REMARKS OF U.S. REPRESENTATIVE JOHN E. FOGARTY AT INSTITUTE OF

7 ADVANCES iN BIQSMEDICAL COMMUBTECATION Leos GOVERNOR'S pare

 
  
 

Biomedical Communication: An Outsider's Views

I am honored to bé here stoday™: to join the discussions of this
Institute on Advances in Bio-Medical Communications. As a member of
Congress long interested in the health needs of this country, I have been
personally gratified in the past few years by the successes of our medical
research programs, by the increased responsibility shown by Congress in
protecting and advancing the health of this nation, and by the priority
being given to proposed legislation designed to bolster both this research
and its application to the national health needs. An effective system of
biomedical communications is an absolute "must" to the success of any such
program, and I am particularly pleased to have this opportunity to examine
some aspects of these matters with those who | are experts in communication
“problens.

This nation is justly proud of its medical research progress. The +
great epidemic diseases, which once swept over the country leaving behind
broad wakes of pain and tragic loss of life, have been brought under con-
trol. In the past half century life expectancy has increased by more than
20 years, and, day by day, painstaking research is adding to the sum of our
knowledge. These past achievements ~~ and the hope that research holds for
the future -- make me greatly concerned about anything that threatens to

limit further progress in improving the health of our people.
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Now, the communications problem poses such a threat. Although this
problem has been defined in terms of two major components =- among scientists
and between the scientists and the practitioners -- it seems to me that
any such distinction is essentially artificial. As an outsider ~m as a
layman interested in health commmications -- I believe that all facets of
scientific commmnications are intertwined and must be considered, each in
the light of the other. And then I would like to throw out some questions
for your consideration, somewhat as I have so often had the pleasure of
doing while listening to expert testimony at the yearly Congressional
appropriations hearings. I will be much interested in your reaction.

Both the researcher and physician are suffering from the fact that
the massive growth of scientific knowledge has clogged our old channels of
coumunication. Like many of our problems today, this one is of rather
recent origin. No doubt all of you are familiar with a recent survey which,
to me, summed up the problem neatly. It seems that in the 18th Century
there were only ten journals to record the research results of the scientific
yorld =~ and today there are 50,000. Further, it is estimated that by the
year 2000 there will be almost one million journals in publication. In
the 19th Century, in order to make possible coverage of the 300 journals
they had, abstract journals began to appear. Now there are 300 abstract
journals == and journals which abstract abstracts are appearing.

Again m= 8S with so many of today's problems == modern technology pro-
vides us with some new means to deal with our problems. After discussions
between scientists, educators, physicians and communications ‘people, modern
information retrieval systems came into being but have hardly yet come into

their own.
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One such system, of course, is the Medical Literature Analysis and
Retrieval System -~- MEDLARS ~~ which was established a couple of years
ago by the National Library of Medicine right wp on the Pike. This
system, as you know, will permit hundreds of medical research articles to
be indexed daily by language, date, title, and subject matter ~~ then be
retrieved by the computer in answering questions of individual research
installations concerning new publications bearing on their immediate pro~
blems. The MEDLARS system also has the capacity to compile and print
bibliographies of papers currently being published in numerous areas. of
specialization and research.

- Unfortunately, the National Iibrary of Medicine is the only library
‘in the nation with these capabilities. Therefore, these piblicgraphies
can be provided only upon request to practicing physicians as well as to
research scientists. The recent report of the President's Commission on
Heart Disease, Cancer and Stroke found the "present state of most medical
libraries in the United States is lamentable, largely because librarians
have not received their due share of the greatly increased attention
and funding for research." The Commission warned that unless something
was done to improve our national medical library base, our increased
growth in scientific knowledge will become an "exercise in futility. "

Partly as a result of the recommendations of this Commission I have
recently introduced a measure into the House -- identical with a measure

introduced #38 in the Senate by my esteemed colleage,

 

Senator Hill ~~ which, I believe, will do much to correct this deplorable

situation.
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This bill -~ if enacted ~- will provide Federal fumds to assist in
the construction and rehabilitation of medical library facilities, the
training of medical librarians, the conduct of research and development ‘in
fields of medical library science, the expansion of basic library resources,
the development of a national system of regional’ medical libraries. It
will also provide for the support of non-profit biomedical publication,
and for the establishment of branches of the National library of Medicine
in various areas of the nation.

If enacted, this measure will provide a vitally needed improvement
in this Nation's library system. Biomedical research results will for
the first time be adequately stored and indexed and an individual scientist
in any part of the country will be able to obtain quickly and efficiently
both a listing of new articles in his area of research and copies of papers
he needs. Physicians » too, can, upon request, obtain comprehensive
bibliographies. concerning disease conditions they will have seen in their
| patients.

I am impressed by the magnitude of the job to be done, here, and I am
as confident as any of you that much can be done with the electronic devices
at our disposal. At the same time I must say that, to me, the retrieval of
‘data is not the most difficult problem in communications which we face today.
There are other problems which seem to me even more basic, and each of them
euernes from one primary consideration: the human element. I am convinced
that while electronic devices are useful, it is men, working together ;
utilizing the best brains available, who are really the keys to an ultimate
solution of the problem. EZ would like now to think out loud about some ,
of the problems so dependent .on the human element -- and to get your reactions

and suggestions as to what might be done.
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Now I would not want to cast aspersions on the productive scientists
of the nation, but what can be done to assure that what you are retrieving
is worth retrieving?

Almost as much has been heard about the “publication explosion" as
about the "population explosion." T’am sure that this association was in
. the mind of an editorial writer on the New York Mmes recently when he
suggested that more thought ought to be given to “birth control techniques"
in the fleld of scientific publication. There is no doubt that the
"publish-or-~perish" syndrome causes the publication of papers which have
little scientific merit and these papers help glut the retrieval mechanisms
and are impossible to differentiate by purely mechanical methods. TI have
been assured by those competent to judge in various fields that papers have
appeared which were rushed into print before the research results actually
warranted distribution -—~ and that this is continuing. It is likely to
continue unless something is done about it. I know that editors of
scientifile journals are being urged to raise their standards for publication;
I wonder if any members of this group are in a position to add their voices
to such urging?. I wonder, too, if this group has other practical suggestions
to offer -—- you mist have considered this problem -~ and I would be interested
to hear what you think.

Directly related to the question of the quality of the selentific work
is the question of whether the paper ts well written. Again, I have heard
it said that a high proportion of sclentific papers are not well written, or
not well enough written. Ifa scientific paper cannot be understood, it

should not be published and might as well not be retrieved. What is anyone

doing about this?
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I know that the American Medical Association -~ in an unusually
forward-looking effort -- is doing something. on its own about this problem.
Two years ago the AMA -- in cooperation with the School of Journalism at
Northwestern University -- began sponsoring a summer Institute on Medical
Writing for medical students and physicians. Througa this Institute (which 7
will be offered again this summer) young scientists are trained to communi-
eate more clearly and are given a greater understanding of the purpose of
medical journalism and medical writing.

It is tragic but no doubt true that in the messive number of papers
being published today many significant findings are Lost because they are
so badly presented that they are not properly understood. Why can we not
have other and larger efforts to train scientists and physicians to be
competent writers?

Yet well-written papers on high quality research == however well
indexed and made available to other researchers -- will not help the
practicing physician who does not have the time to spend in the library.
For him, the collection of data alone is not enough. To organize the
enormous amount of data produced each year requires talented and seienti-
fically trained medical writers. Such writers are today taking laboratory
results -- translating and summarizing -- putting them In a form so that
the practicing physician can read and understand. It is significant that
almost without exception, this gap has been filled -- not by scientists --
but by people with little scientific background but expert at communicating
facts and ideas. Thus, a whole new field of publications aimed at the
physician has grown up in the last 15 years to help the busy family doctor
keep abreast of the latest advances. JI wonder if you think enough utiliza-

tion is being made of this capability in commmication? What more might be done?
~T-

Let me come back to the scientists in the laboratories of this
country. At the heart of the mtter is this question: how does the
bench seientist find out what his colleagues are doing? JI have heard it
gaid that those who talk most about the communications "crisis" are the
professional communicators, not the professional scientists. The argument
runs that the men who are doing the most exciting work in any Pield know
what their counterparts are doing, through personal correspondence with
each other, through personal contacts at national and international meetings,
long before any paper is published on the results of research in progress.

In 1964 the Nobel prize was awarded to two scientists working in the same
research area although they were geographically half-a-world apart. It

is a fair assumption that these two did not work in ignorance of each other's
latest findings, nor did they wait for a new contribution to the literature
to learn what the other had done. I am fairly certain, too, that the men
who are today opening up the new genetics are well aware of what their
colleagues are doing, whether they are in London, New York City, Chicago,

or at the National Institutes of Health here in Bethesda.

This leads me to one last question: Has any survey been made to
determine how the laboratory scientist. feels about the communications
“erisis?" Have numerous surveys determined that these men who are working
on the frontiers of the unknown think it is essential that they pee every
possible plece of relevant data, if they are to be successful? Do they fear
that they are not now as aware of all the related work as they need to be?

I don't know the answers to these questions, but there are probably answers --

and good ones -- that you can provide to me, ‘in the course of this Institute.
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During my 18 years of service on the House Subcommittee which neviews
Federal health expenditures I have exerted every effort to enhance this
nation's efforts in the medical research. JI have heard some doubts raised
concerning the long-range effect of the information retrieval effort.

Surely any system of biomedical communication mst evolve to advance research
not to stifle it. Perhaps I can illustrate this concern with an example
onee told to me by an able and well-known scientific administrator.

It seems that there were two laboratories, each headed by equally
able scientists. In one laboratory the assistants ~- when they came up
with an idea -- were told to go to the library and thoroughly search the
literature before beginning a project. In the other laboratory the
assistants were instructed to plan their projects and proceed with research,
allowing only minimal time for literature searching. The first laboratory,
Iam told, never duplicated any research, but it was the other laboratory
that made outstanding research contributions.

To me, the moral of this story Is that it my be just as well for a
scientist not to know that what he is attempting has been attempted before
and was found to be impossible -- because he may attempt it and do the
"impossible." I do not believe that first-rate scientists will ever be
discouraged from this by whatever they may read ~~ but others, who may have
considerable potential for making discoveries, may be discouraged at a very
critical point in their careers. TI am concerned that this might happen,
and I cannot help wondering if those of you here have given some thought
to the possible eventual optimum size of all information retrieval operations?
And have you considered possible inherent defects in the wide-ranging systems

you are conceiving today for use tomorrow and the day after tomorrow?
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I have spoken straightforwardly, here, this afternoon. The fact
“is that -- on topics that directly ‘concern the medical research progress
of this nation and the health of its people -- I feel strongly. J believe
that you will realize that I ama most friendly critic of your endeavors ==
I am asking for information to answer both your critics and to provide myself —
with a firmer basis upon which to stand when others raise these questions
in my presence. I am seeking information. I can think of no better
opportunity to get it than now. You are specialists in commmications and
its many aspects, and I am sure that you -- for your part ~~ will welcome
this opportunity to educate me. |

I want to thank you for sharing your platform with me today. And I
want to assure you that I stand ready to do anything in my power to help
assure that the recent great strides made in biomedical research will not

be negated or even attenuated by faulty. communications.