I am pleased to present the President's budget request for the National Library of Medicine (NLM) for Fiscal Year 2002, a sum of $275,725,000, which reflects an increase of $29,374,000 over the comparable Fiscal Year 2001 appropriation.

The Library is a key element in the foundation of the biomedical research enterprise. It is said that scientific research begins and ends in the library: from learning about the latest that has been published before embarking on an experiment, to publishing the results of that experiment in a journal that finds its way into an online database and onto the library shelf. In the health sciences, the institution that plays the role of information collector, organizer, and disseminator is the National Library of Medicine. The NLM not only maintains two buildings in Bethesda to house this unparalleled resource (with treasures dating to the 11th century), but the Library is the creator of immense electronic data resources that may be used, free, by anyone in the world.

There is a second aspect of the NLM s infrastructure role as creator, nurturer, and backup for national and international medical information networks. The U.S. National Network of Libraries of Medicine, created by NLM in the sixties, is an organization of 4,500 member institutions that provide vital information services to American health professionals and, increasingly, to the public. NLM is encouraging medical libraries to work closely with public libraries and other community organizations to provide the public with access to high quality health information. The NLM sponsors special programs within the network to support improving information services in areas that disproportionately affect minority groups, such as HIV/AIDS and toxicology and environmental health. There are also special outreach programs within the network for Native Americans and Spanish-speaking minorities. The Library supports an international medical information-sharing network so that it can both receive scientific information from foreign institutions and also provide their researchers and health professionals with access to NLM's electronic information resources.

Primary among these electronic resources is MEDLINE, the Library s immense database of references and abstracts to journal articles. With current usage of more than 250 million searches a year, it is the world s most-used medical literature resource. An easy-to-use Web-based program, known as PubMed, is the popular route of access. It takes only a few seconds to search through an ever- expanding collection of 11 million references and abstracts culled from more than 4,000 journals, covering the world-wide literature from 1966 to the present. The PubMed system also has links to 1800 participating publishers Web sites so that users can retrieve full text versions of articles identified in a MEDLINE search. A new feature, introduced in 2001 by the NLM and the National Center for Complementary and Alternative Medicine because of widespread public interest in the subject, is the ability to search a database limited to the literature of alternative medicine ( CAM on PubMed ). One unforeseen outcome of making MEDLINE available free on the Web was that the database was discovered by the general public and quickly became a favorite source of medical information. Today, the Library estimates that one third of MEDLINE searching is done by consumers.

BROADENING THE MANDATE

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The enthusiasm with which the public embraced MEDLINE on the Web has altered the traditional role of the NLM, which was to serve the nation's health by providing information services through health professionals, scientists, educators, and practitioners. The Library maintains those time-honored services, but now also serves the public directly with information products created specifically for consumers. MedlinePlus and ClinicalTrials.gov are examples of Web-based services that the public can access directly. The most broad-based of these is MedlinePlus.

With help from members of the National Network of Libraries of Medicine across the country, the information specialists who maintain MedlinePlus select and organize a variety of consumer health information issued by the National Institutes of Health, professional medical societies, and voluntary health agencies. MedlinePlus not only has extensive information on more than 425 diseases and health conditions, but an extensive medical encyclopedia, detailed information about prescription drugs, directories of health professionals and hospitals, health-related articles from the daily news media, patient education modules, and links to a variety of organizations that disseminate information on various health problems. MedlinePlus also makes it easy for the consumer to search MEDLINE for up-to- date information from the scientific literature. The Library is working with the National Institute on Aging to introduce more information related to the health of seniors, such as Alzheimer s disease, and to put the information into a format that is easily accessible by that segment of our population.

MedlinePlus has become tremendously popular and now logs about 5 million page hits per month. The NLM has also learned that health professionals of all kinds are finding it to be an excellent source of information. Many physicians use it to keep up-to-date on medical subjects outside of their specialty. Others are referring their patients to MedlinePlus for up-to-date and authoritative information about their health conditions.

One of the most useful features of MedlinePlus is the ability to learn about clinical trials. The Web site ClinicalTrials.gov, developed by NLM, became publicly available in February 2000 and has already proved to be of great help to physicians, patients, and their families. ClinicalTrials.gov is a registry of more than 5,000 federally and privately funded trials of experimental treatments for serious or life-threatening diseases or conditions. It is being expanded to include more clinical trials sponsored by private companies and some performed in other countries. The database includes a statement of purpose for each clinical research study, together with the recruiting status, the criteria for patient participation in the trial, the location of the trial, and contact information. ClinicalTrials.gov is linked closely with MedlinePlus, so that anyone looking for information about a particular disease or condition can easily tell it is the subject of any clinical trials. There is no registration for either MedlinePlus or ClinicalTrials.gov, and complete privacy is assured to all users.

SCIENCE ADVANCES

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The National Library of Medicine's involvement with the infrastructure of medicine extends far beyond its collection and the services built upon it. NLM is also a leader in providing crucial components of medical infrastructure for the 21st century. One aspect of this is ensuring that the nation's biomedical research enterprise has the trained professionals it needs in computational biology, including mathematical modeling in the life sciences, advanced imaging, and molecular biology. This role was brought into focus in the NIH report, The Biomedical Information Science and Technology Initiative (BISTI), which recommends that the NIH invest heavily in computer and information technology. As a result of BISTI, the NLM is expanding the 12 medical informatics training programs it supports at major universities to carry out research in general informatics and in Medical Genomics.

The Library also has internationally recognized program in medical genomics, organized within the National Center for Biotechnology Information (NCBI). The NCBI plays a pivotal role in coordinating, integrating, and disseminating the growing body of data currently being generated by the sequencing and mapping initiatives of the Human Genome Project. These efforts are complemented by the inclusion of individual genomic sequences, from over 75,000 organisms, submitted to NCBI from scientists worldwide, as well as the data generated through the collaborative projects aimed at sequencing the genomes of other model organisms. NCBI has also designed a novel system for linking its genomic resources to the biomedical literature, a necessary step for providing quality assurance, as well as for providing a framework for associating the most current and comprehensive biological information about a genomic sequence. Hence, NCBI s readily accessible genomic and literature databases, as well as their publicly available data analysis tools, represent a true international information infrastructure designed to facilitate and propel the biomedical research advances that will ultimately lead to better health for the American public.

Because the NLM depends to a great extent on the Internet for disseminating its many health information services, it is a supporter of the infrastructure initiative known as the Next Generation Internet. This is a cooperative effort among industry, academia, and government agencies that seeks to provide affordable, secure information delivery at rates thousands of times faster than today. Some NLM health applications, for example those involving the Visible Humans and telemedicine, require more bandwidth and more reliable service than are currently available. The Visible Human male and female data sets, consisting of MRI, CT, and photographic cryosection images, are huge, totaling some 50 gigabytes. They are being used by scientists around the world in a wide range of educational, diagnostic, treatment planning, virtual reality, artistic, mathematical, and industrial uses. Projects run the gamut from teaching anatomy to practicing endoscopic procedures to rehearsing surgery. One new project, being carried out by NLM scientists, is AnatLine, a web-based image delivery system that provides retrieval access to large anatomical image files of the Visible Human male thoracic region, including 3D images. Another is the collaborative project with other NIH Institutes to develop a super-detailed atlas of the head and neck. The Visible Human Project is an example of a program that requires both advanced computing techniques and the capability of the Next Generation Internet if it is to be maximally useful.

The Library also funds innovative medical projects that demonstrate the application and use of the capabilities of the Next Generation Internet. These projects span the spectrum of medical disciplines, geographic areas, and target audiences. One example is to evaluate the potential of telemedicine applications on the health care system in rural Alaska as a way of improving the quality of health care while at the same time containing costs. Another project, in rural Iowa, is measuring the effectiveness of video consultations for patients with special needs, including children with disabilities and persons with mental illness. In addition to supporting such advanced applications, the NLM continues its research on evaluating the performance of today's Internet pathways between and among health institutions and users. This research gives us a glimpse into what the future holds.

The NIH budget request includes the performance information required by the Government Performance and Results Act (GPRA) of 1993. Prominent in the performance data is NIH's second annual performance report which compares our FY 2000 results to our goals in our FY 2000 performance plan. As performance trends on research outcomes emerge, the GPRA data will help NIH to identify strategies and objectives to continuously improve its programs.

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health
Biographical Sketch

NAME: Donald A. B. Lindberg, M.D.

POSITION: Director, National Library of Medicine, NIH

BIRTHPLACE: Brooklyn, NY

DATE: September 21, 1933

EDUCATION: A.B., magna cum laude, Amherst College, 1954, M.D., College of Physicians and Surgeons, Columbia University, 1958

EXPERIENCE

1984-Present: Director, National Library of Medicine, NIH

1992-1995: Director, National Coordination Office for High Performance Computing and Communications, Office of Science and Technology Policy, Executive Office of the President

1996-Present: U.S. National Coordinator for the G8 Global Healthcare Applications Project, Global Information Infrastructure Initiative

1984-Present: Adjunct Professor of Pathology University of Maryland School of Medicine

1969-1984: Director, Information Science Group, University of Missouri

HONORS AND AWARDS:

• Phi Beta Kappa
• Simpson Fellow of Amherst College
• Markle Scholar in Academic Medicine
• Surgeon General's Medallion
• Recipient of first AMA Nathan Davis Award for Outstanding Member of the Executive Branch in Career Public Service
• Walter C. Alvarez Memorial Award of the American Medical Writers Association
• Presidential Senior Executive Rank Award
• Founding Fellow of the American Institute of Medical and Biological Engineering
• Outstanding Service Award of the Uniformed Services University of the Health Sciences
• Federal Computer Week's Federal 100 Award
• Computers in Healthcare Pioneer Award
• Association of Minority Health Professions Schools Commendation
• RCI High Performance Computing Industry Recognition Award
• U.S. National Commission on Libraries and Information Science Silver Award
• Council of Biology Editors Meritorious Award
• Presidential Rank Award of Meritorious Executive in the Senior Executive Service
• Medical Library Association President's Award
• American College of Medical Informatics Morris F. Collen, M.D. Award of Excellence
• Ranice W. Crosby Distinguished Achievement Award
• New York Academy of Medicine Information Frontier Award
• Fellow of the American Association for the Advancement of Science
• 2001 Cosmos Club Award
• Honorary Doctorates, Amherst College, State University, University of MO

Last Reviewed: May 30, 2024