On the Uses of Diversity* BY DAVID BISHOP, Director
Library ofMedicine University of Nebraska Medical Center Omaha, Nebraska ABSTRACT An examination is made of the uses of diversity in medical library activities and personnel. This concept is extended also to the broader field of librarianship and to some forecasts of future directions for medical libraries.
IT is an honor to stand before this association to present the Janet Doe Lecture for 1976. It is also an honor to be introduced so warmly by a colleague whom I have so long admired.t I have never known how to respond to this type of introduction, to this mixture of biography and flattery. I thought it was time I learned how. In search of an answer, I went, by devious routes, to the writings of a seventeenth-century Spanish Jesuit, Baltasar Gracian y Morales. Here is what old Baltasar (as I've come to think of him) has to say in one of his maxims: Never talk of yourself. You must either praise yourself-which is vain-or blame yourself-which is littleminded. It ill beseems him that speaks, and ill pleases him that hears. And if you should avoid this in ordinary conversation, how much more ... in public speaking, where every appearance of unwisdom really is unwise
(1].
Librarianship. History is rampant. I hope, then, that I will be forgiven for focussing more on some philosophical aspects of our present and our future than on our past. In the spirit of the times I will try, at least, to put my reflections in a historical context. To begin, I thought it might be of passing interest to you to know how one goes about giving a Janet Doe Lecture. First, of course, one is asked to. One's immediate reaction to this invitation-or mine at least, and with all respect to my predecessors-was "Dear God, I've joined the dinosaurs." Well, perhaps so. It happens that when I had that reaction, I was trying (unsuccess-
fully) to read James Michener's Centennial. This documentary novel, as many of you know, sets its roots way back in time, and Mr. Michener had this to say of dinosaurs: Long after they disappeared ... it would become fashionable to make fun of the great reptiles.... The lumbering beasts would be held up to ridicule as failures, as inventions that hadn't worked.... Facts prove just the opposite. The giant reptiles dominated the earth for 135,000,000 years.... [They] remain one of the most successful animal inventions nature has provided. They adjusted to their world in marvelous ways and developed all the mechanisms required for the kind of life they led
Heaven forbid that I should give any "ap- ... [2]. pearance of unwisdom" before this audience. We This may not be an exact description of Doe will speak no more of my biography and backbut it will suffice. It also takes care of Lecturers, ground. I hope you will bear with me, though, if an reaction. first the Unfortunately, a second reacoccasional personal note does creep into this Janet It is a cry from the heart: follows. tion closely Doe Lecture. to I "But have nothing say." I wish I were a match This year of 1976, as we all know almost ad ideal person, the one with Bronowski's Jacob for nauseam, is one of great symbolic importance in the creative of truth, and a sense the habit mind, the history of the United States, and in the history or she would have much He human of dignity [3]. of librarianship in this country. In our own smaller to tell us. But most of us mere mortals, faced with world, it is also the tenth year of the Janet Doe the injunction to say something, stand ingloriously Lectures on the History or Philosophy of Medical mute. But again, my peculiar reading habits came to *The Janet Doe Lecture on the History or Philosophy of Medical Librarianship, presented June 15, 1976, at the rescue. In the proceedings of a symposium on the Seventy-fifth Annual Meeting of the Medical Li- the creative process I ran across the following brary Association, Minneapolis, Minnesota. Albert Einstein and the French poet tThe speaker was introduced by Scott Adams, a anecdote [4]. found themselves at a reception in Valery both former President of the Medical Library Association. Bull. Med. Libr. Assoc. 64(4) Oct. 1976
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Paris. Valery seems to have had a consuming ourselves, that we would scorn a narrow uniinterest in the process of intellectual creation, and formity. Total sameness-"library cloning," if buttonholed Einstein immediately. How, he you will would be dull at best. Our work takes us wanted to know, did Einstein go about his work; close enough to biology to see the dangers of clonplease tell him about it. Einstein was rather vague, ing. We can agree that "if we have learned anymentioning that he did start every day by going thing from studies on evolution, it is that a highly out in the morning for a walk. Ah, pounced Va- varied gene pool confers adaptability and survival lery, and of course he took a notebook with him so value upon a species. One of the effects of ... that he could jot down the ideas that came into his cloning would . .. be reduction of the variability of head. Well, no, Einstein admitted, he didn't. Va- the ... gene pool" [6]. lery was crestfallen: "You don't?" "Well, no," Ah, yes. We all favor plenty of variability in the said Einstein, "You know, an idea is so rare." library gene pool. But we must, of course, strive And indeed it is. But with James Michener and for, say, cost-effectiveness. And if a cost-effective Albert Einstein behind one, how can one say procedure is demonstrated by one, then it should "No"? So one becomes a Doe Lecturer. And must be adopted by all. And if a "core list" works in then find a topic. The limits are set. The topic Long Island, it must of course work in San Mateo. must be on the history or philosophy of our And if "measurable learning objectives" are a profession. If one is not a historian-as I am retrieval dimension needed by some, they may as not-one must willy-nilly become a philosopher. well be used by all. Or if, in the world of interlibrary loans, "hierarchical referral," seen large, is IN PRAISE OF DIVERSITY most effective, then it will be most effective, too, My topic itself was chosen in a fit of pique. At of course, seen small. the time, I was annoyed with some of our friends Of course we approve of diversity. We just don't at the National Library of Medicine. I thought want to practice too much of it. Fortunately, we're they were attempting to impose a needless uni- a lethargic group on the whole and we don't take formity on one aspect of the healthily diversified action against the not-too-diverse. Oh, the regional medical library programs. As it happens, bookmen mutter about audiovisuals, and the AVI was mistaken. But my question to myself types talk of "media" and sometimes forget that "Don't they know the uses of diversity?"- print is a medium too. But they live in semistayed with me, and grew. Here, at last, was a harmony, or at least in contiguity. So, too, the topic, one on which some reflection might well computer people may scorn the scribblers, while profit us all. the conscientious reference librarian worries over But would it fit? Consider the Doe Lectures we the mistaking of a limited computer-based file for have had: Annan on our history, Rogers on subject the dawn of universal bibliography. But they work analysis, Brandon on academic status, Brodman side by side. on excellence, Adams on innovation and The hospital librarian calls for recognition of MEDLARS, Darling on certification, Felter on the value of her or his role; the academic medical cooperation, and Bloomquist on fadism. Here is librarian nods agreement and ponders the criteria diversity enough to make the very word the hall- for academic promotion. But they work together. mark of the lectures. The clerk at the circulation desk wonders what on And would it honor Janet Doe? The time has al- earth the regional library office does; the regional ready come, foreseen by Harold Bloomquist just director gives little thought to the irate nursing last year, when "there will be a Doe Lecturer who student gloriously cursing the missing issue. But probably will never have had the opportunity to together, these librarians deliver documents. have met or known Miss Doe" [5]. 1 shook her Sometimes, the diversity appears to get out of hand but once and know her not at all. But from hand and threaten an accepted unity. Then we do all that I know of her, I know her talents to have take action, if only by setting up a committee to been as diverse as her thoughts are incisive. study the "problem." We can set up all the comReflections on the uses of diversity do no dishonor mittees we wish to see if that group is good for the to her legacy. MLA, or this group is bad for the MLA. But I must establish right away that I am not setting people are going to do what they feel they need to up a straw man whom it would be easy, but no do. If a group of catalogers entranced by OCLC honor, to knock down. I am sure we are all con- terminals or a group of uncategorized librarians vinced that we approve of diversity among as worried about population graphs as about Brad-
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ford curves-wants to get together, they will, and there is nothing that can be done to stop them. So we may as well make a virtue of it. And, in fact, there is virtue in it. For, in truth, in diversity lies unity, and the only true unity is in diversity. I am not propounding anarchy. Diversity within a profession is variety within a framework. We cannot be all things to all men, but medical librarians must be many things to many people before our course is run. MEDICAL LIBRARIES: HISTORICAL VIEW Let us consider our roots. We are an old profession, but a new specialty within it. The libraries of ancient and not-so-ancient times served only an elite. Only the elite, after all, could read. Then there came, in this country, the Jacksonian revolution: the franchise was extended to the workingman (provided, of course that workingman meant man, and not woman, and, of course, that he was white). There came, too, at this time the workingmen's libraries of Manchester and Boston. Only then did libraries, however hesitatingly, enter the world of the common people. When our own specialty was begun, it too began as libraries for an elite-the physicians and surgeons of our society, who had a smattering of poor Latin but a groping towards a scientific basis for their calling. We perhaps forget how recent we are, yet as late as 1887, John Shaw Billings could say: ... we are all learning gradually how to use medical libraries, and in a few years more I predict that the wonder will be how we ever got on without them [7].
A good prediction. Yet we all know that it was not until 1937 that medical bibliography courses were begun for librarians, and not until 1942 that the first professional librarian was hired to work at the National Library of Medicine [8]. No wonder, then, that our own Jacksonian revolution-our own diversification of medical libraries beyond the elite-is a thing of living memory and present debate. And what diversification we are seeing! Some of the great private libraries, both society and
academic, have survived, generally by broadening their base to serve more than the doctor of medicine. New academic libraries have been founded, almost all of them including more of the health sciences than medicine alone. "Doctors' libraries" in hospitals, many with long histories of Bull. Med. Libr. Assoc. 64(4) Oct. 1976
their own, have become or are becoming hospital libraries serving the whole gamut of health-care personnel. It is hardly surprising, then, that we have seen diversification too, among ourselves. We have still the one-person library where the sole librarian must try to give "primary care" across the whole range of our services. (What an unsung hero or heroine he or she is, manning these outposts, meeting those needs that can be met from limited resources, sending for reinforcements when necessary-and, as a group, forestalling an invasion by information-hungry hordes before whom the larger centers would quickly crumble.) At the other end of the spectrum is the research librarian whose expertise is in toxicology and the manipulation of TOXLINE, subspecializing in the area of on-line bibliographic services, itself a subspecialty of medical reference work, itself a subspecialty of medical librarianship, itself a specialty within the library profession. There is an obvious danger here. Too narrow a specialization could lead to what Lee Thayer bitingly attacks as "the functions of incompetence" [9]. Yet specialization is a rational response to complex needs. The answer is to see our specialization as being part of and within a unified whole. The things we do select, acquire, record, organize, store, preserve, retrieve, and disseminate-are simple enough to list. But they are complex to do. To carry out this complexity of activities for a multiplicity of clienteles, it is no wonder that we have diversified, nor that we shall diversify further as complexity increases. It is my thesis that health-information services will grow more complex, that even greater diversity will be needed among us in our future. MEDICAL LIBRARIES: THE FUTURE Let's try to see part way into that future. If the past is prologue for our present, our present is prologue for the future. It is not difficult to foresee some continuity. I have, for example, little patience with those who speak of the death of the book. It isn't dead, and it isn't dying. It's a very resilient and, indeed, rather remarkable technological invention. In serving three functions, as a mechanism for specific information recall, as a source for guided learning, and as a stimulus to thought and reflection, it is a hard tool to beat. It got beaten, of course, as a carrier of new information, by the codex-format journal, which for centuries now has taken pride of place as the
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source of the latest information. And it has been joined, in these past few decades, by another dimension in guided learning, the whole complex of audiovisual instructional aids. But these three live, it seems to me, in a healthy, if evolving, symbiosis, without mutual threats of extinction. I have little patience, too, with those who, suffering from historical myopia, speak of the present time as the post-industrial era, or even the Age of Information. We still are very firmly within the Industrial Revolution. The application of science and technology to our daily lives has not ceased; we have not yet finished establishing the unity of nature, let alone the family of man. Nor does our society, present or immediate future, run on information systems. It runs on the extraction of wealth from the land and the sea, on the processing or manufacture of that wealth, on its transportation and its commerce. Formal information systems are indeed one of the lubricants for the complex machine that society has made of these processes and their attendant human needs. But they are not the machine itself, and it behooves us to remember what a small part we play. In case we should be feeling too uppity, remember these chilling words from Albert Szent-
Gyorgyi: I am very ignorant of scientific literature and so, in an hour's time spent in the library, I could find more knowledge that is new to me than I can find at my workbench in a month or a year. All the same, most of the time I sit at my bench and not in the library. It is not knowledge, but new knowledge which attracts me, creating something that was not there before [10].
In his recent book on science and society [11], John Ziman helps put this in perspective for us. He agrees that new ideas come only from individuals-mulling over old concepts, reassessing the known in the light of the unknown. But for the three uses of scientific knowledge-the creation of new knowledge, the social use of physical resources, and the solution of social problems for all of these, information is useless, Ziman reminds us, unless it is communicated. There, and there only, is the heart of our profession. With these caveats in mind, let us look at where we are going. I take it as established fact that our society and its information needs are growing ever more complex. The Industrial Revolution grows in technologic complexity: it does not become simpler. I take it as an equally established fact
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that many people feel alienated by this technology: they wish for individual needs and worth to be recognized, for this technological complexity to be somehow brought to human scale, for man, not the machine, to be the measure. Our society is bearing these two seemingly conflicting trends into its future, and our profession is carried with them. What is also being carried is the seemingly endless growth of scientific information. Our stacks and ourselves are already groaning under its weight. Is there no end in sight? Certainly, it has become commonplace to speak of the exponential growth of scientific information. And in that very phrase some have found hope. After all, exponential growth cannot logically continue forever: it should sweep gently into a nice logistic curve with a flattening of growth and eventual saturation. Derek Price, among others, has expressed the opinion that we are now in the flattening-out stage [12]. But it seems not to be so. In his OECD report, Information in 1985 [13], Georges Anderla demonstrates that the growth curve is as steep as ever. This report has engendered furious debate, but its major qualitative findings have not been refuted. Scientific information, according to Anderla, is indeed growing exponentially, and will continue to do so as long as it is fed by the continuing diversification of the sciences, of which there is no end in sight. Anderla draws yet other conclusions: the greater the quantity of information, the greater its use. That is to say, the supply of information creates a demand for information. And the rate of growth of the supply is almost exactly matched by the rate of growth of the resultant demand. IMPROVING ACCESS TO INFORMATION We will not only have to handle more information, we will have to handle more demand for it. Can our current mechanisms stand the strain? I don't think so. But I think we will have new mechanisms that can. Our current carrier of this ever-increasing new information is the journal. I doubt that it can continue in this primary role. It is fast becoming an uneconomic and inefficient means of transferring new information, and the resources to support an ever-increasing population ofjournals simply do not exist. Once again, technology to the rescue? Yes, I think so. I happen to agree with those who say that ". . unless technology, clearly understood, is Bull. Med. Libr. Assoc. 64(4) Oct. 1976
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systematically evaluated with each application ... it carries with it a propensity to fail. The existence of technology is not a valid reason for its application" [14]. But in this instance, I see no reason why, at this moment, journals should continue in their present format. For those publishers who can afford it, editing and layout are already being done on video display tubes from manuscripts (!) already converted into computer-readable form. It will seem ludicrous to future generations that this computer-based information is then once more put back into print format for distribution. The National Science Foundation has already issued guidelines [15] for proposals for what it calls an "Access Improvement Program," which is bureaucratese for just such computer-readable information-transfer systems. In their study [16] for the NSF on publisher-library relationships, Fry and White give serious consideration to the future electronic storage and distribution of the kind of information currently published in journals. It will not happen overnight, but it will happen: in the future many a scientific article will not be published at all. Rather, through some device, probably an automatically produced alerting system, the information seeker will be led to keyin his need at a remote terminal, perhaps scan an article on a CRT, command its delivery to him (probably in computer-output microform, or perhaps in electronic transfer to his local computer bank), and no doubt be billed automatically for the service. This tale of the future need not alarm us. The technology is already familiar to us, and we don't have to leap ahead to the development of highdensity photo-optical systems with laser scanners; I'll let some future Doe Lecturer comfort us with those. We can take some comfort from the past. Among its other distinctions, 1976 is the 350th anniversary of the death of Francis Bacon, and it was this great believer in natural philosophy who warned us that ".... he that will not apply new remedies, must expect new evils" [17]. And there is comfort, too, in the present. One of my favorite contemporary novelists, Ursula Le Guin, in one of her tales of the future, has her characters use a moving bedtime invocation: "Praise then darkness, and Creation unfinished" [18]. In this I find the artist telling me that all information is imperfect, and that if it were not we would need to strive no more. In a lighter vein, I am reminded of an occurrence some years ago in Kew Gardens in London. A large Cockney family was enjoying an outing, Bull. Med. Libr. Assoc. 64(4) Oct. 1976
having brought with them their very old grandmother. She had not, I gather, been often away from her own city neighborhood. Spying a very beautiful sundial, she wanted to know what it was. Her grandchildren explained in detail how it worked. Beaming with delight, the grandmother could only say, "What will they think of next!" FUTURE ROLE OF MEDICAL LIBRARIES But back to the medical library, now that "they" have thought of the on-line journal. What has become of the medical library with its great store of medical journals and its bibliographic retrieval systems? It has become one site, and one only, of the remote terminal. At least in the major centers its journal-reading clientele is sitting at its own terminals getting its own materials directly, at its own cost. The library will still have its review journals and some journal-compendia. There must be a digestive system between the issuance of new knowledge and its absorption into the teaching corpus of books and audiovisuals and the other instructional aids that the library still will retain. But the medical library will not be the primary source for journal-article dissemination that it is
today. What then will it disseminate? The answer is in-
formation. This is already the thread that ties us together with all of our diversity, from the smallest one-person library to the behemoth that is NLM. It will become an even stronger thread as the diversifying sciences cause us further to diversify among ourselves. For, while on-line systems can be made fairly simple to operate, they cannot be made to simplify the content of their materials. As our knowledge and information increase in complexity, so does the need increase for people trained to thread their way through this maze of information, to find what is pertinent, combine it with what is related, merge it into what is needed. There is a need, in brief, for what Estelle Brodman calls the "information synthesizer." Nor must we wait for the on-line journal, or the use of an in-house minicomputer as a Mixmaster. Already there is an area of need evident between the formal state-of-the-art review and those address lists of information that we call bibliographies. This is the area of need for analyzed, synthesized, packaged information. Our society has entered a phase in the evolution of health care that requires such a service. The allied health professions are proliferating almost as quickly as is new information itself. A
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concerned public will not much longer be content with home medical encyclopedias. In a survey conducted for NLM, the Association for Hospital Medical Education reported that ". . . rather than instantaneous computerized generation of a bibliography, interviewees [in community hospitals] indicated a greater need for some meaningful assessment of the contents of the articles that might be in such a bibliography" [19]. The journal-article bibliography, the full-text document, or even the on-line data bank will not answer these groups' needs. An information center dispensing information will. I do not know where these information synthesizers will come from. I think I know where they will most effectively be-in the medical library. And I hope you realize what they will be doing: giving individualized service in response to need, and using technology as their tools-in-trade. Nor, despite my examples of the allied health professions and a concerned public, will this somehow be a less sophisticated service than some others we profess to. (I must digress here to say that I am always saddened that in a democracy a writer of "popular" scientific articles is somehow considered to be of lesser stature. The only answer I know to Jefferson's noisome "aristocracy of the intellect" is Bronowski's "democracy of knowledge" [20].) All health professionals will need information as they struggle with the never-ending task of continuing education, whether self-inspired or socially required. There will be many support services for continuing education outside the purview of the medical library, and in the future these will include the individual's own computer-terminal access to primary resources. But there will remain that intermediate need, the development of individualized packages from the enormous stock of information, selected, retrieved, and put together. If medical librarians do not do this, I do not know who will. DIVERSITY AND UNITY
Throughout this journey into our possible future, we have travelled two main tracks: the increasing impact of technology and the increasing need for personalized services. I think we have found that these two seemingly conflicting trends have a high degree of complementarity. They will certainly have a profound impact on the practice of our profession. The world we have been talking about is the world of scientific information, not that of the humanist tradition of
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our great scholarly libraries. If information services in the health sciences develop even roughly in the way I foresee, the gap between medical librarianship and general humanistic librarianship will grow even wider. We may well be seen as too diverse a specialty within librarianship, and find ourselves cut adrift. Our historical collections and rare-book colleagues may keep us attached for a while, but they are a fragile connection. Already, if I read correctly between the lines of the reports of the National Commission on Libraries and Information Science, we are considered pesky nuisances who don't really fit. Yet it is as necessary to meet the future information needs of the health sciences as it is to meet society's needs in general to learn from our great humanist traditions, from those works so carefully preserved in our scholarly libraries. Our diversity as medical librarians is necessary if we are to continue to work for the health of mankind. But the unity of all librarianship is necessary to continue the advancement of all learning. Within our own specialty of medical librarianship we have seen the future bringing us yet further diversity. The "firing line" library will not disappear: the immediacy of working information is too important. Yet how different will be the core collection librarian of the future with how qualitatively different a core from our present concepts from the information synthesizer working with his or her computer banks in the area, say, of environmental carcinogenesis. And how different will the monograph cataloger feel still, in Robert Merton's phrase, "converting the tacit empiricism of lists into the analytical rationalism of categories" [21] from the media librarian discussing curriculum design with the biomedical communications specialist and the director of continuing education. Yet these, and many others, will be the diverse members of the profession of medical librarianship. Our strength, our ability to disseminate medical information effectively, will depend on this diversity. But there is danger too: will we become too dissimilar and too removed from our humanistic roots, to form a unity? Can we continue down this road of diversification, at the same time taking aboard colleagues from biomedical communications, computer sciences, management studies, operations research, and Lord knows what other disciplines, and still retain our colleagueship? The question is not one that applies to a profession alone. Mankind itself seems cursed Bull. Med. Libr. Assoc. 64(4) Oct. 1976
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with a need to distrust, or even hate, that which is too divergent from its immediate group. Our society struggles to find an answer that will let all men live together in peace and dignity, yet it is deeply afflicted with the foul disease of racism. There is a recent work on racism [22] that casts aside pious hopes and gives instead some practical recipes for actions that may help bring us together. We, facing our own group interactions in divisive circumstances, might learn from it. Five conditions are set for a favorable outcome to interactions for reducing prejudice. First, there must be positive interdependence in meeting broad goals that are held in common. Second, those working together must have equal status. Third, there has to be a social climate favorable to the goals. Fourth, those working together must do so with a high degree of intimacy. And finally, the outcome should be rewarding. I do not know how well or how broadly this prescription will work in our society at large: the roots of racism are deep and multiform. But I cannot come up with a better prescription for a Medical Library Association threatened by diversification and disunity. We must all, indeed, recognize our interdependence as we try in common to make available the information of the health sciences. We must recognize the equality among us: we are all colleagues. We ourselves must set our standards so that they are favorable to our goals. We must indeed work closely together, one with another; none of us can stand alone. And for a rewarding outcome, what could be more rewarding than the realization that we have helped to improve the health of mankind? Diversity among us is essential if we are to continue our work effectively. Unity among us is essential if our work is to be worthwhile. Let us have both. REFERENCES 1. GRACIAN Y MORALES, BALTASAR. The Art of Worldly Wisdom, transl. from the Spanish by Joseph Jacobs. London, Macmillan, 1930. (Reprint of Ist ed., 1892.) Maxim no. 117. 2. MICHENER, JAMES A. Centennial. New York, Random House, 1974. p. 63-64. 3. BRONOWSKI, J. Science and Human Values. New York, Harper, 1959. 4. KREBS, HANS A., AND SHELLEY, JULIAN H., eds. The
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Creative Process in Science and Medicine. Amsterdam, Excerpta Medica, 1975. p. 3. 5. BLooMQuIsT, HAROLD. The medical librarian as manager; or the fruits of fadism. Bull. Med. Libr. Assoc. 63: 359-365, Oct. 1975. 6. DODSON, EDWARD 0. Further thoughts on molecular biology and metaphysics. Perspect. Biol. Med. 18: 306-312, Spring 1975. 7. BILLINGS, J. S. Methods of research. In: Rogers, F. B., comp. Selected Papers of John Shaw Billings. Chicago, Medical Library Association, 1965. p. 198-206. 8. ANNAN, GERTRUDE L. The Medical Library Association in retrospect, 1937-1967. Bull. Med. Libr. Assoc. 55: 379-389, Oct. 1967. 9. THAYER, LEE. On the functions of incompetence. Perspect. Biol. Med. 18: 332-344, Spring 1975. 10. SZENT-GYORGYi, ALBERT. On scientific creativity. Perspect. Biol. Med. 5: 173-178, Winter 1962. 11. ZIMAN, JOHN. The Force of Knowledge: The Scientific Dimension of Society. Cambridge, England, Cambridge University Press, 1976. 12. PRICE, D. J. DE S. Little Science, Big Science. New York, Columbia University Press, 1963. 13. ANDERLA, GEORGES. Information in 1985. Paris, Organization for Economic Co-operation and Development, 1973. 14. TAUB, ARTHUR. Electrical stimulation for the relief of pain: Two studies in technological zealotry. Perspect. Biol. Med. 19: 125-135, Autumn 1975. 15. NATIONAL SCIENCE FOUNDATION. OFFICE OF SCIENCE INFORMATION SERVICE. Guidelines for preparation of unsolicited proposals for the Access Improvement Program. Inf. News & Sources 7: 259-263, Nov. 1975. 16. FRY, BERNARD M., AND WHITE, HERBERT S. Economics and Interaction of the Publisher-Library Relationship in the Production and Use of Scholarly and Research Journals. U.S. National Science Foundation, Office of Science Information Services, Nov. 1975. (PB 249 108.) (Synopsis in: Inf. Hotline 8(3): 17-21, March 1976.) 17. BACON, FRANCIS. The Essays or Counsels, Civil and Moral, of Francis Ld. Verulam.... Mt. Vernon, New York, Peter Pauper Press, n.d. p. 96. 18. LE GUIN, URSULA K. The Left Hand of Darkness. New York, Ace Books, 1973. p. 232. 19. ASSoCIATION FOR HOSPITAL MEDICAL EDUCATION. Role of Community Hospitals in Continuing Education of Health Professionals; Final Report. Contract no. I-LM-4-4732, National Library of Medicine. Arlington, Virginia, 1975. (PB-243 986.) p. 63. 20. BRONOWSKI, J. The Ascent of Man. Boston, Little, Brown, 1973. p. 435. 21. MERTON, ROBERT K. Thematic analysis in science: notes on Holton's concept. Science 188: 335-338, Apr. 25, 1975. 22. KATZ, PHYLLIS A., ed. Towards the Elimination of Racism. New York, Pergamon Press, 1976.
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Library ofMedicine University of Nebraska Medical Center Omaha, Nebraska ABSTRACT An examination is made of the uses of diversity in medical library activities and personnel. This concept is extended also to the broader field of librarianship and to some forecasts of future directions for medical libraries.
IT is an honor to stand before this association to present the Janet Doe Lecture for 1976. It is also an honor to be introduced so warmly by a colleague whom I have so long admired.t I have never known how to respond to this type of introduction, to this mixture of biography and flattery. I thought it was time I learned how. In search of an answer, I went, by devious routes, to the writings of a seventeenth-century Spanish Jesuit, Baltasar Gracian y Morales. Here is what old Baltasar (as I've come to think of him) has to say in one of his maxims: Never talk of yourself. You must either praise yourself-which is vain-or blame yourself-which is littleminded. It ill beseems him that speaks, and ill pleases him that hears. And if you should avoid this in ordinary conversation, how much more ... in public speaking, where every appearance of unwisdom really is unwise
(1].
Librarianship. History is rampant. I hope, then, that I will be forgiven for focussing more on some philosophical aspects of our present and our future than on our past. In the spirit of the times I will try, at least, to put my reflections in a historical context. To begin, I thought it might be of passing interest to you to know how one goes about giving a Janet Doe Lecture. First, of course, one is asked to. One's immediate reaction to this invitation-or mine at least, and with all respect to my predecessors-was "Dear God, I've joined the dinosaurs." Well, perhaps so. It happens that when I had that reaction, I was trying (unsuccess-
fully) to read James Michener's Centennial. This documentary novel, as many of you know, sets its roots way back in time, and Mr. Michener had this to say of dinosaurs: Long after they disappeared ... it would become fashionable to make fun of the great reptiles.... The lumbering beasts would be held up to ridicule as failures, as inventions that hadn't worked.... Facts prove just the opposite. The giant reptiles dominated the earth for 135,000,000 years.... [They] remain one of the most successful animal inventions nature has provided. They adjusted to their world in marvelous ways and developed all the mechanisms required for the kind of life they led
Heaven forbid that I should give any "ap- ... [2]. pearance of unwisdom" before this audience. We This may not be an exact description of Doe will speak no more of my biography and backbut it will suffice. It also takes care of Lecturers, ground. I hope you will bear with me, though, if an reaction. first the Unfortunately, a second reacoccasional personal note does creep into this Janet It is a cry from the heart: follows. tion closely Doe Lecture. to I "But have nothing say." I wish I were a match This year of 1976, as we all know almost ad ideal person, the one with Bronowski's Jacob for nauseam, is one of great symbolic importance in the creative of truth, and a sense the habit mind, the history of the United States, and in the history or she would have much He human of dignity [3]. of librarianship in this country. In our own smaller to tell us. But most of us mere mortals, faced with world, it is also the tenth year of the Janet Doe the injunction to say something, stand ingloriously Lectures on the History or Philosophy of Medical mute. But again, my peculiar reading habits came to *The Janet Doe Lecture on the History or Philosophy of Medical Librarianship, presented June 15, 1976, at the rescue. In the proceedings of a symposium on the Seventy-fifth Annual Meeting of the Medical Li- the creative process I ran across the following brary Association, Minneapolis, Minnesota. Albert Einstein and the French poet tThe speaker was introduced by Scott Adams, a anecdote [4]. found themselves at a reception in Valery both former President of the Medical Library Association. Bull. Med. Libr. Assoc. 64(4) Oct. 1976
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Paris. Valery seems to have had a consuming ourselves, that we would scorn a narrow uniinterest in the process of intellectual creation, and formity. Total sameness-"library cloning," if buttonholed Einstein immediately. How, he you will would be dull at best. Our work takes us wanted to know, did Einstein go about his work; close enough to biology to see the dangers of clonplease tell him about it. Einstein was rather vague, ing. We can agree that "if we have learned anymentioning that he did start every day by going thing from studies on evolution, it is that a highly out in the morning for a walk. Ah, pounced Va- varied gene pool confers adaptability and survival lery, and of course he took a notebook with him so value upon a species. One of the effects of ... that he could jot down the ideas that came into his cloning would . .. be reduction of the variability of head. Well, no, Einstein admitted, he didn't. Va- the ... gene pool" [6]. lery was crestfallen: "You don't?" "Well, no," Ah, yes. We all favor plenty of variability in the said Einstein, "You know, an idea is so rare." library gene pool. But we must, of course, strive And indeed it is. But with James Michener and for, say, cost-effectiveness. And if a cost-effective Albert Einstein behind one, how can one say procedure is demonstrated by one, then it should "No"? So one becomes a Doe Lecturer. And must be adopted by all. And if a "core list" works in then find a topic. The limits are set. The topic Long Island, it must of course work in San Mateo. must be on the history or philosophy of our And if "measurable learning objectives" are a profession. If one is not a historian-as I am retrieval dimension needed by some, they may as not-one must willy-nilly become a philosopher. well be used by all. Or if, in the world of interlibrary loans, "hierarchical referral," seen large, is IN PRAISE OF DIVERSITY most effective, then it will be most effective, too, My topic itself was chosen in a fit of pique. At of course, seen small. the time, I was annoyed with some of our friends Of course we approve of diversity. We just don't at the National Library of Medicine. I thought want to practice too much of it. Fortunately, we're they were attempting to impose a needless uni- a lethargic group on the whole and we don't take formity on one aspect of the healthily diversified action against the not-too-diverse. Oh, the regional medical library programs. As it happens, bookmen mutter about audiovisuals, and the AVI was mistaken. But my question to myself types talk of "media" and sometimes forget that "Don't they know the uses of diversity?"- print is a medium too. But they live in semistayed with me, and grew. Here, at last, was a harmony, or at least in contiguity. So, too, the topic, one on which some reflection might well computer people may scorn the scribblers, while profit us all. the conscientious reference librarian worries over But would it fit? Consider the Doe Lectures we the mistaking of a limited computer-based file for have had: Annan on our history, Rogers on subject the dawn of universal bibliography. But they work analysis, Brandon on academic status, Brodman side by side. on excellence, Adams on innovation and The hospital librarian calls for recognition of MEDLARS, Darling on certification, Felter on the value of her or his role; the academic medical cooperation, and Bloomquist on fadism. Here is librarian nods agreement and ponders the criteria diversity enough to make the very word the hall- for academic promotion. But they work together. mark of the lectures. The clerk at the circulation desk wonders what on And would it honor Janet Doe? The time has al- earth the regional library office does; the regional ready come, foreseen by Harold Bloomquist just director gives little thought to the irate nursing last year, when "there will be a Doe Lecturer who student gloriously cursing the missing issue. But probably will never have had the opportunity to together, these librarians deliver documents. have met or known Miss Doe" [5]. 1 shook her Sometimes, the diversity appears to get out of hand but once and know her not at all. But from hand and threaten an accepted unity. Then we do all that I know of her, I know her talents to have take action, if only by setting up a committee to been as diverse as her thoughts are incisive. study the "problem." We can set up all the comReflections on the uses of diversity do no dishonor mittees we wish to see if that group is good for the to her legacy. MLA, or this group is bad for the MLA. But I must establish right away that I am not setting people are going to do what they feel they need to up a straw man whom it would be easy, but no do. If a group of catalogers entranced by OCLC honor, to knock down. I am sure we are all con- terminals or a group of uncategorized librarians vinced that we approve of diversity among as worried about population graphs as about Brad-
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ford curves-wants to get together, they will, and there is nothing that can be done to stop them. So we may as well make a virtue of it. And, in fact, there is virtue in it. For, in truth, in diversity lies unity, and the only true unity is in diversity. I am not propounding anarchy. Diversity within a profession is variety within a framework. We cannot be all things to all men, but medical librarians must be many things to many people before our course is run. MEDICAL LIBRARIES: HISTORICAL VIEW Let us consider our roots. We are an old profession, but a new specialty within it. The libraries of ancient and not-so-ancient times served only an elite. Only the elite, after all, could read. Then there came, in this country, the Jacksonian revolution: the franchise was extended to the workingman (provided, of course that workingman meant man, and not woman, and, of course, that he was white). There came, too, at this time the workingmen's libraries of Manchester and Boston. Only then did libraries, however hesitatingly, enter the world of the common people. When our own specialty was begun, it too began as libraries for an elite-the physicians and surgeons of our society, who had a smattering of poor Latin but a groping towards a scientific basis for their calling. We perhaps forget how recent we are, yet as late as 1887, John Shaw Billings could say: ... we are all learning gradually how to use medical libraries, and in a few years more I predict that the wonder will be how we ever got on without them [7].
A good prediction. Yet we all know that it was not until 1937 that medical bibliography courses were begun for librarians, and not until 1942 that the first professional librarian was hired to work at the National Library of Medicine [8]. No wonder, then, that our own Jacksonian revolution-our own diversification of medical libraries beyond the elite-is a thing of living memory and present debate. And what diversification we are seeing! Some of the great private libraries, both society and
academic, have survived, generally by broadening their base to serve more than the doctor of medicine. New academic libraries have been founded, almost all of them including more of the health sciences than medicine alone. "Doctors' libraries" in hospitals, many with long histories of Bull. Med. Libr. Assoc. 64(4) Oct. 1976
their own, have become or are becoming hospital libraries serving the whole gamut of health-care personnel. It is hardly surprising, then, that we have seen diversification too, among ourselves. We have still the one-person library where the sole librarian must try to give "primary care" across the whole range of our services. (What an unsung hero or heroine he or she is, manning these outposts, meeting those needs that can be met from limited resources, sending for reinforcements when necessary-and, as a group, forestalling an invasion by information-hungry hordes before whom the larger centers would quickly crumble.) At the other end of the spectrum is the research librarian whose expertise is in toxicology and the manipulation of TOXLINE, subspecializing in the area of on-line bibliographic services, itself a subspecialty of medical reference work, itself a subspecialty of medical librarianship, itself a specialty within the library profession. There is an obvious danger here. Too narrow a specialization could lead to what Lee Thayer bitingly attacks as "the functions of incompetence" [9]. Yet specialization is a rational response to complex needs. The answer is to see our specialization as being part of and within a unified whole. The things we do select, acquire, record, organize, store, preserve, retrieve, and disseminate-are simple enough to list. But they are complex to do. To carry out this complexity of activities for a multiplicity of clienteles, it is no wonder that we have diversified, nor that we shall diversify further as complexity increases. It is my thesis that health-information services will grow more complex, that even greater diversity will be needed among us in our future. MEDICAL LIBRARIES: THE FUTURE Let's try to see part way into that future. If the past is prologue for our present, our present is prologue for the future. It is not difficult to foresee some continuity. I have, for example, little patience with those who speak of the death of the book. It isn't dead, and it isn't dying. It's a very resilient and, indeed, rather remarkable technological invention. In serving three functions, as a mechanism for specific information recall, as a source for guided learning, and as a stimulus to thought and reflection, it is a hard tool to beat. It got beaten, of course, as a carrier of new information, by the codex-format journal, which for centuries now has taken pride of place as the
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source of the latest information. And it has been joined, in these past few decades, by another dimension in guided learning, the whole complex of audiovisual instructional aids. But these three live, it seems to me, in a healthy, if evolving, symbiosis, without mutual threats of extinction. I have little patience, too, with those who, suffering from historical myopia, speak of the present time as the post-industrial era, or even the Age of Information. We still are very firmly within the Industrial Revolution. The application of science and technology to our daily lives has not ceased; we have not yet finished establishing the unity of nature, let alone the family of man. Nor does our society, present or immediate future, run on information systems. It runs on the extraction of wealth from the land and the sea, on the processing or manufacture of that wealth, on its transportation and its commerce. Formal information systems are indeed one of the lubricants for the complex machine that society has made of these processes and their attendant human needs. But they are not the machine itself, and it behooves us to remember what a small part we play. In case we should be feeling too uppity, remember these chilling words from Albert Szent-
Gyorgyi: I am very ignorant of scientific literature and so, in an hour's time spent in the library, I could find more knowledge that is new to me than I can find at my workbench in a month or a year. All the same, most of the time I sit at my bench and not in the library. It is not knowledge, but new knowledge which attracts me, creating something that was not there before [10].
In his recent book on science and society [11], John Ziman helps put this in perspective for us. He agrees that new ideas come only from individuals-mulling over old concepts, reassessing the known in the light of the unknown. But for the three uses of scientific knowledge-the creation of new knowledge, the social use of physical resources, and the solution of social problems for all of these, information is useless, Ziman reminds us, unless it is communicated. There, and there only, is the heart of our profession. With these caveats in mind, let us look at where we are going. I take it as established fact that our society and its information needs are growing ever more complex. The Industrial Revolution grows in technologic complexity: it does not become simpler. I take it as an equally established fact
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that many people feel alienated by this technology: they wish for individual needs and worth to be recognized, for this technological complexity to be somehow brought to human scale, for man, not the machine, to be the measure. Our society is bearing these two seemingly conflicting trends into its future, and our profession is carried with them. What is also being carried is the seemingly endless growth of scientific information. Our stacks and ourselves are already groaning under its weight. Is there no end in sight? Certainly, it has become commonplace to speak of the exponential growth of scientific information. And in that very phrase some have found hope. After all, exponential growth cannot logically continue forever: it should sweep gently into a nice logistic curve with a flattening of growth and eventual saturation. Derek Price, among others, has expressed the opinion that we are now in the flattening-out stage [12]. But it seems not to be so. In his OECD report, Information in 1985 [13], Georges Anderla demonstrates that the growth curve is as steep as ever. This report has engendered furious debate, but its major qualitative findings have not been refuted. Scientific information, according to Anderla, is indeed growing exponentially, and will continue to do so as long as it is fed by the continuing diversification of the sciences, of which there is no end in sight. Anderla draws yet other conclusions: the greater the quantity of information, the greater its use. That is to say, the supply of information creates a demand for information. And the rate of growth of the supply is almost exactly matched by the rate of growth of the resultant demand. IMPROVING ACCESS TO INFORMATION We will not only have to handle more information, we will have to handle more demand for it. Can our current mechanisms stand the strain? I don't think so. But I think we will have new mechanisms that can. Our current carrier of this ever-increasing new information is the journal. I doubt that it can continue in this primary role. It is fast becoming an uneconomic and inefficient means of transferring new information, and the resources to support an ever-increasing population ofjournals simply do not exist. Once again, technology to the rescue? Yes, I think so. I happen to agree with those who say that ". . unless technology, clearly understood, is Bull. Med. Libr. Assoc. 64(4) Oct. 1976
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systematically evaluated with each application ... it carries with it a propensity to fail. The existence of technology is not a valid reason for its application" [14]. But in this instance, I see no reason why, at this moment, journals should continue in their present format. For those publishers who can afford it, editing and layout are already being done on video display tubes from manuscripts (!) already converted into computer-readable form. It will seem ludicrous to future generations that this computer-based information is then once more put back into print format for distribution. The National Science Foundation has already issued guidelines [15] for proposals for what it calls an "Access Improvement Program," which is bureaucratese for just such computer-readable information-transfer systems. In their study [16] for the NSF on publisher-library relationships, Fry and White give serious consideration to the future electronic storage and distribution of the kind of information currently published in journals. It will not happen overnight, but it will happen: in the future many a scientific article will not be published at all. Rather, through some device, probably an automatically produced alerting system, the information seeker will be led to keyin his need at a remote terminal, perhaps scan an article on a CRT, command its delivery to him (probably in computer-output microform, or perhaps in electronic transfer to his local computer bank), and no doubt be billed automatically for the service. This tale of the future need not alarm us. The technology is already familiar to us, and we don't have to leap ahead to the development of highdensity photo-optical systems with laser scanners; I'll let some future Doe Lecturer comfort us with those. We can take some comfort from the past. Among its other distinctions, 1976 is the 350th anniversary of the death of Francis Bacon, and it was this great believer in natural philosophy who warned us that ".... he that will not apply new remedies, must expect new evils" [17]. And there is comfort, too, in the present. One of my favorite contemporary novelists, Ursula Le Guin, in one of her tales of the future, has her characters use a moving bedtime invocation: "Praise then darkness, and Creation unfinished" [18]. In this I find the artist telling me that all information is imperfect, and that if it were not we would need to strive no more. In a lighter vein, I am reminded of an occurrence some years ago in Kew Gardens in London. A large Cockney family was enjoying an outing, Bull. Med. Libr. Assoc. 64(4) Oct. 1976
having brought with them their very old grandmother. She had not, I gather, been often away from her own city neighborhood. Spying a very beautiful sundial, she wanted to know what it was. Her grandchildren explained in detail how it worked. Beaming with delight, the grandmother could only say, "What will they think of next!" FUTURE ROLE OF MEDICAL LIBRARIES But back to the medical library, now that "they" have thought of the on-line journal. What has become of the medical library with its great store of medical journals and its bibliographic retrieval systems? It has become one site, and one only, of the remote terminal. At least in the major centers its journal-reading clientele is sitting at its own terminals getting its own materials directly, at its own cost. The library will still have its review journals and some journal-compendia. There must be a digestive system between the issuance of new knowledge and its absorption into the teaching corpus of books and audiovisuals and the other instructional aids that the library still will retain. But the medical library will not be the primary source for journal-article dissemination that it is
today. What then will it disseminate? The answer is in-
formation. This is already the thread that ties us together with all of our diversity, from the smallest one-person library to the behemoth that is NLM. It will become an even stronger thread as the diversifying sciences cause us further to diversify among ourselves. For, while on-line systems can be made fairly simple to operate, they cannot be made to simplify the content of their materials. As our knowledge and information increase in complexity, so does the need increase for people trained to thread their way through this maze of information, to find what is pertinent, combine it with what is related, merge it into what is needed. There is a need, in brief, for what Estelle Brodman calls the "information synthesizer." Nor must we wait for the on-line journal, or the use of an in-house minicomputer as a Mixmaster. Already there is an area of need evident between the formal state-of-the-art review and those address lists of information that we call bibliographies. This is the area of need for analyzed, synthesized, packaged information. Our society has entered a phase in the evolution of health care that requires such a service. The allied health professions are proliferating almost as quickly as is new information itself. A
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concerned public will not much longer be content with home medical encyclopedias. In a survey conducted for NLM, the Association for Hospital Medical Education reported that ". . . rather than instantaneous computerized generation of a bibliography, interviewees [in community hospitals] indicated a greater need for some meaningful assessment of the contents of the articles that might be in such a bibliography" [19]. The journal-article bibliography, the full-text document, or even the on-line data bank will not answer these groups' needs. An information center dispensing information will. I do not know where these information synthesizers will come from. I think I know where they will most effectively be-in the medical library. And I hope you realize what they will be doing: giving individualized service in response to need, and using technology as their tools-in-trade. Nor, despite my examples of the allied health professions and a concerned public, will this somehow be a less sophisticated service than some others we profess to. (I must digress here to say that I am always saddened that in a democracy a writer of "popular" scientific articles is somehow considered to be of lesser stature. The only answer I know to Jefferson's noisome "aristocracy of the intellect" is Bronowski's "democracy of knowledge" [20].) All health professionals will need information as they struggle with the never-ending task of continuing education, whether self-inspired or socially required. There will be many support services for continuing education outside the purview of the medical library, and in the future these will include the individual's own computer-terminal access to primary resources. But there will remain that intermediate need, the development of individualized packages from the enormous stock of information, selected, retrieved, and put together. If medical librarians do not do this, I do not know who will. DIVERSITY AND UNITY
Throughout this journey into our possible future, we have travelled two main tracks: the increasing impact of technology and the increasing need for personalized services. I think we have found that these two seemingly conflicting trends have a high degree of complementarity. They will certainly have a profound impact on the practice of our profession. The world we have been talking about is the world of scientific information, not that of the humanist tradition of
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our great scholarly libraries. If information services in the health sciences develop even roughly in the way I foresee, the gap between medical librarianship and general humanistic librarianship will grow even wider. We may well be seen as too diverse a specialty within librarianship, and find ourselves cut adrift. Our historical collections and rare-book colleagues may keep us attached for a while, but they are a fragile connection. Already, if I read correctly between the lines of the reports of the National Commission on Libraries and Information Science, we are considered pesky nuisances who don't really fit. Yet it is as necessary to meet the future information needs of the health sciences as it is to meet society's needs in general to learn from our great humanist traditions, from those works so carefully preserved in our scholarly libraries. Our diversity as medical librarians is necessary if we are to continue to work for the health of mankind. But the unity of all librarianship is necessary to continue the advancement of all learning. Within our own specialty of medical librarianship we have seen the future bringing us yet further diversity. The "firing line" library will not disappear: the immediacy of working information is too important. Yet how different will be the core collection librarian of the future with how qualitatively different a core from our present concepts from the information synthesizer working with his or her computer banks in the area, say, of environmental carcinogenesis. And how different will the monograph cataloger feel still, in Robert Merton's phrase, "converting the tacit empiricism of lists into the analytical rationalism of categories" [21] from the media librarian discussing curriculum design with the biomedical communications specialist and the director of continuing education. Yet these, and many others, will be the diverse members of the profession of medical librarianship. Our strength, our ability to disseminate medical information effectively, will depend on this diversity. But there is danger too: will we become too dissimilar and too removed from our humanistic roots, to form a unity? Can we continue down this road of diversification, at the same time taking aboard colleagues from biomedical communications, computer sciences, management studies, operations research, and Lord knows what other disciplines, and still retain our colleagueship? The question is not one that applies to a profession alone. Mankind itself seems cursed Bull. Med. Libr. Assoc. 64(4) Oct. 1976
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with a need to distrust, or even hate, that which is too divergent from its immediate group. Our society struggles to find an answer that will let all men live together in peace and dignity, yet it is deeply afflicted with the foul disease of racism. There is a recent work on racism [22] that casts aside pious hopes and gives instead some practical recipes for actions that may help bring us together. We, facing our own group interactions in divisive circumstances, might learn from it. Five conditions are set for a favorable outcome to interactions for reducing prejudice. First, there must be positive interdependence in meeting broad goals that are held in common. Second, those working together must have equal status. Third, there has to be a social climate favorable to the goals. Fourth, those working together must do so with a high degree of intimacy. And finally, the outcome should be rewarding. I do not know how well or how broadly this prescription will work in our society at large: the roots of racism are deep and multiform. But I cannot come up with a better prescription for a Medical Library Association threatened by diversification and disunity. We must all, indeed, recognize our interdependence as we try in common to make available the information of the health sciences. We must recognize the equality among us: we are all colleagues. We ourselves must set our standards so that they are favorable to our goals. We must indeed work closely together, one with another; none of us can stand alone. And for a rewarding outcome, what could be more rewarding than the realization that we have helped to improve the health of mankind? Diversity among us is essential if we are to continue our work effectively. Unity among us is essential if our work is to be worthwhile. Let us have both. REFERENCES 1. GRACIAN Y MORALES, BALTASAR. The Art of Worldly Wisdom, transl. from the Spanish by Joseph Jacobs. London, Macmillan, 1930. (Reprint of Ist ed., 1892.) Maxim no. 117. 2. MICHENER, JAMES A. Centennial. New York, Random House, 1974. p. 63-64. 3. BRONOWSKI, J. Science and Human Values. New York, Harper, 1959. 4. KREBS, HANS A., AND SHELLEY, JULIAN H., eds. The
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Creative Process in Science and Medicine. Amsterdam, Excerpta Medica, 1975. p. 3. 5. BLooMQuIsT, HAROLD. The medical librarian as manager; or the fruits of fadism. Bull. Med. Libr. Assoc. 63: 359-365, Oct. 1975. 6. DODSON, EDWARD 0. Further thoughts on molecular biology and metaphysics. Perspect. Biol. Med. 18: 306-312, Spring 1975. 7. BILLINGS, J. S. Methods of research. In: Rogers, F. B., comp. Selected Papers of John Shaw Billings. Chicago, Medical Library Association, 1965. p. 198-206. 8. ANNAN, GERTRUDE L. The Medical Library Association in retrospect, 1937-1967. Bull. Med. Libr. Assoc. 55: 379-389, Oct. 1967. 9. THAYER, LEE. On the functions of incompetence. Perspect. Biol. Med. 18: 332-344, Spring 1975. 10. SZENT-GYORGYi, ALBERT. On scientific creativity. Perspect. Biol. Med. 5: 173-178, Winter 1962. 11. ZIMAN, JOHN. The Force of Knowledge: The Scientific Dimension of Society. Cambridge, England, Cambridge University Press, 1976. 12. PRICE, D. J. DE S. Little Science, Big Science. New York, Columbia University Press, 1963. 13. ANDERLA, GEORGES. Information in 1985. Paris, Organization for Economic Co-operation and Development, 1973. 14. TAUB, ARTHUR. Electrical stimulation for the relief of pain: Two studies in technological zealotry. Perspect. Biol. Med. 19: 125-135, Autumn 1975. 15. NATIONAL SCIENCE FOUNDATION. OFFICE OF SCIENCE INFORMATION SERVICE. Guidelines for preparation of unsolicited proposals for the Access Improvement Program. Inf. News & Sources 7: 259-263, Nov. 1975. 16. FRY, BERNARD M., AND WHITE, HERBERT S. Economics and Interaction of the Publisher-Library Relationship in the Production and Use of Scholarly and Research Journals. U.S. National Science Foundation, Office of Science Information Services, Nov. 1975. (PB 249 108.) (Synopsis in: Inf. Hotline 8(3): 17-21, March 1976.) 17. BACON, FRANCIS. The Essays or Counsels, Civil and Moral, of Francis Ld. Verulam.... Mt. Vernon, New York, Peter Pauper Press, n.d. p. 96. 18. LE GUIN, URSULA K. The Left Hand of Darkness. New York, Ace Books, 1973. p. 232. 19. ASSoCIATION FOR HOSPITAL MEDICAL EDUCATION. Role of Community Hospitals in Continuing Education of Health Professionals; Final Report. Contract no. I-LM-4-4732, National Library of Medicine. Arlington, Virginia, 1975. (PB-243 986.) p. 63. 20. BRONOWSKI, J. The Ascent of Man. Boston, Little, Brown, 1973. p. 435. 21. MERTON, ROBERT K. Thematic analysis in science: notes on Holton's concept. Science 188: 335-338, Apr. 25, 1975. 22. KATZ, PHYLLIS A., ed. Towards the Elimination of Racism. New York, Pergamon Press, 1976.
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