift

if NLM were to stop providing on-line services.

Only very indirect evidence is available with

which to assess the effect of NLM’s provision of

on-line services on commercial information services (vendors). Computer-based information services, a very much larger category of business firms

than the three information services discussed in

this report, realized almost $8 billion in revenues

in 1979 and anticipate increasing their revenues

by 29 percent in 1980 (42). Another indication is

that BRS was recently acquired by a multinational

firm, Thyssen-Bomemisza, for a sum higher than

BRS’ original capital investment. However, in

May 1982, BRS said NLM’s new pricing structures

did not allow BRS to vend MEDLINE profitably

(46). (This issue is discussed further in the next

section. )

NLM and others are concerned that serious

damage to the integrity of NLM’s data bases might

result if NLM were to discontinue providing online services. Because of on-line access, user training, and user services, NLM continuously interacts

with MEDLARS users. The users provide information about any inadequacies of the data bases,

thereby facilitating another quality check of the

data bases by NLM. A counter argument is that

NLM might find other ways to communicate with

users if it did not provide on-line access to NLM’s

data bases. Among others, BIOSIS creates a quality data base without providing on-line services.

A parallel factor is the collection of quantitative

data on users. The Library requires such data, if

it is to create bases that reflect user needs. No matter who provides the search service-NLM or private sector firms-they will be precluded from obtaining comprehensive statistical data on users

because of the privacy of the search process. With

that limitation in mind, it would be possible for

private information services to obtain and provide only general statistical information on users

for NLM’s use, for a fee.

A most important factor to weigh in assessing

NLM’s provision of on-line access to its data bases

is the Government’s cost of providing the service.

The additional cost to NLM of providing on-line

access is relatively low because of user charges.

For fiscal year 1980, according to NLM, approximately $400,000 in appropriated funds would

have been saved if NLM had not provided online access to MEDLINE but had continued to create the data base. Even if NLM were not to provide on-line access to MEDLINE, creation and

maintenance of the data base would still be required. Service support, data base testing, disk

storage, and computer hardware would still be

maintained in order to provide the data base to

vendors (103).

Somewhat higher costs related to NLM’s provision of on-line access to its data bases are reported

for fiscal year 1981 (56). In fiscal year 1981, NLM

incurred costs directly assignable to offering

MEDLINE publicly for on-line searching of $3.241

million. NLM recovered $2.336 million in user fees

(including $42,000 in services by NLM for

MEDLARS carrying out its basic library activities). Thus, it cost the Government $905,000 to

provide on-line access to MEDLINE in fiscal year

1981, or 28 percent of the accessing and tape costs

associated with providing on-line access. The accessing and tape costs associated with providing

on-line access to all the NLM data bases were

$4.757 million. of this, NLM recovered $1.271

million, or 28 percent, in user charges. If NLM’s

current (higher) user charges had been in effect

during 1981, the provision of on-line access would

have cost the Government only $166,000 or 6 percent of the costs associated with providing access

to MEDLINE and only $235,000 and 5 percent of

the costs associated with

NLM data bases (56).

providing access to all

98-764 0 - 82 - 6
72

PRICING ISSUES

Pricing issues related to leasing NLM’s data base

and pricing issues related to NLM’s on-line services receive separate consideration in the following pages. But these pricing issues are interdependent, because the leasing fee that private information services pay for NLM’s data base tapes is a

factor in information services’ pricing of on-line

access to the data bases. The relationship between

leasing fees for NLM data base tapes and NLM’s

on-line access charges illustrates the heterogeneity

and diverse interests of the private information

sector. If NLM’s leasing fees for its data base tapes

are high, private sector firms that produce healthrelated data bases presumably will be in a better

position to market their product. This will especially be true if the leasing fees for NLM’s data

base tapes are higher than the leasing fees for the

tapes of privately created data bases. At the same

time, however, private information services that

lease the NLM tapes and subsequently vend them

will have higher costs in providing on-line

services.

The different effects on different members of

the private sector are reflected in the current

dialog concerning tape leasing fees for NLM’s data

bases. NLM’s current leasing fees for MEDLINE

tapes are new, having become operational as of

January 1982. Thus, it cannot be determined

whether the full costs of creating the data base

are recovered by the leasing fee, although the fee

is much higher than the costs of reproducing the

data tapes and much higher than the leasing fees

for almost all other Government-sponsored data

base tapes.

Some data base producers contend that the

NLM fee for leasing data base tapes should

recover the full costs of creating the data base.

On the other hand, information services (vendors)

in the private sector feel that NLM’s leasing fees

are currently too high, and some propose that

NLM follow the model used by the National

Agricultural Library for AGRICOLA and by the

National Institute of Education for ERIC (see app.

G) (137). The tapes of ERIC are leased by the

General Accounting Office (GAO) at the cost of

reproduction: the tapes of AGRICOLA are leased

by the National Technical Information Service

(NTIS) at $1,220 for domestic use plus a fee. (See

table 12 for NTIS leasing fees for Government

data bases. ) Both computerized data bases have

a wide offering, from in-house systems of computers at universities, companies, and other

organizations, and are offered by commercial vendors at relatively low rates (see table 8 in ch. 4).

Fees for Leasing Data Base Tapes

The principal pricing issues concerning the leasing of NLM’s data base tapes are: 1) whether leasing fees are to recover the costs of reproducing

the tapes only, or to recover both the costs of reproducing the tapes and the costs of creating the

data bases; and 2) whether foreign lessees are to

pay a different fee from domestic lessees.

One view is that leasing the data base tapes at

the relatively low cost of reproducing the tapes

would allow for private sector participation and

at the same time widen the distribution of health

information. Another view is that private producers of health-related data bases could be adversely

affected by this practice. The American Psychological Association, for instance, claims its data

base cannot effectively compete with a base prepared by the National Institute of Mental Health,

which leases its data base tapes to commercial information services at the cost of duplicating the

data tapes (9). Another argument is that all U.S.

taxpayers pay for the data bases, but only a few

commercial information services would benefit

monetarily from leasing the data base tapes based

on reproduction costs only.

The private sector, in general, does not lease

its machine-readable data base tapes to include

the costs of creating the data base. If creation costs

were included, the on-line access cost would be

so high as to discourage usage. For the most part,

the print products associated with the bases subsidize their production. The use of machine-readable data bases, although extensive, is new; the

user communities in the health fields are not quite

prepared to pay high costs for information (69).

In addition, data base production is in a period

of great transition, with a declining demand for

print materials and new technological develop-
73

Table 12.—Selected Data Bases Distributed by NTIS, December 1981

Department Agency Data base Acronym

Agriculture

Commerc e

Defense

Energy

Health and

Human Services

Interior

NASA

National Agriculture

Library

National Oceanic and

Atmospheric Agency

U.S. Patent and

Trademark Office

National Technical

Information Service

Defense Technical

Information Center

Technical Information

Center

National Library of

Medicine

Office of Water Research

and Technology

U.S. Fish and Wildlife

Service

Scientific and Technical

Information Office

Smithsonian Science

Information Exchange

The Agriculture

On-Line Data Base

Aquatic Sciences and

Fisheries Abstracts

Patent Full Text File

Patent Bibliographic

File

Patent Classification

File

NTIS Bibliographic

Data Base

Technical Abstracts

Energy Research

Abstracts

MEDLARS On-Line

Selected Water

Resources Abstracts

Pacific Island

Ecosystem

Scientific and

Technical Aerospace

Reports

Notice of Research

Project Data Base

AGRICOLA

ASFA

NTIS

TAB

EDB

MEDLINE

SWRA

PIE

STAR

SSIE

Annual lease Use fee

$1,220 domestic

1,820 foreign

2,500

10,920 domestic

16,380 foreign

5,460 domestic

8,190 foreign

900 domestic

1,150 foreign

5,350 domestic

7,150 foreign

2,950 domestic

Not available—foreign

20,000

2,300

4,600

500

750

8,000

16,000

Yes

Yes

Foreign only

Foreign only

None

Yes

Yes

Yes

Yes

Yes

Yes

SOURCE: National Technical Information Service, 1982

ments occurring rapidly. Accordingly, it appears

unlikely that the private sector will lease its data

tapes at a price that includes the costs of creating

the data bases in the near future.

The problem is further complicated by the quid

pro quo arrangements that NLM has with foreign

centers. In exchange for either lease of the data

base tapes from NLM or access to them by means

of telecommunication to the NLM computer, these

centers contributed almost $500,000 worth of

services, mainly indexing services, in 1980 and

more than $600,000 in 1981. If NLM were to provide the data base tapes at reproduction costs to

the foreign centers, there would be a large drop

in the quantity of indexing performed for the

Library. Although no money is received by the

Library in this transaction, existing or additional

appropriations would be required by NLM in

order to maintain the same level of indexing.

Whether the foreign centers would agree to be

responsible for the indexing of the foreign literature under a non quid pro quo arrangement is

strictly conjectural.

NLM’s quid pro quo arrangements with foreign

centers have additional advantages. A rough examination of the MEDLINE citations in recent

years shows that the percentage originating in the

United States has remained relatively stable at

about one-third of the total biomedical serial literature indexed (133). Furthermore, NLM’s quid pro

quo exchange agreements are quite important for

the future, because the costs of publishing

overseas have continued to remain below those

of the United States and the probabilities of using

electronic methods for dissemination of research

results may reduce the U.S. percentage of MEDLINE

citations. With a large percentage of medical journals being published overseas, the cooperative international system, mostly among governments

or quasi-governmental organizations, benefits

U.S. citizens as much as, if not more than, citizens of other countries.

A suggested alternative pricing policy to the

current policy is to lease the data bases to private

enterprises in the United States at the cost of reproducing the tapes, but to lease them to foreign
74

countries to recover the full costs of their creation, i.e., differential pricing. On the surface this

idea appears attractive. If the data bases are considered to represent a national investment, it

seems appropriate that U.S. citizens benefit from

the investment, but that foreign nationals not necessarily share in the benefits.

However, the use of differential pricing might

have serious international policy ramifications.

Foreign nations might view this change in pricing policy as an antagonistic act on the part of

the United States. They might conceivably reconsider their arrangements with the Library, thereby

interrupting the flow of some medical information from abroad. In addition, technical considerations reduce the possibility of enforcing differential pricing for domestic and foreign users of the

on-line computerized system. It is very difficult

to distinguish between domestic and foreign users,

and foreign sources often find a domestic source

of information where price barriers exist. Unauthorized copies of data base tapes are also feasible with new technologies.

On-Line Service Charges

If NLM continues to provide on-line access to

its health-related data bases, several specific pricing issues need to be addressed are: 1) whether

to establish charges for on-line access to the data

bases to recover the full costs of accessing the data

base; 2) whether to establish charges for on-line

access to the data bases to recover the full costs

of accessing the data bases and of creating the data

bases; and 3) whether to subsidize MEDLARS or

MEDLARS users. The issues are discussed here

in the context of structuring charges for on-line

access to MEDLARS data bases to best serve the

public purpose for which NLM was created without inhibiting the operations and development of

private information enterprises. The debate on

these issues has been complicated even more by

lack of definition of the term “full cost recovery.”

There are advocates of guaranteeing all citizens

free and equal access to publicly funded library

and information services (161). Conversely, there

are advocates of full cost recovery of Government

information products and services, including the

costs of creating the information. In establishing

the prices for on-line access to MEDLARS, NLM

is between these two positions. (See ch. 5 for the

history of NLM’s pricing policies.) It has adhered

to the policy of sharing the costs of on-line services with the user community, with the taxpayers

assuming the costs of creating the data bases and

the user community assuming the costs of accessing the system.

Within the above framework, however, NLM

has shifted its emphasis on the specific goals of

its pricing structure. An economic analysis of

NLM’s on-line services in 1974 and 1975 investigated alternative pricing strategies and their relationship to social benefit (81). The study recommended marginal cost pricing for access in order

to benefit the health of the Nation’s people. It supported pricing access to MEDLINE at $8 to $15

per connect hour, which was the estimated price

of recovering the full costs of that access, defined

at that time by NLM as costs associated with online access “outside the walls of the library,” such

as telecommunications and backup computer

costs.

In October 1981, NLM increased its price for

on-line access to MEDLINE to $15 to $22 per connect hour. However, it did not justify the increase

on the basis of social benefit as well as on the basis

of full cost recovery of costs, as it did in 1975.

Rather, the justification was on the basis of full

recovery of access costs and on the basis of bringing on-line costs more in line with accessing other

Government data bases and other discipline oriented data bases. The premise of the Library’s cost

calculations was also different, as the Library redefined access costs to include “all related computer and communication charges, all direct labor

for system and network maintenance, all printing

or duplicating charges, overhead and indirect

costs, and training costs” (103) (emphasis added).

NLM excluded from the cost base those costs

which it would necessarily incur in maintaining

the bibliographic apparatus of a national library,

including capital costs.

According to NLM’s definition of the “full cost”

of accessing MEDLINE (i.e., the costs of accessing the data base but not the costs of creating the

data base), and on the basis of NLM’s analysis,

NLM appears to be approaching full cost recovery
75

for accessing MEDLINE on-line (103). * A recent

analysis (56) confirms NLM’s conclusion that it

is arriving at full cost recovery for accessing

MEDLARS data bases. For fiscal year 1981, NLM

recovered 72 percent of the accessing and tape

costs associated with providing on-line access to

MEDLINE and to all the other NLM data bases.

This analysis was based on NLM’s charges for

assessing MEDLINE which had been in effect before 1981. If NLM’s current (higher) charges had

been in effect during fiscal year 1981, NLM would

have recovered about 94 percent of the accessing

and tape costs associated with providing on-line

access to MEDLINE and and about 95 percent of

those associated with providing on-line access to

all of NLM’s data bases. NLM’s method of identifying and allocating costs was in general considered reasonable for achieving order to achieve full

cost recovery of its accessing costs (56).

It is too early to evaluate the effect of the increased charges for accessing MEDLINE on the

private information sector. The lower pricing

structure for on-line services that was in place

until October 1981 did not appear demonstrably

to have impaired the growth of the industry. It

may indeed have fostered its development. As the

first to offer computerized services in the medical

bibliographic field, NLM with its low prices may

have been instrumental in breaking down initial

resistance to new products and services, thereby

opening up markets for private firms (137,163).

In any case, there are problems with generalizing the effects of NLM’s charges on the private

*The rationale for NLM’s cost allocation which leads to this conclusion is that each cost for fiscal year 1980 was allocated entirely

or in part to one of the five categories: 1) essential national library

services (ENLS), 2) data creation, 3) publications, 4) on-line services,

or 5) tape distribution. ENLS were considered to be those activities,

such as selection and acquisitions, technical processing, reference

services, etc., that are basic and essential for a national library to

perform its mission. These are services that would be performed

by a national library whether or not there were products such as

publications, on-line services or tape distribution. The cost of indexing journal articles was considered to be partly basic service and

was divided equally between ENLS and data base creation. Costs

assigned to data base creation were those which were incurred in

gathering or preparing the data on which the publications, on-line

services, or tape distribution are based but which cannot be specifically assigned to one of the three. Each cost which could be allocated

specifically was appropriately assigned. Portions of salaries, benefits,

and other costs associated with personnel (travel and training) were

assigned according to an estimation of the time spent.

information services (vendors). Not only are the

firms diverse, with sometimes conflicting interests,

but the relationship between leasing fees for NLM

data base tapes and on-line access charges masks

the effects of the latter. For example, BRS was able

to successfully vend MEDLINE at the same price

as NLM under NLM’s pre-October 1981 prices for

on-line services and NLM’s pre-January leasing

fee structure. As of January 1982, NLM changed

its leasing fee structure from a flat annual fee to

an annual lease fee plus a $4 per hour usage fee

and a $0.01 per citation print fee all of which BRS

passes through to users. NLM, however, does not

impose a per hour usage fee or a per citation print

fee on users who access MEDLINE on NLM computers. Because BRS customers are high-volume

users and BRS provides on-line access to

MEDLINE in approximately the same market as

NLM, BRS finds it can no longer provide access

to MEDLINE at the same price as NLM does, and

obtain a reasonable profit. Thus, BRS is concerned that its users will switch from its service

to NLM’s and considers NLM’s current leasing fee

structure and on-line service charges unfair (46).

On the other hand, NLM’s increased charges

for on-line access to MEDLARS data bases are

now more in line with DIALOG’s charges.

DIALOG has more of MEDLINE on-line than

either NLM or BRS, and thus incurs higher costs

which are reflected in its prices. DIALOG does

not seem to be unduly affected by NLM’s new

leasing fee structure: the majority of DIALOG’s

users appear to be commercial organizations, and

the majority of NLM’s users are not (137).

Any assessment of the relation between NLM’s

increased on-line access charges to its data bases

and the commercial viability of similar health-related data bases produced in the private sector

would be based on very little evidence. The only

information available are the statements of one

or two private data base producers that, even at

the current higher rates, NLM’s charges for accessing MEDLARS in conjunction with NLM’s leasing

fees are detrimental to the sale of their products.

Since financial data on private companies are proprietary, there is no way to substantiate the statements. As noted earlier, MEDLINE and similar

bases are complementary and not identical, but

there are no data on the extent to which the pres-
76

ence of one in a market influences the use of

another.

A new issue in calculating the full costs of accessing NLM’s data bases is whether or not to include the costs of creating the data base as well

as the costs of accessing the system in the calculation. The issue is of unique interest, mainly because it is of such recent origin. Until the unsuccessfully offered cost recovery amendment of the

Health Care Research and Research Training

Amendments of 1981 (S. 800), the creation of information was not referred to in any Government

directive or practice regarding the pricing of information products or services: even the 1982

GAO report (56) on MEDLARS does not consider

the costs of creating the data bases in its pricing

analysis of NLM’s on-line services.

Principle 6 of the report of the Public Sector/

Private Sector Task Force of the National Commission on Libraries and Information Science (96)

recommends that pricing policies for distributing

information by the Federal Government should

reflect the true cost of access and reproduction;

however, the costs of data base creation are not

included in the recommendation (see ch. 5 and

app. F). The concept of creation costs is vague

because the costs of creation can be considered

indexing or abstracting costs only or can include

acquisition costs and overhead costs as well. As

mentioned above, private data base producers do

not include creation costs in pricing the leasing

fees of their data base tapes, and accordingly creation costs are not included in the on-line access

charges set by commercial information services.

Most important is that a mandated function of

NLM is to acquire, process, and index health

information-and funds are appropriated for that

purpose. It is questionable whether MEDLARS

users should pay for a process that is a general

library function which benefits all users of the

Library.

The major advantages of including data base

creation costs in NLM’s charges for on-line access

to MEDLARS data bases is the increased revenues

to the Government and the possible beneficial effects to the private sector producers of similar data

bases if charges were increased.

As of May 1982, the effects of the new pricing

structure of on-line services for the users that access MEDLARS were unknown. There are a variety of user institutions with a large variety of charging procedures for on-line access. Most pass the

costs through to the users in varying degrees, but

others absorb the costs. It is reasonable to suppose that commercial firms would not be unduly

affected by higher costs of on-line access even if

creation costs were to be included in the full cost

formula that includes creation costs. Even some

of the major academic health center libraries might

financially accommodate to the approximate additional cost of $1 or $2 per search which would

result from the added costs.

But there is valid concern that students, nurses,

and allied health personnel and researchers who

are not working on grants or contracts might find

it difficult to pay much more than NLM currently charges. The libraries in small hospitals might

be adversely affected even by small increases in

charges. Indeed, there is anecdotal evidence that

there has been a 30-percent decrease in searches

performed in a Northeast consortium of smallsized hospitals since the increase to $15 to $22 per

connect hour by NLM (50). Smaller institutions

are extremely limited in their ability to control

costs, and the information center or the library

is one of the few areas subject to cost control.

Differential Pricing

The price to access NLM data bases might be

prohibitive to some users either if the full costs

of accessing the system, or if the full costs of accessing the system and creating the data bases

were recovered in on-line charges. The Government could decide to continue to provide access

to all users by subsidizing the system. Other Government alternatives would be to set different

charges for accessing MEDLARS data bases online for different types of users (i.e., differential

pricing) or offer a subsidy (through grants for example) to particular institutions or individuals to

allow them to select the service and data base they

wish to use.

If the Government subsidized the system, theoretically, then as now, MEDLARS users would
77

not have a choice of information services and

would be dependent on NLM, which might or

might not be responsive to their needs. This

assumption about users’ influence holds if NLM

is providing on-line access to MEDLARS at a lower price than commercial information services and

if price is the only, or even the main, factor in

the choice of services. If the Government subsidizes the system another way —i.e., by paying private information services to provide the information at a low rate—users also would have little

influence on the system. They would find it difficult to withhold payment or to switch services

if they were dissatisfied.

Differential pricing is the alternative to governmental subsidization of MEDLARS that is currently receiving the greatest attention. Many proponents of differential pricing feel that the Government’s subsidization of MEDLARS results in

NLM’s having an unfair competitive advantage

over private information organizations. Some

proponents also think it unfair that for-profit

organizations pay the same on-line access charges

as not-for-profit organizations to access the NLM

data bases on MEDLARS. Differential pricing

might eliminate or modify NLM’s supposed unfair advantage and promote the information activities of the private information sector. The Government might also receive more revenues from

increasing NLM’s on-line access charges to commercial firms and other for-profit organizations.

But there are a number of arguments against

differential pricing. NLM has been opposed to it

in the belief that all users should have equal access to NLM services and all sectors of the user

community should be charged the same amount

for NLM’s products and services. “Domestic commercial enterprises presumably pay their legislated

share for supporting Federal Government activities and should enjoy the fruits of those activities on an equal footing with the non-profit sector” (110). In addition, establishing different

charges for different institutions may require the

imposition of a means test, which is not only demeaning to those who have to prove their inability

to pay, but is usually cumbersome and costly to

administer.

A problem in differential pricing is determining the category or categories of users eligible for

lower prices. One could argue that not-for-profit

organizations fall into this category. The Federal

Government has historically recognized a distinction between not-for-profit and for-profit organizations. This distinction recognizes the important role played by nonprofit organizations in

America. It recognizes the contribution which the

private nonprofit sector has made towards

achievement of social goals.

Precedent for the distinction between treatment

by the Government of profit and nonprofit organizations can be found in many laws and policies.

For example, the Internal Revenue Code recognizes, for tax purposes, a fundamental distinction

between the private, nonprofit corporation organized under 501(C)(3) of the code, and the forprofit corporation. One pays taxes, and one does

not. The code also recognizes that a deduction can

be made for contributions and bequests by individuals to private, nonprofit organizations. Such

contributions are not taxable. But one could also

argue that not all not-for-profit organizations benefit the public and that some for-profit firms provide greater social benefits. In addition, the distinction between not-for-profit organizations is increasingly blurred. For example, the National Institutes of Health, which once limited its grants

to not-for-profit organizations, now provides

grants to for-profit firms as well.

The other alternative to governmental subsidization of MEDLARS is to subsidize MEDLARS

users by grants. This may also require adherence

to some type of qualifying criteria (“means test”).

The key disadvantages of subsidizing users in this

manner are the complexity and the costs both of

making payments to hundreds of users and of enforcing the regulation. Furthermore, the potential for Government regulation of private information firms exists if the Government provides

funds that could be used to purchase on-line access from private information services. Indeed,

a Government subsidy using a mechanism similar

to grants could be structured even if NLM were

not providing on-line access to MEDLINE and its

other data bases.

However, there are advantages in subsidizing

some users of MEDLARS rather than subsidizing

the system. Subsidizing users might encourage

competition and stimulate private sector informa-
78

tion activities, and might increase the efficiency

of on-line information systems. Also, if the administrative costs do not exceed the charges recovered, the Government would recover more

from user charges for on-line services if only some,

as opposed to all, users did not pay the full costs

for the services.

One observer has suggested that an office within the Department of Health and Human Services

could offer credits for bibliographic search services of up to a given amount, such as $3OO to applicants without other sources of funds (43). If the

applicants stated that they were not working on

sponsored research and that they had incomes and

net worths below specified minimums, they would

be granted the credits. A somewhat looser procedure could be followed by schools without asking for income and net worth, much as computing

funds are now allocated in many schools, depending on the total number of students in the categories of interests. The above techniques should

be capable of being administered at a cost of perhaps 10 to 20 percent of the subsidies granted.

Naturally, more assurance of the legitimacy of the

requests could be obtained, but only at higher cost

(43).

Research and Development

NLM conducts, supports, and promotes basic

and applied research in information science and

its technologies. Research conducted at the

Library’s Lister Hill National Center for Biomedical Communications and under research

grants and contracts, along with the efforts of

many other governmental bodies, played a major

FINAL COMMENTS

This chapter has presented arguments concerning NLM’s creation of computerized health-related

data bases, its provision of on-line access to data

bases, and different strategies for pricing the data

base tapes and on-line access to the base. The discussion has focused on MEDLINE, the original

and major data base in the Library’s computerized retrieval and technical processing system,

role in the formation and development of the computerized data base and on-line information industry. Subsequently, private enterprise developed more advanced and innovative technologies

(see chs. 2 and 4).

Research conducted and sponsored by NLM

continues to benefit the private information sector. Among its other contributions, this research

has laid the groundwork for the private production of master tapes for the subsequent production of video disks and the private development

of video disk files of graphical data from patents,

and has been responsible for the establishment of

many private information firms (165).

NLM has also been among the first to recognize

the need of practicing health professionals for

more direct access to biomedical information than

bibliographic sources afford. Thus, need is particularly acute in areas where primary information is limited or unavailable, as in developing

countries. NLM developed the Hepatitis Knowledge Base as a “prototype information system”

to enable users to quickly and efficiently find the

proper information for their needs. Because of the

intellectual input (the contents of the data base

are evaluated by a consensus of experts), it is very

expensive to produce. The Hepatitis Knowledge

Base may serve only as a model of a refereed data

base. Indeed, the American Medical Association

and General Telephone & Electronics Corp. are

launching a knowledge base containing drug-related information this year, but it will be of lesser

magnitude and sophistication than the Hepatitis

Knowledge Base and is expected to be used in concert with bibliographic data bases (128).

MEDLARS. The findings with respect to the issues

follow.

OTA finds that over the years NLM has established strong and intimate ties with health and information communities worldwide who rely on

the Library’s information sources, and, in turn,

contribute to the high quality and comprehensiveness of NLM’s bibliographic sources.
79

A major finding is that the creation of MEDLINE

by the Library seems to be warranted by NLM’s

extensive collection of biomedical materials, by

its legislative mandate, and on economic grounds.

NLM has the world’s largest collection of biomedical literature and is mandated by law to organize

and make its acquisitions available. For more than

a century, Index Medicus has been the guide to

the Library’s collection of biomedical journals,

and today the data base tape that is used in printing Index Medicus is also used in preparing

MEDLINE. MEDLINE is also part of the Government’s investment in biomedical research and

assures ongoing access by researchers and practitioners to information needed to maintain and

improve the public’s health.

In addition, OTA finds that the possibility that

the private sector would be inclined to create

MEDLINE if NLM were to cease doing the activity

is a matter of speculation. The information industry is young: it has been functioning for approximately 15 years. It is uncertain that if NLM were

to cease creating MEDLINE a new or established

private firm would have the desire to produce a

similar product. As noted previously in this chapter, the other major health-related data bases complement rather than duplicate MEDLINE, and the

availability of diverse bases is advantageous for

the user.

Another finding is that there is no convincing

argument that clearly supports any specific method of setting leasing fees for the MEDLINE data

base tape. There is a wide range of interests between the public and private sector and within

the private sector resulting in equally good reasons

for leasing the data tapes to domestic firms at the

cost of reproduction or at the costs of reproduction and creation. The economic arguments for

instituting differential leasing fees are opposed on

technical, scientific, and international grounds.

On balance, arguments for changing the present

policy are not convincing.

OTA finds no compelling reasons at present for

NLM either to continue or to discontinue providing on-line access to MEDLINE. NLM has

nearly achieved recovering the full costs of accessing the system, thus making its on-line charges

more in line with, although still lower than, the

charges of commercial information services.

NLM’s current on-line charges appear to be sufficiently low to adversely affect the ability of one

of the two commercial vendors of MEDLINE to

realize a profit in providing the same service, At

the same time, preliminary evidence indicates that

the charges are sufficiently high to prevent some

small hospitals from continuing the same level of

searching they previously performed on MEDLINE

using NLM’s system.

Another finding is that there is inconclusive

evidence with which to weigh the advantages of

charging the users of MEDLINE who cannot pay

NLM’s current on-line rates (or any future increase

in costs) a lower rate than those who can pay such

charges against the advantages of keeping the

charges at a level all users can pay.

In summary, OTA finds that many of the arguments presented by proponents or opponents on

the issues pertaining to the creation, provision,

and pricing of NLM products and services seem

more reflective of philosophical perspectives than

objective analysis, and there are few empirical

data to support them. Thus, any changes in the

range of NLM’s computerized products or services

or in their pricing structure require caution.

OTA also finds that the rapidly changing nature

of the computer and communications fields gives

additional credence to the need for care in current information policies and practices. The information field is in a period of flux: the shape

of current on-line information systems is expected

to change within a few years, particularly in the

areas of remote processing and software. Along

with technological changes, the economic issues

pertaining to information systems, including

MEDLARS, may change. For this reason, OTA

concludes that decisions made today in reaction

to current problems should be, to the maximum

extent feasible, informed by the ways that technological advances might change those very issues.

OTA urges that this report be considered in the

context of the material presented in appendix H

on future information technologies.
Appendixes
Appendix Am—The National Library of Medicine:

Organization and Activities*

Introduction

The National Library of Medicine’s (NLM or the

Library) organizational structure and intramural activities primarily reflect the legislative intentions of the

National Library of Medicine Act of 1956 (Public Law

84-941). Similarly, its extramural programs are

grounded in the Medical Library Assistance Act of

1965 (Public Law 89-241). These congressional actions

serve to organize the discussion that follows. Three

other legislative and executive mandates have also

shaped the Library and, while not discussed in detail,

warrant mention: the transfer of the Public Health

Audiovisual Center (now the NationaI Medical Audiovisual Center) to NLM in 1967; the development of

the Toxicology Information Program, also in 1967;

and the founding of the Lister Hill National Center for

Biomedical Communications in 1968.

National Library of Medicine Act

of 1956 (Public Law 84-941)

NLM began as a small collection of medical books

and journals in the Office of the Army Surgeon General in 1836. By 1895, it was international in scope,

and had grown from some 1,800 volumes to over

117,000 books and 192,000 pamphlets covering almost

every medical topic. In 1922, it was named the Army

Medical Library. In 1952, it was renamed the Armed

Forces Medical Library to reflect its broadening user

community. In 1956, with passage of the National Library of Medicine Act (Public Law 84-941), the collection was recognized as a “great National medical resource” serving the Nation’s entire medical community.

Congressional Intent

Despite its lofty position as the “largest and most

important medical library in the world, ” by 1956 the

Armed Forces Medical Library was beginning to suffer under an awkward administrative arrangement, inadequate for the increasingly diversified demands levied against its resources. In hearings before the House

Committee on Interstate and Foreign Commerce, the

Library was reported to be “inadequately housed in

a building where its collections are threatened by loss

from fire and by damage through exposure to the

weather. ” Administered by the Department of

*Information in this appendix was primarily obtained from the staff and

publications of the National Library of Medicine in 1981.

Defense, its funding had been subject to wide fluctuations. The committee concluded that “difficulties of

operation have arisen because no clear authority exists for many of the functions which the Library now

serves. ”l

Through the National Library of Medicine Act,

Congress sought to assist “the advancement of medicine and the related sciences, and to aid the dissemination and exchange of scientific and other information

important to the progress of medicine and to the public

health” (Public Law 84-941). It wished to improve the

health of people in the United States by providing access to information for health professionals and policymakers. Congress did not assign the provision of

health information to the public to NLM, but turned

to other branches of the Public Health Service to carry

out this responsibility.

Authorizing Legislation

An amendment to the Public Health Service Act,

the National Library of Medicine Act established NLM

in 1956, and authorized it to acquire, preserve, and

make available materials pertinent to medicine; to prepare and make available indexes, catalogs, and bibliographies of the materials; and to provide reference and

research assistance. The act established a Board of

Regents whose members, appointed by the President,

are to advise the Surgeon General on “important matters of policy in regard to the Library. ” Appropriations for the construction of facilities adequate for the

Library’s use were also authorized. Finally, the act

transferred the Armed Forces Medical Library from the

Department of Defense to the Public Health Service.

Congress recognized the Library’s importance to the

advancement of medicine in both the United States and

throughout the world. Placed under the auspices of

the Public Health Service, the Library is in a position

“where contact with and participation in programs of

medical research will provide the best environment for

the Library’s proper functioning and continued

growth.”2

The National Library of Medicine Act does not require renewal, and since its enactment has had few

changes. One important change was made in 1978,

when the power to appoint members to the NLM

Board of Regents was transferred from the President

to the Secretary of Health, Education, and Welfare

IU. S. Congress, House of Representatives, House Report 84-941, 84th

Cong., 1956.

21bid.

83
—— ———

84

(Public Law 95-622). The amendment was prompted

by the need to quickly fill vacant seats on the Board.

Organization of NLM

Since its designation as a national library in 1956,

NLM has continually expanded its scope of operations

and responsibilities. As evident from its current organizational structure (see fig. A-l), the Library has had

many functions added to those authorized in the

original act. The organizational structure reflects both

legislative and executive actions from 1956 to 1968.

The last major addition to NLM was made in 1968,

when the Lister Hill National Center for Biomedical

Communications was established as the Library’s internal research arm. That same year, NLM was transferred from the Surgeon General’s Office to the National Institutes of Health (NIH).

BOARD OF REGENTS

In accordance with legislative requirements, the 10

members of the NLM Board of Regents, appointed by

the Secretary of Health and Human Services, are leaders in the following disciplines: the fundamental sciences, medicine, dentistry, public health, hospital administration, pharmacology, scientific or medical library work, public affairs, and representatives of the

general public. The Regents serve overlapping 4-year

terms. There are also seven ex officio members: the

Surgeons General of the Public Health Service and the

three Armed Services; the Chief Medical Director of

the Veterans Administration; the Assistant Director

for Biological, Behavioral, and Social Sciences of the

National Science Foundation; and the Librarian of

Congress.

Historically, the disciplines Board members represent have generally adhered to legislative requirements.

Figure A-l .—National Library of Medicine

SOURCE: National Library of Medlclne, January 1981.
85

However, the Secretary has some latitude in his appointments, so they tend to reflect the more immediate

interests of the Library. For example, in fiscal year

1981, there were no obvious appointments from the

public health field or the health services research community, although there have been such members in the

past. Rather, two Board members had expertise in

computer systems or the computerization of biomedical information, as NLM is currently concentrating

many of its resources on the development of MEDLARS

III, the next generation of its computerized on-line bibliographic retrieval system.

The Board meets three times a year and provides

advice to the Secretary of Health and Human Services,

the Assistant Secretary for Health, the Director of

NIH, and the Director of NLM on Library policy. The

Board makes recommendations on “the acquisition of

materials for the Library, the scope, content and organization of the Library’s services, and the rules under

which its materials, publications, facilities, and services shall be made available to various kinds of users”

(Public Law 84-941). The Director of NLM has the responsibility for operating the Library and so, in essence, the Board is advisory to him. The Board promulgates policy, and is the final review body for extramural grant applications, which are evaluated for program and policy relevance.

ORGANIZATIONAL DIVISIONS

Division of Library Operations.—The Division of

Library Operations is the traditional core of the Library. It performs NLM’s basic activities—collecting,

organizing, indexing, cataloging, and making available

much of the world’s biomedical literature—and has

been instrumental in creating and adopting new techniques to improve library services. Its four subdivisions and their functions are listed below:

• The Reference Services Division processes interlibrary loans, provides reference and bibliographic services, and maintains and preserves the Library’s general collection.

● The Bibliographic Services Division indexes serial

literature for Index Medicus and other indexes,

enters references into the data bases, and coordinates the on-line network that makes references

available via NLM’s on-line data bases such as

MEDLINE.

Ž The Technical Services Division selects and acquires printed material; catalogs and classifies

books, monographs, Government documents,

and other materials; and makes the information

available through publications and on-line for

other libraries to use. It is the national authority

for bibliographic control of biomedical publications.

• The History of Medicine Division acquires, processes, and makes publicly available the Library’s

collection of historical biomedical books and journals. It also maintains active public relations and

research programs on the history of medicine.

Office of Computer and Communications Systems.

—This office provides data processing and communications support for all NLM operations. In addition

to its routine activities, the office works toward improving the performance of NLM’s computer equipment, adding new technological features and enhancing the capabilities of MEDLARS, and is developing

a data communications system to manage the internal operations of the Library. As part of NLM’s efforts to reach out to the library community, the office developed an innovative information management

system that supported the 1980 White House Conference on Library and Information Services.

Division of Extramural Programs. —The Division of

Extramural Programs administers five of the six grant

programs that are authorized by the Medical Library

Assistance Act of 1965 (Public Law 89-241). The sixth

is the Regional Medical Library Program, which is administered from the Office of the Associate Director

for Library Operations. All six programs are discussed

in this appendix.

Division of Specialized Information Services.—The

diversity of NLM’s responsibilities is particularly visible in the Division of Specialized Information Services.

The division operates the Toxicology Information Program, established at NLM in 1968 to centralize access

to information on toxicology. The program draws toxicology information from several Federal and private,

nonprofit agencies. The division has established computer-based toxicology data banks from information

in the scientific literature and from the files of collaborating industrial, academic, and governmental organizations. It also established and administers toxicology information services for the scientific community.

The division’s other activities include the Toxicology

Information Response Center in Oak Ridge, Term.,

which performs literature searches in toxicology and

environmental health; produces a number of publications, including one on toxicology testing and one on

toxicology research; and conducts a series of collaborative projects with other Government agencies.

Lister Hill National Center for Biomedical Communications.—The center is responsible for developing

methods to improve information transmission so that

health professionals will have easier access to the overgrowing volume of information. It is the research and

development branch of the Library and investigates

the use of computers and communications technology

in advancing health education, biomedical research,

and health care delivery. Since the dedication of its
86

new facility, the Lister Hill Center Building, in May

1980, the center has emphasized intramural research.

One of the center’s first accomplishments was assisting in the development of NLM’s on-line retrieval system. It has also conducted research programs on the

effectiveness of orbiting satellites for communicating

medical information, the use of two-way television

using microwave links for continuing medical education, and the use of computer-assisted instruction. Current and future projects include the development of

knowledge-based programs in specialized areas of biomedicine that will make new medical findings and research information rapidly available to health professionals, particularly practitioners; and the design, development, and evaluation of an experimental storage

and retrieval system to electronically scan, store,

retrieve, and display documents acquired by NLM.

National Medical Audiovisual Center (NMAC).–

The aim of NMAC is to improve the quality and use

of biomedical audiovisuals in health professional

schools and the biomedical community. Before it was

transferred to NLM in 1967, NMAC was a component

of the Center for Communicable Diseases (now Centers for Disease Control, CDC), and, in fact, remained

in its Atlanta facilities until March 1980. As part of

CDC, the center produced films of award-winning

quality for the health education of high school students

and the public. When it became part of NLM, the

Board of Regents reoriented it to conform to the Library’s legislative purpose, i.e., providing health professionals access to information.

NMAC’s current activities include research and evaluation in audiovisual design and medical photography,

training health educators in the use of audiovisual technology, and the management and distribution of a

large collection of medical motion pictures and videotapes. NMAC was the original developer of AVLINE,

an audiovisual data base, which was transferred to the

Division of Library Operations in 1977, NLM plans

to emphasize NMAC’s research function in the future,

and merge NMAC with the Lister Hill Center (102).

INTERNATIONAL ACTIVITIES

NLM has been active in international programs since

John Shaw Billings became the Librarian of the Library

of the Army’s Surgeon General in 1865. Wanting to

develop a collection that was international in character, Billings collected library materials from throughout the world and began an exchange program with

foreign libraries, medical schools, and other scientific

institutions. Today, NLM has formal exchange agreements with 382 institutions in 72 countries.

NLM’s Special Foreign Currency Program, authorized under the Agricultural and Trade Assistance Act

of 1954 (Public Law 83-480), supports the preparation

of secondary literature, including critical reviews by

outstanding scientists in particular fields, and translations of foreign monographs in the health sciences. The

program is currently active in Poland, Egypt, Tunisia,

India, Yugoslavia, and Pakistan, and in Israel under

awards from the U.S.-Israel Binational Science Foundation. Other international programs include the exchange of biomedical literature, the provision of

library services such as interlibrary loans to foreign

institutions, the specialized training of qualified individuals from abroad who have national or international sponsorship, technical consultation and collaboration with governmental and nongovernmental international organizations, and participation, as appropriate, in formal U.S. bilateral health agreements.

There are, as well, bilateral MEDLARS agreements

with 13 foreign countries—Australia, Canada, Colombia, France, Italy, Japan, Kuwait, Mexico, South

Africa, Sweden, Switzerland, United Kingdom, and

West Germany—and with the Pan American Health

Organization. These agreements do not require the direct expenditure of U.S. moneys, nor the expenditure

of foreign funds to the United States, but provide centers in these countries with access to MEDLARS in exchange for indexing services that foreign centers either

perform on a quid pro quo basis or pay U.S. commercial contractors to perform. Operational decisions,

such as determining who accesses the data bases, are

the responsibility of the foreign center.

Appropriations and Staffing

NLM’s appropriations in 1970 to 1982 are displayed

in table A-1. A continuing resolution appropriated

$44.4 million for 1982. Funds for the extramural grant

program declined by more than $2 million from the

1981 level, while funds for library operations increased

by more than that amount. NLM will use most of the

operations increase for development of MEDLARS III.

The decrease in the grant program was required in the

reauthorization of the Medical Library Assistance Act

for 1982.

The full-time permanent staffing level remained fairly stable from 1975 to 1980, reaching a high of 495

in 1978. However, in recent years part-time temporary

staff have swelled the ranks (see table A-2). During

these same years, the services rendered by NLM have

increased substantially (see fig, A-2).

Medical Library Assistance Act

of 1965 (Public Law 89=241)

After World War II, the Federal Government assumed an increasing responsibility y for funding scientif-
87

Table A-1 .—NLM Appropriations, 1970-82 (dollars in thousands)

1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982

Medical Library Assistance

Act

Grants . . . . . . . . . . . . . . . . . .

Contracts . . . . . . . . . . . . . . .

$3,950

1,842

$5,792

4,080

1,912

4,790 4,547 4,455 4,330 3,712 5,375 5,187 5,987

2,102 2,075 2,574 2,352 2,721 2,625 2,600 3,000

6,892 6,632 7,029 6,682 6,433 8,000 7,987 8,987

6,725 6,831 5,000

3,200 3,000 2,500

5,992 9,928 9,831 7,500

Intramural

Lister Hill Center. . . . . . . . .

National Medical

A/V Center ., . . . . . . . . . .

Library Operations. . . . . . . .

Toxicology Information. . . .

Direct Operations . . . . . . . . . .

Program Management. . . . . . .

$945 1,456 1,960 2,055 2,103 2,863 2,922 4,952 5,031 6,255 5,554 5,105 5,045

2,224

7,431

1,552

594

1,144

2,196

8,348

1,280

810

1,354

21,436

20,280

2,558 2,795

9,030 9,018

1,370 1,590

985 1,160

1,332 1,910

24,127 25,150

21,815 21,812

2,888

9,502

1,627

1,236

1,944

3,263

10,860

1,915

1,389

1,874

3,303

10,821

1,947

1,582

2,057

3,846

12,255

2,277

1,563

2,341

4,074

13,147

2,334

1,661

2,512

4,343

15,258

2,401

1,728

2,459

4,350

16,014

3,368

1,808

2,981

4,198 3,125

17,527 20,082

3,105 3,299

1,788 1,821

3,092 3,330

44,666 44,402

22,673 21,660

Total. . . . . . . . . . . . . . . . . . . . . . $19,682

Total (in constant dollars) .. .$19,682

26,329 28,850 29,065 35,234 36,746 41,431 44,000

21,6843 21,840 20,850 23,823 23.024 24,102 23,822

SOURCE” National Library of Medicine

Table A.2.–NLM Staff, Fiscal Years 1975.81

(actual on-board count)

Activity 1975 1976 1977 1978 1979 1980 1981

Lister Hill Center ... ... ... ... ... ... ... P 22 24 24 35 30 34 40

0 3 5 9

National Medical A/V Center . . . . . . . . . . . P 101 101 88 88 76 37 56

0 7 1 4

Library Operations . . . . . . . . . . . . . . . . . . . . P 196 201 212 221 212 202 217

0 38 36 24

Office of Computer Services . . . . . . . . . . . P 52 54 52 51 51 51 54

0 4 4 3

Specialized Information Services . . . . . . . . P 17 18 17 18 19 19 27

0 3 4 4

Extramural Programs . . . . . . . . . . . . . . . . . . P 22 24 27 25 25 23 22

0 6 5 8

Program Direction. . . . . . . . . . . . . . . . . . . . . P 48 50 52 57 55 62 58

0 ————— 11 9 14—

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P 458 472 472 495 468 428 474

0 72 64 66

458 472 472 495 540 492 540

P - Permanent full-time,

O - Other.

SOURCE: National Library of Medicine,

ic research, particularly in the health sciences. The

result was an explosion of new scientific information

in the biomedical and health sciences that overwhelmed the ability and facilities of health science

libraries. Libraries had received little Federal support

comparable to that given research, and lacked the

trained personnel, resources, and techniques to ensure

that the full value of this new knowledge could be realized. By 1965, the growth of information had also outstripped health practitioners’ ability to apply it,

prompting the need for continuing education programs

to update professionals’ skills. The possibility of using

medical libraries as educational tools for health professionals was an important factor in enacting the Medical

Library Assistance Act of 1965 (3).

Congressional Intent

In hearings before the House Committee on Interstate and Foreign Commerce in 1965, 3 studies were

cited indicating a need for additional library space,

more trained biomedical librarians, additional volumes

and periodicals, support for research and development

projects in biomedical communications and medical

3U. S. Congress, House Report 89-1026 accompanying H.R. 3142, Interstate

and Foreign Commerce Committee, Sept. 20, 1965.

98-764 0 - 82 - 7
.

88

Figure A-2.–Representative NLM Services, 1970-81

’70 ’71 ’72 ’73 ’74 ’75 ’76 ’77 ’78 ’79 ’80 ’81

Fiscal year

%tertibrary loan.

SOURCE: National Libraw of Medicine.

library science, and a system of regional medical resource libraries to ensure access to medical documents

and avoid the costly duplication of extensive collections.

Congress thus faced a series of interrelated problems. Considerable Federal assistance had been directed toward “the intensive development of health

research institutions, medical schools, and other medical facilities,” including hospitals, and to increasing the

supply of physicians, nurses, and other health professionals.4 Concurrently, and again largely due to Federal funding, the knowledge bases of medical research

and practice were broadening, drawing on many new

fields and disciplines, and requiring, as well as adding

to, a widening, complex body of literature.

During this period, there was little support for medical libraries. The condition of many deteriorated from

the pressures of rapidly developing programs in medical institutions, and they were unable to meet the demands of a dynamic medical community (37). In 1964,

a Presidential commission noted “that unless major at41bid.

tention is directed to improvement of our national

medical library base, the continued and accelerated

generation of scientific knowledge will become increasingly an exercise in futility” (121)0

At the urging of numerous professional and academic associations, Congress enacted the Medical Library

Assistance Act of 1965 (Public Law 89-241) to address

medical libraries’ needs for additional resources and

personnel to meet the demands of a growing user population and an expanding body of biomedical and

health science information. Through the act, Congress

hoped to strengthen local and regional health science

libraries so that researchers and practitioners could

keep more fully informed of research findings and new

medical developments, and ultimately provide better

health care for the American people.

Authorizing Legislation

The Medical Library Assistance Act reflected a fundamental change in Government policy regarding sup

port for libraries allied with the health sciences. An

amendment to the Public Health Service Act, it provided financial assistance for the development of

facilities and techniques necessary to “collect, preserve,

store, process, retrieve, and facilitate the dissemination and utilization of biomedical and health science . . . knowledge and information” (Public Law

89-241).

The act outlined a 7-point approach to strengthen

the Nation’s medical libraries. The Surgeon General,

through NLM, was authorized to:

assist in construction of new and renovation of

old medical library facilities;

assist in the training of medical library personnel

and personnel in fields related to health;

financially assist physicians and other scientists

in the compilation of existing and new scientific

knowledge;

assist in the development of innovative technological advancements in medical library techniques;

assist in the expansion of the resources and services of medical libraries;

assist in the establishment of a system of regional

medical libraries to coordinate the geographic

sharing of resources; and

assist financially in the publication of biomedical

science works.

Medical Library Assistance Act of 1965 also established the authority to assist in the establishment

of regional branches of NLM in the National Library

of Medicine Act of 1956.

NLM had previously submitted almost identical

legislative specifications to Congress and the ad-
89

ministration. One of its concerns was that, with the

continued dependency of local libraries, NLM would

evolve into a “monolithic medical resource in this nation” (37). NLM believed that the country required “the

development of a complex of regional medical libraries . . . with adequate facilities, resources, and personnel to serve those sections of the Nation with underdeveloped library facilities” (37).

The act authorized NLM to provide financial assistance, through a system of competitively awarded

grants and contracts, to “all appropriate public and

private institutions and individuals active in the provision of health services or in health-related teaching

and research” (Public Law 89-241).

Congress has reauthorized the Medical Library Assistance Act six times since 1965. Although the original

intent remains, the legislators have modified some portions of the act over the years. For instance, in the

original legislation, Congress intended “medical

libraries” to be defined in the broadest sense, to include all libraries affiliated with health and biomedical

sciences, though the need for this legislation was largely defined in terms of the needs of medical school libraries. In 1970, the title of the act was changed to

include “health communications, ” adding emphasis to

the breadth of intent for participation in the programs.

Eligibility extended to all “clincial fields including

medicine, dentistry, optometry, pharmacy, osteopathy, veterinary medicine where relevant to human

health, nursing, public health, other health-related

fields, and fundamental and applied sciences when

related thereto” (Public Law 91-212).

In 1973, Congress removed the authority to assist

in the construction of library facilities. The next year,

it authorized a single appropriation for the assistance

programs, leaving the allocation of funds for individual programs to the discretion of the Library. In

the 1978 reauthorization, NLM was encouraged to

“play a more aggressive role in the collection and

dissemination of research findings directly relevant to

clinical practice” and was reauthorized through

September 1981. The most recent reauthorization extends the Medical Library Assistance Act through

September 1985.

Appropriations

The 1965 Medical Library Assistance Act authorized $105 million for 1965 to 1970 for NLM to initiate

programs assisting the Nation’s medical libraries and

the health science community. However, only $40.8

million was appropriated for this period. In assessing

the achievements of programs established under the

act, the Director of the Library concluded that although NLM had significantly improved medical libraries and information resources and services, the objective of the act had not been fully realized due to

insufficient funding (37). This sentiment was echoed

in the Senate Report accompanying the 1970 reauthorizations

As can be seen in table A-3, a large discrepancy between the funds authorized and those appropriated

persisted until the most recent reauthorization. For

fiscal year 1981, $9.8 million was appropriated, and

$7.5 million is scheduled for fiscal year 1982. Although

there is an apparent growth of appropriated funds

from 1970 to 1981, figure A-3 indicates an actual

decrease in constant dollars.

Extramural Grant Programs

NLM’s Division of Extramural Programs originally

administered seven authorities, but, as noted earlier,

Congress removed the authority to assist in construct-

‘U.S. Congress, Senate Report 91-460 accompanying H.R. 11702, Labor

and Public Welfare Committee, Oct. 16, 1969.

Table A.3.—Medical Library Assistance Act Authorizations and Appropriations,

Fiscal Years 1975-82 (dollars in thousands)

Percentage of Difference between

Funds Funds authorized funds authorized and

Fiscal year authorized appropriated appropriated appropriated funds

1975 . . . . . . . . . . . $17,500 $6,682 38 $10,818

1976 . . . . . . . . . . . 20,000 7,658a

38 12,697

1977 . . . . . . . . . . . 20,000 8,983b

62 5,613

1979 . . . . . . . . . . . 15,000 8,986 60 6,014

1980 . . . . . . . . . . . 16,500 9,924 60 6,576

1981 . . . . . . . . . . . 18,500 9,831 53 8,669

1982 . . . . . . . . . . . 7,500C

7,500 100 0

aln~lude9 fiscal year transition quarter, JUIY 1, 1976-Sept. ~~ 1976,

blncludes original appropriation of $7,967 thousands and an additional $1 million of reprogrammed funds approved by Congress.

cAuthorization extends through September 1962

SOURCE: National Library of Medicine.
1

Figure A-3.—Medical Library Assistance Act

(MLAA) Appropriations and Regional Medical

Library Program (RMLP) Budget Current and

Constant Dollars, Fiscal Years 1971-81

(based on 1969 constant dollars)

(7.5)

2. training grants in health sciences and computer

technology;

3. research, development and demonstration grants;

4. special scientific projects; and

5. publication grants.

Each of the grant programs is described below, including its evolution from 1965 to the present, its current status, and OTA’s assessment with respect to congressional objectives. Table A-4 displays the distribution of funds among the grant programs for fiscal years

1980, 1981, and 1982.

RESOURCE GRANT PROGRAM

(3.2)

(2.5)

(1.1)

’71 ’72 ’73 ’74 ’75 ’76 ’77 ’78 ’79 ’80 ’81

Fiscal years

SOURCE. National Library of Medicine

ing library facilities from the Medical Library Assistance Act in 1973. The authority had been exercised

only between 1968 and 1969, when NLM awarded

grants to nine medical schools, one school of optometry, and one school of veterinary medicine with

the $11.5 million appropriation.

In 1981, the Associate Director for Library Operations was assigned responsibility for the Regional

Medical Library Program (RMLP). Nevertheless, all

the extramural programs are interrelated, and many

of the grant programs administered in the Division of

Extramural Programs, particularly the resource grants,

promote the aims of RMLP. (RMLP is discussed

below. )

The division sees its role as interpreting and advancing the intent of Congress by means of various grant

mechanisms. The major areas of emphasis have altered

over the past 15 years in response to the health professional community’s perceived needs. Currently, the

grant programs emphasize biomedical communication,

e.g., the storage and retrieval of biomedical information, the role of computers in medicine, and librarianship. The grant mechanisms the division uses are:

1. resource grants;

At its inception, the resource grant program was primarily intended to correct deficiencies in collections,

equipment, and organization of collections of established libraries. Health science libraries’ resource needs

appeared to be endless: in 1965, Congress observed

that the libraries needed more than $85 million, and

authorized $5 million per year for a 5-year period.

Only $11.8 million were appropriated for those 5-years

however; NLM supported 401 libraries rather than its

goal of 600 to 700.

Distribution of the funds from 1965 to 1970 reflected

the formula grant then in use. The grant was based

on a library’s budget, and as a result, larger libraries

received a larger proportion of the funds. Medical libraries in academic settings received 23 percent of the

grants awarded, but more than 62 percent of the funds.

The smaller hospital libraries received more than sO

percent of the grants awarded, but only 26 percent of

the distributed funds. Other awards went to schools

of dentistry, pharmacy, and veterinary medicine, as

well as other academic institutions, State institutions,

and professional societies. Grants could be used to acquire library materials, increase staff, or purchase

materials.

Because more than so percent of the funds was used

to increase libraries’ collections, the Director of NLM

concluded that the most immediate need had been the

acquisition of books, journals, and other publications,

Table A“4.—Medical Library Assistance Act:

Distribution of Funds Among Grant Programs,

Fiscal Years 1980-82

(dollars In thousands)

Program 1980 1981 1982

Resource, . . . . . . . . . . . . . . . . . . . . .$1,598 $1,641 $1,206

Training. . . . . . . . . . . . . . . . . . . . . . . 1,638 1,308 1,000

Research. . . . . . . . . . . . . . . . . . . . . . 2,724 2,774 2,257

Special scientific projects. . . . . . . 142 290 23

Publications . . . . . . . . . . . . . . . . . . . — — 787 818 514—

Total . . . . . . . . . . . . . . . . . . . . . . . 6.887 6.831 5.000

SOURCE: Nationai Library of Medicine.
91

but that “the time had come for putting emphasis on

improved service” (37).

In the 1970 reauthorization, Congress acknowledged

that the grant program had been effective but that additional funding was required to bring health science

libraries up to desired standards. In authorizing increased funding, Congress dropped the requirement

for formula grants, but retained the provision of the

original legislation that no institution receive more

than $200,000 in grants in any fiscal year.

After assessing the first 5 years of the program, NLM

decided that two types of grants were required. Most

of the larger libraries had rebuilt their collections, due,

in part, to the advantages offered by the formula grant.

A Resource Project Grant Program was established so

that existing services could be expanded or new ones

created. The emphasis was on sharing resources and

improving services (but not collections) by funding

projects to streamline operations, utilize new technologies, and assist libraries in introducing and improving the use of new media, such as microfilm, audiovisuals, and computer-assisted instruction.

But it was also clear to NLM that many smaller

(mainly hospital) libraries still needed assistance in

developing their collections. In addition, the 1970

reauthorization had permitted grants to establish new

libraries. Thus, in 1971a Resource Improvement Grant

Program was started that provided a l-year, one-time

grant award of up to $3,000 to assist in establishing

and/or developing a basic information collection in

smaller community hospital libraries.

As a result of an evaluation conducted in 1974 by

the NLM Office of Program Planning and Evaluation,

the Resource Improvement Grant Program was modified to fund consortium arrangements as well as individual institutions (M). Single institutions can be

funded for 1 year to a maximum of $4,000, with a

matching requirement of $1,000 from the institution

to develop a collection. Grants are also available for

up to 2 years to support activities necessary for the

planning, organization, and development of a health

science library consortium, which is composed of a

number of libraries, usually within a defined geographic area, that agree to share resources.

Up to $4,000 can be provided per eligible consortium member, with a matching requirement of $1,000

to support the purchase of basic information collections. The resource improvement grant program objectives are to strengthen the Regional Medical Library

Network by developing adequate health science library

collections at the local level, and to encourage resource

sharing among local health-related institutions. Resource improvement awards for individual institutions

and consortia are considered “seed money” to further

the program’s purposes and are not to be used for

operating expenses.

The consortium program has been well received by

the health science library community. The program’s

goal was to organize 250 institutions in consortia

within 5 years; it was realized in 2 years. At the outset

of the program, an average of five institutions participated in each consortium. This average now stands

at 10. Further, though Federal seed money is provided

to each consortium for only 2 years, the size and

number of consortia continue to grow. In part, this

may reflect the increasing costs of maintaining collections and financing interlibrary loans, factors that

make sharing resources more attractive. Currently,

about half the Nation’s 7,000 hospitals have access to

an information facility, many through consortia arrangements.

As noted earlier, the formula mechanism used to

determine the size of awards was an advantage for

medical school libraries and a disadvantage for the

smaller hospital libraries. The abolishment of the formula mechanism in 1970 partially corrected this discrepancy. Based on figures from NLM, libraries in

medical schools received 48.5 percent of the funds

awarded from 1971 to 1978, in contrast to 62 percent

received from 1965 to 1970, and hospital libraries

received 32 percent from 1971 to 1978, up from the

26 percent they had received from 1965 to 1970.

Libraries in hospitals still receive the largest proportion of the awards (61 percent), while those in medical

schools receive 23 percent (see fig. A-4).

In 1981, there were 74 active grants: 32 resource

project grants and 42 resource improvement grants.

Examples of the former are: 1) a Veterinary Medical

Information Center Project; 2) an effort to organize

the Adolf Meyer Papers; 3) a Computer Assisted Dental Simulation Project; and 4) a Community Information Network for Health Education Project. Funding

for resource project grants varies widely, ranging from

$8,000 to Up to $452,000 for multiyear awards. Funds

for the resource improvement grants develop consortia for better resource sharing or develop library collections; thus all the projects are similar in scope and

title, as well as in funding: more than half receive from

$3,000 to $4,000.

Table A-5 shows the number of awards and funding

levels from 1971 to 1982. More than $1.5 million was

allocated for fiscal year 1980 for 73 awards. The

number of awards is considerably lower for fiscal year

1981, and there is a decrease in both funds and awards

for fiscal year 1982: 42 awards totaling $1,206,000 are

scheduled.
92

Figure A-4.– Distribution of Resource Grants, Fiscal Years 1971=78

SOURCE: National Library of Medicina, Extramural Programs.

Table A-5.—Medical Library Assistance Act:

Resource Grants, Fiscal Years 1971-82

(dollars In thousands)

Year Amount Number of awards

1971 . . . . . . . . . . . . . . . . .

1972 . . . . . . . . . . . . . . . . .

1973 . . . . . . . . . . . . . . . . .

1974 . . . . . . . . . . . . . . . . .

1975 . . . . . . . . . . . . . . . . .

1976 . . . . . . . . . . . . . . . . .

1977 . . . . . . . . . . . . . . . . .

1978 . . . . . . . . . . . . . . . . .

1979 . . . . . . . . . . . . . . . . .

1980 . . . . . . . . . . . . . . . . .

Subtotal . . . . . . . . . . . .

1981 . . . . . . . . . . . . . . . . .

1982 . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . .

$2,231

2,505

2,298

2,632* b

1,469

726

1,773

2,013

2,008

1,596

19,251

1,641

1,206

22,098

469

372

153

127

75

43

66

52

78

73

1,509

56

42

1,607

alncludes Regional Medical Librav Grants.

b~ciudea interqencymr~ment of$27,000paidwithca~~~rfunds fromflecal

year 1973.

SOURCE: National Llbraryof Madlcine.

TRAINING PROGRAMS

Currently, Medical Library Assistance Act training

grants support graduate level programs in computer

technology within the health sciences. The objective

is to promote the integration of computer technology

with all phases of clinical medicine: teaching, practice,

and research.

The focus of the training program has shifted considerably since it was initiated in 1965. Originally, it

was to increase the number and quality of medical librarians. In the early 1960’s, four distinguished advisory bodies concluded that there was a critical shortage of trained professionals to staff health science

libraries and to meet the information needs of the

health science community (78). Available resources

were clearly not capable of alleviating the shortage;

only 10 schools in the country offered even one course

in medical librarianship, and just three medical librar-
93

ies offered post master training programs, with a combined capacity of only eight places each year.

In 1965, Congress authorized $5 million to train 750

information personnel over a 5-year period. The appropriations were almost at the level of authorization:

$4.5 million were used to establish 20 programs that

trained 350 people in medical librarianship. In addition, eight fellowships were awarded to study the

history of medicine and biomedical communication.

At the end of 5 years, the Director of NLM reported

that the program had met many of its goals, but that

insufficient attention had been placed on the retraining of employed librarians in modern information

handling techniques (37). The Extramural Program

staff still considers this a problem, in that an expeditious way of retraining experienced professionals

has not been found.

In 1970, Congress concluded that the program had

had an encouraging beginning, but had not satisfied

the identified need for medical librarians. Thus, it increased training grant funding at a higher level for the

next 3 years. However, a 1973 NLM-funded study reported that the training grant program had perhaps

produced too many medical librarians relative to the

current job market. The study also noted that, at least

in some sections of the country, the apparent shortage

of the mid-1960’s had been largely eliminated (51).

Similarly, other studies released at about the same time

corroborated the finding that by 1973 sufficient medical librarians were available to meet the needs of

health science libraries. There remains, however,

disagreement in the library community, especially in

graduate programs, over the accuracy of these findings

and conclusions.

NLM received these evaluations as indication of the

training program’s success. The staff of the Division

of Extramural Programs note that the Library had not

intended to fund long-term training programs, that the

Library’s justified expectation was that NLM funds

would provide only the nucleus for growth, and that

the programs would continue with support from academia. In fact, during the 1974 reauthorization hearings, Congress complimented the Library for accomplishing this objective. *

Aside from the supply of medical librarians, NLM’s

1972 decision redirecting its program to train health

professionals in the application of computer technology to medicine was prompted by a comprehensive

report by the Association of American Medical Colleges (AAMC) on medical education technology.7

bU. S. Congress, Senate Report 93-7M accompanying H.R. 11385, Labor

and Public Welfare Committee, Apr. 1, 1974.

‘E. A. Stead, C. M. Smythe, C. G. Gunn, et. al. (eds. ), “Educational Technology for Medicine: Role for the Lister Hill Center, ” J. Med. Educ. 46:1, 1971.

AAMC found that major changes in the current system

of libraries, publishing, and medical school curricula

required personnel to be familiar with computer technology.

The Library initiated its training grant program in

health sciences and computer technology after obtaining the approval of the appropriations committees of

Congress. Currently, training grants are designed for

health science faculty and potential faculty in the anticipation that their knowledge of computer techniques

will be transmitted to the next generation of practicing physicians, researchers, educators, and other

health professionals, and that computers will be utilized in solving medical problems. An evaluation of

the program is now being designed at NLM.

Appropriations for the training programs are displayed in table A-6. Except for a dip in expenditures

from 1973 to 1975, the table shows a gradual but

steady increase in expenditures, uncorrected for inflation, from 1972 to 1980. In fiscal year 1980, of the $1.6

million available, more than half was to cover direct

trainee expenses and the rest partially reimbursed the

grantee institutions for additional expenses resulting

from the training grants. The 1981 budget appropriates

$1.3 million for the support of 10 training programs,

and the 1982 budget has $1 million allocated for continuing nine of these programs.

For the past 3 years, the Library has funded a

$343,000 experimental internship program for library

administrators (82). This program was initiated in

response to the frustrations of search committees

unable to find individuals qualified to be directors of

many large health science libraries. The librarians

trained in NLM-sponsored and other programs had not

yet attained the experience required to direct a large

Table A-6.—Medical Library Assistance Act:

Training Grants, Fiscal Years 1971-82

(dollars in thousands)

Year Amount Number of awards

1971 . . . . . . . . . . . . . . . . . $1,000 13

1972 . . . . . . . . . . . . . . . . . 1,234 15

1973 . . . . . . . . . . . . . . . . . 720 13

1974 . . . . . . . . . . . . . . . . . 901 11

1975. , . . . . . . . . . . . . . . . 891 9

1976 . . . . . . . . . . . . . . . . . 1,389 13

1977 . . . . . . . . . . . . . . . . . 1 ,331a 11

1978 . . . . . . . . . . . . . . . . . 1,459a

11

1979 . . . . . . . . . . . . . . . . . 1,472a 10

1980 . . . . . . . . . . . . . . . . . 1,638 10

Subtotal. . . . . . . . . . . . 12,035 116

1981 . . . . . . . . . . . . . . . . . 1,308 10

1982 . . . . . . . . . . . . . . . . . 1,000 9

Total . . . . . . . . . . . . . . 14,343 135

alnClu@~couflcll of Li&a~ Resources Tralniwcontract.

SOURCE: National Libraw of Medicine.
94

library. To date the NLM training program in library

administration has produced nine graduates. When

measured by the pragmatic criteria of employment, the

program has had partial success, as most graduates

have been hired as assistant directors or are under consideration for a directorship. NLM is now reassessing

the program.

RESEARCH GRANT PROGRAM

In the 1965 Medical Library Assistance Act, Congress proposed to foster research and investigations in

medical library science and related fields in the interest

of improving biomedical information services. With

appropriations of $6 million for 1965 to 1970, NLM

funded 103 projects concerning the development and

evaluation of information activities in libraries, studies

in the broad field of biomedical communication, and

historical studies of matters related to health and

medicine. Because most medical librarians were inexperienced in research, and few of the projects led to

applying and implementing new modes of biomedical

communication, in 1970 the Director of NLM concluded that such expenditures were among the least

rewarding in the extramural program (37).

In succeeding reauthorizations, Congress emphasized that its research interest was in advancing the

science of health communications. In 1970, it added

an amendment permitting support for demonstration

projects for new techniques, devices, or systems that

were ready for application, and later added the

authority to support projects for the development of

new techniques and materials for processing and disseminating health information (Public Law 91-212).

Clinical librarianship, a successful and well-known

project funded by the program, was initiated by Gertrude Lamb at the University of Missouri in Kansas

City in 1972 (6). The clinical librarian provides information services in a patient care setting as part of a

patient care team. As part of the team, the librarian

is intimately acquainted with the health professionals’

information needs. Although the specific functions performed vary with the medical or surgical service and

with the medical facility, the basic design is generally

similar: medical librarians accompany physicians on

daily rounds and attend weekly staff conferences,

noting particularly difficult aspects of individual cases.

The librarian then conducts a literature search, using

manual and on-line methods, including MEDLARS,

selects a few relevant articles, and provides them to

the attending physician(s). Clinical librarians often

teach courses in information techniques to both students and teachers in medical facilities. Since the initial research and development grant was awarded, the

clinical librarian program has been incorporated into

120 medical schools and teaching hospitals (75).

In a similar vein, the Cleveland Health Sciences

Library at Case Western Reserve University began the

Circuit Librarian Program in 1973, linking suburban

hospitals to its resources. On a regular (usually weekly) basis, medical librarians visit hospitals in surrounding communities, taking information requests from

physicians and nurses, ancillary departments, and administrators. Before returning to a hospital, a librarian

will have spent time at a resource library filling requests for biomedical and health care literature and

audiovisual items. Circuit librarians also assist

hospitals in developing in-house collections of core

medical literature. The program has been adopted by

a number of resource and large hospital libraries, often

with NLM grants (10). Many programs, including that

of the Cleveland Library, are now self-supporting,

with costs covered by the hospitals receiving service.

Although generally considered successful, the research grant program did not achieve all its goals. In

1978, an NLM task force evaluated the program, recognized its many contributions to the biomedical communications process, and applauded the quality of the

projects the program supported (131). Nevertheless,

the task force was concerned that too few first-rate

grant applications were being submitted to the Library

to assure adequate advances in the state of the art; that

long-range commitments to improve biomedical communications in research and training were lacking; and

that potential applicants, staff, and consultants were

uncertain about program goals and objectives.

Partially as a result of the recommendations made

by the task force, NLM made a number of changes in

its research grant program. It now uses four grant

mechanisms, similar to those used throughout NIH,

to fund research activities:

1.

2.

3.

4.

Program project grants—clusters of research efforts having a common focus with coordination

by a senior principal investigator.

Research project grants—single projects initiated

and directed by a single investigator.

New investigator research grants—small awards

for the young investigator with less than 5 years

experience since obtaining a doctorate.

Research career development awards—awards

providing salary and related support for promising researchers to devote full-time to research for

5 years.

The last two categories were added to augment the

supply of research manpower capable of advancing

biomedical communications, and were recommended

by the task force.

The Library has identified three areas of interest for

these grants: new methods for the representation of

medical knowledge; classifying, indexing, and abstracting information; and user needs and behavior.
95

The task force had indicated the urgent need for

research in these areas. However, applicants can propose to conduct research in all the areas identified in

the Medical Library Assistance Act, which include

medical library science, computer technology, biomedical communications, and the history of medicine and

related health sciences.

Another innovation, prompted by the 1978 task

force report, is the Computers in Medicine Program,

a subset of the total NLM research effort. It emphasizes

computer science research in knowledge representation, data base management, and clinical decisionmaking (108). In 1980, Congress designated $1.3 million

specifically for this program. The Library uses the

same grant mechanisms in this program as in the entire research grant program. All the current new investigator grants, the research career development

awards, and 9 of the 27 research project grants are in

this program.

Table A-7 illustrates the funds distributed for the

research grant program and the number of projects

funded. For 1980 and 1981, the funds stabilized at

about $2.7 million per year and the number of projects remained constant at about 30. In fiscal year 1982,

the Library expects to fund 27 projects with $2.3

million.

SPECIAL SCIENTIFIC PROJECTS

As conceived in the original 1965 legislation, the

special scientific grant program was to assist established researchers in reviewing, evaluating, and synthesizing extensive collections of medical literature.

The recipient was expected to devote full-time to examining the scientific record in a field relevant to the

Table A-7.—Medical Library Assistance Act:

Research Grants,a Fiscal Years 1971-82

(dollars in thousands)

established programs, and to produce a thorough,

book-length literature review. Although the special

scientific grant program has varied little in its 15-year

existence, the 1970 legislation changed the funding

mechanism from fellowships to grants in recognition

of the program’s research orientation, and allowed

awards to institutions as well as individuals (Public

Law 91-212).

The current program supports qualified scientists

and practitioners preparing comprehensive analytical

and interpretive documents on major health topics. Investigators are expected to bring together dispersed

literature in a subject area, or bridge different subject

areas, in the health field. In this way, other health professionals obtain easier access to the continuously expanding biomedical literature. In almost all cases, the

work produced has a limited audience and as such

would not be of interest to a commercial publishing

house. Indeed, one of the criteria used in awarding a

grant is that the proposed publication be commercially nonviable.

The program was and remains small in respect to

the total funds expended in the extramural programs

and the number of projects supported. In 1965, it was

expected that the $2.5 million authorization would

support approximately 125 medical scholars for the

5-year period. Instead, appropriations totaled $200,000

and only 10 fellowships were awarded. Although the

funds appropriated and the number of awards more

than doubled in the next 10 years, they still represented

only 41 grants totaling $1.2 million (see table A-8).

There are seven grants totaling $290,000 scheduled for

1981 and two grants estimated at $23,000 for 1982.

Table A.8.—Medical Library Assistance Act: Special

Scientific Project Grants, Fiscal Years 1971.82

(dollars In thousands)

Year Amount Number of awards Year Amount Number of awards

1971 . . . . . . . . . . . . . . . . . $ 590 19

1972 . . . . . . . . . . . . . . . . . 640 24

1973 . . . . . . . . . . . . . . . . . 608 26

1974 . . . . . . . . . . . . . . . . . 875 22

1975 . . . . . . . . . . . . . . . . . 1,292 20

1976 . . . . . . . . . . . . . . . . . 1,353 17

1977 . . . . . . . . . . . . . . . . . 1,180 15

1978 . . . . . . . . . . . . . . . . . 1,111 13

1979 . . . . . . . . . . . . . . . . . 1,593 21

1980 . . . . . . . . . . . . . . . . . 2,724 31

Subtotal. . . . . . . . . . . . 11,966 208

1981 . . . . . . . . . . . . . . . . . 2,774 31

1982 . . . . . . . . . . . . . . . . . 2,257 27

Total . . . . . . . . . . . . . . 16,997 266

alnCIUde~ ~O~e publication grants awarded with research 9rants, ‘isCal Year

1971-75,

SOURCE: National Library of Medicine.

1971 . . . . . . . . . . . . . . . . . $ 5 1

1972 . . . . . . . . . . . . . . . . . 100 4

1973 . . . . . . . . . . . . . . . . . 76 3

1974 a . . . . . . . . . . . . . . . . 95 3

1975 . . . . . . . . . . . . . . . . . 153 4

1976 b . . . . . . . . . . . . . . . . 72 3

1977 . . . . . . . . . . . . . . . . . 109 3

1978 . . . . . . . . . . . . . . . . . 248 7

1979 . . . . . . . . . . . . . . . . . 214 7

1960 . . . . . . . . . . . . . . . . . 142 6

Subtotal. . . . . . . . . . . . 1,214 41

1981 . . . . . . . . . . . . . . . . . 290 7

1982 . . . . . . . . . . . . . . . . . 23 2

Total . . . . . . . . . . . . . . 1,527 50

alnCludeS release of fiscal year IW3 mounded funds,

blncludes transition quarter funds, July l-Sept. 30, 1976.

SOURCE: National Library of Medicine.
93 ——— .

Despite the program’s moderate funding, the reports

accompanying the 1974 and 1978 legislation considered

it successful in enabling senior health professionals to

analyze and synthesize biomedical literature, and produce and disseminate biomedical publications of a nonprofit nature.8 9

There are currently 13 active special scientific projects ranging in size from $2,160 to $82,529, and covering a variety of health subjects, including disclosure

and consent in medical and legal practice; control of

infectious disease in the 20th century; and environmental hazards to small children.

PUBLICATION GRANTS

Publication grants support the preparation and

publication of scientifically significant secondary

manuscripts—such as indexes, critical reviews, and

monographs—to aid health professionals in obtaining

relevant literature. The grants are limited and short

term, and support projects that NLM believes are important, but whose products attract only a few select

readers. These scientific publications are not commercially viable, and have no alternative source of support.

With the uninterrupted growth of published primary

biomedical literature, the need for such secondary

literature is as pressing today as when the Medical

Library Assistance Act was first passed in 1965. At that

time, legislators saw a need for supporting publications

other than original articles. Interest in this area remained through the five reauthorizations. Although

the appropriations were always considerably less than

the authorized funding, the report accompanying the

1970 reauthorization congratulated the Library for its

efforts and accomplishments in funding the development and publication of over 150 bibliographies, critical reviews, handbooks, translations, and other

monographs in biomedical communications.10

The original legislation clearly differentiated publication grants from special scientific project grants, in

that the former were to be awarded only to medical

or scientific scholars to synthesize a body of literature

related to their particular research topic, and who

wished to devote full-time to this enterprise. Publication grants focused on the publication of biomedical

information in forms other than journal articles. The

lines between the two programs appear to have

blurred, and today the emphasis of both authorities

is on providing grants for critical reviews. The staff

of the Extramural Program Division have a favorable

‘U.S. Congress, Senate Report 93-764, op. cit.

W,S. Congress, Senate Report 95-838 accompanying S. 2450, Human Resources Committee, May 15, 1978.

Iou. s, cowrH5,senate Report 91-480, oP. cit.

attitude toward this merging, as they consider the production of critical reviews “one of the major purposes

of the extramural programs. ” Such publications synthesize, and thus provide access to, billions of dollars

of biomedical research findings, much of it funded by

the Federal Government, primarily through the National Institutes of Health.

The funds appropriated under this authority and the

number of grants awarded are displayed in table A-9.

Funding increased from $280,000 in 1971 to a maximum of over $1 million in 1978. Since then it has

decreased, with a 1982 budget of $514,000. Currently, there are 49 active grants with awards ranging from

$500 to $111,839.

Regional Medical Library Program

The mission of RMLP is to provide health science

practitioners, researchers, educators, and administrators with timely, convenient access to health care and

biomedical information resources, through a coordinated network of health science libraries and information centers. Specifically, RMLP’s objective is “to assist

in the development of a national system of regional

medical libraries, each of which would have facilities

of sufficient depth and scope to support the services

of the medical libraries in the region served by it”

(Public Law 89-241). Although RMLP is now organizationally separated from other Medical Library Assistance Act programs, it shares the general objective of

improving information services in the health field, and

serves as the focus of many Medical Library Assistance

Act program activities.

Table A-9.—Medical Library Assistance Act:

Publication Grants, Fiscal Years 1971-82

(dollars In thousands)

Year Amount Number of awards

1971 . . . . . . . . . . . . . . . . . $ 280 16

1972 . . . . . . . . . . . . . . . . .

1973 . . . . . . . . . . . . . . . . .

1974a 

. . . . . . . . . . . . . . . .

1975 . . . . . . . . . . . . . . . . .

1976b 

. . . . . . . . . . . . . . . .

1977 . . . . . . . . . . . . . . . . .

1978 . . . . . . . . . . . . . . . . .

1979 . . . . . . . . . . . . . . . . .

1980 . . . . . . . . . . . . . . . . .

Subtotal. . . . . . . . . . . .

1981 ., . . . . . . . . . . . . . . .

1982 . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . .

311

389

451

614

668’

773C

1,069C

795

787

6,137

818

514

7.469

19

20

25

36

44

43

47

36

35

321

34

19

374

alncludeg releage of fiscal year 1973 impounded ‘unds.

blncludes transition quarter funds, July I-Sept. 30, 1976. ‘Includes council of Libra~ Resources Tralnlng Contract.

SOURCE: National Libra~ of Medicine.
97

When RMLP was originally conceived, the NLM Director recognized a need to decentralize some of the

Library’s activities into regional arrangements. The inadequate state of medical libraries and the problems

in communicating up-to-date information to practitioners and researchers were described in hearings on

the need for the Medical Library Assistance Act.

Through RMLP, NLM sought (and continues) to encourage strong libraries to share collections and expand services, so that resources will be available locally to meet local and regional needs. The program is

intended to increase access to the biomedical literature,

particularly for health professionals remote from libraries of excellence, through improving immediate

resources and developing a network of backup resources, while avoiding duplicating extensive or

specialized collections which are not needed as local

resources.

NLM implemented the program by awarding grants

to libraries with existing resources and regional services that could be expanded without interrupting normal local services. Such libraries serve as a link between NLM and local libraries. As may be expected,

most libraries initially designated as Regional Medical

Libraries were in academic institutions. Each was to

provide seven basic services to the libraries in its

region, the most important being the free loan of books

and photocopies of journal articles (i.e., document

delivery). Other services include MEDLARS searches,

traditional or manual reference services, evaluation of

regional information needs and resources, training and

orientation, publicity about RMLP, and continuing education for health professionals about sources of

information.

Document delivery was initially emphasized, especially for the journal literature, because it was the most

effective way to meet the program’s mission. The

specifics of program implementation, however, differ

from region to region to match the needs of users and

the characteristics of the regional library. Document

delivery (or interlibrary loans) remains a fundamental service of the program.

The first grant was awarded in 1967 to the Countway Library at Harvard University, and by 1970 all

10 planned programs had been started. (The 11th

regional medical library is NLM itself, which serves

the mid-Atlantic region. ) In 1970, Congress noted that

progress toward developing a large, coordinated, and

cooperative program had been “encouraging; the response of the health library community in its efforts

to work with this program [had] been enthusiastic. ”11

By succeeding reauthorizations, Congress has reasserted its appreciation of the program’s achievements.

1 lu.s. congre~, Senate Report 91-480, op. cit.

RMLP emerged as a four-tier pyramid, with each

tier serving as a backup resource for the one below,

particularly for document delivery. At the peak of the

pyramid, NLM provides policy and planning at the

national level in addition to its backup function. At

the next level, the regional libraries implement the national policy, coordinate regional library services and

educational activities, publicize the program, and provide backup for document delivery. Each regional library has considerable responsibility and freedom of

action in the management of the program in its region.

As a result, the program has developed differently in

each region to match both the needs of users and the

characteristics of the regional library. In all regions,

however, the interlibrary loan program has a high

priority.

The next tier is that of the resource libraries, which

subcontract from the regional medical libraries for

some of the services they provide. Currently, there are

about 100 resource libraries, located mainly in medical

schools. Their major function is to fill interlibrary loan

requests from the basic unit libraries, the fourth tier

of the pyramid. When one resource library cannot fill

a request, it transmits the request to another resource

library in its region or to the Regional Medical Library.

In addition, resource libraries assist with the coordination of network development and with educational activities.

The basic unit libraries at the base of the pyramid

are mainly hospital libraries, although any healthrelated library is eligible to become part of RMLP. Approximately 3,800 basic unit libraries now participate.

Their financial responsibilities were originally limited

to only those costs associated with communicating

with the resource libraries, but they now pay part of

the costs of interlibrary loans as well. Basic unit

libraries are an essential element in RMLP because they

are usually the entry point to the network for the

health professional. In fact, the relationship between

RMLP and the other extramural programs authorized

by the Medical Library Assistance Act is most evident

at this level. As noted earlier, many resource improvement grants have been used to encourage community

hospitals to develop collections of text books and journals, share resources, and become active participants

in RMLP.

The vertical, pyramid structure of RMLP is organizationally important for the sharing of core biomedical

information resources. But as the health sciences’

knowledge base broadens, and health care delivery encompasses evermore diverse and specialized subjects

from the social sciences, law, and economics, the

horizontal sharing of resources is becoming increasingly important, especially for the level of sophistication found in the resource and basic unit libraries.
98

Rather than looking to libraries above them in the

RMLP pyramid, smaller libraries are beginning to tap

specialized resources outside the pyramid for materials

outside the traditional field of biomedicine and

unavailable in medical libraries. While not a program

objective, this horizontal sharing of resources has been

encouraged by the existence of RMLP (27).

Although RMLP has retained the same general objective since its inception in 1965, program format and

activities have been modified in response to legislative

and administrative demands, user needs, level of each

region’s network development, and technological

change. The 1970 extension of the Medical Library

Assistance Act permitted the use of contracts as well

as grants for financing the program, and by 1972, all

awards to regional medical libraries had been converted from grants to contracts. The contract

mechanism was again modified in 1979 according to

DHHS regulations to require competitive bidding

among regional medical library applicants. Eight institutions were awarded contracts in fiscal year 1980

under this new method; a ninth contract was awarded

the following year. The only site change resulting from

this new process was in the Midwest region, where the

University of Illinois replaced the John Crerar Library

as the Regional Medical Library.

In 1972, NLM issued a policy statement that committed the Library to the development of a Biomedical

Communications Network (BCN) and described

RMLP as the first phase (106). The long-term objective of RMLP was to serve as a model for BCN, which

would be designed for information transfer supporting

health services delivery, education, and research. Its

immediate objective was to develop a document delivery system for the Nation’s medical libraries. In

1979, a Library committee reaffirmed RMLP’s general

objective, but broadened its immediate objective to include encouraging greater resource sharing and providing services beyond document delivery.

A cost-sharing plan for document delivery was also

implemented in the RMLP in 1979, based on NLM’s

belief that local libraries should bear the financial

responsibility for documents provided to their primary

users. The concepts of the plan were developed in 1970

when the Library determined “that it [was] not wise

to base the finding of the entire [Regional Medical

Library] network upon appropriated funds.” Cost

sharing will gradually eliminate NLM’s financial commitment to document delivery by October 1982, leaving the Library responsible only for those materials not

available in the Regional Medical Libraries and allowing it to support other aspects of resource sharing and

the development of better communication links.

Cost sharing has already permitted NLM to decrease

its funding level for document delivery from 50 to 25

to 30 percent. Because of the increasing volume of

loans along with the rate of inflation and the desirability of having material as close as possible to the requester, the Library concluded that it was essential that

local libraries exercise greater fiscal responsibility.

The notion of cost sharing for document delivery

services has been controversial since it was first raised

in 1970. Some regional libraries now view the plan as

a shift on the part of NLM away from funding interlibrary loans and towards funding the development of

MEDLARS III, the latest version of the Library’s online retrieval system. Because MEDLARS III is primarily designed to alleviate the Library’s internal burden

of managing a growing body of medical literature,

these regional libraries see the Library withdrawing

support from the Regional Medical Library network

at a time when new demands are levied against their

resources by small libraries with newly acquired access to MEDLARS.

NLM insists that its reduction in direct financial support for document delivery does not equate with a

“reemphasis” of that activity. Further, the Library

notes that an important feature of MEDLARS III will

be the full automation of interlibrary loan referrals,

a development that will eventually enhance document

delivery in that it will be easier to identify and locate

a bibliographic entity. Further, development costs for

MEDLARS III are drawn from the Library’s operating

budget, not from funds authorized for the Medical

Library Assistance Act.

In October 1981, NLM announced a reconfiguration

of the Regional Medical Library network, reducing the

11 geographic regions to seven effective November

1982. The proposed change is intended to reduce the

administrative costs of the program to make more

funds available for program activities, and is in

response to congressional sentiments evident in 1981

hearings on the reauthorization of the Medical Library

Assistance Act. As library and information services

have become increasingly computerized, larger geographic areas have become easier to manage, allowing NLM to consider redrawing boundaries as a more

cost-effective mechanism to meet current and anticipated budget constraints (94). Along with the new regions, the Library proposes to establish a national network advisory board, similar to those presently in

place in each region. NLM believes this commission

will allow users of RMLP’s resources and services to

be more involved in the program.
Appendix B.— U.S. Information Policies

This appendix briefly reviews the history, current

standing, and future prospects of domestic information policy issues to provide a larger context for issues

considered in the report. The relationship between domestic information policy and international information policy is noted as well.

The United States does not have a uniform, articulated, national information policy guiding the information activities of the country and, so for the most

part, these activities have evolved informally. However, the Government has long been involved in creating, gathering, organizing, and disseminating information.

Three separate constitutional provisions define the

role of the Government in relation to publishing. The

first amendment denies to the Government the right

to abridge freedom of publishing. The other provisions

give the Government a specific role in the promotion

of publishing. The copyright clause empowers Congress to give authors exclusive rights to their products,

and the postal clause allows Congress to establish post

offices and post roads.

From colonial days through the 19th century the

Government supported development of the press in

various ways. Postmasters were often the first newspaper publishers, because they had a source of news

and a means of distribution. Benjamin Franklin, the

first Postmaster General, was the most famous of the

postmaster-publishers. Official notice advertising and

Government printing was used to support newspapers.

Thomas Jefferson, finding no Washington newspaper

supporting his administration, brought the Philadelphia publisher, Samuel Harrison Smith, to Washington to start the National Intelligencer, and had Congress give it printing contracts. Congress gave newspapers free local distribution through the post office

until it substituted second-class mailing rates in the

mid-19th century, a revised form of subsidization.

Despite this early concern with information, it was

not until after World War II, with the extraordinary

growth in science and technology, that the United

States expressed a sustained interest in developing a

coordinated information policy. As a result of the

increased tempo of scientific activities, scientific

knowledge had expanded and become unwieldly, and

scientists had increasing difficulty keeping informed

of new developments, In searching for a way to facilitate full and open communication among scientists,

the Federal Government sponsored a series of reports

on information policy issues. A common thread running through the studies from 1958 to the late 1960’s

is the need for improved and coordinated science information services, particularly on the part of Federal

agencies. The studies devoted little attention to the

private sector, and then only to individuals and the

nonprofit professional societies.

By the mid-1960’s the Federal Government had

begun to view information as a national resource.

Although it remained interested in the improvement

and coordination of scientific and technical communication, the Government gradually broadened its

perspective on information activities. Information in

many fields, such as commerce and law, and varied

aspects of information, information communications,

information technology, and information economics,

were incorporated into the national dialog. At the

same time, the private sector began to assume more

importance in the policy debate, and the focus shifted

from the nonprofit to the profit component of the

private sector.

Today, information is so central in our social order,

that some observers have termed the United States a

“postindustrial society, ” a “knowledge-based society,”

and an “information society. ” Accordingly, information policy concerns have increased rapidly in number,

diversity and complexity.

In 1976, information policy was described as having many connotations, including “policy dealing with

the regulation of information messages over common

carrier facilities, policy with respect to postal rates for

the distribution of books throughout the country,

policy affecting the information requirements imposed

by Federal and State governments, and policy concerning the communication of research results to the scientific and technical community in the public and private

sector” (144). By 1981, an OTA report focusing exclusively on computer-based national information systems noted (115):

It would not be possible for any one study to capture succinctly a single set of policy issues that would

apply to all national information systems in American

society. The specific system applications are too diverse,

the potentials and problems too complex, and the parties-at-interest and relevant institutions and legal frameworks too diverse.

The OTA report (115) did identify current policy

issue areas concerning national information computerized systems, including:

privacy;

security;

Government management of data processing;

society’s dependence on information systems;

transborder data flow;

information gap;

innovation, productivity and employment;

constitutional rights;

99
100

● computer crime; and

. regulatory boundaries; and computer software

protection.

Many of these issues are not confined to computerized information systems, but extend to other information activities. Some pertain to information activities in the international arena.

The OTA report (115) also noted the absence of a

uniform, coherent national information policy. The

type of information policy or policies, domestic and

international, that would best serve the interests of this

country has received considerable attention, but still

remains elusive. Most studies regard a national information policy, as prerequisites for effective information pursuits, although it is not a universally held

position.

If a national policy were developed, many structural

questions would still be undecided, among them:

should there be a uniform, monolithic policy for all

information activities; should there be a diverse set of

policies to account for the wide variation in information activities and issues; should the power for designing and administering domestic or international information policy be centralized or decentralized; if centralized, where should its locus be; and, if decentralized, which Government agencies and departments

should be involved.

The present pluralistic and undefined domestic information policy is considered by some to hinder the

ability of the United States to devise and effect

strategies concerning information and communication

in the international arena. Whereas the majority of

foreign administrations dominate their domestic communications activities, in the United States, communication and information functions are exercised by

both the Government and the private sectors. Although this pluralistic approach to communications

and information has contributed to the eminent position of the United States in telecommunications, it has

complicated the definition of a domestic and international information policy. In addition, international

information policy is tightly intertwined with foreign

policy, and is viewed as a negotiating tool from some

perspectives.

The formulation of an international information

policy is becoming more and more important as technological developments stimulate international information activities. Projections suggest that within two

decades an integrated global network for information

transmission will be developed and that a person with

a universal terminal will be able to access the network

from almost any place in the world to obtain information on nearly any subject (127). Other technologies, such as video disks, may increase the ease of

transmitting information globally even earlier, with

less need for international telecommunication networks (133). These developments force attention to

many international information issues, such as privacy, copyright and restraint of trade.

The current responsibility for information activities

is fragmented in numerous Government agencies.

There is no coordinating mechanism for intragovernmental policy issues, nor is there an opportunity or

locus for Government and private dialog about matters of mutual concern. The Paperwork Reduction Act

of 1980 (Public Law 96-511) gives the Office of Management and Budget (OMB) the major responsibility

for regulating executive agencies regarding information acquisition and distribution; OMB directives concerning information activities appear to be focused on

saving the Government costs in a time of extreme

budgetary constraints and placing reliance on the

private sector for goods and services needed by the

Government and U.S. citizens. They do not provide

the broad perspective required to address the complex

issues of an information age.

Because of the interlocking nature of these international and domestic information issues, it has been suggested that they be addressed in a coordinated fashion

by a high-level centralized executive body. However,

the prospect for an integrated approach to information issues appears small. Rep. George E. Brown, Jr.,

notes the need for involving the executive and congressional branches in an understanding of information

policy issues (23):

Few members of Congress appreciate the potential

contributions and consequences of information science

and technology. Nor are they aware . . . of policy

issues and the need to plan for the changes to come.

A 1981 OTA study (115) supports this conclusion and

comments on the lack of interest among present policymakers in a uniform Federal information policy to address the many problems that might conceivably occur from the use of data systems.

List of Selected Domestic Information

Policy Activities

1952.—Title V of the Independent Office Appropriations Act (31 U.S. C. 483a) provides that agencies set

prices to recover as fully as possible the entire costs

of providing a service, taking into account the public

good and the benefit to the user. Although the Independent Office Appropriations Act is not confined to

information services, charges for data bases and dissemination services fall under its purview. The

guidance it provides is very general and open to interpretation.
101

1956.—The National Library of Medicine (NLM) is

established as a national library and resource for biomedical information by the National Library of Medicine Act (Public Law 84-941).

1958.—The Baker Report (122) affirms the need for

a free flow of scientific information and recommends

a Federal research and development coordination

mechanism.

1959.—0MB issues Circular A-25 (48) to implement

the Independent Office Appropriations Act by requiring that charges be made to each identifiable recipient

of a Government service from which a special benefit

is derived, and that the Government recover full costs

in rendering the service. Exceptions are made when the

activity is designed for public safety, health or welfare.

The circular is difficult to interpret with respect to who

and how much should be charged.

1960.—The Subcommittee on Government Reorganization and International Organization’s report,

“Documentation, Indexing and Retrieval of Scientific

Information” (147), recommends improved Federal

and private information services, and strengthened

coordination.

1962.—The Crawford Report (142), prepared for the

Federal Council on Science and Technology, recommends that each agency have a single office responsible for science information activities.

1962.—The Surgeon General’s Conference on

Health Communications issues a report (138) on the

need for improved communications of scientific research results, research training, and the use of libraries

as communication centers and resources.

1963.—The Weinberg Report (120) asserts that the

Federal Government should assure the ready availability of information concerning research in progress,

through a network of Government information centers

of the Federal Council for Science and Technology.

Nongovernmental information systems were to be examined for overlap with Government systems.

1963.—The National Academy of Sciences/National

Research Council’s report Communications Problems

in Biomedical Research (111) stresses the biomedical

community’s responsibility for improved facilities, research and development, training, and coordination

for the biomedical information complex.

1964.-The Committee on Scientific and Technical

Information (COSATI), established by the Federal

Council on Science and Technology to coordinate a

wide range of activities, commissions a report (145)

examining alternative means for developing a Federal

information program, Because of its charter, COSATI

focused totally on the governmental components.

1965.—The President’s Commission on Heart

Disease, Cancer, and Stroke stresses the need for better communication of biomedical research and improved medical libraries to prevent the loss of new

scientific knowledge (121).

1965.—The Medical Library Assistance Act (Public

Law 89-241) is passed to improve the production and

dissemination of information in the health field.

1967.—A report by Stafford L. Warren (158) to the

President on a National Library of Science System recommends that NLM be one subsystem of an overall

science system.

1968.—The Lister Hill National Center for Biomedical Communications is established as part of NLM to

improve biomedical communications through advanced technologies.

1969.—The National Academy of Sciences and the

National Academy of Engineering jointly commission

the Scientific and Technical Communication

(SATCOM) Report (95). The report calls for a nongovernmental body to be responsible for national information policy, at least in the area of science and

technology, as a joint commission of the National

Academy of Sciences and the National Academy of

Engineering. The SATCOM Report explicitly recommends close cooperation between the public and private sectors in future development, and suggests Government financial support for information services

operated by professional and scientific societies. The

needs of the for-profit sector are less clearly defined. Coordinating mechanisms for the Government

(COSATI) and the private sector (SATCOM) are established to promote interrelated activities.

1971.—The Kozmetsky Report (73), explicitly recognizes the general value of information as a critical resource, both nationally and internationally, rather

than limiting it merely to the realm of scientific and

technical contexts.

1972.—The Greenberger Report (59), done for the

Federal Council on Science and Technology and the

National Science Foundation, examines the role of

COSATI, and concludes that the Government is not

well organized to deal with the problems in developing information as a national resource. It recommends

that new policy mechanisms be created and that the

private sector have input in policy and program development.

1975.—The National Commission on Libraries and

Information Science (NCLIS) presents Toward a National Program for Library and Information Services

(97), a report based on extensive public hearings and

meetings throughout the country. This report considers a broad range of information needs, including those

of the general public, science, technology, business and

industry, and education. Like earlier reports, it identifies the need for cooperation among the several sectors in developing information as a national resource.

It also suggests a governmental role in providing tech-
102

nical inducements and finding incentives for the private

sector and State governments.

1976.—The Oettinger Report (114) reviews issues

related to fragmentation, confusion, and contradiction

in present Federal information policies.

1976.—The Becker Report (15), done for the National Science Foundation, summarizes the history of

information policy and reiterates the need for a coordinated national effort, with Government sponsorship

for an institute for information policy and program

planning in which private organizations can be accommodated.

1976.—The report National Information Policy

(141), prepared by the Domestic Council Committee

on the Right of Privacy, is published by NCLIS. It

identifies issues affecting the relationship between the

Government and the private sector in the production

and dissemination of information and argues for a

standard set of policies clarifying the relationship between the two sectors. It recommends a strong information policy group in the Executive Office of the

President and the creation of appropriate intergovernmental and non-Federal committees.

1976.—The SCATT Report (2) provides a comprehensive plan for integrating the various public and

private components in the production and dissemination of scientific and technical information.

1978.—lnto the Information Age: A Perspective on

Federal Action on information (60), a study commissioned by the American Library Association, calls for

Federal leadership in developing information to meet

societal needs such as air quality, energy, economic

well-being, public safety, and environmental preservation.

1978.—The National Telecommunications and Information Administration is established in the Department of Commerce to examine broad information policy questions.

1979.—OMB distributes Circular A-76 revised (49),

“Policies for Acquiring Commercial or Industrial Products and Services Needed by the Government .“ It declares that the general policy of the Government is to

“rely on competitive private enterprise to supply the

products and services it needs.”

1979.—The Library of Congress surveys the publications policies of executive branch agencies.

1979.—The congressional Joint Committee on Printing publishes Federal Government Printing and Publishing: Policy Issues (143), identifying issues with respect to: 1) administration of policy, 2) Federal Government printing production and procurement, 3) impact of new technology, 4) access to and distribution

of Government information, 5) the depository library

program, and 6) the pricing of Government information.

1979.—The General Accounting Office publishes,

Better Information Management Policies Needed: A

Study of Scientific and Technical Bibliographic Services (55), confirming the need for better Government

management of information centers, and identifying

duplicative services and facilities, failures to recover

costs, and inconsistent cost recovery procedures

among agencies. It recommends that the Director of

OMB direct each department and agency to designate

a high level official responsible for information management, that Congress consider more precise language

when authorizing information centers to alleviate duplication and provide more specific guidance on which

information services should be exempt from cost recovery requirements.

1979.—The President announces measures to “help

ensure our country’s continued role as the world leader

in industrial innovation” including “enhancing the

transfer of knowledge” and “increasing technical

knowledge.” One of the actions taken to ease and encourage the flow of technical knowledge and information establishes the Center for Utilization of Federal

Technology at the National Technical Information

Service (Department of Commerce) to improve the

transfer of knowledge from Federal laboratories and,

through the Departments of State and Commerce, to

increase the availability of technical information

developed in foreign countries.

1980. -OMB Bulletin No. 81-16, “Elimination of

Wasteful Spending on Government Periodicals, Pamphlets, and Audiovisual Products,” imposes an immediate moratorium and institutes a comprehensive

review of the production, procurement, and dissemination of new audiovisual products, periodicals, and

pamphlets, and calls for user fees to recover the costs

of production.

1980.-An OMB draft circular, “Information

Management and Dissemination of Federal Information,” outlines a cost recovery program for information provided by the Government. The proposal covers all costs associated with dissemination, including

printing, processing, and retention, but excludes the

cost of producing or creating the information. The

policy is not made official, though some aspects are

included in the Paperwork Reduction Act of 1980.

1980.-The Working Group on Private Sector/Government Relationships for Scientific and Technical Information, of the Federal Coordinating Committee on

Science, Engineering, and Technology identifies the

four key issues in private sector/Government relationships: 1) the different philosophical views of information as a resource; 2) determination of Government’s

legitimate role in the operation of services for a given

philosophical view; 3) the historical and future role

of Government as a risk-taker in the development of
103

technologies and markets; and 4) the kind of platform

or mechanism through which agencies and the private

sector can resolve differences. The group concludes

that attempts to develop guidelines for resolving differences across Government agencies and between sectors is not feasible, as neither sector acts and reacts

as a single entity.

1980. -OMB issues Circular A-121 to “establish policies that promote effective and efficient management

and use of certain data processing facilities” by instituting business-like procedures of cost accounting, cost

recovery, and interagency sharing of data processing

facilities.

1980.—The Paperwork Reduction Act (Public Law

96-511) establishes an Office of Information and Regulatory Affairs within OMB to regulate and coordinate

the activities of executive branch agencies with respect

to information acquisition and distribution. It requires

that each agency have a single authority, at the assistant secretary level, responsible for information activities within the agency. It also authorizes the establishment of a Federal Information Locator System, to

be composed of a directory of information resources,

a data element dictionary, and an information referral service.

1981.—Issues in Information Policy (38), a report

of the National Telecommunications and Information

Administration (Department of Commerce), divides

information policy issues into two groups: 1) those encompassing constitutional and statutory authority for

permitting, requiring, or inhibiting the availability and

accessibility of information; and 2) those focusing on

economic policies for inhibiting, managing, or facilitating the distribution of information to certain sectors of society.

1981.—The OTA report, Computer-Based National

Information Systems: Technical and Public Policy Issues (115) describes how future applications of computerized information systems may intensify or alter

the character of the policy debate and the need for new

or revised laws and policies.

1981.—The Public Sector/Private Sector Task Force

of NCLIS (see app. F) concludes that the four major

issues in the conflict between the sectors rest on the

need for the Federal Government: 1) to take a position of leadership in facilitating the development and

fostering the use of information products and services;

2) to encourage private sector investment in information resources, products and services; 3) not to engage

in commercial information activities unless there are

compelling reasons for it to do so (and there must be

well-defined procedures for determining that such

reasons indeed are present); and 4) to protect private

sector property rights in any package of governmentally distributed information, that includes private information resources, products, or services.

1981.—0MB releases Memorandum 81-14, providing criteria for the evaluation of Federal information centers by executive departments and agencies

conducted under the Paperwork Reduction Act. The

criteria are used to determine whether an information

center duplicates private endeavors or can be consolidated with other centers, and whether centers

should provide information on a full cost recovery

basis.

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Appendix C.— MEDLARS Evaluations:

A Review of the Literature

Introduction

This appendix reviews published and unpublished

studies evaluating MEDLARS services and usage. In

many ways, these studies have been dated by a decade

of rapid technological advances in computerized

retrieval systems. A paucity of studies is available on

the system in place today; thus, generalizations based

on the findings presented here may be misleading. The

literature review here is offered to illustrate the kinds

of questions one must ask in evaluating on-line retrieval systems, and the complexity and difficulty inherent in such an undertaking.

The National Library of Medicine (NLM or the

Library) has devoted extensive time and other resources to internal and external review and has examined not only system performance but the basic purposes, goals, and constituency groups MEDLARS is

designed to serve. Few institutions, public or private,

have matched NLM’s commitment to evaluation. This

appendix reviews studies of user satisfaction, searcher

variation, and the retrieval capabilities of the

MEDLARS system. It also presents OTA’S evaluation

of MEDLINE’s coverage of selected topics. First, however, it describes the types, number, and motivations

of MEDLARS users.

Users and Usage of MEDLARS

NLM collects utilization data for MEDLARS solely

on an institutional basis. There is information on how

many medical schools and hospitals have MEDLARS

terminals, but there is relatively little information on

the individuals requesting on-line searches, their

reasons for seeking the information, or their level of

satisfaction with search results. Further, and perhaps

more importantly, there is no study available of the

nonusers of MEDLARS and their reasons for not using

its services.

Because so few data are available, users’ expectations can only be appraised in light of their organizational affiliations, and the respective orientation of

those institutions. In September 1980, 1,243 institutions in the United States had direct access to NLM’s

data bases. Forty-one percent of these institutional

users were hospitals and clinics, 23 percent were commercial firms, and 9 percent were medical schools (see

table 4 in ch. 2 for complete data).

This discussion defines the librarians and information specialists who conduct searches at computer terminals to be intermediate users of information systems,

while end-users are the researchers and clinicians who

104

request that searches be done and who utilize the information retrieved. Sometimes, though rarely, end

users conduct their own searches. In 1977, an estimated

80 percent of all searches were conducted by trained

intermediate users alone, 20 percent by intermediate

users with end users present at the terminal, and less

than 1 percent by unassisted end users (160).

Patient Care Institutions

Hospitals are the largest and fastest growing group

of institutional users of MEDLARS services. In 1978,

hospitals represented one-third of NLM’s on-line institutional users; by 1980, this figure had grown to

over 40 percent. There are more than 7,000 hospitals

in the United States; over 700 have MEDLARS terminals, and many others obtain on-line services from

hospitals in nearby communities. In 1976-77, one study

indicated that hospitals with terminals each processed

an average of 493 MEDLINE searches per year (160).

For that same period, professional schools conducted

an average of 1,429 searches. The average for all institutions with access to MEDLINE was 842.

Hospital librarians report that about half their

search requests are from physicians wanting information directly applicable to patient care. Often, the information is needed to aid the diagnosis and treatment

of disease. In such instances, physicians are generally

looking for a few relevant articles and need to obtain

them within 24 hours. MEDLARS is also helpful to

the physician preparing an article or lecture, or simply as a way of the physician keeping abreast of the

literature on a particular subject or specialty. Nurses

are also frequent users, often for reasons similar to

physicians.’ Questions on patient management represent the most common queries, though nurses also request searches for patient education, staff development

programs, and the preparation of papers and presentations. MEDLARS is increasingly being used by ancillary service departments and administrative staffs in

hospitals, especially for the planning of new services

and the purchase of new equipment.

Though MEDLINE is the most frequently used data

base in hospitals, the HEALTH and CANCERLIT files

are also popular. Twenty-two percent of hospitals with

on-line access to NLM’s data bases also reported having used other non-NLM data bases in 1977, with

PSYCHOLOGICAL ABSTRACTS and SCISEARCH

the most often used. As the holdings of most hospital

libraries are generally not extensive (the 1977 average

number of serial subscriptions was under 400 for hospitals, but over 2,OOO for professional schools) and
105

primarily clinically oriented, some document delivery

problems are reported for articles identified through

non-MEDLINE data bases. Sixty-one percent of all institutional MEDLARS users said they needed to acquire additional holdings based on the demand from

on-line searches but did not have the funds to do so

(26).

Research Institutions

The majority of institutional users are interested in

MEDLARS as a research tool. These users include

Government agencies, research foundations, professional associations, medical and professional schools,

commercial research and development firms, and information brokerages, Little information is published

on the utilization of MEDLARS services by such organizations, though some basic descriptive data has

been reported by medical school libraries on their individual users (58,88,139,140,141). Although medical

schools constitute only a small portion of research institution users, their experience with MEDLARS reflects that of similar institutions and is particularly

useful for identifying the reasons that researchers request on-line searches.

MEDLARS usage in medical schools is characterized

by utilization patterns similar to those found in

hospitals. Both hospital and medical school libraries

conduct searches for physicians, nurses, lab technicians, and administrators, and often for the same

reasons—patient care, preparation of articles and lectures, and planning. Medical school libraries, however,

see the majority of searches requested for research purposes (58,88,139,140,141).

While health practitioners tend to want a few relevant articles, researchers more often request broad,

comprehensive searches. Faculty members, who divide

their time between teaching, research, and patient care,

tend to be the heaviest users of MEDLARS, requesting

information needed for both ongoing and prospective

research. For them, MEDLARS is an invaluable means

of saving time and effort; for identifying articles that

might be missed in a manual search; and for ensuring

that they have a comprehensive bibliography available, especially when considering research in a new

field (139,141).

Clinical Librarianship Programs

Clinical librarianship programs first appeared in the

early 1970’s, in response to the need for more timely

dissemination of current developments and research

findings. Primarily undertaken in large medical centers

and teaching hospitals, the programs are designed to

bring the skills of medical librarians directly to the

delivery of health services by providing “highly specific, case-related medical literature . . . in a manner

that permits the information obtained to influence

ongoing case management” (14). In a technical sense,

the success of such programs depends on the librarian’s

ability to conduct highly specific, narrowly focused

searches, in a brief period of time, ensuring that the

relevant information reaches the clinician in time to

influence the care of the patient. The ultimate objective of clinical librarianship is improved patient care.

Although these programs have received considerable

attention and several articles are available describing

their focus, methods, and results (129), evaluative efforts found in the literature have been limited in scope

and have not adequately assessed any effects of such

programs on patient care. They do report, however,

significant increases in utilization of hospital library

services resulting from the introduction of clinical

librarians. For instance, one study showed a 120-

percent increase in search requests from a staff with

a clinical librarian program (61). A second study reported that 92 percent of physicians said that they read

the articles given to them by clinical librarians, 86 percent said they learned something new from them, and

another 20 percent indicated that the articles affected

patient management to some degree (129). This study

hypothesized that clinical librarianship programs could

be a cost-effective alternative to many ancillary services, by substituting relatively inexpensive literature

searches for more costly diagnostic tests.

MEDLARS Evaluation Studies

OTA reviewed three types of MEDLARS evaluation

studies. The first group of studies, user satisfaction

studies, asked end users to determine the relevance of

retrieved documents to their requests. End users

queried in these studies generally found MEDLARS

search helpful in their research and/or clinical practice. A second group of studies evaluated variation in

MEDLARS search results based on characteristics of

intermediate users, These studies indicate that the

training and experience of the searchers and the interaction between intermediate and end users in formulating search requests are key to the success of the online search. Finally, Lancaster’s landmark study (77)

evaluated the retrieval capabilities of MEDLARS

before it was available on-line. Lancaster reported average recall and precision ratios of 58 percent and 50

percent respectively, found extraordinarily high variability from question to question searched, and conducted an extensive analysis of recall and precision failure. On the whole, Lancaster found little critically

wrong with the system.
106

The fourth topic discussed below is OTA’s evaluation of MEDLINE’s coverage of selected topics.

User Satisfaction Surveys

Several librarians have attempted to determine how

well MEDLARS satisfied the information needs of end

users in their individual libraries. In 1977, Brown (22)

reported that users of on-line services, including

MEDLARS, were “generally satisfied” with those services. The population studied represented only a fraction of those who could potentially benefit from online searches. Underlining the significance of the latter point, 2 years later a MEDLINE feasibility study

undertaken at the behest of the Northeastern Consortium for Health Information was based on the theory

that “most potential users and supporters of MEDLINE

within hospitals [were] unaware of its usefulness and

application” (89). A concerted effort to publicize the

system’s services through the NLM network increased

demand significantly. The author concludes that the

13 member hospitals participating in the study could

generate sufficient usage to justify the costs of

MEDLINE, at least on a shared-service basis.

Sharing access to NLM’s data bases was also suggested in a study done on the use of on-line services

in academic settings not affiliated with medical schools

(11). Here, interest in such systems was identified in

students and faculty members engaged in research in

disciplines related to the health sciences. In each of

these studies, users were given the opportunity to have

searches conducted at minimal (or no) cost, and then

asked whether they would request searches if charges

for on-line time were somewhat higher. The majority

of users in each study said that they would pay, although instituting charges was never tested. Nevertheless, by 1977, 90 percent of medical school libraries

charged users for MEDLARS services (160).

Several evaluations have been conducted by submitting questionnaires to MEDLARS users, asking them

to identify their purposes in requesting on-line searches

and their satisfaction with search results. OTA reviewed two efforts undertaken in individual information centers (93,141), and two others that evaluated

data combined from seven centers (139,140).

In one study, 246 of 428 users of MEDLINE services

at the University of Virginia Medical Library responded to a survey asking whether searches had been

of assistance to their research or clinical work, and

whether they would continue to utilize the system after

the imposition of modest charges. They were also

asked if MEDLINE was a “substantial improvement

over the traditional methods of searching through the

printed indexers” (93). The study group was composed

of nursing, medical, and graduate students, nursing

and medical faculty, and staff; health professionals

outside the medical center were included in the study

through a statewide medical information service. Over

93 percent indicated that MEDLINE had assisted in

their research and clinical work, and that it was an

improvement over manual searching, Seventy-five percent indicated that they would continue using the service after the imposition of charges.

The remainder of the studies reviewed in this section were conducted by Tagliacozzo of the University

of Michigan, and are the most sophisticated user satisfaction studies of MEDLARS. In her first study, published in 1973, Tagliacozzo identified two sets of issues

that must be considered in evaluating the service provided by any information system such as MEDLARS

(141). The first relates to the performance and costs

of the system. The second relates to the end users of

the system: who they are, whether they represent all

categories of users the service was designed for, and

whether using the system altered the progress of their

research and clinical practice.

The first Michigan study assumed that utilization

of an information service could be explained, and to

some extent predicted, on the basis of end-users’ subjective assessments of its usefulness. Questionnaires

were distributed to 275 MEDLARS users. Of 168 completed surveys, 7.2 percent reported their MEDLARS

search as “not helpful, ” 25.9 percent as “moderately

helpful,” and 66.9 percent as either “helpful” or “very

helpful.” The respondents listed a variety of reasons

for requesting on-line searchers, though clearly the majority of requests was for ongoing or prospective research. Only 24 respondents classified their work as

“exclusively clinical, ” a number far too small to draw

any conclusions about the role of MEDLARS as a

source of information for practitioners.

In 1975, Tagliacozzo published a second study, specific to MEDLINE, and drawing on data collected in

seven Midwestern medical centers (139). The study examined the characteristics, motivations and purposes,

expectations, and perceptions of MEDLINE users at

a time when the system was just beginning to be used

in the medical centers.

Tagliacozzo found that users tended to be either

research faculty members working in the basic and

clinical sciences, or students working toward advanced

degrees or in clinical training. Again, it was difficult

to determine the role of MEDLINE in the acquisition

of knowledge, though it was apparent that use of the

system was not confined to academicians. Most

MEDLINE users reported that the retrieved information was primarily for research purposes and that the

search was requested because the service was perceived

“as a more effective means of reaching relevant citations than the traditional bibliographic instruments. ”
107

Tagliacozzo’s third study allowed users to distinguish between the value of the search process and the

usefulness of the search results, rather than simply

offer an overall judgment of the service (140). Data

were again collected by questionnaire in seven Midwestern medical centers. Sixty percent of the respondents reported positive reactions to search results,

though many others noted that while the search had

not provided many useful citations it had saved the

time and energy required for a manual search, or had

confirmed opinions that all relevant literature for a

subject had previously been identified. In her conclusion, Tagliacozzo cautions against taking the users’

judgment at face value, especially for determining

whether information needs are satisfied through use

of an on-line system, because so many factors, such

as familiarity with relevant literature and the nature

of the search requests, can influence users’ responses

to the system.

These studies leave the impression that end users

find MEDLARS helpful to their work in research and

clinical practice. However, for the most part they did

not sufficiently test critical questions such as: were the

information needs of the user satisfied? and did the

system provide the user with all, or most, of the relevant literature which the data base contains?

Evaluations of Intermediate User Variation

Several studies have examined variation in

MEDLARS search results based on characteristics of

intermediate users. Two studies examined the results

of searches conducted by end-users themselves, without the assistance of a trained librarian. One found

that “nonlibrarian users” were quite capable of interacting with MEDLINE, as measured by the number of

modifications to their search statements made at the

terminal (118). A second study reported usage of two

NLM data bases, MEDLINE and TOXLINE, and concluded that, when access to terminals was provided

to pathologists and pharmacists, nonmediated use by

researchers (i. e., without the assistance of a trained

MEDLARS searcher) could be beneficial, if such users

were given a “minimanual” describing MeSH vocabulary (130).

A 1978 study compared results of MEDLARS

searches conducted through different software

packages, one available from NLM, the other from a

commercial vendor, Bibliographic Retrieval Services

(125). The study reported that searches could be done

equally well on either system, but that they differed

significantly from a technical standpoint. The differences were reported to be important only to intermediate users and did not affect search results. It

was recommended that these variations “justify the

dual availability of the files.”

A recent evaluation, funded by NLM, examines the

effect that the type of user training has on searching

style and performance (156). The study considered 535

searches from 191 intermediate users, and found no

statistically significant differences in searcher performance between intermediate users trained by NLM and

those receiving MEDLARS training “informally.” Performance measures for all searches were reported to

be 23 percent for recall and 67 percent for precision.

Evaluation of MEDLARS’ Retrieval Capabilities

The only intensive effort to determine MEDLARS’

ability to retrieve relevant information efficiently was

conducted in 1968 before the system was available online. This was a study of batch processing: today’s

system is very different. Lancaster’s landmark study,

Evaluation of MEDLARS Demand Search Service (77),

reported the precision and recall performance of the

system for over 300 search requests. Users (practicing

physicians and researchers) were asked to assess the

relevance of articles retrieved through MEDLARS

searches. An article was considered relevant if it had

“value to the user in relation to the information need

that prompted his request.” On the average, Lancaster

found MEDLARS to be operating at a 58 percent recall

level and 50 percent precision level. He noted that these

averages, though characteristic of retrieval systems,

might be misleading, since results of individual searches were widely scattered.

Much of Lancaster’s study was devoted to an analysis of “search failure:” that is, the reason why searches

did not identify more of the relevant literature and why

so many irrelevant articles were retrieved. The author

reported that 25 percent of the recall failures and 17

percent of the precision failures could be attributed,

in part, to a communication breakdown between the

user and the system. He recommended that search request forms be redesigned to more accurately reflect

the information need of the end user. Changes in indexing, indexing language, and approaches to searching strategy were also recommended.

OTA’s Evaluation of MEDLINE’s Coverage

of Selected Topics

OTA evaluated MEDLINE’s coverage of literature

relevant to five selected topics in biomedical and health

services research. The topics and results are displayed

in table C-1. Review articles on each topic were identified, and their bibliographies provided a relevance

base of pertinent documents against which MEDLINE’s

coverage could be measured.
108

Table C-1 .—MEDLINE’s Coverage of Selected Topics

Number of Percent in Percent

Topic relevant citations MEDLINE recall a

Hepatitis and

hepatoma. . . . . 161 69% 840/0

Hemoglobin

genetics . . . . . . 385 81 94

CT scanners . . . . 166 86 82

Patient

compliance . . . 323 62 77

Health care

delivery . . . . . . 423 20 71

aNU~ber of items retrievedlrlurnber of items included in the data base.

SOURCE: Office of Technology Assessment.

MEDLINE’s coverage is more than adequate for the

biomedical topics, but less so for those related to health

services research. This finding is not surprising, and

does not necessarily reflect a deficiency in NLM’s

system. Documents related and pertinent to the health

services topics appear in a wide variety of publications,

including law, business and public administration journals, conference reports, and monographs. These publications are not normally indexed for MEDLINE, and

it is unreasonable to expect NLM to cover such diverse

information sources. Coverage for these topics may

be much better in other NLM data bases, especially

HEALTH.

Conclusions

task, for at the most fundamental level a system’s performance is based on human behavioral patterns that

do not readily lend themselves to description by simplistic facts and outcome measurements. Human behavior affects every stage of the indexing, search, and

retrieval processes-effects that are not reflected in

measurements of recall and precision, nor in most

studies of user satisfaction. Evaluation procedures

specific to information science are being developed,

and the study of information needs and systems capabilities is expanding to include communications to

other than scientists and researchers, the traditional

users of information services. But more creative approaches to evaluation are still needed if information

processing and dissemination are to improve (28).

The findings of evaluation studies OTA reviewed

are not generalizable to the present MEDLARS systems, nor to its entire user community. Many studies

were conducted on earlier versions of MEDLARS, in

essence evaluating a system vastly different from that

in place today. Others examined a user population or

set of search requests too small to carry external validity. Still others paid insufficient attention to the intricacies of the task before them. In the absence of soundly developed evaluation methods applicable to large,

complex systems like MEDLARS, the limited value of

these studies, though frustrating, is not unexpected.

Evaluating any information system’s ability to satisfy the needs of its users is an enormously complex
Appendix D.— Development of Computerized Biomedical

Bibliographic Retrieval Systems

In every half-century since 1750, the number of

scientific journals increased tenfold, reaching well over

100,000 by 1950, and straining the abilities of readers

to stay abreast of the literature and retrieve earlier

published information (l). Following World War II,

science shifted away from strictly academically based,

disciplinary research and toward mission-oriented,

multidisciplinary approaches to solving social and

technical problems. Thus, scientists had to draw

needed information from a body of knowledge that

was not only expanding at unprecedented rates, but

compiled in increasingly diverse (and seemingly remote) sources.

This dilemma was quite pronounced in biomedicine:

19,000 biomedical journals were printed in 1950, well

over 22, OOO in 1970, and the boundaries that traditionally defined biomedicine as a field of practice and

research were continually expanding to encompass

new disciplines. Today, the field is so broad it defies

attempts at delineation. In 1950, it was clear that traditional scientific publications were exhausting their effectiveness in communicating important advances and

keeping readers abreast of the literature (1). Science

turned to computers to accelerate the processing, storage, and retrieval of information, and thereby revolutionized all information-seeking activities.

Information Products and Services

The single most important source of biomedical information are primary publications—books, journals,

technical reports, Government studies, patents, etc,—

though the dramatic rise in their number often makes

access to this literature difficult and confusing. Secondary publications—bibliographies, abstracts, catalogs, and indexes which facilitate access to the primary

literature—are thus serving as an increasingly important element in the transfer of information.

Secondary services trace their historical roots to the

learned and professional societies that flourished in the

late 19th century, and which sought to fulfill the

discipline-based information needs of their members

in the basic sciences. In general, such services acquire

and analyze primary publications, usually provide a

bibliographic description of each document, indexing

each according to an established system of content

analyses, and, periodically, produce a product which

provides subject access to the references for the

documents indexed during a specific time period (112).

Secondary services guide users to the primary source

of needed data, rather than directly provide the information. By 1950, 3,ooO abstract journals for the scientific literature were available in print form (1).

Until World War II, the need for interdisciplinary

communication was met through a few broad-based

professional organizations (e.g., the American Association for the Advancement of Science), the various

academies (e.g., New York Academy of Sciences), and

multidisciplinary publications (e. g., Science and

Nature). When new scientific or technical areas arose,

they were usually cross-disciplinary, like biochemistry.

Information access needs could be met by establishing

a new section of an abstracting and indexing service:

witness the issuing of Chemical Abstracts by sub-area

of chemistry, today including a section on biochemistry, and one on toxicology.

After World War II, the rise of Government-sponsored, mission-oriented research programs created a

need for broader, multidisciplinary coverage of the

scientific literature within a single secondary service.

While professional (nonprofit) societies addressed this

need through subspecialization, commercial organizations began offering selective, focused services relating

to particular program areas that cut across disparate

subject disciplines (e. g., the environment).

Technological Developments and

Growth of On-Line Services

The secondary service adaptations after World War

II were hard-pressed to meet the growing needs of the

scientific community. In the late 1950’s, producers of

printed abstracts and bibliographic indexes turned to

the new computer technologies to reduce costs by

mechanizing the construction and publication of their

products. The sophisticated application of computers

to the processing of biomedical bibliographic information was pioneered by the National Library of Medicine (NLM), and by 1964 the first computerized biomedical bibliographic retrieval system, MEDLARS,

was in use.

Most of the other machine-readable data bases in

health-related fields, as well as in other subject matter fields, were originally built when the production

of traditional indexing and abstracting journals

switched to computer-driven photocomposition. It

soon became clear that machine-readable data bases

developed in the 1960’s for the production of print

copy could also be searched via computer: this development became the basis for on-line information retrieval services, These and subsequent developments

109
110

were sponsored by both public and private enterprises.

Government investment enhanced the potential of

communication networks to attract other customers.

The increased volume of business then lowered costs

sufficiently to allow the industry to be cost effective

and to grow.

All libraries have been affected by the electronic

revolution, but none so much as those which serve the

scientific, technological, and medical communities.

Though these libraries have provided and will continue

to provide traditional services and print products, the

use of computerized services to support and enhance

their services is rapidly growing. The growth of computerized services has depended on, and been driven

by, the technical development and coordination of

time-sharing computers, machine-readable data bases,

fast-access disk storage devices, interactive retrieval

programs, and low-cost terminals and telecommunications networks. Although this study focuses on data

bases and their on-line services, other technological

developments were necessary to the growth which we

now see.

Machine-readable data bases, which began and continue as a more efficient method of preparing printed

indexes, enhancing the value of primary publications,

have grown in size and scope to compete with their

printed counterparts, and form the basis of information transfer activities. A 1979 directory of data bases

available on-line lists 528 separate entries, up from 301

cited 3 years earlier; 90 of these were relevant to biomedicine and health care (166). The number of requests

for on-line searches grew from 700,000 in 1974 to over

4 million in 1979 and to 6 million in 1981. Over onequarter of these were conducted on MEDLARS alone

by users in 40 countries (1). Specific data on the services provided by commercial firms is considered proprietary and is thus unavailable for publication,

though the industry as a whole is said to be enjoying

a 20-percent annual growth rate (168).

As data bases have grown to be at least as, if not

more, important than printed products as a source of

bibliographic information, they have diverged from

the publications they were developed to prepare. For

example, a number of journals in the special interest

areas of dentistry, nursing, and population science are

indexed for NLM’s major data base MEDLINE. However, these citations do not appear in Index Medicus.

On-line products are beginning to contain more information than their printed counterparts, clearly the result of the economics of the process of information

transfer to secondary sources. It is simply less expensive to add information to a data tape than to a printed

product (112).
Appendix E.— MEDLINE: Technical Processes

Introduction

The processes involved in the creation and use of

the data base MEDLINE were discussed in chapter 2.

Four aspects of these processes—literature selection,

the development of medical subject headings (MeSH),

indexing, and searching—are described here in more

detail. The same search process is employed for all

MEDLARS data bases.

Literature Selection

The data tape used for the printing of Index Medicus

is used as the source of data for MEDLINE. Thus,

references to articles selected for Index Medicus are incorporated into MEDLINE. In selecting journals for

Index Medicus/MEDLINE, the National Library of

Medicine (NLM or the Library) receives the advice of

seven to nine outside consultants who are acknowledged specialists in their fields. They are selected by

the staff with the approval of the Director of NLM.

Health educators, researchers, librarians and editors

of medical and scientific journals have often been advisors. In 1981, in addition to representatives from

these fields, the set of consultants included the vicechairman of a health planning commission, who was

formerly commissioner of a State health department.

His appointment may indicate NLM’s interest in health

services research and delivery. Consultants are appointed on an ad hoc basis and serve no set term. They

meet as a group three or four times a year, and the

chief of the MeSH section/editor of Index Medicus acts

as chairperson.

Journals considered for inclusion in Index Medicus/

MEDLINE are suggested to the editor by publishers,

the selection and acquisition staff of NLM, and, occasionally, by users. Several issues of each journal title

are reviewed and discussed at length by the consultants.

In the selection process, the consultants consider the

scientific merit of the publications, and their relevance

to NLM’s objectives. Other than these general standards, and a scope and coverage manual for the selection of materials for the Library as a whole, there are

no formal selection criteria. NLM believes that the

diversity of material included in Index Medicus/

MEDLINE precludes the establishment of a set of criteria that would be relevant for all the categories included in the Index.

After each consultant rates each serial on a scale

from 1 to 5, the chairperson averages the scores and

ranks the serials according to their average ratings.

With a score of 2.5, the serial is eligible for, but not

assured, inclusion in the Index. In comparison to the

number contained in NLM’s collection, the number of

serials indexed for Index Medicus/MEDLINE is very

small. Only 2,664 of the more than 20,000 serials collected by the Library were indexed in 1980, an increase

of slightly over 100 in the past 2 years. However, many

of the serials are directories, annual reports, and newsletters. The number of articles indexed in 1980 was

restricted to 273,750.

While management considerations (budget, number

of positions, scope of the data base) have been important in delimiting the size of the universe of publications indexed for Index Medicus/MEDLINE, the question of quality control has dominated the restrictions

on its size. The journal literature of the health sciences

exhibits a high degree of repetition and a mixed degree

of scientific excellence. The inclusion in or exclusion

from Index Medicus/MEDLINE represents an effort to

maintain a standard of scientific quality (3). With the

purchase of the new IBM 370/168 computer, NLM expects to increase the number of articles indexed, and

has requested that users, particularly foreign centers,

update their equipment in the coming year to accommodate the change.

A similar mechanism is used to review journals that

are being considered for deletion. In 1981, NLM added

145 new serials to Index Medicus/MEDLINE and

deleted 142, 30 because they were no longer published.

The consultants periodically review all the serials in

an area, such as obstetrics-gynecology, and add or

delete titles as appropriate.

As noted earlier, Index Medicus/MEDLINE has contained a small number of references to non journal literature such as monographs and proceedings of biomedical meetings. Because of the difficulty in selecting

this type of material, the journal selection consultants

recommended that this practice be discontinued; in

1981, it was. However, there is one type of document

that is not covered in Index Medicus/MEDLINE and

receives poor attention in NLM’s entire collection, and

that is the “fugitive” literature (see ch. 3).

Medical Subject Headings (MeSH)

The terms that are most commonly used by the

authors of English-language literature are used in the

MeSH vocabulary. New terms for the MeSH vocabulary are suggested by the literature itself, MEDLINE

users, professional associations, staff indexers, biomedical scientists, and special, NLM-concerned committees. With few exceptions, MeSH tends to follow

the literature rather than to lead it. One exception occurred when the American Psychiatric Association re111
. —

112

cently revised its classification of psychiatric disorders;

MeSH was changed accordingly, even before the new

classification had come into common usage. Similarly, NLM revised the MeSH terminology on the neurological aspects of speech disorders last year, with the

assistance of experts in the field.

MeSH is arranged alphabetically and categorically.

The 15 categories are further subdivided, and arranged

in a hierarchical manner to show relationships between

broader and narrower terms. The hierarchical structure and the indexing principles of specificity (i.e., indexing toward the most specific concept discussed) permits what is termed an “explode” capability during the

search process. At the command of “explode,” the

system searches for all subcategories of a more general

concept. For instance, if one were to search for the effect which a certain group of drugs, such as tranquilizing agents, had on animals, the “explode” feature

would allow the searcher to specify only the phrase,

“tranquilizing agents,” and references indexed with the

general term “tranquilizing agents,” or specific agents

would be retrieved.

Because the MeSH vocabulary is used for Index

Medicus, for MEDLINE, and for cataloging, it has inherent problems; what is optimum for one may not

be optimum for the other. For example, the Index

Medicus user usually has a general interest in a subject and wants to search in fewer places than does the

MEDLINE user who may have a specific topic of interest. Thus, the 14,000 MeSH descriptors are divided

into 9,OOO major and 5,000 minor descriptors. Whenever an indexer assigns a specific minor descriptor for

the on-line searcher, the computer adds an appropriate

predetermined, more general major descriptor under

which the citation may appear in Index Medicus.

Indexing

There are prescribed qualifications for indexers who

assign headings from MeSH to articles. In 1981, NLM

had 21 full-time and one part-time indexers/revisers

on its staff. Almost all of them had undergraduate

training in the biological sciences; some held masters

and doctoral degrees. One or two of the foreign

language experts have had the science requirement

waived. As noted in chapter 2, NLM and some foreign

centers contract out some of the indexing to U.S. commercial firms. The commercial contractors are required

to hire individuals with biomedical backgrounds acquired either through formal education or comparable

experience.

All domestic indexers must take an NLM-operated

2-week formal training course. After completing the

course, each new indexer is assigned to a reviser, who

continues the training in an individual one-on-one setting. This one-to-one relationship lasts anywhere from

2 to 6 months depending on the reviser’s estimate of

the new indexer’s ability. The training of foreign indexers has varied over time. In the late 1960’s and early

1970’s, many foreign centers sent their staff to NLM

for training. Later, NLM sent experienced indexers

abroad to some of the centers, to train the respective

centers’ staff. For the most part, new foreign indexers

now receive their training from indexers previously

trained at or by NLM.

NLM continually provides training to indexers. In

the United States and abroad, indexers are in weekly

or monthly contact by telephone or mail with their

revisers. There is, as well, a day-long training session

for indexers in the United States each fall, when the

new MeSH is published. NLM sends orientation packages to indexers (usually from foreign centers) who do

not attend the session. In addition, seminars with the

revisers are held periodically in order to increase consistency of indexing. Technical notes and memoranda are published, generally monthly, to increase indexing consistency.

NLM staff indexers have specific performance standards to fulfill. They are expected to index four articles

of medium difficulty per hour and five articles of lesser

difficulty per hour. Revisers, who are highly qualified

indexers, are responsible for reviewing and revising 15

articles per hour that are indexed by new indexers, and

scanning 25 articles per hour that are indexed by more

experienced indexers. Unlike NLM staff indexers, contract indexers are not held to index a set number of

articles per hour, but are paid for each article indexed.

NLM exercises a high degree of control over the

quality of the indexing by means of a sequence of computerized validation routines, by proofreading (which

is performed at a number of stages in the flow of

material through the indexing section), by controlling

the qualifications and the training of the indexers, and

by the use of revisers. In addition, NLM provides the

commercial contractors with NLM indexing tools, such

as MeSH, and requires the firms to supply the indexers with dictionaries, textbooks, and other aids.

Despite their qualifications and the training they

receive, indexers make errors: a few find their way into

Index Medicus and MEDLINE. Library personnel

ascribe this to the complexity of the indexing processes

and policies and to what they perceive as the inconsistencies of MeSH. There are, in particular, subtle differences between some of the subheadings, which may

cause the indexers to be inconsistent in assigning them

to MeSH. For example, the indexer may perceive the

difference in the subheadings of metabolism or physiology as being so slight that the choice between them
113

may be arbitrary in some instances. A computer program checks all indexing terms on the citation forms

against MeSH, identifying spelling errors, ineligible

subject headings/subheading combinations, and nonMeSH terms for correction.

In late 1981, an average of 69 days passed between

the time a top priority journal was received at NLM

and its entry into MEDLINE. Other journals took even

longer. Since Index Medicus and MEDLINE are updated monthly, it would take the minimum of 30 days

to process a journal. Concerned with the flow-through

time, NLM is currently planning

puterize the indexing process.

to partially comSearching and Retrieval

Searchers formulate a search on the basis of knowledge of indexing principles, such as specificity, the use

of subheadings, MeSH, and Boolean logic, and transmits the search statement to the computer via a

keyboard terminal. (Searches can also be formulated

on-line and then stored in the computer for reference

and later use. ) The computer searches the data bases

and produces an individualized bibliography.

On-line search requests are generally broken down

by trained information specialists into concepts that

can be translated into MeSH terms and retrieved by

querying the computer using one MeSH term or a combination of MeSH terms combined according to Boolean logic, a system that uses the connective “and,”

“or,” and “not” to express relationships between concepts. For example, to obtain every article discussing

either potassium or cyanide, a searcher would ask for

“potassium cyanide.” To obtain only discussions including both poisons, a searcher would ask for “potassium and cyanide. ” To obtain articles dealing with

potassium only when cyanide does not also appear,

a searcher would ask for “potassium and not cyanide. ”

For new or abstract concepts that cannot be found

in MeSH, the searcher uses text word searching. A text

word search usually results in fewer, more specific citations than a search using MeSH. It also allows for

retrieval of very new concepts that MeSH may not

have incorporated into its vocabulary, and allows for

the occasional user who may not know medical terminology to use the system. Unlike MeSH, text word

searching does not have the “explode” feature and requires searching for a concept under all its possible

expressions.
Appendix F.—Public Sector/Private Sector Task Force of

the National Commission on Libraries and Information

Science: Principles and Recommendations

The principles and recommendations of the Public

Sector/Private Sector Task Force of the National Commission on Libraries and Information Science presented below were drawn from the 1981 task force

report, Public Sector/Private Sector Interaction in Providing Information Services (97).

Governmental Leadership

Principle I.—The Federal Government should take

a leadership role in creating a framework that would

facilitate the development and foster use of information products and services,

The recommendations related to this principle specify several areas in which Government can provide

leadership: enhancing the competitive forces of the

market-place; affirming the application of the first

amendment; providing legislative consistency; using

efficient technologies; supporting education, research,

and data collection in this field.

Recommendation No. I. —Provide an environment

that will enhance the competitive forces of the private

sector, so that the market mechanisms can be effective in allocating resources in the use of information

and in directing innovation into market-determined

areas.

Recommendation No. 2. —Affirm the applicability

of the first amendment to information and services.

Recommendation No. 3. —Encourage Congress to

be consistent in the language used and in the application of principles relating to information products and

services, such as those identified in this report, when

it formulates legislation and when it exercises its oversight role.

Recommendation No. 4. —Encourage Government

agencies to utilize the most efficient (information)

technologies.

Recommendation No. 5. —Encourage the setting and

use of voluntary standards that will not inhibit the further development of innovative information products

and services.

Recommendation No. 6. —Encourage and support

educational programs that provide the professional

skills needed to further the development and use of

information as an economic and social resource.

Recommendation No. 7. —Encourage and support

both basic and applied research in library and information science.

Recommendation No. 8. —Encourage and support

statistical programs and related research to provide the

data needed to deal with information policy issues.

Recommendation No. 9. —Conduct a periodic economic assessment of the impact of Federal Government

information products and services.

Recommendation No. 10. —Encourage Federal agencies to regard the dissemination of information, especially through the mechanisms of the private sector

(both for profit and not for profit), as a high-priority

responsibility y.

Recommendation No. 11. —Identify and evaluate

alternatives to existing Federal information dissemination mechanisms.

Recommendation No. 12. —Develop and support

the use of libraries as active means for access to governmental information by the public.

Encouraging Private Sector Investment

Principle 2. –The Federal Government should

establish and enforce policies and procedures that encourage, and do not discourage, investment by the private sector in the development and use of information

products and services.

Six recommendations are presented as means for implementing this principle. They relate to encouragement of new development, reducing uncertainties, and

reducing risks.

Recommendation No. 13. —Identify and eliminate

legal and regulatory barriers to the introduction of new

information products and services.

Recommendation No. 14. —Encourage private enterprise to “add value” to Government information (i.e.,

to repackage it, provide further processing services,

and otherwise enhance the information so that it can

be sold at a profit).

&commendation No. 15. —Provide incentives to existing organizations, such as libraries and bookstores,

that will encourage them to expand their activities in

dissemination of governmentally distributable information.

Recommendation No. 16. —Establish procedures

that will create a realistic opportunity for private sector involvement in the planning process for Government information activities.

Recommendation No. 17. —Involve the private sector in the process of formulating standards relating to

Federal information activities.

114
115

Recommendation No. 18. —Create or improve

mechanisms for ensuring that the actions of Government agencies, in developing information resources,

products, and services, are consistent with the policies,

goals, and long-range plans that are announced.

Government in the Marketplace

Principle 3.—The Federal Government should not

provide information products and services in commerce except when there are compelling reasons to do

so, and then only when it protects the private sector’s

every opportunist y to assume the function(s) commercially.

The related recommendations are to be considered

as integral parts of this principle, since they embody

the procedures for determining that there indeed are

“compelling reasons” for the Government to provide

services in commerce:

I?ecommendation No. 19. —Announce plans sufficiently ahead of time to provide an opportunity for

private sector involvement when a Government agency, for reasons it regards as compelling, should plan

to develop and/or to market an information product

or service.

Recommendation No. 20. —Review and approve,

before implementation, any plans for the Government

to develop and/or market an information product or

service, the review to be carried out by an agency appropriate to the branch of Government (such as the

Office of Management and Budget, General Accounting Office, Congressional Budget Office).

Recommendation No. 21. —Include an “information

impact and cost analysis” as part of the process of

review, evaluation, and approval of any plans for the

Government to develop and/or to market an information product or service, the analysis to cover

economic and social effects on potential private sector products and services, and benefits to the public.

Recommendation No. 22. —Review periodically to

evaluate the desirability of a continuation of any information product or service as a governmental activity.

Recommendation No. 23. —Do not arbitrarily

restrict the Federal Government from enhancement of

information products and services, even if solely to

meet the needs of constituencies outside the Government itself.

Government Use of Private

Sector Information

Principle 4.—The Federal Government, when it

uses, reproduces, or distributes information available

from the private sector as part of an information resource, product, or service, must assure that the property rights of the private sector sources are adequately protected.

Availability of Government Information

Principle 5.—The Federal Government should make

governmentally distributable information openly

available in readily reproducible form, without any

constraints on subsequent use.

Recommendation No. 24. —Announce the availability of governmentally distributable information

and maintain one or more registers to help the public

determine what governmentally distributable information is available.

Recommendation No. 25. –Deposit governmentally

distributable information, in whatever form it may be

available, at national and regional centers, including

regional depository libraries, where it may be examined at no charge.

Recommendation No. 26. —Do not assert any Federal Government copyrights on information the Federal Government makes domestically available.

Pricing of Government Information

Principle 6.—The Federal Government should set

pricing policies for distributing information products

and services that reflect the true cost of access and/or

reproduction, any specific prices to be subject to review by an independent authority.

Use of Private Sector

Dissemination Means

Principle 7.—The Federal Government should actively use existing mechanisms, such as the libraries

of the country, as primary channels for making governmentally distributable information available to the

public.

Recommendation No. 27. —Use the Nation’s

libraries and nongovernmental information centers as

means for distribution of governmentally distributable

information instead of creating new governmental

units or expanding existing ones.
.

Appendix G.— AGRICOLA and ERIC*

Introduction

The Federal Government uses a variety of methods

to produce and distribute data bases. The approach

adopted by the National Library of Medicine (NLM

or the Library )-creating and providing access, directly and indirectly, to its product—has been discussed

in some detail. The efforts of the National Agricultural Library (NAL) and the National Institute of Education (NIE) described below further illustrate avenues

available to the Government to ensure that needed information reaches researchers, practitioners, and in

some cases, the public in a timely fashion.

The National Agricultural Library

and AGRICOLA

The Agricultural On-Line Access (AGRICOLA) is

a family of data bases containing citations to journals,

monographs, and U.S. Government reports on agriculture and related subjects, including food and nutrition, economics, law, rural sociology, and many of

the basic sciences. Currently, AGRICOLA contains

1.75 million citations to articles published in approximately 6,000 serial titles dating from January 1970.

Unlike NLM, NAL does not provide on-line services,

but rather makes its data base available to purchasers

at a charge slightly above the costs of reproducing the

file on magnetic tape, plus a minimal use fee.

AGRICOLA is available on-line at $18 to $40/hour

through the commercial services, DIALOG Information Services, Inc. (DIALOG), Bibliographic Retrieval

Services (BRS), and System Development Corp. (SDC)

(see table 8, ch. 4).

Legislative Mandate

AGRICOLA was developed and is maintained by

NAL, the cornerstone of the U.S. Department of

Agriculture’s (USDA) Technical Information Systems.

NAL began as the Department of Agriculture Library

in 1862, but was not established as a national library

until 1962. The congressional act establishing USDA

states that “the general designs and duties [of USDA]

shall be to acquire and to diffuse among the people

of the United States useful information on subjects connected with agriculture in the most general and comprehensive sense of that word,” and that “it shall be

the duty of the Commissioner of Agriculture to acquire

and preserve in his Department all information concerning agriculture which he can obtain by means of

● Information in this appendix was supplied by the U.S. Department of Agriculture and the National Institute of Education.

116

books and correspondence.” NAL’s current primary

functions include coordinating a national agricultural

science information network and serving as the prime

information resource for land-grant and other academic libraries across the Nation. NAL is the second

largest U.S. Government library in existence, and use

of the largest agricultural libraries in the world. It has

holdings of over 1.7 million volumes.

Indexing and Coverage

NAL is primarily responsible for generating the

AGRICOLA data base. The original thrust was to

automate the manual indexing procedures of the

Bibliography of Agriculture, published since 1942.

NAL receives approximately 25,000 journals per year

and indexes over 6,000 of these journals and other

serials for the AGRICOLA data base. It spends

$710,000 per year on journal acquisitions. Titles are

selected in accordance with the published selection

policies of NAL and on the recommendations of NAL’s

Board and staff. In addition, agreements with 56

foreign countries establish a quid pro quo exchange

of agricultural publications—approximately one-half

of the citations in AGRICOLA are to international

works, and 70 percent of the NAL collection is obtained through exchange arrangements.

Unlike NLM’s MEDLARS, which uses free text word

searching and medical subject headings (MeSH), a controlled vocabulary, AGRICOLA uses only free text

word searching, though NAL is currently studying the

United Nations’ AGRIS (International System for the

Agricultural Sciences and Technology) vocabulary for

future use. AGRICOLA is updated on a monthly basis;

130,000 records are added each year.

AGRICOLA covers the broad field of agriculture

related subjects as listed below:

agricultural economics ● fertilizers

agricultural engineering ● foods

agricultural products ● soils

animal husbandry ● forestry

aquiculture • human nutrition

botany ● hydroponics

chemistry ● pesticides

ecology and ● plant sciences

environmental science ● rural sociology

energy in agriculture ● water management

entomology

In addition to AGRICOLA, USDA compiles CRIS

(Current Research Information Service), a-data base

similar to NLM’s CANCERPROJ. CRIS contains project summaries for 95 percent of ongoing U.S. agricultural and forestry research efforts, in all over 25,000
117

summaries. CALS (Current Awareness Literature

Searching System) is similar to SDILINE, providing

regular screenings of the current literature available

through AGRICOLA and eight other data bases leased

from commercial vendors.

CAB (Commonwealth Agricultural Bureau), a data

base produced in the United Kingdom, covers 60 percent of AGRICOLA citations. There is also some overlap with BioAbstracts and MEDLINE, especially for

articles in biology and veterinary medicine.

AGRICOLA is also distributed by NAL through the

National Technical Information Service (NTIS) to private producers of printed bibliographies (e.g., The Bib

liography of Agriculture) and dictionary catalogs, and

to several foreign Governments with large agricultural

research centers. NTIS has full responsibility for the

duplication and sale of the AGRICOLA tapes to 24

customers, though it relies on NAL in assuring user

satisfaction.

Users

Like MEDLARS users, AGRICOLA users are difficult to enumerate and describe. NAL assumes that

most users are researchers and educators who obtain

AGRICOLA’S services through the Nation’s 69 landgrant colleges. Greatest usage probably is by employees of USDA though the system is valuable for researchers working in many of the general and applied

sciences, agricultural engineers, food inspectors, and

State extension agents, as well as faculty members, students, and private sector employees.

Document Delivery

NAL fills between 250,000 and 300,000 individual

requests for books and journal articles per year. Document delivery is indeed one of major activities. Like

NLM’s Regional Medical Library Program, NAL has

established 24 regional document delivery centers,

based in the land-grant agriculture colleges, using its

own resources only when documents are unavailable

elsewhere. Documents are made available without

charge to USDA employees. Other requests for photocopied articles are charged $3 per 10 pages. The regional centers are reimbursed for services provided to

USDA researchers.

Training

Though AGRICOLA is available only through commercial vendors, NAL offers training courses in searching its data base, Workshops last 5 days, include at

least 8 hours of on-line time, and are provided without

charge. NAL’s courses are less restricted by demand

than those offered by NLM for MEDLARS, and are

open to information specialists in both the private and

public sectors.

Two levels of training are offered: one for those with

no prior experience with AGRICOLA, and a second

that focuses on subject searching for searchers with 6

months to a year’s experience. The commercial vendors offer training programs on their systems, but they

are not specific to AGRICOLA.

National Institute of Education and ERIC

ERIC (Educational Resources Information Center)

is an information service funded by NIE (Department

of Education) that maintains a bibliographic control

system for educational journals and research reports.

ERIC’s beginnings resulted from a boom in education research in the mid-1960’s that overwhelmed existing systems’ abilities to catalog and announce research

findings to practitioners and other researchers. The

agency’s collection and indexing activities are decentralized around the country in 16 clearinghouses representing different levels and areas in education (see table

G-1). Like medicine and health care, many electic subdiscipline contribute to the knowledge base of education, often without communicating with each other.

The series of ERIC clearinghouses allows professionals

tied to these communities, and with the expertise

needed to identify important research from each discipline, to identify and select materials for the ERIC data

base.

Publications

ERIC’s principal activity is the publication of two

secondary journals, Research in Education (RIE) and

Current Index to Journals in Education (CIJE). Begun

in 1966, RIE is a monthly bibliographic index to the

“fugitive” educational research literature, e.g. reports

of federally funded research that are neither copyrighted nor available in refereed publications, Reports

that the clearinghouses index for RIE are available on

microfiche from ERIC. CIJE was first available in 1969

and is similar to Index Medicus. The clearinghouses,

with the assistance of advisory boards, select articles

from 750 journals to be indexed and abstracted for

CIJE. NIE has no requirements for what a clearinghouse must include.

For both publications, clearinghouses build bibliographic records of journals and reports based on a

single thesaurus of indexing descriptors. Every month

each clearinghouse sends its records to the ERIC central facility in optically readable, printed form, where

the records are transferred to magnetic tapes. The tapes
118 — —

Table G-l .—ERIC Clearinghouses and Operating Organizations, 1981

ERIC clearinghouse for/on Operating organ&at/on:

Junior colleges University of California at Los Angeles

Science, mathematics, and environmental education Ohio State University

Social studies/social science education Social Science Education Consortium

Adult, career, and vocational education Ohio State University

Counseling and personnel services University of Michigan

Educational management University of Oregon

Elementary and early childhood education University of Illinois

Handicapped and gifted children Council for Exceptional Children

Higher education George Washington University

Information resources Syracuse University

Languages and linguistics Center for Applied Linguistics

Reading and communication skills National Council of Teachers of English

Rural education and small schools New Mexico State University

Teacher education American Association of Colleges

Tests, measurements, and evaluation for Teacher Education

Urban education Educational Testing Service

Columbia University

SOURCE: National Institute of Education,

are then given to the Government Printing Office

(GPO) which publishes RIE and provides (without

charge) tapes to the commerical publisher of CIJE,

Oryx Press. GPO also furnishes the ERIC tapes to parties wanting on-line access to the data base.

Collections

ERIC is handled through GPO rather than NTIS because educational research information is outside the

normal scope of NTIS interests. Additionally, it is important to note that while the ERIC data base is available on-line, the primary purpose of its construction

is the publication of printed indexes, not the provision of on-line retrieval services. Thus, the on-line data

base is a “spin-off” of the publications, and is sold to

interested parties, including commerical vendors, for

a few hundred dollars. Because the cost is so low,

many universities purchase the tapes to mount on their

own computers, giving them direct access to ERIC

without using a commercial service.

In addition to the printed journals RIE and CIJE,

Oryx Press publishes the Thesaurus of ERIC Descriptors from the ERIC tapes. The Thesaurus is the controlled vocabulary of educational terms used to enter

and describe documents in the data base. Together,

the three documents comprise a “minimal” ERIC collection, and are available at an annual subscription rate

of $136 for domestic users and $153 for foreign users.

An “intermediate” ERIC collection includes the three

publications and the ERIC microfiche collection, containing documents announced and indexed in RIE.

Subscribers may order the entire microfiche collection

from the ERIC Document Reproduction Service for

$2,000/year, or may purchase subsets of the collection. Currently, these are over 700 subscribers to the

microfiche collection, including over 50 subscriptions

to foreign users.

Like NAL, NIE does not offer on-line services. ERIC

tapes are provided at cost of reproduction, and are

available at over 500 libraries and information centers.

For the most part, those libraries are served by the

three major commercial vendors at rates of $15 to

$35/hour. AS noted, about so organizations have their

own computer facilities, and purchase and mount the

tapes directly for their own use. In July 1979, the entire ERIC data base, including retrospective files, consisted of seven RIE tapes and four CIJE tapes and cost

$875. Thus, to purchase a “complete” ERIC collection,

including RIE and the microfiche collection retrospect

to 1966 and CIJE to 1969, an organization would spend

approximately $20,000, and contact ERIC again only

for annual updates. A number of directories and indexes tools are available, often at no cost, to enhance

any level of an ERIC collection.

Users

Providers of ERIC resources are called “access

points” 52 percent of which were affiliated with institutes of higher educational (Only discrete locations

were counted; a single organization may have multiple access points. ) There are an estimated 2.7 million

“usage contacts” with the ERIC resources each year

that prompt the identification of 32 million bibliographic records. Users spend 10.5 million hours annually with ERIC.

The number of on-line searches conducted on ERIC

is growing. In 1980, 200,000 were performed, most (95

percent) by professional searchers and most often (65

‘National Institute of Education, persona] communication, 1981.
119

percent) in academic settings. Of these, 50 to 60 percent were conducted for full-time students. Indeed, the

bulk of ERIC “usage contacts” are from students and

counselors, and for teaching and training educators.

NIE sees the need to expose educational practitioners

to the value of ERIC as its most pressing policy problem.

NIE does not anticipate on-line searches of ERIC

growing to replace the importance of its publications,

RIE and CIJE. Yet ERIC is the most frequently searched

data base offered by the three commerical vendors,

BRS, SDC, and DIALOG. It is the major source of bibliographic information for the social sciences, as well

as education. A layman’s guide to using ERIC is under

development to encourage utilization by practitioners,

though only a modicum of training is funded through

the clearinghouses, and that usually as part of students’

coursework. No Federal funds are spent marketing

ERIC or its services. The Government has taken a

“low-profile approach” to developing a public awareness of the data base; users have discovered it on their

own.

The Federal Government spends $5.5 million a year

for the development of ERIC. NIE’s budget has remained at the same level for several years—necessitating, due to inflation and higher production costs,

cutbacks in the amount of relevant literature, especially journals, captured for the data base. The ERIC clearinghouses also receive support from their organizational affiliates

Private Efforts

Wilson Publish ing produces the Education Index, a

monthly guide similar to CIJE’. The two journals have

some overlap; Education Index captures more of the

topically relevant literature in publications outside traditional education disciplines, but is not so sophisticated a system for bibliographic control. It does not

use keyword indexing, nor is it available on-line. Most

educational libraries, however, have both ERIC and

Education Index.

98-764 0 - 82 - 9
Appendix H.— Future Information Technologies:

Implications for Biomedical Retrieval Systems*

Introduction

Electronic computation used to retrieve information

from large data bases is an evolving technology, still

only in its early stages. Its course can only be dimly

perceived at this time. In the relatively near future,

very little of today’s techniques may have any more

than historical interest.

Today’s biomedical data base retrieval systems are

primarily based on remote time-sharing computers,

which means that the processing time of the computer

is shared among several completely independent activities. Each user is unaware that there are other simultaneous users of the system, as the processor spends

only fractions of seconds with each activity in turn

before proceeding to the next. The computers compare

indexed citations against a list of search terms. These

terms are typed at remote terminals by researchers or

trained computer search analysts. Terminals are connected to time-sharing computers via conventional telephone systems, specialized data networks, or both.

Projections for the next few decades indicate that

changes are going to be even more radical than that

of the past few decades. Machines are getting faster

and more powerful. Telecommunications links are getting faster and capable of more sophisticated processing. Both are getting cheaper, but, relative to telecommunications, computation tends to become more cost

effective at each technological jump.

Tomorrow’s data base technologies may range over

a wide variety of systems more powerful than the current methods. Full-text retrieval of articles, computeraided searching of data, and other possibilities are being demonstrated today in experiments; some of these

are expected to have an impact in the near-term future.

The physical location where information is processed

may alter within the next few years. High-speed data

networks are expected to connect microcomputers sitting on researchers’ desks; and it may prove more cost

effective to move massive amounts of data processing locally than on distant time-sharing computers.

The present information policy issues are the result

of usage patterns that have evolved over the past decade and may change greatly in the next few years as

new technology based on distributed data processing,

particularly the personal microcomputer, is applied to

data base access. This observation is not meant to min-

● l%is appendix is based on papers prepared for OTA by Richard Solomon,

of the Research Program on Communications Policy of the Massachusetts

Institute of Technology, Cambridge, Mass., and by Jose Marie Griffiths, of

King Research Associates, Rockville, Md.

120

imize the current difficulties. The present problems are

important for the information industries today, and

they are also important because what is done about

them by policymakers now will affect the information

systems of the future.

Past Application of Information

Technology to Biomedical

Bibliographic Retrieval Systems

Computers were first applied to information storage

and retrieval systems in the late 1950’s when a number

of systems were developed in the United States by the

Armed Services Technical Information Agency (now

the Defense Technical Information Center), National

Ordnance Laboratory, National Aeronautics and

Space Administration, and the National Library of

Medicine (NLM or the Library). The system developed

by NLM, MEDLARS, was the largest of these both in

terms of the size of its files and in terms of its user

population. When MEDLARS was implemented, it

was the first large computerized retrieval system to be

made widely available without security and other restrictions.

The characteristics of MEDLARS are typical of the

information systems that became available during the

1960’s. The systems were operated in an off-line batch

processing mode. This technique of batch processing

required data to be brought to a data center where they

were punched onto cards, and then were subsequently

read into the computer. The desired program, usually

stored on magnetic tape, was also selected and entered

from the tape into the computer memory. The program acted on the data and the results of the processing were output via a printer, or sometimes stored on

a second deck of cards for further processing. The user

of the data then came to the data center to collect the

results. This form of processing worked quite well for

applications that occurred at periodic intervals.

MEDLARS was originally designed not as a retrospective search system for bibliographic material, but

as a publication system to produce the printed index,

Index Medicus. The computer was used to manipulate

bibliographic records in machine-readable form. It was

used to check for errors, perform sorting and formatting, and interface directly with photocomposition

equipment. For this, it was necessary to put the index

records into machine-readable form and then update

it, say monthly. Once this was done and the index produced, for example monthly, the machine-readable

data base was available for further exploitation.
121

Such data bases could be used in a number of different ways. First, they could be used to conduct retrospective searches. These are searches through a body

of recorded literature to find items on a specifically

defined topic. Another application was for selective

dissemination of information (SDI). In SDI, the current interests of users or groups of users are defined

in interest profiles which are stored in machine-readable form. After the data base has been updated the

additions are checked against the interest profiles.

Matching records are printed out and sent to the appropriate users, thereby enabling users to keep up-todate with the literature of their field of interest on a

regular basis.

Computerized information systems developed in the

1960’s offered significant advantages over their printed

counterparts. These advantages are outlined by Lancaster as (79):

1.

2.

3.

4.

5.

6.

7.

The possibility through batch processing of conducting many searches at the same time.

The ability to provide several access points to a

document extremely economically.

The ability to handle complex searches involving large numbers of terms in complex relationships.

The ability to generate output in the form of a

printed bibliography, and even to produce highquality publications by interfacing the retrieval

system with a photocomposition device. Output

can also be made directly to microfilm.

The ability to collect, on a regular basis and essentially as a byproduct of normal systems operation, management data on how and how much

the system is used.

The ability to produce many outputs and services

from a single input operation. MEDLARS tapes,

for example, although produced as a result of one

indexing operation and one procedure for reducing the index records to machine-readable form,

can be used to generate a general printed index,

specialized bibliographies, retrospective search,

and SDI searches.

The data base, once captured in machine-readable

form, can be duplicated simply and cheaply; it

is easily shipped around and thus can be used in

the provision of information services by a number

of different centers. This is perhaps the most important advantage of all. The growth of machinereadable data bases has had a dramatic impact

on the provision of information services in the

last 20 years.

Although the computer offered many advantages in

information handling activities, the off-line batch processing systems have considerable disadvantages. Most

significant is the delay in obtaining results, and if the

search was unsuccessful on the first run, then it may

have to be modified and reprocessed. In the same way,

there is no facility for browsing through the literature.

There was clearly room for further development of

such systems.

In the early 1950’s, it occurred to a number of people that the computer could be useful as a tool for researchers whose problems were too small to justify the

initiation of a formal batch operation. Teletype terminals were sited in laboratories at the Massachusetts

Institute of Technology, and these enabled researchers,

each from his or her own teletype, to program the

computer remotely. The computer would process each

program in turn and return the results to the appropriate user’s teletype as printout. This development

marked the introduction of the on-line systems we are

familiar with today.

The term “on-line” refers to the searcher’s being in

direct communication with the system he or she wishes

to use. The user provides input to the system and it,

in turn, reports back to the user. The user then makes

decisions based on that report and provides further input. For this reason the system is also referred to as

being “interactive” or “conversational. ” The development that made such systems feasible was time-sharing.

All these activities were carried out on mainframe

computers and, to a large extent, still are. However,

the late 1960’s saw the introduction of minicomputers.

Minicomputers were initially developed as low-cost

computers with a minimum of processing power and

memory. They were used primarily for control processing. It was soon recognized that minicomputers had

a potential use in a number of unrelated areas and that

they should be adaptable to the requirements of each.

This resulted in the development of a number of general purpose minicomputers and the “unbundling” of

software. Previously, machines were sold for specific

applications with software provided as part of the

overall system package—all “bundled in” together.

The advances in computer technology that have had

a significant impact on information handling can be

separated into two categories—processing and storage.

Processing

The first computer ENIAC (Electronic Number Integrator and Computer) was completed in 1946 at the

University of Pennsylvania for the U.S. Army. It consisted of about 18,000 vacuum tubes and was very

large, requiring a room 60 ft by 25 ft to contain it and

weighing more than 30 tons. This computer (and

others based on vacuum tube technology—later

known as “first generation computers’ ’)–had high
122

power consumption, had failures every few hours or

so, and required cooling plants often as large and complex as the computer itself.

Two years later, the first transistor was developed

at the Bell Telephone Laboratories. Transistors, while

comparable to vacuum tubes in terms of the tasks they

could perform, required much less electrical power,

generated very little heat, and were more reliable.

They became the basic component of “second generation computers. ”

Early efforts to miniaturize electronic components

were not motivated by computer designers and engineers. Various satellite and missile projects, however,

called for complex electronic systems to be installed

in equipment in which size, weight, and power requirements were severely constrained. Thus, the effort to

miniaturize was promoted by military and aerospace

agencies.

The latest type of miniaturization is the semiconductor integrated circuit. Several researchers saw that the

characteristics of semiconductors such as silicon or

germanium that had been exploited to make transistors

might be further exploited. The physical composition

of semiconductors contained equivalents of individual

electronic components (resistors, capacitors, etc.), and

by combining them with transistors in the same material complex circuits could be created.

The integrated circuit was the basic component of

the “third generation computers. ” In the early 1970’s

integrated circuits were being produced with about

1,000 components. The first microprocessor was developed by Intel Corp. in 1971, was about one-fourth inch

square, and carried the equivalent of 2,250 transistors.

By 1976, large-scale integration (LSI) produced chips

carrying over 30,000 components, and by 1980 very

large-scale integration (VLSI) saw chips with over 1

million components.

The individual elements on the silicon chips are defined by a photographic process. The smallest component dimensions on the chips are currently 3 to 4 micrometers (1 micrometer = 1 millionth of a meter).

It is expected that this will be reduced in the near future

to less than 1 micrometer and that by the 1980’s it will

lie between 0.05 and 0.005 micrometers.

The overall effect of these advances in processor

technologies on information handling has been the reduction in size, cost, and operating requirements of

digital computing equipment. Prior to the late 1960’s,

equipment had been far too expensive to justify use

for what were then considered peripheral applications

of information handling. However, by the mid-1970’s

many information-handling organizations were able

to justify the cost of purchasing computing equipment,

either alone or as part of a cooperative. Many large

libraries and information services have their own

small-scale equipment, but the continued reduction in

size and cost of such equipment is beginning to influence the small and special libraries in particular.

Storage

The technology of digital storage is probably the

most rapidly changing sector in all of microelectronics.

Over the past decade, operating speed and reliability

have been increased by at least an order of magnitude

at the same time as physical size, power consumption,

and cost per bit of storage have been reduced by factors of up to 1,000. Similar improvements are predicted for the next decade before physical limitations

are encountered.

The newest electronic memory systems have been

made possible by modern semiconductor technology.

In the 1950’s and 1960’s, electronic memories were arrays of cores (rings) of ferrite material a millimeter or

less in diameter. Ferrite core memories have now been

succeeded, on the whole, by semiconductor memories

which provide faster data access, smaller size, and lower power consumption at significantly lower cost. The

overall effect of advancing digital memory technologies on information handling is an increase in the capacity and reliability of information systems, faster

and more efficient retrieval of information (although

because of increased capacity of storage, searches are

made through larger volumes of information, and the

faster access may not reduce the retrieval times as far

as the user is concerned), together with an accompanying decrease in cost.

Current Status of

Information Technology

Computer Processors

Although significant advances have been made in

computer processor technology, very few of the commercially available retrieval systems have taken advantage of them. To a large extent, this is understandable. During the 1960’s and 1970’s, considerable investments were made in the acquisition of computer hardware. The effective lifetime of a single computer processor is 7 to 10 years, so organizations are unwilling

(and often unable) to replace a processor within its

lifetime. This is the so-called “technology trap.” Those

who hesitate to invest in a rapidly changing technology because new, improved products are imminent

never reach the point of acquisition, and those who

do make a decision to acquire a product acquire one
123

which is usually no longer state of the art by the time

it is in operation within an organization.

A second factor in the lack of change in commercial bibliographic retrieval services is that the functional capabilities of minicomputers and microcomputers

are not as great as with the larger mainframe machines.

Over the next 5 years or so, this situation is likely to

change. The larger end of the minicomputer range (the

32-bit machines)—the superminis or megaminis as they

are sometimes called—will be able to compete with the

large IBM, Univac, Burroughs, and similar machines,

both in terms of system software (operating systems

and system utilities) and number of users that can be

simultaneously serviced.

Areas where smaller machines have been applied are

in individual organizations and libraries. Minicomputers have been used successfully in libraries for many

years now, primarily for automation of many of the

day-to-day library operations—acquisitions, cataloging, and circulation control. As the costs of computer

processors fell dramatically, a number of libraries began to acquire these low-cost machines for maintaining bibliographic files for relatively small collections.

The retrieval programs available on such small machines are not as sophisticated as those for larger systems, nor is retrieval as fast, but they are quite adequate for the environment within which they are

applied.

Storage Devices

Digital storage devices are probably the fastest moving area of microelectronics. In particular, two new

types of digital storage devices are likely to have a

significant impact on retrieval systems in the future:

1) video disks, and 2) charge-coupled devices (CCDs)

and bubble memories.

There are two approaches to recording information

on video disks (or optical disks). One is an analog

method which yields a color television (TV) picture,

and the other is a digital method which stores data in

digital form. It is the latter type, in particular, that

could revolutionize information handling in the not

too distant future. The current capacity of such disks

is of the order of 1011 bits, This means that the equivalent of the Library of Congress card catalog could potentially be stored on one side of a digitally encoded

optical disk. However, this is unlikely to happen for

several years yet.

The disks can be written once only. A laser is used

to burn away a thin metallic film from the disk surface to create a hole about 1 micrometer (one ten-thousandth of a centimeter) in size. The presence of a hole

signifies a 1, and the absence of a hole signifies a zero.

The projected cost for the disk is $10, and copies could

be made for almost the same amount. A disk can store

about 10,000 books (the full text), making the projected cost per book 0.1 cents. The bulk of the cost

(over the $10 disk cost) will be the cost of digitizing

the textual material and the disk reader.

The other type of storage devices under development are electronic serial access memories, in which

the stored bits of information circulate as if they were

in an enclosed pipeline. Each bit that is stored is transferred sequentially through 64 or more storage locations. These memories are smaller and cheaper to produce than other forms of electronic memory, mainly

because the circuitry can be simpler. They cannot,

however, compete in terms of speed with other electronic memories. Their most attractive potential application is the replacement of tape and disk memories

with a capacity of on-board storage of between 1 million and 10 million bits.

COMMUNICATIONS

Most data communications systems currently under

development are based on the concept of packet

switching. The rationale for packet switching is that

the length of a message is very short in relation to the

time it takes to establish a conventional communications connection, and that it is more economical to

transmit that message stage by stage through the network, storing the message segments at each node in

a network until a link is available for transmission to

the next node. It is now possible to purchase services

from a commercial packet switched communications

network.

To some extent, the microprocessor counteracts the

rapid growth of networks. The central idea of networking is to share both functions and data. As small

computer systems have become more powerful and

compact, they have also become more independent in

function. People are now able to buy low-cost computers to solve most of their routine problems. The

general trend is away from network designs based on

functions shared over a network of computers towards

data sharing across networks.

The major trend in telecommunications at present

is the fundamental shift from analog to digital modes

of transmission. The new transmission channels (based

on optical fiber technology) will have enormous capacities. The shift involves all types of communications—

voice, facsimile, computer transmissions, TV communications, microwave and satellite communications,

and radio links. Digital circuits are less prone to interference and noise than analog ones, and their cost-performance ratio is constantly improving.
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Communications may be expected to play an increasingly central role in information handling. Satellite-based communications systems offer a different approach to the present ground-based systems in terms

of technology, but the services offered by the two systems should be similar. Satellite communications will

probably develop as an extension to the ground-based

systems, and will provide a more cost-effective solution in sparsely populated areas, for example.

INPUT/OUTPUT DEVICES

New and improved means of communicating with

computers are pouring onto the marketplace at an

ever-increasing rate. The standard teletype terminal

and cathode ray tube terminals for interacting with

computers are being replaced with sophisticated graphics devices, color screens, touch-sensitive screens, letter quality printers, laser printers, and so on. Many

of these input/output devices themselves contain

microcircuits, thereby providing the user with localized

intelligence.

The key change in the mode of interaction with biomedical bibliographic retrieval systems has been in the

use of graphic terminals (especially for displaying organic compounds in schematic form) and/or intelligent

terminals for search development and storage on input, and bibliography editing, sorting, and merging

on output. However, until the retrieval systems themselves change, the mode of user-system interaction is

unlikely to change much at all.

MASS MEDIA COMMUNICATIONS

One of the growing applications of communications

systems to information handling is the provision of

electronic mail services. It is possible to convert any

type of message into digitized for transmission. Naturally, different messages require varying numbers of

bits for their representation, for example:

● high-quality color photograph 2 million bits

• newspaper-quality photograph 100,000 bits

● color television frame 1 million bits

• brief telephone voice message 1 million bits

• document page in facsimile form 200,000 bits

• document page in computer code 10,000 bits

● coded request for library document 200 bits

Recent additions to information services are those

based on the broadcast systems. Two types of systems

exist: Videotex (sometimes called Viewdata) and teletext. Although their services and technology differ,

both are accessed through the adapted domestic TV

set, distinguishing them from other home information

utilities that require computer terminals.

Videotex is an interactive system linking computer

data bases to the adapted television set through the

switched telephone network. Canada, France, and the

United Kingdom have developed systems of their own

and are selling the technology to other nations. A variety of Videotex systems exist, but they all operate in

basically the same way. To access the signals transmitted via the telephone network, users must have

special decoders and a modem built-in or attached to

their TV sets. To connect to the central data base the

user must first dial the appropriate telephone number

and place the receiver in the modem. When the connection has been accomplished successfully, an index page

appears on the TV screen and users begin to search

for the information they require by pressing numbered

keys on their hand-held control panel (keypad). Instructions appear on the screen telling the user which

keys to depress for particular types of data,

The central Videotex data base may contain an almost unlimited amount of information provided by

sources ranging from local newspapers to travel

agents, department stores, and libraries. The data are

stored in “frames” or screenfuls and can be updated

instantly. Several frames of information on the same

topic comprise a “page” and may be accessed sequentially. To retrieve information from the data base,

users employ a “tree structure” search method, starting

with broad subject headings and narrowing down their

choices until they arrive at the frame of information

they require. Such a system is fairly limited in capability and has no cross-referencing.

Unlike Videotex, teletext is a noninteractive system

linking the information provider to the home via regular or cable TV broadcast signals. Once again, only

TV sets with special decoders are able to pick up teletext. Pages of information are broadcast one at a time

in recurring cycles. To access them, users consult a

contents page, then use the keypad to key in the numbers of the pages to be retrieved. The decoder then

selects the appropriate pages when they cycle by, and

the information is displayed on the TV screen.

Teletext’s chief virtue is its ability to be updated continuously for a large viewing audience. It can provide

users with the most current information on a range

of subjects and is easily accessible. Because it is broadcast rather than telephone based, teletext is also less

expensive than Videotex, which requires users to pay

for the telephone service and for each individual frame

accessed.

Teletext has disadvantages, the greatest being its

limited data base size. To access information, users

have to wait until the specific page they are seeking

cycles by, giving the decoder time to read, decode, and

display the data. The wait time becomes excessive

when the data base exceeds about 100 frames. Thus,

teletext is severely limited in the amount of information it can carry efficiently.
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Developments in the areas of processing, memory

and storage, and communications interact to produce

some very sophisticated information systems. On the

whole, these systems are more compact, less expensive, considerably more reliable, store larger quantities

of information, and offer newer types of service than

the traditional type of information service. Moreover,

access to the systems from remote locations is simpler

and more efficient than ever before. Can we cope with

the volumes of stored information that are available

to us?

It is interesting to note that with the emergence of

new technologies there has been a fundamental shift

in the concerns of the information profession. This

shift can be expressed, in simple terms, as a change

from the attitude—’’How can we give the user more

information to solve his problem?” to “How can we

make sure that the information we give the user is accurate, reliable, and up-to-date?” The basic questions

concerning the organizations, classification, indexing,

and retrieval of information are regaining importance,

having been overshadowed over the last few years by

the concerns of automation of systems and services.

With increasing volumes of information being stored

and transmitted in digital form, and access to the stores

being effected increasingly from the home environment, attention must return to the traditional areas of

information handling mentioned above. It is envisaged, therefore, that a number of investigations will

be initiated in the near future to consider potential

solution to the problems of selection and quality assurance.

Future Trends

There are several trends under way today that will

change the way researchers access data bases within

the next few years. They cannot be ignored, for unlike

the pioneers in the first generation of information retrieval, today’s pioneers are outside of the biomedical

field—and the evolution of the technology will go on

no matter what resolution is made of current problems with access to MEDLARS. These trends are summarized here, since detailed discussion is beyond the

scope of this paper. Many of the problems that private

vendors have with NLM’s policies reflect tensions

being created by these changes.

1) The widespread use of microcomputers is expected in the future. We are now in the age of desktop

microcomputers that have the power of the large computers of about a decade ago. Within the next 2 years,

desktop machines with the ability to make sophisticated searches of the entire MEDLARS data base will

be for sale in computer stores. Many, if not most of

MEDLARS users in the developed nations might have

such machines as general-purpose office research tools

just as they now have typewriters, calculators, and lab

equipment.

The key to matching indexes to a citation or abstract

data base lies more in the size of a computer’s core

memory and the amount of external data it can access rapidly than in its speed of operation. About l/z

million to 1 million characters (1 megabyte) or more

would be adequate for a stand-alone desktop machine

for data base retrieval. Such machines have been on

the market for the past 2 years, costing about $30,000

to $40,000. Their price should drop by half or more

in the next few years. These are also precisely the type

of machines that many nonscientists would use for

general number crunching, and they may make central processing on time-sharing systems obsolescent.

2) Timesharing, as a model for data base access is

expected to be radically altered as distributed computing becomes more widespread. In the 1970’s, data bases

were placed on large central computers to which many

terminals had simultaneous access, That was called

“time-sharing. ” MEDLARS data bases and most of today’s electronic data bases reflect that technology,

which is undergoing transformation. The coming crop

of 16-bit and 32-bit microcomputers attached to software represents a several orders-of-magnitude advance

in computing, while commensurate improvements in

long-distance data communications, and thus in timesharing, during the next few years may be only one

or two orders of magnitude beyond that of today.

With a microcomputer, a user would only have to

slide in the data base mass storage device—perhaps

a video disk of the data base without waiting for a

time-sharing connection or paying time charges. The

latest information, always a tiny percentage of the total

data base, could still come via telecommunications

lines, but not necessarily at that instant. Each evening,

for instance, a microcomputer can be programed to

call in for the latest citations, articles, or specialized

data. The amount should be able to easily fit on the

disk drives, which hold some 5 million to 20 million

characters of data. There are now available for desktop machines at costs ranging from $2,500 to $6,000.

Any user will tell how constrained one can feel when

trying to browse through an on-line data base and the

meter is ticking; in fact, browsing and experimenting

with searches is the antithesis of current data base networks, but would be encouraged by distributed procession on a user’s own machine, Many other features

would be possible—e.g., generating a private profile

of interests, reuse of material often needed, retransmission of important information to colleagues, reformatting information to one’s own needs or tastes.
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3) Computing costs are expected to drop faster than

communicating costs. This relationship has been true

for the past 30 years and all indicators show that the

trend will continue for the near future. While these

technologies are linked—the cost of telecommunications drops because of computer-related and electronics advances—the decline of both do not follow

uniform parallel lines. While the cost of computing has

been dropping regularly and in half every 2 to 3 years,

universal telecommunications advances tend to come

in somewhat unpredictable spurts (for reasons that are

beyond the scope of this study) and on the average

at a slower rate.

As a result, the “time windows” are different for the

introduction of computing and communications products. It appears that computing devices for local data

base processing will enter the market about 2 to 3 years

before the advanced telecommunications systems.

These data base products are now available: the microcomputers already mentioned, and laser video disks

capable of storing all of MEDLARS on one or two

disks.

Laser disks, which can store digital data, are being

manufactured commercially today for about $5 in

small lot quantities. The master disk costs about

$2,000, not including the cost of the original videotape.

Converting computer data to a video pattern is no

major obstacle. But problems of data integrity and

software for search and access on such disks are still

to be resolved.

If MEDLARS had 5,000 customers worldwide, each

paying $500 per year for a complete updated data base

to date (assuming two disks), then the cost of producing 10,000 disks would come to $50,000 + $2,000 +

distribution. The revenue of $2,450,000 annually surely would cover distribution and a great deal of the cost

of production of the data base. Another $500 per year

could be charged for updating via floppy diskettes or

some other system, and the user would still be saving

a great deal of money, not to mention the added revenue to NLM or a private vendor providing the service. These figures are only meant as an illustration of

the economics of the new medium of video disk plus

microcomputers for data base access; the normal scientific marketing algorithms for pricing such a service

might come out with more appropriate fees.

4) The future telecommunications networks are expected to mix data, voice, and other traffic making

it simple to connect distributed machines but also confusing national boundaries, property rights based on

print, and what is information and what is communications. Even Euronet is expected to disappear as new

technology is introduced that will merge telephone,

Telex, and data systems into “integrated services digital networks” (ISDN). With ISDN, virtually all local

telephone connections will be able to handle voice as

well as high-speed data; and the data links will connect directly to a packet-like network permitting instantaneous connections, the ability to transfer hundreds of pages per minute between computers or desktop workstations, and most likely distance-insensitive

pricing for data. Most major cities, however, will offer some sort of ISDN service by the end of the decade

both in Europe and the United States, if replacement

projections for older telephone equipment continues

at the current rate. In the United States, such networks

should begin to emerge within the next 3 to 4 years,

at first in industrial suburban and some rural areas.

5) Copyright questions in the computerized information age will continue to be extremely complex. International property rights are particularly complicated, since property rights are defined differently in

different jurisdictions. Though U.S. copyright law forbids NLM from claiming copyright protection domestically, NLM places a copyright notice in its printed

material claiming protection internationally, and

claims contractual rights both domestically and internationally preventing computer centers from replicating its tapes.

Furthermore, applying property concepts derived

for the printed press to computer-based scientific information necessary for worldwide health and biomedical research creates a need to reconcile some mutually exclusive goals: Do we want to minimize U.S. Government expenditures in regard to medical information at the risk of encouraging the biomedical data

bases which may create a negative balance of trade

in information? Do we want to restrict access by foreigners to Government originated publicly available

information? Is it strategically effective to try to use

this resource to trade for similar rights to foreign data

bases? Do we want the originators of the literature to

share in the proceeds from abstracting or retrieval or

do we want to encourage the widest dissemination of

information at the risk of discouraging future information providers? (Abstracters or bibliographers in the

print media have never had to pay royalties to the

authors of the material described. ) How do we fix

property rights if a computer does the abstracting?

What rights do the authors of the abstracting program

have? Countries are likely to answer these questions

differently—once more making costs in different countries very different.

6) Machine retrieval of biomedical information has

only scratched the surface with on-line literature citations and abstracts; the technology is evolving to permit retrieval of full text of articles, raw data, and eventually automated search, Precedents established for
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the rather primitive technologies of today can hamper

further developments in the future; the converse could

also be true: imaginative solutions to the domestic

public/private mix of MEDLARS data base vending

may encourage new techniques and industries to develop in the United States, rather than elsewhere. Several

complex issues come to bear here: 1) the ability to enforce a form of international copyright on U.S. Government-generated data; 2) the property rights of the

originator and “publisher” of the cited material; and

3) the comparative economics of data bases development and input outside and inside of the United States.

Solutions to these problems are not going to be simple. Transnational as well as cross-industry agreements

will be necessary to protect information property

rights. In some cases, there will be conflict between

societal goals, particularly where information important to policy and technological decisionmaking is involved. Designing laws that will withstand decades of

change is going to take a great deal of skill, both in

anticipating technology and in anticipating new applications. The effects of new interventions are often

unpredictable.
Appendix I- Issues in International

Access to MEDLARS*

Introduction

Though the congressional request for this study did

not specifically ask OTA to address issues in international access to MEDLARS and international health

information policy issues, understanding these issues

is essential to the development of sound public policy

toward health information resources. Those issues are

so complex that a comprehensive assessment of them

is beyond the scope of this report. This appendix identifies and discusses selected relevant issues, to both illustrate this complexity and demonstrate the necessity

of addressing the international aspects of U.S. information policy. The discussion is divided between developed and developing countries, though in theory

and in the future issues relevant to developed countries may become applicable to the Third World.

Quid Pro Quo Arrangements

The National Library of Medicine’s (NLM or the

Library) activities have extended into the international arena since its earliest years. Its responsibilities to

serve as a repository of biomedical literature necessitate that it actively acquire and preserve information

from around the world. Indeed, fully two-thirds of the

journals included in Index Medicus are published

abroad.

The international nature of NLM’s collection is reflected in its MEDLARS data bases, so that many

countries were naturally interested in obtaining access

when the system became operational in 1964. The Library established quid pro quo arrangements, first

with Sweden and the United Kingdom, to provide foreign countries with the MEDLARS tapes or on-line access to the NLM computer. In exchange, participating

countries provide indexing and other services and/or

pay commercial firms in the United States to perform

such services for NLM. NLM currently has quid pro

quo agreements with 13 countries and one international organization, the Pan American Health Organization (PAHO).

NLM enters these bilateral agreements with a single MEDLARS center selected by each country as

its national biomedical information resource. The

MEDLARS centers must meet NLM-established technical requirements for personnel, equipment, and fiscal

● This appendix is based on papers prepared for OTA by Richard Solomon

of the Research Program in Communications Policy at the Massachusetts Institute of Technology and Tefko Saracevic of the School of Library Science and

Information at Case Western Reserve University.

resources, and serve a user community sufficiently

large for the support of extensive computerized services. Indexing services are either provided in-house by

the foreign centers, or contracted out to American

firms. Though no moneys are transferred between

NLM and the foreign centers, these indexing services

are valued by the Library at $500,000. The agreements allow foreign centers access by mounting the

MEDLARS tapes on their own computers with or

without NLM software, or directly accessing NLM’s

computer (see table I-l).

In the late 1960’s, NLM and the Organization for

Economic Cooperation and Development (OECD) discussed the possibility of establishing a single consortium to serve as a European MEDLARS center, but

no agreement was reached. Had events in the late

1960’s moved differently at OECD—and at the European telephone and telegraph administrations—

we might have seen totally different patterns for

MEDLARS access, by 1970 it was clear that transatlantic satellites and specialized terrestrial data networks were going to be an important force in data

communications. With only one center in Europe, and

one in the United States, national centers would not

have developed and the issues of restrictions might

have taken a different course today, but the concept

was technically and politically premature. Communication linkages were poorly developed, and the European nations lacked a common will for cooperation

(3). The incipient changes in technology which tend

to track anything related to computers might have

been much easier to introduce in 1981 if OECD had

been foresighted in 1966. This has obvious implications for the decisions we may be making in the next

few years about the next generation of U.S.-sponsored

public data base system.

Table 1.1.- Foreign Centers’ Access to MEDLARS,

March 1982

Tapes Tapes/software On-line NLM

Germany Sweden France

Japan United Kingdom South Africa

Australia Canada

Pan American Health Mexico

Organization Colombia

Kuwait

Italy

Switzerland

SOURCE: National Library of Medicine,

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International Issues: Developed Nations

Restraint of Trade

Until recently American commercial data base vendors have felt that they were in competition with their

own Government in trying to sell biomedical information overseas. This has arisen because of the complex

relationship between health services and governments

in general, not the least domestically. As it has become

profitable to sell health information via remote computers, the question of the proper role, if any, for a

governmental agency in the United States has been introduced. But other governments have different views

on this subject. In general, medical care is a quasi-governmental concern in most developed countries, historically linked to concerns for public health responsibilities.

Quid pro quo arrangements have complicated the

problem: their general pattern is that there be “ . . . no

transfer of monies between the participating country

and NLM. ” NLM makes MEDLARS available, either

through tapes or (when this became possible) on-line

access to the NLM computer, and provides technical

documentation and training. The participating country must meet technical criteria involving personnel,

equipment, and fiscal resources and have a user community large enough to justify an extensive computerized service activity. The participating country then

provides and/or funds the indexing of journals for input to the MEDLARS data base in return for access

to the system. This concept is consistent with a policy

adopted in 1966 by the Committee on Scientific and

Technical Information (COSATI) of the Office of Science and Technology in the Executive Office of the

President, which was that Federal information systems

would be made available in return for some form of

contribution (31).

NLM at first had only one licensing agreement with

a U.S. commercial information service, Bibliographic

Retrieval Services (BRS), to lease the MEDLARS data

base tapes. This agreement limited the firm to vend

access to the data bases to the United States and the

U.S. territories, unless specifically authorized by the

Library in writing. Upon the firm’s request, NLM permitted BRS to provide information services to countries outside the United States for which the Library

did not have bilateral agreements in December 1978.

An amendment to the licensing agreement was executed in March 1979, which, in effect, made it possible for foreign users of MEDLARS to connect to other

sources if they were willing to take the risks, and make

the effort, of establishing such connections since

translational telecommunications links were readily

available, though at some cost.

In spring of 1981, the policy was modified and the

new contracts that NLM has with commercial information services do not contain a national exclusivity

clause. However, new contradictions and unenforceable requirements have now been introduced in regard

to Communist countries by the Department of Commerce. The standard contract has recently been extended to prevent resale of data bases (from either U.S.

vendors or foreign centers) to the Soviet Union or the

People’s Republic of China without NLM’s permission,

but not to other Communist nations.

This approach is ineffective, since NLM has no

mechanism to investigate all their potential users that

are given authorization user codes. Merely restriction

by location is ineffective for electronic information

transfer. All a potential user in those nations would

have to do is obtain an authorized use code in an

authorized nation and access the MEDLARS data bases

through any number of public networks. In fact, this

is a common pattern for information transfer to Sovietbloc nations. Such rules are almost as unenforceable

as would be one that told book buyers that they may

not resell a book at second hand to a Communist

buyer.

However, the major issue of restraint of trade due

to geographic restrictions appears to be resolved for

the most part. The private information services still

are concerned that all licensees of MEDLARS data base

tapes pay exactly the same amount. The current price

structure and terms are the same for these with whom

NLM has international bilateral agreements as for the

U.S. domestic licensees who are commercial organizations. Nonetheless, some private sector firms state that

quid pro quo services are not equivalent to the transfer

of money. NLM notes that “the fees are identical for

a bilateral center or a license” (110). In addition, the

latter saves U.S. tax dollars and brings dollars to U.S.

businesses, who frequently provide the actual indexing under contract with the foreign country (110).

Transborder Data Flow—National Restrictions

The ability to access MEDLARS in Europe via

means other than national data base centers is possible because the growth of specialized data telecommunications networks. During the past few years, the

European telephone administrations have instituted

several different types of networks optimized for the

connection of terminals to time-sharing computers. In

addition most of the European Post, Telegraph, and

Telephone Administrations (PTTs) have joined in a

continentwide consortium to provide data services,

called Euronet. Most important to the users of data

base computers, such as those which offer MEDLINE,

the cost of service for access is not based on distance.
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Instead, charges are normally related to the connection time and the amount (measured in bits) of data

transmitted, plus a connection charge. As a result, a

use often can access a distant time-sharing system as

easily, and at the same telecommunications cost, as

a nearby machine.

These European systems are similar to the “packet

nets” in the United States, but the state-monopoly

PTTs have chosen not to pass all the savings onto the

end user. On packet systems, data is only transmitted

between terminals and computers when a key is

pressed or a letter is received, instead of maintaining

a continuous connection between two points, as on

an ordinary telephone or Telex circuit. This data traffic travels in relatively small packets and is switched

or routed via a complex network of computers that

may process the data as well as transmit it. Though

this technique shows distinct economies in line utilization, since most traffic on time-sharing systems tends

to be in small “bursts,” traffic shifts from traditional

Telex systems represents a threat to the PTT’s revenue

base.

Technically, a worldwide system of packet data networks could equalize charges to virtually any point

on the globe, since packet networks have the additional advantage of satellite technology with computer

switching. But in practice other factors have intervened, so that artificial pricing barriers to uniformcost data transmission exist between Europe and North

America.

Restrictions on access are set by each nation, usually

through telecommunications tariffs, or by general

agreement among the user community. However, due

to open access to telecommunications links across

European borders, backed by agreement among the

European nations themselves, enforcement of such

tariff restrictions is purely fiction. Enforcement by

NLM or its vendors has only been through password

controls, which are extremely difficult to monitor.

In many countries, inducements are offered to process data locally. It should not be surprising that a nationally subsidized medical community could be encouraged by another government agency to do its bibliographic searching on domestic machines. In some

cases, MEDLARS services are offered at rates lower

than by NLM itself. Despite subsidies, in general these

institutional goals to localize data processing are often

in conflict with the goals of the data base user. The

user prefers convenience in accessing systems, the opportunity to access competing services to maximize retrieval possibilities, and to minimize total costs. The

telephone carriers, some of whom also dominate timesharing or data processing in their countries, want to

maximize revenue and are not interested in competitive

services.

Other subtle restrictions imposed by the foreign nations on the use of the NLM data base overseas are

designed to prevent data from being processed outside

a nation’s borders. These rules are somewhat indirect,

and rarely overtly stated in terms of computer processing. One rule concerns transmission lines used for data

which are tariffed at a higher price than if used for

voice, so a user may not send data over an ordinary

telephone line. The other rule is that the device that

attaches a digital computer terminal or computer to

the analog telephone line (called a “modem” for modulator-demodulator) must be obtained from the telephone administration. Where the telephone administration is a powerful government agency, such as in

West Germany, enforcement of such rules severely

restricts attaching terminals and computers to the telephone system.

To overcome some of the problems of access to

U.S. data bases, some American firms offer the full

MEDLARS data base via time-sharing systems on

Euronet. Due to PTT tariff barriers, there is a tradeoff

between transatlantic data links and European data

processing in favor of the latter for certain services.

BRS has licensed Datastar in Geneva to offer MEDLARS,

using the proprietary BRS search system, and Lockheed similarly will mount MEDLARS tapes on a computer in London connected to Euronet. Separate copies

of NLM’s tapes are purchased for these European machines, since the NLM contracts prevent copying of

the tapes (except for normal time-sharing computer

operations at a single site). (See section below on

copyright. )

Copyright

The use of copyright to protect various forms of

property or artistic rights is not an abstract application of property law, but has been traditionally linked

to the technologies of creation, reproduction, and distribution of literary, artistic, or commercial works.

The radical changes in information processing technology which will affect international data base access

become even more confusing in the sphere of copyright

law, especially when applied to U.S. Governmentowned materials such as MEDLARS.

Technological changes in the retrieval of information from computerized data bases have an important

impact on international copyright issues. The computer is not like the printing press; it does not even work

like an office copier. To be sure, there are some superficial resemblances to “publishing” or “copying” using

computers, especially since some computer systems use

such printing devices for paper output. But this imitation of publishing is merely a transitional phase. The

computer manipulates information in ways that were
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never dreamt of by the framers of existing laws on

copyright and the property rights of authors.

Because computers perform the functions of storage

and dissemination of information in a radically different manner, discussion of issues of international copyright protection must recognize that existing technological concepts cannot serve as a framework for the

future. Even current concepts of data processing are

rapidly becoming obsolete; these are not dreams, there

are working models of future systems now in place in

many institutions and research organizations.

There is a radical difference in concepts of copyright

based on the printing press, or on similar devices that

slowly impress exact copies of an artistic or literary

creation, and property rights based on the use of computation-based techniques to store and replicate information. For the printing technologies, copying is the

penultimate step before distribution or storage; while

the use of computers to perform parallel functions requires “copying” at every step in the process, from creation of the work to its final application. Since, in the

coming decades, most useful information will be machine-readable, automation of reproduction has altered

the essence of “copying,” as well as “authorship” and

the meaning of original work. Even today, magnetic

and optical methods, and computerized techniques of

data manipulation, make it possible to automatically

reproduce and save virtually anything humans can see.

Attempts to enforce rules that were designed for a

different age may make the existing copyright conventions and laws ineffective, and perhaps counterproductive. For example, with modern electronic technologies, pirate editions of the MEDLARS data base could

be produced by Third World or Soviet-bloc nations

for distribution on some mass storage device, perhaps

by scanning the printed data base with a laser character

reader and placing the resultant data on a video disk;

justification for such activity could be made on the

basis that public health-related materials should have

as low a price as possible, and copyright enforcement

is unfair to poorer nations.

Of course, despite high motives, distribution of the

pirated data base would be open to all comers. More

important, quality control by the original producer

would be lacking. Essentially, what the pirate would

have accomplished is a shift of income from the

MEDLARS producer to the pirate. Since he would not

have to produce the original data, the pirate would

have lower overhead. But this form of cream-skimming simply increases the costs to the legitimate data

base subscriber. Electronic publishing contains many

variations of this theme, with other less invidious

schemes for capturing and replicating information.

Furthermore, the NLM contracts with licensees contain provisions regarding replication of the data base

that make analogies to printing in the mounting of

computer tapes. The vendors will deny that they copy

the tapes for any purpose when they mount them on

their machines, but this is a contradiction in terms as

any programmer knows. There is no way to read a tape

without copying it in some fashion. Yet, despite this

fact, data base vendors feel they would have to purchase a second set of tapes, if they maintained an overseas data center. This would be unnecessary if the vendors operated a distributed system with a link between

the United States and the foreign center, but their interpretation of the NLM contract assumes that such an

operation would be prohibited, and is not even considered despite potential customer savings and other

efficiencies.

We are witnessing the reactions to early phases of

this new technology in the rules and laws promulgated

which restrict certain information flows. This came

about as telecommunications networks were established that made large-scale data transfers much easier

between computers. This has made property rights in

information more difficult to protect. It is in the interest of U.S. data base vendors, the U.S. Government

included, to get involved in the protocol discussions

for these data communications networks so that any

copyright laws enacted can be readily enforced, and

more involved types of international trade restraints

are not further encouraged by the technology.

MEDLARS and Developing Countries

In developing countries, the situation regarding and

needs for biomedical information are considerably different from those found in the United States and other

developed nations. The issues surrounding NLM’s provision of data bases and on-line services are indicative

of a broader set of issues that are far more profound

than the implications of gathering information technologies. These issues are rooted in the most basic

problems of development, and cannot be addressed

nor redressed simply through changes in information

policies. They are selectively presented here as problems that must be solved if MEDLARS is to enjoy

wider usage in developing countries, but they are barriers to the use of all information services and

products.

Further, these issues are symptomatic of larger

trends in the developed countries and their relations

with the developing world. The developed countries,

and the United States in particular, are moving in significant ways toward a social order, which is variously labeled as “postindustrial society,” “communication

era, ” “knowledge society, ” or “information society. ”

In developing countries there is not yet a widespread

awareness of these trends. But where the awareness
132

exists the movement toward information society is

viewed with some alarm. Namely, while developing

countries were by and large moving after the model

of developed countries into industrialization, the developed countries themselves started moving away from

industrialization into an information-based society.

The view from the developing world is that in this way

the developed countries will continue to be “one up”

on developing countries, no matter how successful industrialization may become. The hated dependence

will continue.

The long-term trend is viewed as follows: in the past

we (developing countries) have supplied the developed

world with raw materials and cheap labor, while the

developed world had industries and manufacturing as

the basis of its prosperity. Now that we are gaining

industries (and in the process depleting raw resources,

selling our clean air and water, and endangering our

environment) we may end up providing the developed

world with relatively cheap industrial products and

continuous cheap labor, while the developed world

will have the control of information and communication technologies, and continue to build its prosperity. Information policy is becoming grounds for continuation and even expansion of the conflicts between

the North and the South. Policies and actions on

biomedical data bases, including MEDLARS, should

be such to minimize this conflict.

Biomedical Data Bases:

A Contribution to Development

Many countries consider data bases as part of foreign policy, even if the United States may not want

to do so. Two aspects of foreign policy should be considered in relation to biomedical data bases and developing countries; the potential U.S. contribution to the

process of development and the potential gain in biomedical information from developing countries.

The contribution to the process of development is

twofold. Biomedical data bases have information that

directly impinges on and potentially contributes to the

health of people; national health efforts area high priority in most countries and biomedical data bases can

contribute to these efforts; and the U.S. data bases are

of benefit to the world as a whole. The use of biomedical data bases contributes to an increase in the general

skill and level of use of modern information technology and resources in a country, i.e., biomedical data

bases can generally contribute to the attainment of the

symbols of the age and benefit developing countries

through every practical use of modern information

technologies.

The gain to the United States is also twofold. Increasingly, developing countries themselves are producing valuable biomedical knowledge of universal

utility to health, including health and biomedical

research and development in the United States. However, this information is not widely distributed through

international channels; thus, through cooperation in

data bases, the United States can gain information that

otherwise might not be obtained directly and easily,

Cooperation in biomedical data bases is one step that

contributes to the free flow of information on an international level and to a freer society. Thus, one of

the general U.S. foreign policy interests can be

positively affected through biomedical data bases.

There is considerable isolation in biomedical communication in developing countries which impedes the

free flow of information. For instance, on the global

level, English-speaking and U.S. scientific publications

are by far predominant over all other languages and

countries. They are also the most cited. It is not surprising then that scientists from developing countries

try to place their best publications in well-known

American, British, or other European journals rather

than in their own national journals. This creates what

is known as a “manuscript drain” (related to the wellknown “brain drain”). Although native journals are

very important for scientific communication within

their realm, they are not prospering domestically and

have an even harder time being recognized internationally (e.g., being covered by Current Contents, Science

Citation Index, or Index Medicus) incorporation into

these sources is highly coveted, bringing with it domestic prestige.

Bilateral Agreements and Developing Countries

As noted earlier, NLM signed its first bilateral agreement in the United Kingdom and Sweden in the mid1960’s. Also in the mid-1960’s, through cooperation

with the Pan American Health Organization (PAHO),

the South American Regional Library of Medicine

(BIREME) was established in Sao Paulo, Brazil, to

serve Latin America. In the late 1970’s, BIREME started

its own computerized service from MEDLARS tapes

for Brazil and South America. The success of cooperation with PAHO and BIREME had a lasting effect on

the NLM perceptions of what maybe ideal in cooperation between NLM and developing countries.

In contrast to PAHO, the agreements for services

to developing countries with the World Health Organization (WHO) headquartered in Geneva, Switzerland,

varied over the years. Various experimental operations

were established, but they changed and lapsed over

time. In various ways NLM has either provided WHO

with direct access to MEDLINE (and other data bases)

or conducted searches itself on behalf of WHO; however, no permanent mode exists for U.S. bibliographic
133

data base services through WHO: no model for cooperation has evolved from those rather disappointing

collaborations.

Presently, there are 13 countries in the world and

one international organization, PAHO, with which

NLM has bilateral agreements regarding U.S. data

bases or MEDLINE access. In addition to PAHOBIREME, which is oriented toward developing countries, 3 of those 13 countries are developing nations:

Mexico, Colombia, and Kuwait. The agreements with

Colombia and Kuwait were signed in 1981: Kuwait’s

is not yet completely operational. Thus, BIREME and

Mexico are representative of developing countries in

the bilateral agreements.

However, there is a second tier effect of MEDLARS

and other data base services to developing countries

over which NLM has no control nor is directly involved. Namely, some developed countries that have

a bilateral agreement to mount on their own MEDLARS

tapes do provide services to developing countries. For

instance, Japan offers searching to Southeast Asian

countries, Sweden to Poland, Germany to Yugoslavia,

and Australia to Western Pacific countries. This trend

is spreading, and soon a good number of developing

countries may have MEDLARS (and other U.S. data

base) access without direct agreements with NLM (but

based on NLM agreements with some other country).

The mode of arrangements for this second tier access

varies from country to country providing the access:

most of the time it is based on outright assistance.

Barriers to Effective Transfer and Use

of MEDLARS in Developing Countries

If we accept that the basic aim of all information

activities (including those connected with biomedical

data bases) is for information to be utilized, then we

have to consider that the minimum conditions for effective transfer and use of information for socioeconomic development include: a propensity on the part

of decisionmakers and problem solvers (in the case of

biomedical information: health workers and policymakers) to use information, which is based among

other things, on recognition of the value of the need

for information; a level of infrastructure (indigenous

information systems, including libraries) that makes

the right information first available and then accessible for use, and a type of political and social conditions which is favorable for encouraging the use of information and development of an information infrastructure.

In contrast to the United States and other industrialized countries, developing countries meet these conditions only partially and to highly variable degrees.

RECOGNITION

While European countries recognized the importance of biomedical data bases relatively early, and

not long after initiation of MEDLARS began providing

some form of MEDLARS access, widespread recognition is not evident in the developing countries. Recognition exists in international bodies and at international

meetings, but in most developing countries themselves,

the recognition is limited to a very few senior librarians

and government officials. All working librarians have

heard about MEDLARS and MEDLINE, but for most

it is very far removed from their daily experience and

problems.

Where this recognition exists, NLM and MEDLARS

are held in absolutely highest regard. NLM has a great

reputation in developing countries, and is perceived

as the world’s biomedical information resource. In no

other subject area has the United States (or for that

matter any other country) a single library and information institute that effects such a tremendous influence

on the whole world.

As a result of this recognition, the expectations for

NLM are also very high. At times these expectations

are unrealistic. There is little or no understanding of

the U.S. governmental mechanism under which NLM

operates, its responsibility to Congress and its domestic

role, trials, and tribulations. The view that NLM is

a world institution precludes seeing it as a U.S. domestic institution.

In turn, there is little recognition in the United States

of NLM’s tremendous influence, though unintended,

on the world’s biomedical information transfer in general, and on every country’s medical libraries in particular. NLM’s concern for developing countries has been

defined through the looking glass of international organizations and the eyes of the world’s professional committee or conference members, rather than by actual

domestic situations and practicing librarians.

INFORMATION NEEDS AND COVERAGE

MEDLARS is primarily oriented toward the information needs of U.S. biomedical communities in research, clinical medicine, and health practice. Where

similar communities are found in developing countries,

their information needs are well covered by MEDLARS,

particularly for researchers and clinicians. However,

in many respects MEDLARS coverage is not fully adequate for the information needs of developing countries. For instance, MEDLARS covers only a fraction

of biomedical literature published in developing countries, and thus can offer the world’s biomedical information for use in developing countries, but not domestically published information. Eight countries contrib-
134

ute approximately 80 percent of the items in MEDLARS:

over one-third of them are from the United States.

Thus, MEDLARS does not and cannot serve as a domestic data base in the developing countries,

Hence, MEDLARS is not a data base that is oriented

in a comprehensive way toward the needs of developing countries, nor is it so mandated. It can satisfy some

of those perceived needs only to a degree. In this lies

one of the problems of an indiscriminate use of

MEDLARS in or for developing countries.

The success of BIREME, the South American Regional Medical Library organized by PAHO, in the

publishing of Latin American Index Medicus, with a

view toward developing it as a regional data base, has

also brought to the surface expression of needs to publish similarly an African Index Medicus, and an Index

Medicus in other world regions. These present rich opportunities for developing strong relations between

NLM and the respective regions, relations similar to

those that exist between NLM and Latin America.

A further problem in meeting the expressed information needs of developing countries stems from the fact

that MEDLARS is a bibliographic data base. These

needs might better be met by factual data bases, i.e.,

those providing actual information or data found in

the literature and not simply bibliographies of literature containing data of information. The NLM Hepatitis Knowledge Base is a splendid example of such a

data base. The production of such source data bases

may possibly be a proper way for the private sector

of the information industry or WHO to become involved in services for developing countries.

SELECTION PROBLEMS

MEDLARS does not cover all of the world’s biomedical literature, but selects, in a comprehensive manner, biomedical literature deemed most substantive.

However, in this selection no distinction is made

among papers as to their relative quality, value, validity, usefulness, redundancy, etc. A Nobel prize-winning paper receives the same attention as one with no

or questionable value. Selection is based only on a given article’s relevance to a particular subject or its

source journal, and gives MEDLARS an important

characteristic—comprehensiveness.

However, developing countries have expressed desires for data bases with selectivity-based quality, appropriateness, value, and similar attributes of information. MEDLARS cannot satisfy such desires, nor

should it be expected to do so. But, it maybe possible

to create out of MEDLARS smaller data bases satisfying these different criteria of selectivity. Again, it is

an open question as to who should create such selective sub-data bases, This maybe done at NLM but may

also be accomplished by the private sector, developing

countries themselves, international organizations, or

consortia.

At the root of the problem is the fact that MEDLARS

searches, and searches in other bibliographic systems,

often retrieve too much information for an individual

to deal with and absorb. Although MEDLARS capabilities allow the user to tailor a search so that a broad

search which retrieves many citations or a narrower,

more focused retrieval can be obtained, many factors

affect the character and quality of the search performed. These include the precision of the search question, the amount of information on the topic of the

search, the quality of the indexing The size of MEDLARS

is large and growing, and so is the output. Thus, ultimately selectivity of the type described is aimed at producing outputs that on the one hand are within the

realm of human scale for dealing with information (offering options by which an individual can adjust the

threshold for that scale) and on the other hand are

reasonably the best (or at least better) representatives

of what is known on the topic requested.

ACQUISITION PROBLEMS

One of the elements of NLM’s policy is to have a

central organization in each country with a bilateral

agreement which will undertake all responsibility for

mounting of and services from MEDLARS tapes or access to MEDLINE; this organization must meet various

technical criteria, as enumerated. Very few, if any developing countries can meet these; thus, this requirement effectively precludes developing countries from

entering into bilateral agreements as presently instituted.

Most developing countries simply do not have an

organization that is capable of meeting the technical,

fiscal, and personnel requirements. Making arrangements with Ministries of Health as central organizations makes little or no sense, because they are not in

the information business, and although they have influence and play a most important role in health and

the dissemination of health-related information, they

have little or no connection with local libraries and

information users, Furthermore, many countries are

not capable of meeting the quid pro quo requirements

as instituted at present.

Even where a large medical library exists in a country or a region, agreement with such a library does

not guarantee access to other libraries, because operational connections and cooperation among libraries is,

in general, low. Also, most developing countries have

inadequate collections for coping to any significant extent with document delivery problems. This presents

a most frustrating aspect for users who find citations
135

with electronic speed and then must wait months for

documents to arrive from abroad by surface mail, if

they ever arrive at all.

Thus, the present policy requirements work as a barrier, if not as an exclusion, for most developing countries to acquire some form of access to U.S. biomedical

bibliographic data bases.

The regional approach to acquiring MEDLARS access, as in the case of BIREME, certainly has great

merits, but also has great limitations. Regional structure and cooperation in Latin America is not at all the

same as in the United States. Thus, besides the expected technical and personnel problems, BIREME has

a great problem of finding an effective mode for service to the libraries and users in the region.

So far, the private sector of the information industry

has used the same policies for acquiring access to their

biomedical data bases (including MEDLINE) as in the

United States. No specific policies for developing countries has been implemented or even debated. Private

industry as yet seems to be unprepared to approach,

in a significant way, the potential information markets

in developing countries.

In conclusion, no one approach to acquiring access

to U.S. bibliographic data bases by developing countries seems to bear as much fruit as the policies worked

out with developed countries. It seems that more flexibility and experimentaiton maybe in order, if success

in this area is to be realized.

ACCESSIBILITY PROBLEMS

Intellectual Organization. -Intellectual organization

of U.S. bibliographic data bases based on MeSH (medical subject headings) seems to be satisfactory for developing countries, though it does not conform in

many instances to local desires and needs. However,

MEDLARS, with its standardized terminology, classification and high quality of application, and indexing seems to have an additional beneficial effect wherever introduced: it adds to standardization of intellectual organization. Resource-sharing for intellectual

organization (cataloging, indexing) is low in developing countries. MEDLARS has not yet changed this

in any significant way; however, the potential is there.

It is possible that a wider application of U.S. bibliographic data bases may stimulate implementation

of resource-sharing plans.

Another issue in this area are indexes. Index

Medicus, produced by NLM, is the most widely accepted indexing tool in biomedicine in developing

countries. However, it is widely recognized that Index Medicus, although fully adequate for general

medical (particularly research and clinical) needs, does

not fully cover local publications, needs, and language.

Thus, national or regional indexing tools are urged

with great frequency and vehemence. In 1979, after

many years of discussion and 2 years of preparation,

with great help of NLM, and under the auspices of

PAHO, the Latin Arnerican Index Medicus (IMLA)

started publication by the South American Regional

Library of Medicine (BIREME) in Sao Paulo, Brazil.

The event is considered with unabashed jubilation as

a breakthrough for developing countries—and rightly so. It is also considered a model for what can be

achieved through cooperation between all parties concerned. A similar African Index Medicus is being

urged, as well as indexes for other regions.

Printed indexes and data bases are at present closely connected. Index Medicus whets the appetite for

MEDLARS data bases, MEDLINE in particular. Latin

American Index Medicus is a prelude for a regional

data base.

Physical Access.—Mexico is the only developing

country that has up to the present implemented physical access to MEDLINE through NLM computers and

BIREME. In turn Mexico provides further domestic access through a central institution in a way which has

a restrictive effect on the number of libraries and other

institutions accessing MEDLINE. BIREME has limited

on-line capacity: there are terminals at four subcenters

—at BIREME itself and three other cities in Brazil. Online access from other Latin American countries was

and is still being planned, but telecommunication and

other difficulties have as yet precluded the implementation.

In many cases, the access from developing countries

to MEDLARS centers around the world (including accessing NLM for MEDLINE searching) is by international mail. All the implications of slow and bad mail

service pertain to this mode of access. Turnaround

time is long, and interaction nonexistent. Mail access

to computerized searching has not proved effective or

desirable, but it is still better than no access. If well

organized, it can be a stop-gap measure.

Finally, the physical access to comprehensive library

collections to satisfy document delivery is also very

difficult for the majority of present or potential online users in developing countries. It also depends on

mail. The turnaround time for requests to be fulfilled

is often 2 months, and a goodly number are not filled

at all or lost in shipment.

Dissemination and Service.—Libraries in developing countries generally offer a limited number of services. On-line searching, even where possible directly

or indirectly by mail, is not yet a service that has penetrated libraries to any significant extent. NLM has

relatively little dealings with the mass of libraries in

98-764 0 - 82 - 10
136

—

developing countries; thus, it cannot directly affect use

in such services.

Information Technology .—Information technology

presents a formidable obstacle to further proliferation

of MEDLARS centers in developing countries. It is not

so much the lack of computers, but the lack of capacity

to make the technology work. Transfer of ELHILL

software for running NLM’s data bases is wrought with

great difficulties, however, it is not ELHILL alone that

poses difficulty—all similar software transfers for all

kinds of information retrieval system have similar

problems. Closely connected is the problem of technologically competent personnel. No solution has been

found by NLM (or for that matter by any institution

involved in information retrieval) for more effective

and faster transfer of technology, software, and hardware, for establishment of MEDLARS centers in developing countries. Many calls for simplified software

have not been answered.

The technological problems for direct on-line access

to MEDLINE from developing countries is centered

around telecommunications. Where TELENET or

TYMNET nodes exist this is not that difficult. However, where they do not exist it is impractical, if not

impossible, to establish effective direct access for reasons of high costs, restrictive regulations, and poor

technical quality and reliability.

Information Networks.—As yet, the NLM network

(including NLM connected networks such as BIREME

or those in Europe and Japan) is the only true international network affecting developing countries at

least to some extent in the realm of any and all biomedical data bases. Private U.S. vendors that have

mounted MEDLINE (and other biomedical data bases)

began offering these data bases to developing countries through their network or networks. However, as

yet they have not penetrated this market.

It is quite hard to consider NLM being in competition with the U.S. private information industry in developing countries, because the structure of medical

libraries and all health institutions in developing countries is entirely government-affiliated and dependent,

and is very much influenced in action and philosophy

by WHO and other regional health organizations. As

such, this very structure seeks governmental and not

private connections, structure is the only one through

which network connections can eventually be established. Thus, if NLM were eliminated from or restricted in data base cooperation with developing

countries, there would not be any biomedical data base

services in developing countries in the foreseeable future, and those meager beginnings made would be

eliminated.

UTILIZATION

The use of MEDLARS centers or MEDLINE searching from developing countries is low, and in comparison with the total number of searches performed on

MEDLARS the number is probably very small. For example, BIREME performs about 2,500 annual searches,

some 70 percent from Brazil, the rest from countries

throughout South America (78). The Southeast Asian

Medical Information Center (under auspices of the International Medical Foundation of Japan) reports, for

the period of August 1979 to September 1980, having

filled 38 search requests coming from five countries

in the region (93). However, at present a direct comparison between levels of use of U.S. data bases in

developing countries with those in the United States

is clearly not valid. What should be considered is the

long-term potential and benefit, not present use.

Neither NLM nor any other institution has been involved with user education, marketing, or promotion

in developing countries in respect to U.S. data bases.

While a number of librarians in developing countries

have been exposed to MEDLARS and MEDLINE (or

at least heard of it), not many potential users have.

This may also account for low present use.

Some other U.S. agencies, the National Technical

Information Service (NTIS) in particular, have been

engaged for some time in marketing and promoting

their scientific and technical information products and

services in developing countries to a much greater extent than NLM. NTIS created special bibliographies

and newsletters, some translated into Spanish, special

promotional material, traveling presentations and

demonstrations and the like, for marketing and promotion in developing countries. Some similar or even

joint approach may be desirable for U.S. biomedical

data bases.

INFORMATION PROFESSIONALS

NLM has trained a number of librarians and information scientists in MEDLARS construction and

MEDLINE searching This is one of the most highly

praised and desirable activities. Requests for more

training of personnel are made with increased frequency and urgency. NLM has developed a very good training program, probably better than that of any other

U.S. information agency.

Still, as mentioned, the vast majority of biomedical

librarians in developing countries are not knowledgeable of MEDLARS, particularly as to operational aspects—e.g., constructive searches, structure of vocabulary, etc. As extensive as NLM’s training efforts are,

they have penetrated only skin deep. It appears that

MEDLARS foreign centers in developing countries or
137

at BIREME have not yet conducted any extensive

amounts of training on their own.

Final Remarks

Although most of the issues concerning the use of

MEDLARS in developed and developing countries appear to vary widely between the two disparate spheres,

they share strategic issues. The issues that transcend

data base issues are: the evolution of U.S. society into

an information society, information as a national symbol and element in foreign policy, free flow of information in general and in biomedicine in particular,

transborder data flow and the restrictions imposed

against that flow, and cooperation rather than competition as a base for information activities.

There are vast dissimilarities, however, between the

information problems and the issues between developed and developing areas, and even among individual

countries, and the activities of the United States and

NLM in each of the areas, In general, MEDLARS is

being used effectively for the public’s health in

developed countries. MEDLARS and other data bases

have so far exercised a minimal operational impact on

developing countries, but they have a high and still

growing impact on expectations in developing countries. Thus, policy decisions should also be carefully

weighted in relation to these expectations and needs.

More thought must be given to means of increasing

MEDLARS’ utilization in developing nations. It is beyond the scope of this report to consider the basic

problems associated with development that lie at the

root of the problem, but it should be noted that technological advances in computation may be an aid to

improvement.

As noted previously, the technological problems for

direct on-line access to MEDLARS data bases from developing countries is centered around telecommunication. This problem may be ameliorated by future

trends in computerized data bases (see app. H). Among

them are the widespread use of microcomputers and

their potential low cost. At the same time there has

been the development of the video disk, with which

one can access most of a data base on a microcomputer without waiting for time-sharing connections or

paying time charges. The disk would also be relatively inexpensive. Applying these technologies to developing countries may be one step in the major and complex problems in improving the transfer of biomedical

information.
Appendix J.— Health Program Advisory Committee

and Acknowledgments

HEALTH PROGRAM ADVISORY COMMITTEE

Sidney S. Lee, Chairman

Vice President, Michael Reese Hospital and Medical Center

Stuart H. Altman

Florence Heller School

Brandeis University

Robert Ball*

Institute of Medicine

National Academy of Sciences

Lewis N. Butler*

Health Policy Program

School of Medicine

University of California, San Francisco

Kurt Deuschle

Mount Sinai School of Medicine

Zita Fearon*

Consumer Commission on the Accreditation

of Health Services, Inc.

Rashi Fein

Center for Community Health and Medical Care

Harvard Medical School

Melvin A. Glasser

Committee for National Health Insurance

Patricia King

Georgetown Law Center

Joyce C. Lashof

School of Public Health

University of California, Berkeley

Mark Lepper

Vice President for Inter-Institutional Affairs

Rush-Presbyterian-St. Luke’s Medical Center

Margaret Mahoney

President

The Commonwealth Fund

Frederick Mosteller

Department of Health Policy and Management

Harvard School of Public Health

Beverlee Myers*

Director

Department of Health Services

State of California

Mitchell Rabkin

General Director

Beth Israel Hospital

Dorothy P. Rice

Department of Social and Behavioral Sciences

School of Nursing

University of California, San Francisco

Richard K. Riegelman

School of Medicine

George Washington University

Walter L. Robb

Vice President and General Manager

Medical Systems Operations

General Electric

Frederick C. Robbins

President

Institute of Medicine

National Academy of Sciences

Rosemary Stevens

Department of History and Sociology of Science

University of Pennsylvania

Kerr White

Deputy Director for Health Sciences

Rockefeller Foundation

“Former members of the Health Program Advisory Committee whose terms expired prior to the completion of this study.

138
139

ACKNOWLEDGMENTS

This technical memorandum was prepared with the

advice and review of not only the advisory panel for

the study but the Health Program Advisory Committee and many other people. The Director of the National Library of Medicine, Martin M. Cummings, the

Deputy Director, Kent Smith, and numerous other

members of the NLM staff were extremely helpful.

OTA staff would also like to thank the following individuals for their valuable contributions.

Scott Adams

Louisville, Ky.

Ken Allen

Office of Management and Budget

William Baker

Bell Telephone Laboratories

Howard Bleich

Beth Israel Hospital

Jane Bortnick

Congressional Research Service

Yale Braunstein

Brandeis University

John Bruer

Macy Foundation

Michael D. Cooper

University of California

Melvin Day

National Technical Information Service

Nancy DeWath

University of California

Jan Egeland

Bibliographic Retrieval Services

Nancy Fazzone

Salem Hospital

Gail Fisher

National Center for Health Statistics

Dorothy Fitzgerald

University of Western Ontario

Allan Fox

Kaye, Scholar, Fierman, Hays & Handler

Oswald Ganley

Harvard University

Carole Ganz

National Science Foundation

James Hahn

Veterans Administration

Joseph Heinmiller

National Institute of Education

Sherrill Hites

Harvard Medical School

Mary Horres

University of North Carolina

David Hoyt

National Agricultural Library

Edward J. Huth

American College of Physicians

Laura Kassebaum

Bibliographic Retrieval Services

Gertrude Lamb

Hartford Hospital

Joan Marshall

McMaster University

Nina Matheson

Association of American Medical Colleges

Grace McCarn

H. W. Wilson Co.

H. Calvin Meadows

National Health Planning Information Center

Peggy Miller

Kaye, Scholer, Fierman, Hays and Handler

Lynne Neufeld

Federation of Abstracting & Indexing Services

L. Daniel O’Neill

Advanced Computer Techniques

Raymond Palmer

Medical Library Association

Michael Pollard

Federal Trade Commission

Johnathan Ruby

Elscint Corp.

William Schecterley

General Accounting Office

Charles W. Sergeant

Texas Technical University

Winifred Sewell

University of Maryland

Vladimir Slamecka

Georgia Institute of Technology

John Timour

University of Pennsylvania Medical School

Richard Tuey

Department of Health and Human Services

James Ullom

National Center for Health Services Research

Rick Weingarten

Office of Technology Assessment

William J. Welsh

The Library of Congress

Jane Sisk Willems

Office of Technology Assessment

Martha Williams

University of Illinois

Richard Willard

Information Industry Association

Marvin Wilson

National Technical Information Service

Paul Zurkowski

Information Industry Association
Appendix K.—Acronyms, Abbreviations, and Glossary

Acronyms and Abbreviations

AAMC Association of American Medical

Colleges

AGRICOLA Agricultural On-Line Access (NAL)

AIM-TWX

AMA

APHA

BCN

BRS

CAS

CIJE

CIM

CITE

COSATI

DHEW

DHHS

DIALOG*

ERIC

FAMLI

GAO

GPO

HEW

HHS

IRL

ISDN

ISI

MEDLARS

MEDLINE

MeSH

MLAA

NAL

NAS

NCLIS

NHPIC

NIE

NIH

NLM

Abridged Index Medicus via the

Teletypewriter Exchange Network

American Medical Association

American Public Health Association

Biomedical Communications Network

Bibliographic Retrieval Services

Chemical Abstracts Service

Current Index to Journals in

Education

Cumulated Index Medicus

Current Information Transfer in

English

Committee on Scientific and

Technical Information

Department of Health, Education,

and Welfare (now DHHS)

Department of Health and Human

Services

DIALOG Information Services, Inc.

Educational Resources Information

Center (NIE)

Family Medicine Literature Index

General Accounting Office

(U.S. Congress)

Government Printing Office

see DHEW

see DHHS

Information Retrieval, Ltd.

integrated services digital network

Institute for Scientific Information

Medical Literature Analysis and

Retrieval System

MEDLARS On-Line

medical subject headings

Medical Library Assistance Act

National Agricultural Library

(USDA)

National Academy of Sciences

National Commission on Libraries

and Information Science

National Health Planning Information

Center

National Institute of Education

(Department of Education)

National Institutes of Health (DHHS)

National Library of Medicine (NIH)

● This is not only the short name of the organization specified but is also

the name of a data base.

140

NMAC

NTIS*

OECD

OMB

OTA

PAHO

RIE

RML

RMLP

SATCOM

SDC

SDI

SUNY

USDA

WHO

Glossary

National Medical Audiovisual Center

(NLM)

National Technical Information

Service (Department of Commerce)

Organization for Economic

Corporation and Development

Office of Management and Budget

Office of Technology Assessment

(U.S. Congress)

Pan American Health Organization

Research in Education

Regional Medical Library

Regional Medical Library Program

Scientifc and Technical

Communication

System Development Corp.

selective dissemination of information

State University of New York

U.S. Department of Agriculture

World Health Organization

Batch searching: A method of information processing

whereby data are read into a computer from keypunched cards. The desired program, usually stored

on magnetic tape, is entered from the tape into the

computer memory. The program acts on the data,

and the results are made available on a printer or

a second set of keypunch cards. Unlike on-line

searching, the batch method does not allow the user

to interact directly with the computer to change

commands while the search is being done.

Boolean logic: A system for expressing relationships

between concepts using the connective “and,” “or,”

and “not. ” Many information retrieval systems use

Boolean logic as a method of searching data bases.

Cataloging: The process of describing and classifying

books or other library materials.

Data base: An organized collection of information,

usually on a specific subject, in machine-readable

form and accessible by computer.

Distribution computer system: An arrangement of

computers in which the computer complex has many

separate computing facilities all working in a cooperative manner, rather than a single computer in a

single location. The system is versatile, and small

computers in geographically dispersed locations can

be used for simple tasks in conjunction with a powerful large computer that is used for larger tasks.

End users: Individuals, such as physicians and researchers, who request and use on-line search results.
741 — — — .

Indexing: The process of assigning headings (from a

specialized thesaurus) to articles that have been

analyzed. The key words assigned are then used in

the retrieval process to identify the relevant citations

in a bibliographic search.

Intermediate users: Librarians and other information

specialists trained to conduct on-line searches of

computerized data bases.

MEDLARS: NLM’s computerized retrieval and

technical processing system, a complex IBM multiprocessing system that maintains data files, provides

on-line retrieval services, and produces computer

photocomposed publications. The current system is

often referred to as MEDLARS II; the system under

development is MEDLARS III

MEDLINE: The original, largest and most utilized

MEDLARS data base. MEDLINE contains references

to biomedical and other literature relevant to health

and health services.

Natural language: Standard English.

On-line: A computer program is considered to be “online” if it can respond to commands while the information specialist is working with the program at the

computer terminal. “On-line” capability allows for

near-instantaneous response, and thus allows the

user to interact with the computer.

Periodical: A publication, such as a journal, which is

issued at fixed intervals usually longer than a day

between issues or numbers.

Precision ratio: The number of relevant items retrieved

in a bibliographic search divided by the total number retrieved in the search.

Recall ratio: The number of relevant items retrieved

in a bibliographic search divided by the number of

relevant items indexed by the system.

Regional Medical Library: A library that provides document delivery services and assistance in organizing collections to smaller hospital and medical

school libraries in a given geographic region under

a contract awarded by NLM. Currently, the United

States is divided into 11 regions, but NLM plans to

reorganize the Regional Medical Library Program

into 7 by fall 1982.

Serial: A publication issued as one of a consecutively

numbered and indefinitely continued series. It may

be a periodical or a publication, such as a monograph or conference proceeding, that is issued at

irregular intervals.

Terminal: A machine similar to a typewriter which is

capable of transmitting and receiving electronic signals to/from a computer.

Text word searching: The process of searching a data

base using words that appear in the title, abstract,

or text of the article cited. Text word searching does

not require that an article be indexed using terms

from a subject heading list, i.e., a controlled vocabulary.

Two-tiered searching: The process of searching a data

base using both a controlled vocabulary (used for

indexing articles) and words appearing in the title

or abstract or the text of the article cited.
-

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