[Biomedical Communications]

[Mary E. Corning, Assistant Director for International Programs, National Library of Medicine]

Mary Corning: Biomedical Communications is a necessary ingredient of medical research, education and practice. It is a mirror of medicine. It is also a factor in the progress of medicine. Seventeen seventy-six can be compared with 1976 in terms of information resources, whether they be people, products, or institutions.

Contrast the 350 physicians in 1776 with the 325,000 of today, the one medical book with the 2,000 new medical books produced every year, and the one medical library with over 3,000 of today. And the predecessor for the 6,900 journals today had still not been created.

Thus numerically there have been tremendous increases, but of course progress is not measured by numbers alone. The first United States journal, "The Medical Repository" was founded in 1797. Prior to that time, the American Philosophical Society had been established.

It was the first society to use critical review prior to publication to insure some quality. The Pennsylvania Hospital had established the first public medical library and the United States Copyright Act was passed in 1790. This was modeled after the British Act of 1710.

The latter was an effort to move away from governmental control of the press, monopoly by the publisher, and to restore some legal recognition to the author. Twenty-five years after the first medical journal appeared on the U.S. scene, this quote of Sidney Smith appeared in the frontispiece of the Philadelphia Journal of Medical and Physical Sciences:

"The [inaudible] landed and the U.S. was then launched on an ever-increasing production of biomedical literature." Oliver Wendell Holmes endured one of the characteristics of publications in those days. He published his essay "The Contagiousness of Puerperal Fever" in a journal which had a lifespan of one year. Holmes was named to chair a special committee of the American Medical Association to examine American medical literature.

This committee criticized the quality of the American literature and suggested that it simply set English portraits of disease in American frames. It encouraged the U.S. to establish a national literature. We see this philosophy today in new and emerging countries who feel that the prime prerequisite before entree into the international scene is to have a national bibliography.

We have tried to place American literature into the international scene by examining some characteristics of the world's biomedical literature, its growth, country of origin, language of publication, subject coverage, and we have detected some trends.

This is a bar chart comparing biomedical journal production by country for three points in time: 1775, 1875 and 1973. In absolute numbers there were 22 biomedical journals in 1775.

These increased by a factor of 10 by 1875 and we believe that the last century will show an increase by almost 100 times. Great Britain, France and Germany accounted for 80 percent of the biomedical literature in 1775, 50 percent in 1875 and only 21 percent in 1973.

This is due to the fact that the United States became significant as a generator of biomedical information accounting for 36 percent of the biomedical journals.

There were also 61 countries in the other category which accounts for 38 percent of the publications. Japan and the U.S.S.R. are prominent in this category. There are approximately 19 thousand biomedical periodicals in the world today. Roughly one-third of these are about 6,000 are the ones most actively used in providing biomedical information services.

If one places a more rigorous definition on the quality of publication, then again one-third of the 6,000 or approximately 23 hundred journals are those which have been selected for inclusion in "Index Medicus." These eight countries account, therefore, between 68 and 78 percent of the biomedical literature depending upon the category of definition. Switzerland is included here, not because it is a generator of information, but because it is a publisher.

The language of publication has also changed over the past century. In the first year of "Index Medicus" in 1879, there were about 20 thousand articles. Forty- two percent of these were published in the English language. Today there are over 217 thousand articles in the 1973 issue of "Index Medicus." Sixty-six percent of these are in the English language. This does not mean that we have been parochial and have added only more journals from the United States.

Rather, 50 other countries have joined the United States and Great Britain in using English as the primary language of publication. For those articles which still continue to be published in a non-English language, there are a number of English language abstracts.

This is very helpful for those of us who do not have a facility with other tongues. There has been a lament for over the past century that there are too many biomedical journals.

It is important when one quantitatively assesses these journals to take into account that not only are new journals created, but some have a very short lifespan. We were able to identify three points in time where we felt the data accurate enough for comparison. You can see that within the last five years, for every journal which died, six new ones were created. There is no pattern to the disappearance of these journals.

The age may range from one to 77 years. They may be sponsored by a professional society or by a commercial organization. It would appear however that a professional society is able to redirect the contents of its journals by name changes or by actual emphasis within the journal to accommodate to its membership. This is something which the commercial sector cannot achieve.

You will recall that we mentioned earlier the Serline Database. This represents a little over six thousand journals which are used most often in the provision of biomedical information services. This is a point-by-point plot by initial year of publication. The dotted line represents new journals. The solid line is the sum of these new journals plus continuation journals: that is journals which have undergone a name change.

There is a hiatus in this growth curve during World War Two but the slope of the curve prior to World War Two is the same as that after the war. It is simply raised on the scale level. Beginning in 1965, there was a sharp increase in the growth of the biomedical literature.

We have detected a decrease for 1973. Whether this decrease will be maintained, become a plateau or merely an oscillation in an ever increasing curve can only be determined after we have completed analyzing the data which we have been acquiring for these more recent years.

In terms of the subject coverage of the medical literature, Dr. Billings in 1879 was able to categorize 20 thousand articles in 14 major categories. Today these same categories account for only 38 percent of the literature in the 1973 "Index Medicus."

Sixty-seven additional categories or a total of 81 are necessary. This means there has been not only greater specialization, but also broader subject area fields such as physiology and biochemistry.

Dr. Billings in 1876 was able to talk in very specific terms of literature and institutions. He detailed accomplishments in articles and by authors. Today, we speak of biomedical communications. This is because there have been unique and dynamic interactions between and among users, libraries, technology, and the federal government.

Dr. Billings believed that the medical literature had no value without a subject access. We maintain that philosophy today. Only the size of the task has increased and the techniques for handling it have changed. Dr. Billings was able to take the material home at night and index it in the study of his home.

These activities were carried on by Fletcher and Garrison. In Dr. Billings's day, a user may have sat within the library and pored through many tomes.

Today the user may sit at a terminal 3,000 miles or more away from the computer that contains the information needed,or the user may be a health aide in Alaska who is connected via satellite to physicians in a hospital in order to get the information needed to provide healthcare.

These are examples of technology which have been used within a library or a communication setting.

It is interesting to compare the time lag between the advent of technology and its application. The 19th century showed the beginning of modalities for communication that are non-print. The telegraph, the telephone: these preceded the bibliographic control of the biomedical literature as exemplified by "Index Medicus" and "Index Catalog."

At the turn of the century, physicians and librarians met to organize The Association of Medical Librarians. The first half of the 20th century again emphasized non-print media: the radio, television. We see computer theory coming into existence in 1936 and the first zero graphic image in 1938.

It is interesting to note that the first United States electronic computer had as its companion in time of development the ball-point pen.

The 1954 to 1964 period again showed emphasis on television, satellites, lasers and the first zero graphic copier was marketed. The National Library of Medicine bibliographic information storage and retrieval system - MEDLARS - became operational in a batch mode in 1964 at the same time that time-sharing computers first began to appear upon the scene.

It is in the late 1960s in the early 1970s that we see applied that technology which actually makes a biomedical communications network a reality: the use of satellites, online interactive computers. It is a fact that we have today a national biomedical communications network in the United States and its constituent elements are identified here on this slide.  [Slide reading: libraries, educational resources, audiovisual, specialized information services, data transmission]

This network utilizes a number of regional libraries throughout the country and Medline Centers. The intent is to bring information as close as possible to the user. This network has been extended internationally via telecommunication linkages.

And the National Library of Medicine has had for a number of years international bilateral agreements relating to our computer-based information storage and retrieval system.

Three of the countries with whom we have such arrangements are represented at this colloquium by Dr. Sidney Bergstrom, Sweden, Sir George Pickering of the U.K. and Dr. Evans of Canada. The federal government has had a very important role to play in biomedical information.

As a result of The Medical Library Assistance Act of 1965, approximately one-fourth of the library's operating budget has gone to external institutions. These funds have been used to construct medical libraries, to improve resources, the caliber of the staff, and most importantly of all, to improve the effectiveness of information services to the user.

However, the 28 million dollar budget of the National Library of Medicine is a mere hairline on this bar chart which shows that there are over 120 billion dollars expended annually for health in our country. The future issues of biomedical information cannot be examined in a vacuum but within the setting of biomedicine.

And this is turn must be viewed within the total scientific scene. Taken into account must also be the political, economic, and social factors which have a bearing on it. There have been developed through the years relationships involving the academic, private, commercial, and governmental sectors.

These relationships are dynamic, unique and often times uneasy. Biomedical information much be examined in its totality: that is, in the generation, communication and application of information.

Traditionally, the communication of information has moved from an author to a user primarily through published modalities. Most recently the library has become a very active element in this communication process with technology and the federal government impacting on the total process.

There are two technical problems which still face us. One of these has been raised with the debate on the copyright scene.

You will recall that I mentioned that the passage of the first copyright act in this country was to protect the individual author. In current discussions, the publisher and the library have been cast in adversary roles. The author seems to have been forgotten and the user appears indifferent. The other technical issue is the economics of biomedical publications.

Will publishers begin now to use existing technology or to become interested in new technology in order to develop modalities that will both be useful, economical and timely? We also believe that the user can no longer exist as an aloof end-recipient of all this activity.

The scientist must become involved actively in the validation of information, the selection of information to be transferred, and in its application.

The fundamental issue is how does one move from medical research to healthcare, which will be beneficial both to the individual and society? Within the next several decades, medical information will be transferred at great speed and accuracy to a physician anywhere on earth and perhaps on other planets.

We believe that the limitations will not be on the side of technology. It is the selection and the application of this information for problem-solving which will be the challenge of the next century. Thank you very much.

[Biomedical Communications]

[Mary E. Corning, Assistant Director for International Programs, National Library of Medicine]

[Discussant: Francis O. Schmitt, PhD, Professor and Founder and Chairman of the Neurosciences Research Program, Mass. Institute of Technology]

Dr. Francis O. Schmitt: Well these two excellent papers that have just been presented, it's my pleasant assignment to discuss them both may seem to be on quite different subjects but they have at least one [?] in common which is that they deal with communication and the processing of information.

First about neuroscience, the paper by Dr. Magoun on neuroscience, written with doctors Frank and Marshall.

The authors are certainly to be complimented for their very perceptive historical account of the birth of neurosciences in this country which began in just a century ago in 1870. There was very little actually in the 18th century as they point out. There are very few books indeed in the area of neuroscience.

Then they turned to the building of a neurological tradition in the period from 1870 to 1920, primarily at Johns Hopkins as so many firsts were recorded. And then followed the development and diversification of the neurological disciplines, 1920 to 1950. And here they chose eight selected medical schools and chose the individuals there for indicating the way in which neuroscience, if you like, but that word wasn't used then,  differentiated and diversified.

Finally the authors present a kind of a smorgasbord of some 20 major topics that had been developed in the last 25 years. One could think of a number of other kinds of things that could be added to that smorgasbord including neurochemistry and electron microscopy.

However, it does remind us that the last year in November, The Neurological Institute - NINCDS - celebrated its 25th anniversary. In other words, it was through this period of 25 years that the institute has been in existence and in which this great diversification in neuroscience occurred. But before proceeding further, I would like to explain the word neuroscience itself: how it came into usage only recently, about 1960.

And it signifies a unification of the neurological or brain sciences on the one hand and behavioral sciences on the other hand. One might think of these sciences according to four levels: the molecular, the cellular - that is neuronal and glial - the tissue level, the brain level itself, and the behavioral level. And these are disparate sciences.

It's very difficult for experts in one level to understand experts in the other level. How might we merge these very different modes of scientific research in the interest of making real progress in the search for the neural substrate of behavior to discover the physical and biological basis of learning, memory, perception and other cognitive functions?

Even partial success in this search would have an enormous impact on human suffering from debilitating nervous and mental disease, inherited or acquired. But perhaps more important than the -- more important for the survival of the race on this planet would be to discover something really basic about the neural substrate of learning, memory, thinking and so on.

If we knew even as much as we do about genetics for example, neuroscience might be though of as being in a kind of a neoclassical period at the present time, comparable perhaps to genetics in the '20s and '30s. Very sophisticated in many aspects but lacking a conceptual breakthrough comparable in any way to that in genetics in which it was discovered that you need only four codons as you need, say, four suits in a deck of cards.

But if you have a hundred thousand codons in a polymer of DNA, you have forked a hundred thousand variations: in other words, enough information to build a man including his brain. All of this came in the golden decade of molecular genetics in 1955 to '65 in neuroscience. While continuing the development of each of these four levels that I mentioned, we seek a powerful unifying concept to explain the phenomena far more complex than those of genetics.

Well, success of course in this search would revolutionize science itself and its derivative technology and would mark a major turning point in man's cultural evolution. Important also, was the influx into neuroscience of highly creative scientists from other disciplines: some of them theoretical physicists fresh from their triumphs in molecular genetics.

Many such new recruits as well as veterans in neuroscience sense the possibility of creating a yet more exciting science capable of explaining higher brain functions in terms of basic principles of molecular and cellular biology.

The ancient problem of the neural basis of sentient processes, long considered too complex and difficult for human comprehension, has become a citadel under siege by the confluence of several scientific armies now united under a single banner: neuroscience.

Advances in neurohistology and electron microscopy augmented in recent years by fluorescence studies and retrograde transport of radio-labeled molecules in axons and dendrites and across synapses has led to widespread interest in what might be called the new circuit-tology. Recently we asked David Hubel, who is one of the NRP associates, to come over and tell us what he thought was hot about neurophysiology these days.

And he said, "Nothing." He said, "What's hot is in neuroanatomy." And he spoke about this process. You see there is what is called "fast transport," about a hundred millimeters a day of transport of materials bidirectional in axons and dendrites. And if you introduce radio-labeled material at the ending of an axon, it goes retrograde up the axon, through the soma and up the dendrite and across synapses and into the next neuron and so on.

So that if you use [?] labeled material you can literally outline microcircuits which is a new deal. Well, synaptology joined the neurophysiology repertoire with elegant investigations of the linkage of receptors for neurotransmitters coupled with cyclic nucleotide-mediated changes in membrane polarization and the result and firing of postsynaptic neurons.

Plasticity in synaptic excitability was considered a reasonable model of memory storage. Well, I have never been...this is quite plausible of course. I have nothing against that. On the other hand, it's very difficult to see what specific advances have been made with conventional neuro-physiological, in conventional neuro-physiological terms with spike potentials in axons and so on towards an understanding of a higher brain function.

From such studies of spike waves in long axons, like long axon neurons, emerge the fabric of this very sophisticated modern sensory motor neuro-physiology. While the mechanisms of higher brain function remain elusive, during the last decade a silent revolution, to use Bullock's term in 1959 and Bodian's term in 1972, has been going on in our ideas about synaptic function.

The dynamic polarization aspect of neuron doctrine which states that dendrites are passive receivers of synaptic excitation and axons are the primary medium of communication, has been abrogated by recent studies that reveal that dendrites synapse with other dendrites.

That is, dendrites can be pre- or post-synaptic to each other to form a vast dendrodendritic net composed of neurons that have either very short axons or no axons at all, new ground rules are required to understand the biophysics and physiology of dendrodendritic reciprocal synapses, electrotonic junctions and other components of spikeless neuronal local circuits.

Hopes are high that a new era is at hand that may be as fruitful in understanding higher brain function as was axonology half a century ago in laying the basis for a conventional sensory motor neural physiology.

Just as I can say that I was present in the laboratories where axonology was founded half a century ago, so young neuroscientists working in the new world of electrotonic information processing may be able a century, half century, to say that they were present in the earliest beginnings of a fruitful new period of neuroscience which may lead to real understanding of higher brain function.

[Discussant: Francis O. Schmitt, PhD, Professor and Founder and Chairman of the Neurosciences Research Program, Mass. Institute of Technology]

[The Neurosciences. Biomedical Communications.]

Don Tower: I'm Don Tower, the Director of The National Institute of Neurological and Communicative Disorders and Stroke. As I listened to Ted Magoun talk about the behavioral sciences and to refer us to his written work for the neurosciences, it occurred to me that some people might not see that we are perhaps on the threshold of a convergence between these two areas.

But before I speak about that, let me call your attention to something which surprised me when I learned it. And that is that the word neuroscience does not translate into most other languages in the world.

I learned this at the World Health Organization where they have started a program called The Collaborating Centers in the Neurosciences and they've encountered an astonishing difficulty in explaining what this is all about to countries where the word neuroscience does not translate. So here we have a major communication problem right in our midst.

But to come back to the question of convergence. At the laboratory level if you will, some of the things which I'm sure are in the Magoun manuscript and which Frank Schmitt alluded to are certainly symptomatic of the way in which both the behavioral and the neuroscience fields are tending.

The fact of plasticity within the nervous system, of central processing which is occupying the attention of a great many of our best neuroscientists today, and the role of the local circuits or connections that Frank Schmitt talked about, these are all really facets of the same general central problem of how impingements from the exterior that are perceived by the nervous system, are recognized, processed, interpreted, and appropriately acted upon.

And after all, when the actions are inappropriate then we encounter behavioral problems. And so the other part of this convergence I think is at the clinical level. And we're seeing things crossing from what was traditionally psychiatry into neurology and neuroscience at an increasing rate. And I just picked out a few things at random.

Learning disabilities such as dyslexia, the hyperkinetic child, the problem of psychosurgery, the problem of the autistic child, the role of various drugs and their action on various central processes as illustrated by the whole area of the biogenic means, the cyclic nucleotides and so forth, many genetic disorders and more recently the exciting advances in understanding specific opiate receptors in the central nervous system, receptors for the [?] hormones and so forth.

Now in the history of neuroscience, there was a long period in which the traditional disciplines like neuroanatomy and neurophysiology came to a point, which I guess Frank was talking about when he talked about axonology, in which they needed an infusion of new blood, new ideas which came from areas like neurochemistry, neuropharmacology and so on.

And I think one of the problems that the behavioral sciences may face is precisely the same sort of thing unless they can bridge the communications gap. This will have to occur both in the laboratory and in the clinic, but also in the resources which the National Library of Medicine and other places provide to bridge the communications gap between disciplines that are traditionally not taught very well with each other. Thank you.

John Z. Bowers, M.D.: Thank you very much. I wonder if the panelists would like to...

Schmitt: Regarding the word neuroscience, as Mary Corning pointed out, 60 percent of the publications are in English now and that every Congress that I've attended it's the official language has been English. So that I think they'd understand.

[Inaudible background]

Bowers: Well, let's get away from the language problem and talk about bridging the gap, which perhaps is more important between the behavioral sciences and the neurological sciences. Dr. Magoun, would you like to comment on that?

Dr. Horace Magoun: An example of this convergence and interrelationship strikes me in that one of the major Rockefeller Foundation grants arranged by Alan Gregg, was to Wilder Penfield to establish the Montreal Neurological Institute, from which the National Institute of Neurologic and Communicative Disorders has now obtained its current director. If that isn't interrelating situations institutionally and personally, I don't know what could be.

Bowers: Mary Corning, would you like to comment on that?

Dr. Schmitt, do you have other comments?

Schmitt: No, I think Dr. Tower put the problem well.

Bowers: I do too.

[The Neurosciences. Biomedical Communications.]