type of demonstration activity, that the degree of application and the emphases selected are closely linked to availablity of resources and to the particular program's key objectives, that many of the things suggested already are being done to some degree by some agencies, and that not all have been tested for efficacy.

1. Stimulate good research proposals by (a) streamlining grant and contract procedures, including providing a small planning stipend after approval of an informal proposal, and by (b) inviting and reaching out for submission of proposals in a given field to assure desired complementary studies and needed coverage of given subjects, not just waiting for proposals to be submitted.

2. Prepare and distribute to potential users comprehensive but succinct periodic reviews of the state of the art/knowledge in given fields. In these reviews, point up gaps which might be filled by Research and Demonstration (R & D) or Experimental and Demonstration (E & D) projects.

3. Ask and try to answer continuously, from inception to completion of a project, the questions of its aims and ultimate use of results. Whom is the demonstration intended to influence? What are the obstacles to the good use of results, and how can these obstacles be overcome? What criteria should be used to evaluate the results? When these questions have been tentatively answered, either before the project begins or at the start, bring in representatives of the identified program group who will be needed to implement the findings (in addition to requiring that each proposal include recommendations by the sponsor on how to implement the findings of his project). The representatives will meet with the project staff and funding agency program officer, for consultative reactions to the tentative answers. These persons may well be helpful with practical advice not only regarding possible improvement of the project, but also regarding appropriate ways of interesting potential users or colleagues in their own field.

4. Provide for continuous interaction between grantor or contractor and grantee, from the beginning of the project through the period of dissemination and efforts to apply results. This may imply more technical training for Washington agency staff; more staff devoted to keeping in contact with projects and stimulating use of results; better interagency coordination; development of a clearinghouse and data retrieval system similar to that of the Office of Education.

5. Provide in the project methodology a built-in component on reporting procedures and statistical data which would permit subsequent evaluation and utilization.

6. Summarize findings in separate, brief, nontechnical, and very readable reports, in addition to the full technical reports. Get criticisms of at least the summary reports from key representatives of potential users before they are put into final form. Then disseminate them widely to members of the various groups of potential consumers.

7. Conduct seminars in conjunction with site-visits, where potential users can discuss the innovation, perhaps see it and "feel" it as something alive, and consider its applicability to other situations. The participants could have small group discussions of ways to adopt and perhaps to improve the innovation. Give encouragement to each participant to tell about innovations in his own facility. Thus, each participant can become a giver as well as a receiver of information. 8. Replicate important demonstrations as a means of accumulating more experience and, through reaffirmation, making them more credible and impactful. 9. Identify and recruit key practitioners in various localities to apply the innovation to their own settings. Their example might be expected to foster adoption among others with whom they are influential. To facilitate application of the innovation, provide human links or change agents who are thoroughly familiar with it to serve as consultants to the institution which is interested in exploring, adopting or adapting the innovation.

10. Invite attention to the potential rewards of adopting the innovation-for example, winning approval from key persons or sources, gaining prestige, reducing costs, improving services-so that the potential user can identify them with his self-interest.

11. Obtain policy commitment from funding agencies to the idea that dissemination and utilization functions are an integral part of its research program. Implement this commitment by training agency program officers in these skills and providing each research-support operating division with a dissemination and utilization staff of its own, in addition to an overall Bureau or Office capability. This operating division staff would work with agency program

officers and sometimes with the demonstration project staffs to see that their procedures contain evaluation, dissemination, and implementation components. Unless steps are taken to promote implementation after research and development and unless someone is responsible for seeing that such steps are taken, considerable lag can be expected.

12. Confront the financial considerations involved in putting project findings to use; e.g., the extent to which the project supplements or supports existing, ongoing practices or services; the cost-benefits involved; a differentiation be tween critical or essential elements of a project and those which are marginally valuable.

Senator HARRIS. Dr. Glaser, will you be having a complete report of that seminar group before long?

Dr. GLASER. Yes, sir.

Senator HARRIS. As I understand, it is not prepared yet?

Dr. GLASER. No, it will go to the typist tomorrow and be photocopied within the next 2 weeks. There will be 200 copies delivered to the Department of Labor in approximately 2 or 3 weeks.

Senator HARRIS. I am very much impressed by that summary of their findings and suggestions and I wondered if it might be possible that you send to us a copy of your report when it is final?

Dr. GLASER. Yes, sir; I will do that.

Senator HARRIS. Let me say that I am very grateful for your presence here and for your thoughtful testimony, which I think will help us understand better how change comes about and how innovations come to be useful and used. It seems to me you have stressed primarily two problems: one, the concept of change, the resistance to it and how it is accepted; and secondly, the age-old problem of communication and dissemination of knowledge. When Vice President Humphrey was a member of this committee, the Senate Committee on Government Operations, the dissemination of research results or of knowledge generally was one of his particular interests and a considerable amount of work was done by him and the subcommittee which he headed in that field.

I also am very much impressed by what you suggest in the way of a traffic policeman for people who are interested in doing contract research in that you might direct them to various agencies who might be interested.

It seems to me that there might be a better way. To some degree, it is done, but it is rather fragmented now and uncoordinated.

For example, the Department of Commerce, I believe, publishes a list of contracts which have been let. But that is after the fact. There are some published in advance, but by and large, what we do is to report after the project is done or after the contract has been let. It seems to me that we might combine a couple of your thoughts in that virtually every agency and department in the Federal Government is involved in some kind of research and development, and very much of it touches on biomedicine. As a matter of fact, nearly everything touches on everything else these days.

It could be that each agency or department might make a statement at the beginning of each year, which could be available in some central place, on request, as to what frontiers of knowledge they are particularly interested in. They could make it up based on what they are doing, both in-house and by contracts and grants. That would be rather interesting, it seems to me, because we would find, I think, bio

chemists working with problems in some other field altogether and physicists with problems working in the biomedical field and so forth. So those who would look at such statements of requirements or research needs would have an opportunity to see where they might be useful. Then, the same office from which you receive that information or perhaps some other office could direct you where to go if you are interested in doing some research along that line. I think it might be a very helpful innovation if that is done.

The other problem, of course, is the dissemination of information we already have. That is a problem within the Government itself. I think that even one agency must be aware of what is being done by another agency. So I think you have made some good suggestions. The bringing together of investigators in a particular field is not new, but it seems to me you have made a good suggestion in that regard.

I am very much interested, for example, in how we change attitudes and improve self-image, because I think that is a rather basic thing in so many governmental programs. AID, for example, I think, more and more is going to concentrate on the development of human resources. OEO, the Office of Economic Opportunity, ostensibly is involved in the development of human resources. The Bureau of Indian Affairs is involved in the development of human resources and is going to have to be more so. The Peace Corps is involved in the development of human resources. So many agencies are. The Department of Labor is. The Department of Health, Education, and Welfare and its many components are. Public Health Service, perhaps even more than it has ever realized, is involved with attitudes as much as with health.

If we could decide on more refined goals in regard to attitudes and to the improvement of self-image, and if we could refine our methodologies somewhat, we would find something rather universally useful and basic.

I have found at least two programs going on-one financed by the Department of Labor and one financed by AID-that are doing some things in those fields that are not generally known by other agencies. I speak about this because it is in your particular field. But it seems to me that we have somehow got to develop a better reporting process and I don't know how we are going to do it. The Department of Defense and the space people, I think, now have some kind of compatible data processing equipment, but that is not generally so in other agencies and might not be applicable to their needs if it were. But that continues to be at least as much of a problem as when Senator Humphrey was here, if not more so.

I appreciate very much your testimony and I think the suggestions you made here and particularly this abstract will be very helpful to us. Do you have anything further you want to add?

Dr. GLASER. Just that I think that your own summary here is very pertinent and wise in terms of focusing on major problems. I would add that the Office of Education has just developed a new information storage, retrieval, and abstracting system, the initials of which are ERIC. But this would be compatible, I believe, with the Defense system. At any rate, it would be one that the other agencies in the social science and health related fields could plug into if they wanted to adapt it to their purposes.

Senator HARRIS. Many people do not realize what a massive thing you and I are talking about right now. I did not when this subcommittee was first established in 1965. It seemed wise to us that we start off by cataloging by agency the various research contracts and grants which had been made and to try to correlate, if we could, the areas in which they had been granted, and the recipients of the grants. At that time, we were even ambitious enough to think that we could put some other information in. We thought that the first part would be rather easy to do and then we could go a little deeper than that and ask why the grant was originated by the grantee or the grantor and, then, who made the decision to fund, with how much money, and so forth. We thought that would all be relatively easy to find and put together in some sensible way.

Well, we only received the reports of NIH and we had to find another room. That was the first problem, just the space problem, of what to do with the NIH reports.

So I would not think it is generally recognized what sort of a massive problem we have. On even a more permanent basis, take, for example, the Library of Congress and the tremendous amount of books that they receive daily for their collection. I think we commence to see what a great problem we have in trying to store and retrieve knowledge and information these days. By the time it is in a book-as a matter of fact, by the time it appears in a scholarly periodical, it may already be obsolete. This is a tremendous problem in our own day and it threatens to get worse as time goes by and we don't come up with solutions.

So I appreciate your putting your mind to it, because it is one of the central problems of government and of modern life.

Dr. GLASER. Thank you, Senator.

Senator HARRIS. Thank you very much, Dr. Glaser.

We are very pleased now to hear from Dr. Shannon. Dr. James A. Shannon is Director of the National Institutes of Health. His Ph. D. degree is from New York University.

Without objection, we will place in the record at this point a brief biographical sketch concerning Dr. Shannon.

Biographical Sketch: James A. Shannon, M.D.

Director, National Institutes of Health, Bethesda, Md.

M.D., New York University, 1929. Ph. D., New York University, 1935. Background Data: Medical Investigator, educator, administrator, and professor of physiology, New York University; Director of Research Service, New York University Medical Division, Goldwater Memorial Hospital; Director, Squibb Institute of Medical Research; Assistant Surgeon General, Director, National Institutes of Health.

Member: Consultant-President's Science Advisory Committee; Advisory Committee on Medical Research-World Health Organization; American Academy of the Arts and Sciences; National Academy of Sciences; President's Committee on the National Medal of Science.

Recipient: Presidential Medal for Merit, 1948; Public Welfare Medal, National Academy of Sciences, 1962; Mendel Medal Award, Villanova University, 1964; Rockefeller Public Service Award, 1964; Public Health Service Distinguished Service Medal, 1966; the Presidential Distinguished Federal Civilian Service Award, 1966.

Senator HARRIS. Dr. Shannon took part in our conference in Oklahoma last October on the general subject of these hearings. I want to say that Dr. Shannon, long before I became interested in the improve

ment of man's health, was involved in a very strategic and helpful

way.

I know, Dr. Shannon, you understand that this subcommittee holds. you in the highest respect and admiration, because I think you have had a vital part in making the field of biomedicine in the United States foremost in the world. We are grateful that you share some of our concerns, and that you have devoted a great amount of time and effort to them. We are glad you are here this morning to help us as we look to the future.

TESTIMONY OF JAMES A. SHANNON, M.D., DIRECTOR, NATIONAL INSTITUTES OF HEALTH, BETHESDA, MD.

Dr. SHANNON. Senator Harris, you are very generous, and I am delighted to be here.

Mr. Chairman and members of the committee, the topic the committee has selected for these hearings is one of keen interest to all members of our national biomedical community. I am glad, therefore, to have the opportunity to participate. The "role of the Federal Government in biomedical development and application" has become, in the past year, one of the most debated and discussed aspects of science policy. My statement is longer than I would have it, yet the importance of the subject to our program argues against substantial curtailment.

The subject is a major concern for the Department of Health, Education, and Welfare, which I represent here today, and particularly for the National Institutes of Health, whose research programs are my responsibility.

I am concerned that, despite the quality and extent of discussions to date, so many misconceptions remain. This is true with respect to the nature of the issues and at a very practical level to the options that are in fact open to us. I would like the impact of discussions here to be clarifying and constructive, and the record of this committee to date gives me confidence that they will be just that.

To meet the issues before the committee as directly as possible, I propose to answer each of the six questions you have posed to participants; then add a thought or two on such general issues as still seem to warrant further comment.

Your first question was:

Whether there is a need for additional attention by Federal agencies in the field of biomedical development and applications.

My short answer here is "Yes." But this, by itself, would be misleading. However we may care to label them, there are at least three distinctively different aspects of "biomedical development and application." The problems for Federal involvement differ in each; the nature of Federal programs seeking solutions also differs in each.

First is the translation of a particular research finding into improved techniques directly applicable to problems of clinical medicine or health care. Characteristically, this translation takes places in major university medical centers, certain independent hospitals, or research foundations. The program stimulus for this-to the extent it is Federal-is most likely to be one of the research or research training pro

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