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J Med Libr Assoc. Jan 2002; 90(1): 4–20.
PMCID: PMC64753

Adjusting to progress: interactions between the National Library of Medicine and health sciences librarians, 1961–2001*

Betsy L. Humphreys, M.L.S., Associate Director for Library Operations1

Abstract

Most health sciences librarians would agree that the National Library of Medicine's (NLM's) leadership and its services have been highly beneficial to the field, but this does not prevent specific NLM actions—or lack of action—from being perceived as annoying or infuriating. Over the past forty years, NLM's interactions with health sciences librarians have been affected by significant additions to NLM's mission and services, the expansion of NLM's direct user groups, and the growing range of possible relationships between health sciences librarians and NLM. The greatest friction between NLM and health services librarians occurs when there is a fundamental change in the way NLM carries out its mission—a change that adds to the web of relationships that link librarians and NLM and prompts corresponding changes in the way other libraries do business. Between 1961 and 2001, there were two such fundamental changes: the implementation of the National Network of Libraries of Medicine and the development and promotion of services targeted toward individual health professionals. On a lesser scale, each new service that connects NLM and health sciences librarians is another potential source of irritation, ready to flare up when the service is interrupted, changed, or eliminated. Other factors—including strong personalities, mistakes, and poor communication—add to, but do not cause, the intermittent problems between NLM and its most longstanding and engaged user group. These problems are in essence the price we pay for the leadership and vision of NLM's directors and for NLM's success in developing excellent services and in enhancing them based on advice from librarians and other users.

INTRODUCTION

When I arrived at the National Library of Medicine (NLM) in 1973, one of the first things I learned was that health sciences librarians are not always pleased with NLM. Most would agree that NLM's leadership and its services have been highly beneficial to the field, but this does not prevent specific NLM actions—or lack of action—from annoying or infuriating some health sciences librarians. The problem may lie with the substance of what NLM does or, more likely, with the way actions are done or communicated.

In my twenty-eight years at NLM, I have lived through a number of highs and lows—some of them simultaneous—in the remarkably productive and resilient relationship between health sciences librarians and NLM. The invitation to present the Janet Doe Lecture gave me a welcome excuse to examine the history of NLM's interactions with the health sciences library community in greater depth, to look for some underlying patterns, and to think about what it all means for our collective future. Other Doe lecturers have spoken of difficulty in selecting a topic [1]. For me, selecting the title was difficult. I considered and rejected several others—including “NLM Is from Mars …,” “Sleeping with an Elephant …,” and “Our Best Friends Do Tell Us ….” While I was trying out one of these, my husband began referring to me as the “Doe-Nut.”

From 1961 to 2001, NLM's budget increased from $1.8 to $246 million (a 25-fold increase in constant dollars), and the number of MEDLINE searches grew from zero to more than 300 million per year. This paper will focus on interactions between NLM and health sciences librarians during this eventful forty-year period. It will describe how these interactions were affected by additions to NLM's mission and services, the expansion of NLM's direct user groups, and the growing range of possible relationships between health sciences librarians and NLM (Table 1). I will pay particular attention to the way things stood at decade intervals beginning in 1961. To provide some perspective, I will touch briefly on selected developments in NLM programs (Figure 1). Many important NLM accomplishments, particularly in the toxicology information and research programs, will not be mentioned.

Figure 1
History of the National Library of Medicine, selected events, 1961–2001
Table thumbnail
Table 1 Growth of the National Library of Medicine's (NLM's) direct remote user groups, major NLM services, and relationships between librarians and NLM, 1961–2001

THE NATIONAL LIBRARY OF MEDICINE (NLM) AND THE DOE LECTURES

In her review of the Janet Doe lectures, Alison Bunting noted that “The histories of [the Medical Library Association (MLA)] and the National Library of Medicine are inextricably intertwined, and many of their joint efforts are documented in the Doe lectures” [2]. By my count, only five of the previous thirty-four lectures made no mention of NLM and its services. All of the previous lecturers had one or more relationships to NLM—as users, advisors, grantees, trainees, current or former NLM or Regional Medical Library (RML) staff members, or developers of innovations that were incorporated into NLM services. These people were exceptional, but they were not unusual in having ties to NLM. In the second half of the twentieth century, it was hard for any U.S. health sciences librarian to avoid interacting with NLM in some way.

As a quintessential NLM insider, I approach the examination of NLM's relationship with health science librarians with a sizable inherent bias. I cannot claim to be objective, but I have examined many sources of blunt opinions about NLM and its programs, including MLA oral histories; the archives of NLM, MLA, and the MEDLIB-L email discussion list; and the published literature. I also have been the direct recipient of more than a few unvarnished opinions about NLM. At my very first MLA meeting in 1975, when Estelle Brodman, Ph.D., (by then a former MLA president, Doe lecturer, and Noyes award recipient) introduced me as a speaker in a session on serials automation, she used roughly the following words: “Whenever I travel around the world I am always struck by how fortunate medical libraries in the United States are to have the leadership of the National Library of Medicine. It's a shame that NLM has never shown this leadership in the field of serials automation.”

JANET DOE AND NLM

Janet Doe's own important interactions with NLM provide a useful prologue to the last forty years (Figure 2). From 1943 to 1944, as librarian of the New York Academy of Medicine, Doe was a member of the committee of six distinguished librarians who surveyed the state of the Army Medical Library (as NLM was then called). The survey was commissioned from the American Library Association (ALA) by Colonel Harold Wellington Jones, M.D., director of the Army Medical Library, using funds obtained from the Rockefeller Foundation. ALA's initial proposed list of members of the survey committee contained only one medical librarian and no women. When it was sent to MLA President Mary Louise Marshall for review, she supplied the names of ten medical librarians, topped by Janet Doe, and pointed out that “many outstanding librarians in the medical field were women” [3]. Although she did not recommend herself, Marshall, Doe, and Thomas Fleming of Columbia's medical library ended up on the Survey Committee, which produced a highly critical report with recommendations for major changes and improvements, including a new building [4]. Over the next sixteen years, Dr. Jones and his two immediate successors, Joseph McNinch, M.D., and Frank Bradway Rogers, M.D. (Figure 3), used this outside report and its forthright recommendations to garner additional resources and to justify sweeping changes in staffing, operations, and products [5]. Doe continued to serve NLM's predecessor institutions, first on the Committee of Consultants on Indexing for the Army Medical Library (Figure 4) and then on the Armed Forces Medical Library Advisory Group, a precursor of the NLM Board of Regents. She testified before Congress for MLA in favor of the act that transformed the Armed Forces Medical Library into NLM and later worked for NLM's grant-making authority.

Figure 2
Janet Doe, 1949
Figure 3
Colonel Joseph McNinch, M.D., Colonel Frank Bradway Rogers, M.D., 1949
Figure 4
Honorary consultants to the Army Medical Library: John F. Fulton, M.D., Ebbe C. Hoff, M.D., Colonel Joseph H. McNinch, M.D., Sanford V. Larkey, M.D., and Mortimer ...

NLM AND THE HEALTH SCIENCES LIBRARY COMMUNITY IN 1961

By 1961, Dr. Rogers, a physician and a librarian, had been NLM's director for twelve years. NLM was celebrating its 125th birthday and the fifth anniversary of the National Library of Medicine Act. The Board of Regents, then NLM's only advisory committee, included one medical librarian, Thomas Keys of the Mayo Clinic (Figure 5). The staff was getting ready to move the collections from Washington, DC (Figure 6), and Cleveland, Ohio (where the History of Medicine Division was then located) (Figure 7), to a new building (Figure 8) on the campus of the National Institutes of Health in Bethesda, Maryland. NLM was already a high-volume operation known for its innovative use of technology. The request for proposals for a contract to develop the Medical Literature Analysis and Retrieval System (MEDLARS) had been issued, and the contract was about to be awarded to General Electric, using funds provided by the then-named National Heart Institute.

Figure 5
Visit of NLM Board of Regents to construction site, National Library of Medicine, Bethesda, Maryland, April 11, 1960: Warner L. Wells, M.D, William S. Middleton, M.D., Ernest H. Volwiler, M.D., ...
Figure 6
National Library of Medicine (until 1956 the Army Medical Library and Museum), the Mall, Washington, DC
Figure 7
Dudley P. Allen Memorial Library, Cleveland Medical Library Association
Figure 8
National Library of Medicine, circa 1962

In 1961, health sciences librarians were the primary direct users of NLM's products and services. With the exception of those who visited the NLM Reading Room, health professionals, researchers, educators, and students obtained NLM services via another health sciences library. Compared to today, NLM had only a few critical services: Index Medicus, the annual NLM Catalog, historical catalogs, the NLM Classification, Medical Subject Headings (MeSH), and interlibrary loan (ILL). NLM was not yet a major source of training for health sciences librarians, but it did have an internship program, a precursor of today's associate fellowship program. Irwin Pizer, who would deliver the Doe lecture in 1984, was an NLM intern in 1961.

Use of NLM's bibliographic tools and ILL service was not very intrusive; it did not require librarians to change procedures or learn new skills. In contrast, deciding to use the NLM classification or its subject headings in cataloging local collections necessitated substantial effort, changes to existing practices, and staff training [6]. In the preautomated era, there were fewer compelling reasons to adopt the NLM classification or its subject headings, and many health sciences libraries continued to use other systems [7].

In 1961, the state of other U.S. health sciences libraries in academic centers and hospitals was generally poor. Serious underfunding had prevented libraries from keeping pace with the massive increase in biomedical research literature after World War II [8–10]. Nonetheless, the proceedings of the 1961 MLA annual meeting [11] gives an impression of a profession that is optimistic and growing rapidly. There is a sense that increased spending on research, strong interest in translating research into practice, new information technologies, and application of business management principles offer exciting new opportunities to improve the quality of U.S. health sciences libraries and their services.

Evidence of a strong collegial and mutually supportive relationship between MLA and NLM appear throughout the 1961 proceedings and the Bulletin of the Medical Library Association. Dr. Rogers often discussed NLM's plans and problems informally with leaders in the field. In 1961, this meant that he discussed them primarily with library directors from academic centers and large medical societies. Dr. Rogers was elected MLA's vice-president/president-elect and received the Noyes Award in 1961. In recognition of NLM's 125th anniversary, the July 1961 issue of the Bulletin sported a metallic gold cover and included a special NLM section, with an account by Doe herself about the 1943/44 survey of the Army Medical Library and all that had been accomplished since its report was published [12].

In addition to being discriminating users of NLM products and services, health sciences librarians had become accustomed to serving NLM as advisors and advocates. In 1961, Doe and other leaders of the profession knew that their advice and advocacy had helped to make NLM a reality. They looked forward to the expansion of NLM's legislative authority and budget to encompass an extramural program that would improve medical library resources across the country. They were ready to help NLM achieve this goal.

1961–1971

The decade from 1961 to 1971 was the era of Martin Luther King, Jr., the Vietnam War, and Woodstock. It finished up with the Watergate break-in. In 1963, MLA established the Federal Relations Committee, a precursor of today's Governmental Relations Committee, in part to advocate for the establishment of NLM's extramural authority.

Martin Cummings, M.D., assistant director for extramural programs at the National Institutes of Health, succeeded Dr. Rogers as director of NLM in 1964. With this change in NLM leadership, Dr. Brodman, then MLA president-elect, suggested setting up an MLA/NLM liaison committee, because she thought something more formal “than having a gin and tonic with Brad Rogers” [13] might be necessary.

NLM's mission and programs expanded dramatically under Dr. Cummings's leadership. In 1964, NLM implemented MEDLARS and began batch search services. In 1965, Congress passed the Medical Library Assistance Act (MLAA), which gave NLM authority to award extramural grants and the mandate to establish the Regional Medical Library (RML) Network, now known as the National Network of Libraries of Medicine (NN/LM). NLM's Toxicology Information Program began in 1966. In 1967, the National Medical Audiovisual Center was transferred to NLM from the Communicable Disease Center in Atlanta, and the first RML was established at the Countway Library of Medicine in Boston. In 1968, NLM's fledgling internal research and development program was officially named the Lister Hill National Center for Biomedical Communications. That same year, NLM was sued by the Williams & Wilkins publishing company for “systematic copying” of journal articles. As T. Scott Plutchak recently reminded us [14], NLM's contention was that all of its ILL activity fell within the realm of “fair use” and was therefore permissible under U.S. copyright law. In 1970, the eleventh and last RML in the first set was established at the McGoogan Medical Library at the University of Nebraska.

NLM AND THE HEALTH SCIENCES LIBRARY COMMUNITY IN 1971

By 1971, the easy collegiality between NLM and health sciences librarians was gone, a victim of the NLM extramural program,§ which the library community had so strongly advocated. There is a built-in tension—and a requirement to maintain a certain distance—between a funding agency and its grantees and contractors. In 1971, the funding relationship between NLM and health sciences librarians was still new and quite uncomfortable for those who remembered previous informal collaboration with the NLM senior staff.

The purpose NLM defined for its extramural program, “to evolve a national information apparatus founded on existing medical libraries” [15] was not seen as a problem nor were the objectives for the various types of grants. In fact, the 1966 description of these objectives seem remarkably forward thinking. For example, NLM urged “examination of the possibility that … the library … be designed for the recovery and transmission of information to scholars at the point of use” [16]. As is frequently the case, the devil was in the implementation details.

In the early years of NLM's grant program, competing with peers for grants was a new experience for many health sciences librarians. In 1966, NLM announced plans to provide assistance for the construction of forty to fifty libraries [17], and many proposals were received. Unfortunately, the appropriated funds covered only eleven library construction projects [18]. Library directors in institutions that did not receive construction funds were understandably upset. Few of the librarians competing for any NLM grant would have previously served on federal grant review committees. Some were highly suspicious of the process used to select the winners.**

Problems that arose between NLM and the health sciences library community over construction grants, resource grants, and research grants were destined to diminish, if never to disappear completely, as everyone, including NLM, became more comfortable with the grant process. In any event, these problems pale in comparison to the upheaval caused by the implementation of the RML program. Most of the objectives of the RML program sound uncontroversial, such as, “to provide prompt access by any health researcher, practitioner, or student of the health sciences in the United States to library materials he may need and to equalize opportunities for access despite accidents of geographic location” [19]. The initial regional configuration was not dictated by NLM, but was to be determined by librarians and health professionals in the field. The general strategy—to strengthen the resources of existing institutions and to build on existing cooperative service patterns among health sciences libraries—seem eminently reasonable. Grant funds were to be used to subsidize document delivery. So what was the difficulty?

Bunting's excellent history of the network [20] provides the details; I will just hit the highlights. At bedrock, the implementation of the RML network required academic health sciences librarians to work with people and institutions they had never worked with before, to adhere to policies they might not agree with, to serve users outside their customary clienteles, and—maybe worst of all—to make changes in internal procedures. To give a concrete example, many academic libraries could no longer send ILL requests directly to NLM after the regional configuration was put in place. Given the level of appropriations NLM received for the program, each regional medical library had to be responsible for a large multistate region (Figure 9). Existing cooperative arrangements among medical libraries were more loosely defined and generally on a smaller scale. The Regional Medical Programs [21], which were initiated at roughly the same time by a companion piece of legislation,†† covered much more restricted geographic areas (Figure 10).

Figure 9
Regional Medical Library Network 1967–1981
Figure 10
Regional medical programs

Absent relevant models, it was not surprising that there were major disagreements on how to proceed, not just between NLM and academic health sciences librarians, who were chiefly involved in planning the initial programs, but also between leading librarians in the field. In some regions, competition to become the RML was intense, an added source of stress that remains with us today. NLM was the RML for the Mid-Atlantic states, which was seen as a distinct disadvantage by the academic health sciences libraries in that region.

While libraries in a given region worked toward agreement among themselves, NLM quickly became convinced that some basic level and quality of service should be uniformly available in all parts of the country. NLM expected the RMLs to provide document delivery service for health professionals who currently lacked access to a medical library. NLM also wished to establish uniform policies regarding its own back-up role in the network and RML service standards for MEDLARS searches and ILL. From the librarians' perspective, there were far too many occasions when NLM essentially dictated how network programs would operate.

NLM had been a federal agency for all of its long history, but it was not until the passage of the MLAA and the initial implementation of the library network that some health sciences librarians began to see NLM as the embodiment of the insensitive and misguided federal bureaucracy interfering in local affairs. As Bernice Hetzner, the first director of the RML for the Midcontinental Region, commented “some people involved in the regional library program looked upon the National Library of Medicine as an adversary …. In fact, one region threatened to secede from the whole system” [22]. Some directors of large medical libraries resented the fact that NLM's top management team, which in 1971 included no librarians, did not give greater weight to their professional counsel. Some were offended by the notion that NLM funding should influence the way services were provided in their institutions. At varying levels of intensity, these views have remained part of the substrate for NLM's interactions with health sciences librarians ever since. In 1971, as in subsequent years, there were strong personalities on all sides. Hetzner was one of the very few diplomats involved in the process. I am not sure there were any at NLM.‡‡

During the 1960s, the addition of new NLM programs brought new categories of direct users of NLM services, but in 1971 these additional groups had relatively little impact on NLM's interactions with health sciences librarians. While the RML wars were being fought, NLM had been developing new services that were generally seen as advantageous to librarians, although they also increased the number of points of potential friction between NLM and the field. Responding to repeated requests from the MLA-NLM Liaison Committee, in 1971, NLM offered its authoritative cataloging and indexing data in multiple forms. NLM's cataloging records also became available via a commercial catalog card service in 1971. The rapid availability of NLM cataloging data had a standardizing effect on cataloging practices in health sciences libraries. Increasing numbers of libraries switched to the use of the NLM classification and MeSH [23]. In turn, the growing reliance of health sciences libraries on NLM cataloging copy would have a substantial effect on NLM's cataloging decisions over the next three decades and on its contributions to national bibliographic standards. In 1971, many recurring bibliographies were published from MEDLARS in addition to Index Medicus. Abridged Index Medicus had finally been launched in 1970 with MLA's cooperation, following years of prompting from MLA members. In April 1971, the MEDLARS tapes became available on subscription. The Lister Hill Center's successful AIM/TWX experiment, which demonstrated the viability of online retrieval via nationwide communications networks, led to the implementation of MEDLINE on the ELHILL retrieval system in October 1971.

Both AIM/TWX and MEDLINE built upon the experience of the State University of New York (SUNY) biomedical communications network, which had provided online access to MEDLARS data for a limited number of libraries since 1968 [24] (Figure 11). This was a spectacular example of a recurring pattern in NLM's interactions with other health sciences libraries. NLM has often obtained good ideas from successful local or regional initiatives led by health sciences librarians. A notable early instance was the use of the general arrangement of Eileen Cunningham's classification, when the NLM classification was developed in the late 1940s [25]. Usually when an idea is coopted in this fashion, NLM changes some parameters and many implementation details to accommodate the larger national scale and to build on previous investments in related NLM products or services. This process is positive and healthy, but it has a bittersweet side. The national implementation may exclude helpful features that cannot be scaled up efficiently. As time goes on, the successful NLM service may obscure the contribution of the pioneers who preceded it.

Figure 11
Irwin Pizer, Bertha Izyk, and Richard Fenzl, Ph.D. (left to right). Originally published in the Upstate Medical Center Newsletter1968 Oct 9;8(2). Used with permission.

NLM's direct involvement in training health sciences librarians had gradually increased in the 1960s. The NLM internship program had been revamped into the associate program but still involved only a few good people each year (Figure 12). Beginning in 1965, a relatively small number of librarians from MEDLARS search centers in other U.S. and international institutions came to NLM for months to learn batch searching using punched cards. The first two MEDLINE online searching classes were held at NLM in the fall of 1971 (Figure 13). These classes were three weeks long. Although NLM's big involvement in direct training of librarians lay just ahead, the library had been a significant funder of education since the passage of the MLAA in 1965. In 1971, a total of 112 people received training support through seventeen NLM-funded training grant programs, including master's degree programs in library science, post-graduate library internship programs, and doctoral programs. Nearly all of the trainees were librarians [26].

Figure 12
1970/71 NLM associates, Jane Port, Daniel T. Richards, Dorothy Moore, and T. Daniel Tonkery, with Joseph Leiter, Ph.D., (far left) and Carol Long (far right)
Figure 13
Early MEDLINE training class, with NLM staff, 1972: Davis McCarn, Clifford Bachrach, M.D., William Caldwell, Mary Louise Gladish, Grace Jenkins, Philip Arberg, Robert Murphy, Cathy Gallagher, Barbara Greehey, and Virginia Miller (standing ...

In 1971, health sciences librarians still served NLM as advisors. In NLM's formal structure, Hetzner and Susan Crawford, then of the American Medical Association, joined NLM's Board that year (Figure 14). There were medical and other librarians on the Biomedical Library Review Committee, which reviewed NLM grant applications, although many health sciences librarians were apparently unaware that their profession was represented in NLM's grant review process.

Figure 14
Meeting of NLM Board of Regents at the National Medical Audiovisual Center in Atlanta, 1972: Faye G. Abdellah, Ph.D., Capt. Edward J. Rupnick, M.D., James Pittman, M.D., Harve J. ...

In MLA's formal structure, the MLA-NLM Liaison Committee was in full swing. It had two all-day meetings with Joseph Leiter, Ph.D., then NLM's associate director for library operations, and other senior NLM staff members in 1971. Both technical and policy matters were discussed, and the frustration and irritation on both sides came through in the committee's annual report.

“The committee believes more written information on NLM polices, activities, staff, programs, and plans is very much needed.” Dr. Leiter commented that

communication is a two-way street; when information is needed the librarians should ask for it—all letters to NLM are always answered. … to announce preliminary plans would serve no useful purpose. … Some Committee members believe that even when information is requested the answers are nonproductive or evasive. [27]

NLM's director, Dr. Cummings, was in fact a member of the MLA Board in 1971, just as Dr. Rogers had been in 1961. However, Dr. Cummings saw a conflict of interest with his position as head of the chief funding agency for medical libraries, and he felt constrained from active participation on the board [28]. In retrospect, it was surprising that he agreed to serve at all, although no doubt it would have been a very difficult invitation for him to refuse. The level of animosity toward NLM prompted MLA officers and NLM management to discuss how to move communication between the two organizations to a higher, more productive plane—an approach that would be used again in the future.

As a group, health sciences librarians continued to be strong advocates for NLM and its extramural programs in the political arena, despite the disappointment and anger of individuals in the profession. MLA's Committee on Legislation, as the Federal Relations Committee had been renamed, had a busy year in 1971. In addition to testifying in favor of NLM and MLAA appropriations, it joined forces with the Association of Research Libraries in submitting an amicus curiae brief to support NLM's position on fair use in the Williams & Wilkins case. In 1972, the Committee on Legislation sent a memo to every MLA member urging them to continue current photocopying practices. It said in part:

Libraries may soon be deluged with offers from publishers to provide copyright protection with royalty-paying arrangements. It would seem to be premature to accede to any of these before the Williams and Wilkins case has been finally decided; such action could severely damage the libraries' case and weaken their ranks. [29]

Most health sciences libraries were better off in 1971 than they had been a decade earlier. Institutional support of health sciences libraries had increased in the positive economic climate of the 1960s. Disagreements notwithstanding, NLM's expanding intramural services, the RML program, its extramural funding, and funding from other federal agencies had benefited health sciences librarians. Yet the proceedings of the 1971 annual meeting (Figure 15) and the 1971 issues of the Bulletin indicate that librarians were bracing for a period of retrenchment. The U.S. economy was weak, and government subsidies for research and education had been cut.

Figure 15Figure 15
Social event, 1971 MLA Annual Meeting, New York: Gwendolyn Cruzat, Ph.D., C.K. Huang, [unknown], Jean Miller, [unknown], and [possibly Patrick Brennan], (top picture); Ann Jefferson, Sam Hitt, Lila Pederson, Charles Bandy, ...

1971–1981

The decade from 1971 to 1981 saw the end of the Vietnam War, the resignation of Richard Nixon, and double-digit inflation. It was a much less expansive era for the federal government than the 1960s had been. No major new program areas were added to NLM, but existing activities were modified in ways that had an impact on NLM's relationship with health sciences librarians.

In 1971, NLM established the resource improvement grant, which could be used to help establish new hospital libraries. In 1972, NLM revamped its training grant program to focus on doctoral and post-graduate fellowship training. Funding for master's degrees in library science and library internship programs was eliminated, and a new training program in computers in medicine was established, with physicians as its primary target population. NLM-funded research on workforce requirements by David A. Kronick, Ph.D., and Alan M. Rees indicated a declining demand for new health sciences librarians [30]. The addition of the computers in medicine program was recommended in a 1971 report entitled “Educational Technology for Medicine: Roles for the Lister Hill Center” [31], produced by the Association of American Medical Colleges and commissioned by NLM. The Stead Report, as it was known after its editor, Eugene Stead, M.D., also led to the establishment of AVLINE, as well as other changes in NLM's audiovisual and research programs.

This decade was when the great majority of health sciences libraries went online. NLM built many other online databases—starting in 1973 with CATLINE, SERLINE, and TOXLINE—and instituted charges for online searching to defray growing telecommunications costs. In 1975, NLM implemented consortia grants to stimulate local cooperation, primarily among hospital libraries.

In 1977, NLM's Lister Hill Center began its pioneering and influential work on a minicomputer-based integrated library system appropriate for academic health sciences libraries. The Association of Academic Health Sciences Library Directors (AAHSLD) was established. The first Symposium on Computer Applications in Medical Care was held. It has since become the Annual Symposium of the American Medical Informatics Association.

In January of 1978, eleven hospital librarians, one from each region in the network, met with NLM staff to discuss the needs of hospital libraries and ways hospital librarians could have more input into NLM and regional network decision making. Three past or future MLA presidents were among the “Bethesda 11” as they were sometimes called: Jacqueline D. Bastille, Barbara Coe Johnson, and Judith Messerle.§§ The meeting led to changes in NLM's plans for online training, serial holdings data, and grant programs, as well as NLM and RML advisory mechanisms. In a statement issued after the meeting, the hospital librarians captured the essence of the enduring communication problem between NLM and health sciences librarians:

Since the environments in which we function and the places from which we come are so different, we feel that regular opportunities for direct communication are necessary if we are to achieve the genuine understanding of one another's problems and concerns that is essential for progress. [32]

As NLM expanded its online training program and the RMLs increased training opportunities in their regions, concern arose over the invasion of MLA's territory as a provider of continuing education (CE) to health sciences librarians. In 1978, agreement was reached that MLA would provide CE opportunities for professional health sciences librarians, sometimes using courses developed by NLM or RML staff; NLM would restrict itself to training in the use of NLM databases and systems; and the RMLs would focus on training for nonprofessionals with responsibility for managing health sciences libraries.

In 1980, NLM completed the functional specifications for MEDLARS III, which was to provide both greatly enhanced user functionality and more rational and integrated data creation and library processing capabilities (Figure 16). The last piece of functionality described in those specifications may have finally been achieved in 2001. One long-term effort that did reach fruition in 1980 was the opening of the Lister Hill Center Building. Lois Ann Colaianni, then MLA president, represented association members in the opening ceremony.

Figure 16
1979 MEDLARS III Task Force: Ben Erdman, Betsy Humphreys, Duane Arenales, Richard Dick, Ph.D., Grace McCarn, John Cox, Laura Kassebaum, Lillian Kozuma, and Joseph Leiter, Ph.D. (clockwise around the table from lower left); ...

NLM AND THE HEALTH SCIENCES LIBRARIANS COMMUNITY IN 1981

Relations between NLM and the health sciences library community were considerably less strained in 1981 than they had been in 1971. During the 1970s, there were no fundamental changes in the relationships between health sciences librarians and NLM, and both sides were more accustomed to NLM's role as funding agency. NLM had introduced many new services, but, with a few exceptions, they could be characterized as much more of what had been available a decade before. NLM's involvement in national bibliographic programs had expanded dramatically. The SERHOLD database debuted in 1981. NLM was now able to generate union lists considered useful by health sciences librarians.

In 1981, health sciences librarians were still the primary user group for most NLM products and services, and they continued to be very discriminating and demanding users. Of course, online databases were more difficult and expensive to use than printed indexes and catalogs; they required librarians to obtain special training and equipment and to implement new procedures. By 1981, a large percentage of health sciences librarians had received training in the use of NLM's online databases (Figure 17). The cadre of former NLM associates working in other health sciences libraries had continued to increase (Figure 18).

Figure 17
1977 MEDLINE training class, Bethesda, Maryland: Michael Homan, Tish Eubank, Debbie Bliss, Elaine Keefer, Jim Myers, and Grosvenor Pollard (left to right front row); Thomas Lange, Lane Price, Mabel Norton, Margaret Horacek, Nena Perry, Julia Speakes, ...
Figure 18
NLM associates, 1981: John Ulmschneider, Katherine Branch, Kevin Beverly, Susan Hawk, and Karen Kameen

Medical informaticians (as they subsequently became known) were now the major beneficiaries of NLM training grants. Since 1978, some research grants had also been focused on computers in medicine, with earmarked funding added in 1980. NLM's grant programs continued to fund developing and testing innovative library services, including circuit rider and clinical librarianship programs.

By 1981, the RML network had improved document delivery considerably and provided training, consultation, and other support to many librarians, especially in hospitals. RML and resource library staff members continued to see NLM's management of the program as heavy handed. The recompetition of the RML contracts continued to be stressful. Resource constraints led to unpopular changes in network programs, such as the gradual phasing out of partial ILL subsidies. In his 1981 Doe lecture, Robert G. Cheshier characterized the Regional Medical Library Program (RMLP) as a bureaucracy “which uses inordinately large parts of the financial resources available to it” and, as then constituted, “an idea whose time has passed” [33]. His views were controversial, and they elicited several letters from hospital librarians in defense of the program. To quote Judith Topper, “One of the great successes of the RMLP … has been to encourage the professional growth of hospital librarians … the RMLP has helped hospital libraries to demonstrate their effectiveness and broaden their user population” [34].

Health sciences librarians continued to serve NLM as advisors. In 1981, James F. Williams, III, then director of the Wayne State Medical Library and an RML director, and Gwendolyn S. Cruzat, professor of library science at the University of Michigan, served on NLM's Board of Regents (Figure 19). Nina Matheson chaired the Biomedical Library Review Committee, which also included several other health sciences librarians. The MLA-NLM Liaison Committee was now responsible for technical and operational issues only. Policy matters were discussed by the NLM director and the MLA Board. In 1981, the committee had few technical issues to raise with NLM staff but continued to organize a session on NLM programs for the annual meeting.

Figure 19
NLM Board of Regents, 1981: Charles E. Molnar Sc.D, Colonel Michael J. Scotti, Eloise E. Clark, Ph.D., James F. Williams, II, John L. Townsend, M.D., Edward Huth, M.D., ...

In 1981, health sciences librarians played a particularly important role as advocates for NLM and its programs. In the early 1980s, some commercial interests viewed NLM's online services as unfair competition for the private sector. This view led to several government studies of NLM's systems and its pricing policies. At the same time, David Kessler, then on the staff of Senator Orrin Hatch (R-Utah), identified NLM's extramural programs as potential candidates for elimination. The combination presented a threat to the NLM budget and the scope of its activities.

At this critical juncture, Mary M. Horres was chair of the MLA Legislation Committee. The outstanding work of her committee, and of the legislative committees of MLA chapters across the country, was invaluable in educating Congress about the importance of NLM programs. In one example, the Legislation Committee arranged for Priscilla M. Mayden, director of the Eccles Library at the University of Utah (Figure 20), and Richard Polascek, M.D., director of the Welch Library at Johns Hopkins, to testify at a hearing chaired by Senator Hatch on April 1, 1981. Following testimony from the Congressional Office of Technology Assessment, Eugene Garfield, Ph.D., of the Institute for Scientific Information testified that NLM's online pricing policy led to unfair competition with the private sector and spoke in support of payment of copyright fees for materials supplied under interlibrary loan. Mayden and Dr. Polascek made statements about the value of the RML program and NLM's extramural programs. In response to a question from Senator Hatch about whether NLM was competing with the private sector, Mayden effectively ended the discussion when she said the following:

what I think I find puzzling is the idea of it being competitive because the services are different. I agree with Dr. Garfield. Dr. Garfield himself, within the last year on the occasion of the 100th anniversary of the Index Medicus, stated that his service and the Index Medicus do not compete but complement one another. I would not dream of trying to run my library without the services of the Institute for Scientific Information. [35]

Figure 20
Priscilla Mayden, circa 1979. Photograph courtesy of the Spencer S. Eccles Health Sciences Library, University of Utah.

1981–1991

The 1980s began with the Reagan revolution in the United States and finished up with the fall of the Berlin Wall and Nelson Mandela's release from jail. Personal computers first arrived in offices and homes in appreciable numbers, and Internet access became commonplace in U.S. research universities. At the end of the decade, the combination of huge federal budget deficits and rising health care costs brought renewed interest in U.S. health care reform and a strong impetus for managed care.

NLM's extramural programs and its online pricing policy survived the challenges of the early 1980s, but the budget for the extramural program was cut early in the decade, and NLM was required to use a more inclusive definition of the cost of access that increased charges for online services. The tight extramural budget led NLM to reduce the number of network regions from eleven to seven in 1982 (Figure 21), thus cutting the amount spent on administrative bureaucracy, as Cheshier had suggested the year before. This was a disruptive change for the seven regions that were combined into three larger ones.

Figure 21
Regional Medical Library Network 1982–1990

Beginning in 1982, the Midcontinental Region implemented Octanet, which built upon the pioneering serials system at Washington University at St. Louis to provide automated routing of ILL requests within the region and to NLM. The Association of American Medical Colleges published the NLM-funded Integrated Advanced Information Management Systems (IAIMS) report that same year [36], and NLM made its first IAIMS awards in 1983.

In 1984, Donald A. B. Lindberg, M.D., a physician and pioneer in the application of computers to medical information, succeeded Dr. Cummings as NLM director and launched another period of great expansion in NLM programs and services. In 1985, NLM implemented DOCLINE nationwide as a free service to RML network members. DOCLINE adopted Octanet's routing table design, which allowed libraries to take advantage of existing reciprocal borrowing patterns. NLM completed its preservation plan in 1985 and subsequently established a new Preservation Section, a major preservation microfilming program, and in 1987 a campaign to increase the use of permanent paper in the biomedical literature. Also in 1985, MLA and AAHSLD formed a joint legislative task force, which complemented the work of what was now known as the MLA Governmental Relations Committee.

NLM celebrated its sesquicentennial anniversary in 1986 and introduced the initial Grateful Med search interface software designed for individuals without search training [37]. The first Unified Medical Language System (UMLS) research and development contracts were awarded [38]. The Board of Regents published the NLM long range plan [39], to which many health sciences librarians contributed. The most dramatic outcome of the planning effort was the legislation that established the National Center for Biotechnology Information (NCBI) at NLM in 1988.

In 1987, the MLA-NLM Liaison Committee was disbanded due to lack of substantive issues to address. As part of the agreement to disband the committee, the MLA Board reserved at least one hour of each annual meeting for an NLM Update.

In 1989, the NLM Board of Regents published an outreach plan, known as the “DeBakey Report” after Michael DeBakey, M.D., the chair of the committee that produced it [40]. The report called for expanded efforts by NLM—and by a renamed National Network of Libraries of Medicine—to reach health professionals who lacked ready access to information services, with special emphasis on those serving rural and inner city populations. As one follow-up to the report, in November 1989, NLM sent a letter signed by Dr. Lindberg to U.S. hospital administrators informing them about Grateful Med. In a mistake that we would undo if we could, this letter did not mention hospital libraries or library services. It elicited a storm of protest from hospital librarians.

In 1990, NLM issued the first purchase orders for Grateful Med outreach projects. The Loansome Doc feature of Grateful Med was introduced to allow individual health professionals to submit document requests automatically. NLM also released the first experimental edition of the UMLS Knowledge Sources [41].

NLM AND THE HEALTH SCIENCES LIBRARY COMMUNITY IN 1991

By 1991, librarians and other information specialists no longer constituted the majority of those who accessed NLM's services directly from remote locations, although librarians continued to use a wider range of NLM services more frequently and heavily than other categories of users. Some librarians thought it was a hostile act for NLM to develop and promote services designed for direct use by health professionals. By my interpretation of contemporary comments, there were at least five underlying concerns:

  1. individual health professionals did not have the time or the inclination to do effective searches;
  2. by implying that health professionals could search effectively on their own, NLM was belittling the expertise of trained librarians and, given the economic picture for hospitals, perhaps threatened the very existence of hospital libraries;
  3. by marketing directly to health professionals, NLM was inserting itself between librarians and their users, offering sometimes different, and less informed, advice on what tools were most useful in the local context;
  4. if health professionals did do their own searching, then librarians would lose a part of their work that had both improved their status and been intellectually challenging and rewarding and would be left with more mundane tasks like document delivery; and
  5. if NLM focused on products and services for unaffiliated health professionals, it would devote fewer resources to helping librarians serve their primary clienteles and to managing other programs that might improve the status of librarians within their institutions.

From this perspective, NLM was adding insult to injury by asking librarians to promote NLM services, to train health professionals outside their primary clienteles, and to provide supporting technical assistance and document delivery service, even if NLM was willing to provide financial support for these activities. Yet involving librarians in outreach had become a major objective for NLM and for the NN/LM, as the RML Network was renamed in 1991. At this point, New England reemerged as a separate region (Figure 22). Those who worked in RMLs during this period had many stories to tell about the level of hostility they encountered from some network member librarians—words like “Gestapo” were not uncommon.

Figure 22
The National Network of Libraries of Medicine 1991 to the present

On the other hand, NLM and the multidisciplinary advisors (including health sciences librarians) who contributed to the DeBakey Report saw the combination of new end-user services and active outreach as a powerful way for NLM to pursue its longstanding goal of enhancing access to medical information by health professionals who currently lacked library service. From this perspective, NLM was taking appropriate advantage of advances in technology to further its basic mission. The assumption was that many health sciences librarians would find outreach to underserved health professionals both personally rewarding and beneficial to their status in their institutions. This eventually proved to be the case [42], but the first librarians who embraced NLM funding for outreach activities received considerable flak from some of their colleagues.

On top of more basic concerns, some health sciences librarians resented “NLM's cutesy naming tendencies,” as they have been called on MEDLIB-L. Some also disapproved of expanded NLM publicity, which they saw as overstating NLM's contribution at the expense of theirs and exaggerating the utility of some NLM products. Complaints about NLM's overblown publicity go back at least to 1975, when Harold Bloomquist referred to the “hucksterism” surrounding MEDLARS in his Doe lecture [43], but NLM increased publicity efforts in the late 1980s as part of its outreach strategy.

Of course, health sciences librarians are not a homogeneous group, so whatever NLM does, some librarians applaud the substance of what others deplore. In 1991, NLM's activities were probably viewed more favorably by many academic librarians than by hospital librarians, although those in privately funded institutions were generally not interested in outreach. In academic environments with good networks, Loansome Doc could be used by affiliated faculty, staff, and students to request documents from offices, homes, or clinical rotations. Other high-profile NLM initiatives—like IAIMS; NCBI, which introduced the Entrez retrieval software in 1991; UMLS; and NLM's new participation in the multiagency High Performance Computing and Communications (HPCC) Program [44]—were seen as having important potential benefits by academic librarians. Librarians might play important roles on multidisciplinary teams in all these areas. It is interesting to note that several of the 1991 participants in the NLM associate program moved directly into multidisciplinary research and development projects after finishing the program (Figure 23). At this juncture, some health sciences librarians thought that NLM should do more to promote the education and training of health sciences librarians for these and other new roles.

Figure 23
NLM associates, 1991: Denise Radow, Jeffrey Bridgers, Anna Harbourt, and Leona Coffee

In 1991, NLM's official advisory structure included many health sciences librarians: Beverly E. Allen, Rachael K. Anderson, and Wendy N. Carter on the Board of Regents (Figure 24); seven on the Biomedical Library Review Committee; and Pat L. Walter on the more recently formed Literature Selection Technical Review Committee. NLM's Board and its management agreed that the library should look for ways to highlight NLM services to librarians and should take visible action to underscore the importance of librarians in enhancing access to health information. The 1992 satellite broadcast on the importance of information services and librarians in the hospital environment was one such action [45] (Figure 25). On MLA's side, the MLA-NLM Liaison Committee no longer existed, but MLA established a Task Force on MLA/NLM Collaboration in 1992, chaired by Susan Russell Lessick, echoing the approach used in 1971 to address strained relations between NLM and MLA members.

Figure 24
NLM Board of Regents, 1991: Robert Kahn, Ph.D., Rachael Anderson, Joseph Howard, Don E. Detmer, M.D., Wendy Carter (front row); Kathleen McCormick, Ph.D., Ronald E. Cape, Ph.D., ...
Figure 25
Information Stat! Green room photographs: left photo: Alison Bunting; top photo: Bernie Todd Smith, Gertrude Lamb, Ph.D., and Trudy Gardner, Ph.D. (left to right), Donald Lindberg, M.D., and Daniel Masys, ...

1991–2001

The 1990s saw the failure of the Clinton health care reform initiative, the rise of managed care, the closure and merger of many hospitals and hospital libraries, and changes in Medicare reimbursements that had a negative impact on academic health sciences centers. Y2K and health data standards and privacy regulations mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) became significant issues in the information technology departments of health care organizations. The Internet, the Web, and electronic full text influenced NLM's services and its interactions with health sciences librarians.

In 1992, NLM initiated its Internet connections grant program, the week-long Woods Hole medical informatics course, and applied informatics fellowships, which offer a format and stipend attractive to some practicing librarians. Congress established NLM's National Information Center on Health Services Research and Health Care Technology in 1993. In 1994, NLM put up its first Website, released the first Visible Human [46], and started the system reinvention project that would eventually replace all of its legacy systems. That same year, NLM began funding AIDS information outreach projects and applications of High Performance Computing and Communications.

In 1995, NLM used funds from its AIDS information budget to provide free access to the AIDS databases. Building on MLA's educational policy statement, the NLM Board of Regents published the report of its Planning Panel on Education and Training of Health Sciences Librarians. NLM then issued a set of challenge grants to support planning of innovative education programs for health sciences librarians.

In 1996, Internet Grateful Med was launched. PubMed and “free” Internet access to MEDLINE followed in 1997. Free access arrived just in time to facilitate outreach to traditionally underfunded public health professionals. In 1997, NLM funded health applications of the National Information Infrastructure, emphasizing evaluation of the impact of telemedicine and approaches to protecting electronic patient data.

By 1998, NLM had announced that the PubMed retrieval system, Entrez, would replace ELHILL as NLM's basic retrieval system for MEDLINE and other citation data. This announcement caused great concern among librarians, given the then-current state of PubMed features for expert searchers. In April 1998, NLM hosted a meeting of expert searchers from every region to discuss specific deficiencies and develop strategies for addressing them. As had occurred twenty years earlier with the hospital librarians' meeting, all the participants found the interchange valuable and it led to many enhancements in PubMed and Internet Grateful Med.

Once NLM's databases were free via the Web, the general public became a significant NLM user group. In 1998, NLM initiated a pilot consumer health project that paired health sciences libraries with public libraries and launched MEDLINEplus, a Web information service especially designed for the general public. After assessing the results of the librarian education challenge grants, NLM added a second fall session to the Woods Hole course, expanded the NLM associate program, and added more slots for librarians to some of NLM's medical informatics training center grants.

Online access to ELHILL ended in September 1999. By that time, at least 93% of network members had Internet access, thanks in part to special efforts by the Regional Medical Libraries. Web-capable workstations and connections supported access to new NLM services, including Profiles in Science and ClinicalTrials.gov. In 2000, NLM awarded more than fifty consumer health outreach projects involving health sciences libraries in NN/LM, a new DOCLINE system was released, and PubMed Central debuted.

NLM AND THE HEALTH SCIENCES LIBRARY COMMUNITY IN 2001

Readers may be the judges of the status of interactions between NLM and health sciences librarians in 2001, but they are definitely less contentious than in 1991. There was no fundamental change in the range of relationships between librarians and NLM during the 1990s. Once again, the recompetition of the Regional Medical Libraries has recently been a source of strain. NLM's services have migrated to the Web, and there are many more of them. PubMed LinkOut and PubMed Central are the most visible of NLM's efforts to grapple with organizing and ensuring permanent access to digital information. NLM now sees daylight on its multiyear system reinvention project, which will totally replace the systems that support NLM's basic services and its internal operations. Because many NLM systems are integral to the work of health sciences librarians, their reinvention has caused unwelcome ripple effects in libraries across the country.

During the 1990s, NLM increased its support for training and educational opportunities for health sciences librarians (Figure 26). NLM has also partnered with MLA to increase scholarship opportunities for minority library students and to expand minority recruitment to the field. NLM's new strategic plan includes examination of the need for specialist librarians in such areas as bioinformatics, clinical informatics, and health policy [47]. Work is already underway to develop courses that would equip librarians to train students and researchers in the use of NCBI's advanced genomic information services.

Figure 26
NLM associates, 2001: Tao You, Marlo Young, Jennifer Heiland, and Janice McPeak (back row); Amy Seif, Lou Duggan, and Tomeka Oubichon (front row)

Perhaps the most significant development of the 1990s was the addition of the general public as a target group for some NLM services. The new services and support for outreach to the general public have been applauded by health sciences librarians, some of whom have been serving patients and their families for decades. PubMed Central has been welcomed as a potential part of the solution to permanent access to electronic biomedical literature.

In 2001, librarians serve with distinction on five NLM advisory groups (Figure 27), including the Lister Hill Center Board of Scientific Counsellors and the PubMed Central National Advisory Committee. NLM continues to receive outstanding support from MLA's Governmental Relations Committee and from the MLA/Association of Academic Health Sciences Libraries Joint Legislative Task Force. In the era of digital information, copyright and intellectual property rights demand continuing attention from NLM and all health sciences libraries, as do many other information policy issues, including privacy and security. Once again, NLM needs a new building, and the health sciences library community is helping to educate Congress about its importance to NLM programs and services.

Figure 27
NLM Board of Regents, 2000: Herbert Pardes, M.D., Alison Bunting, Enriqueta Bond, Ph.D., Wendy Carter, Michele Klein-Fedyshin, and Pamela Andre (front row); John Gage, Joshua Lederberg, Ph.D., Raymond J. ...

“WE ARE ALL IN FAVOR OF PROGRESS … IT'S CHANGE WE DON'T LIKE”***

My review of the past forty years has led me to the unsurprising conclusion that the greatest friction between NLM and health services librarians occurs when there is a fundamental change in the way NLM carries out its mission—a change that adds to the web of relationships that link librarians with NLM and prompts corresponding changes in the way other libraries do business. Between 1961 and 2001, there were two such fundamental changes: the implementation of the National Network of Libraries of Medicine and the development and promotion of services targeted toward individual health professionals.

On a lesser scale, each new service that connects NLM and health sciences librarians is another potential source of irritation, ready to flare up when the service is interrupted, changed, or eliminated. Even a slight and positive shift in the NLM infrastructure that supports daily activities in other libraries can have short-term seismic effects on local services and operations, especially because other health sciences libraries have little or no control over the timing of the changes. Other factors—including strong personalities, mistakes, and poor communication—add to, but do not cause, the intermittent problems between NLM and its most loyal and engaged user group.

These problems are in essence the price we pay for the leadership and vision of NLM's directors and for NLM's success in developing excellent services and in enhancing them based on advice from librarians and other users. If NLM continues to lead and to provide services that are important to other libraries, then we can count on a future that includes episodes when some health sciences librarians will be temporarily at odds with NLM. There will be lots of change in our collective future as the electronic health record meets the digital library and genomic information becomes ever more critical to science and medicine. But we have survived and prospered through major changes before. If we continue to work at it, the relationship between NLM and health sciences librarians should prove to be as resilient, and as productive, as it has been for the last four decades.

Acknowledgments

I thank Roma Samuel for extensive document location and reference assistance, Joe Fitzgerald for graphic design and production of the timeline and maps, and many other colleagues at NLM and elsewhere for assistance in locating photographs and individual documents.

Footnotes

* The Janet Doe Lecture on the history or philosophy of medical librarianship, presented at the 101st Annual Meeting, Medical Library Association, Orlando, Florida, on May 28, 2001. 2000 Janet Doe Lecturer Judith Messerle, director, Francis A. Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, gave the introduction. The lecture was illustrated with numerous photographs and charts, of which only a few have been printed here. The complete set are linked to the electronic version of the lecture available on PubMed central, when this article is archived.

 In 1975, the National Library of Medicine (NLM) was only beginning to automate internal serials processing functions. Other health sciences libraries—for example, the Medical Library Center of New York, University of California at Los Angeles, and Washington University at St. Louis (Dr. Brodman's institution)—were pioneers in serials automation.

 Marshall directed the medical library at Tulane University. The other three members of the committee were: Keyes D. Metcalf, Harvard University; L. Quincy Mumford, New York Public Library (later librarian of Congress); and Andrew D. Osborn, Harvard University.

§ From 1966–1970, NLM expended $40.8 million under the Medical Library Assistance Act: 28% for resource grants, 28% for library construction, 15% for research and development, 12% for the Regional Medical Libraries, 11% for training, and 6% for publications.

** In an MLA Oral History interview conducted in 1987, Dr. Cummings commented of this time period that “one of the low points of my participation in any MLA meeting is when one of your officers got up … and simply said that the NLM grant review mechanism … was a mess of porridge or something like that.” (Oppenheimer G. Medical Library Association Oral History Committee interview with Martin M. Cummings [transcript]. 1987:23.)

†† The Regional Medical Library Network and the Regional Medical Programs were “Great Society” programs that were given impetus by the President's Report on Heart Disease, Cancer, and Stroke produced by a committee chaired by Michael E. DeBakey, M.D., in 1963.

‡‡ In an MLA Oral History interview conducted in 1988, Erika Love recalled that Dr. Cummings said “Don't kill the goose that lays the golden egg” in a speech at an MLA annual meeting. (Porter S. Medical Library Association Oral History Committee interview with Erika Love [transcript]. 1988:41.) NLM was concerned that the relative dearth of applications for some categories of grants and criticism of its administration of the grant program would jeopardize future authorization and funding.

§§ Marilyn Gibbs, Sara Hill, Kay Kammerer, Jane A. Lambremont, Faye Meyn, Alice J. Sheridan, Betsy Schreder, and Judith M. Topper also participated in the meeting.

*** Attributed to Will Rogers.

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