- Email: [email protected]
The Reagan administration and health information: A summary of trends
Government Publications Review, Vol. 11, pp. 1 l-74, 1984 Printed
Copyright
in the USA. All rights reserved.
THE REAGAN ADMINISTRATION HEALTH INFORMATION: A SUMMARY OF TRENDS VALERIE Documents,
Librarian
0277-9390/84 $3.00 + .OO D 1984 Pergamon Press Ltd
AND
FLORANCE
and Editor, MEDOC, Eccles Health Sciences Utah, Salt Lake City, UT 84112
Library,
University
of
This issue’s column has several purposes. First, I want to describe the way in which government information is produced and disseminated, particularly with regard to the distribution of responsibility among offices of the federal government. Second, I want to illustrate some of the ways a president can affect this process, to illuminate the connection between formal structure and political reality. Finally, I want to recommend some ways this knowledge can be used to make the complicated process of acquiring federally produced health information less intimidating. You’ve probably all heard the statement that the U.S. government is the most prolific publisher in the world. A considerable portion of that effort is dedicated to materials on health and medicine. The Health and Human Services Department (HHS), the second largest publisher within the government, spent over 23.9 million dollars on publishing during 198 1 [ 11. My analysis of the publishing patterns of HHS shows that about 60% of HHS publications are devoted to reporting research results or providing practical information for health professionals. Another 15% are flyers aimed at advertising the various programs administered by HHS; 11% are informational materials directed at the general public and 14% are administrative reports and manuals [2]. Clearly, the federal government is an important source of information in health and medicine. However, because the complexity of government organization is reflected in its publishing process, lack of familiarity with the nature of government publishing can inhibit our efforts to gain and provide access to federally produced materials. To illustrate the federal publishing process, let’s create a hypothetical periodical to be sponsored by the National Library of Medicine; we’ll call it Medical Library Notes. To get Medical Library Notes off the ground, we’ll have to complete an internal publication clearance form describing the purpose, intended audience, approximate cost, number of copies and estimated life of our publication. This request will go through the 17-step control sequence within the Health and Human Services Department. The approval cycle will spiral our request upward in the bureaucracy, through the National Institutes of Health, the Public Health Service, and on to the Office of the Assistant Secretary for Public Affairs where final departmental approval will be awarded or denied [3]. Now that Medical Library Notes has made it through the internal review cycle, we must convince the Office of Management and Budget (OMB) of its merit. Since the early 197Os, OMB has had final say on the production of all government periodicals [4]. We must make a written request to OMB that includes a justification for Medical Library Notes’s existence, the projected costs, audience, and so on. The OMB examiner assigned to Health and Human Services will sit down and negotiate with us about cost, alternatives and such, and will make 71
12
VALERIE
FLORANCE
a final decision about the life or death of our journal. If Medical Library Notes is approved, a letter will be issued authorizing publication for up to five years; at its expiration, we must rejustify the publication. With departmental and executive approval in hand for Medical Library Notes, we now notify the Government Printing Office (GPO) in writing of our intent to publish. From this point, we turn over the mechanics of production to GPO. GPO will set a price for the journal and decide how many additional copies it wants for depository and subscription distribution. The issues will be printed by GPO at its own plant or, more likely, will be contracted out to a private printer. We will receive our copies, which we may distribute on mailing lists or use for filling individual requests. We may even send copies to NTIS for single copy sales. GPO will handle depository distribution and subscription fulfillments. We’ve gone through quite a laborious process to get Medical Library Notes off the ground, a process which involves both the executive and legislative branches of the government. With minor modifications, every government publication works its way through a similar cycle. The complexity of the system provides us with several potential access points for ordering copies of Medical Library Notes. That’s why it’s important to understand which part of the system has responsibility for which aspect of the publication. For example, there’s no point in writing to GPO for a free copy of Medical Library Notes, because it is in the sales business. Likewise, a similar request sent to the Public Health Service or even National Institutes of Health is not likely to receive the kind of attention you want; aside from their part in the approval cycle, these departments have nothing to do with Medical Library Notes. Your best chance of obtaining a free copy is to write directly to NLM and hope that your letter gets there before their stockpile of freebies is exhausted. Don’t bother writing to them for a subscription, though; all paid distribution is handled by the Government Printing Office. Knowing the general form that publishing takes in the federal government is only part of the challenge. The changing philosophy of presidential administrations can affect the accessibility of publications at any point in the process. Though government publishing seems immutable, policy decisions made by the president can have dramatic effects on the quantity, cost, format and content of publications issued. I will use actions of the Reagan administration to illustrate some of the ways this occurs. Though my examples are from Health and Human Services, the restrictions and changes I’m talking about have affected all agencies in the executive branch. The most drastic measure a president can take is to bring government publishing to a halt. President Reagan did this in April 1981, declaring a moratorium on the production of new pamphlets and periodicals that lasted about two years for HHS. Though some items continued to be printed, any new publication had to be approved by OMB, the agency assigned to implement and oversee the moratorium [5]. Short of shutting down the machinery, the president can take action to reduce the number of titles produced. The implementation of Reagan’s moratorium required HHS to submit a list of all its current publications, along with suggested cuts and consolidations. According to OMB figures, 87 HHS titles were cancelled during the moratorium period, representing about 8% of current HHS publications [6]. Sources within the department suggest that the real figure was much higher. According to one report, the Office of Human Development Services cancelled more than 100 titles, including the bestseller, Your ChildFrom One to Six. Other titles that got the axe: Poison Control Center Bulletin, annual reports of the Administration on Aging and the Child Abuse and Neglect Office; statistical sources like Facts at Your Fingertips, and Health Resources Statistics; and grant listings from several bureaus [7].
Reagan
administration
and health
trends
13
Another significant pressure point is the organization’s publishing structure. President Reagan required all departments to institute fairly rigid publication control plans which included top-level management evaluations. At HHS, Reagan appointees at the top form a panel with final say on all publication requests, a responsibility which was previously assigned to a career public employee. This “political” review board can (and does) manipulate both the number and subject matter of departmental publications. In this way, the president can be sure that publications issued during his term of office reflect his official position on a subject. Thus, we see an increase in publications from HHS which deal with personal responsibility for disease and a decrease in those which detail environmental and occupational hazards. Another Reagan thrust into government publishing has been in the area of cost recovery. Though existing legislation bars departments from setting prices or handling sales, they are being encouraged to “follow the Department of Agricultural model” and review their publications for increased user fees [8]. This usually takes the form of handling charges. The most recent Consumer Information Catalog states, “Please note: There is now a $1 .OO user fee for processing an order for two or more free titles” [9]. Another budget reduction tactic has been to eliminate or drastically curtail the distribution of free copies to individuals. The National Center for Health Statistics will no longer provide free copies of the Vital and Health Statistics Series. The National Library of Medicine has adopted a similar approach, making its publications available for purchase from both GPO and NTIS. Some departments have also dispensed with free mailing list distribution to institutions. In conjunction with the disappearance of individual free copies, pricing and distribution policies at the Government Printing Office have changed to reflect the Reagan philosophy. Hundreds of titles were dropped from the GPO Sales inventory for being “slow-movers” and in the future, titles which do not generate $1000 in sales in a year will be dropped. At present, GPO sells only about 10% of all government-produced publications; NTIS makes some small additional percentage available. GPO has instituted a minimum charge of $1.75 per document, and subscription prices have been adjusted upwards. For HHS periodicals available by subscription from GPO, price increases averaged 82.4% between 1981 and 1983, including the following price increases in familiar titles: a 91% increase in Abridged Index Medicus, a 75% increase in Cancer Treatment Reports, a 30% increase in Index Medicus, and a 58% rise in FDA Consumer. The National Library of Medicine’s Current Catalog increased 72%) Psychopharmacology Bulletin went up lOO%, and the Registry of Toxic Effects rose 192% [lo]. Public pressure and an internal study have caused the Public Printer to reconsider some of these actions; an across-the-board 10% price increase was rescinded and some promise is being held out for further reductions. Yet another focus of Reagan publishing policy is the format of documents produced. For some publications, this has meant consolidation, either cutbacks in frequency or the merger of individual titles into a single publication. For example, Health Care Financing Trends was merged with Health Care Financing Review. Design changes in Public Health Reports, the FDA Consumer and the Journal of the National Cancer Institute testify to the effectiveness of pressure to use fewer colors and cheaper materials. According to OMB, 195 HHS titles, about 18% of HHS’s inventory, received this treatment [ 111. All of you who purchased the National Library of Medicine’s recent cumulation of the Current Catalog are aware of another trend in format modification, the move toward publishing on microfiche. For titles like this one, no paper format will ever be available. At the Medical Library Association annual meeting in Houston this spring, we were warned that more NLM publications will be following this path.
74
VALERIE
FLORANCE
Political and philosophical ramifications aside, if we survey the current government publishing situation as it relates to our efforts to provide timely, useful medical information, we find: (a) fewer titles being produced; (b) fewer free copies of the titles which are produced; (c) fewer titles available for sale; (d) modifications in format, especially the shift to microfiche; and (e) price increases and user fees. As you know, information is becoming the single resource upon which our economy is based. As you also know, battle lines are being drawn between private and public publishers regarding the control of this valuable resource. Because the federal government underwrites the production and dissemination of so much medical scientific research, this battle has some serious implications for us as librarians. It is no longer enough just to know that the government publishes important information in the medical sciences. It’s not even enough to know where to go to get those publications. Librarians must also be aware that government information policy is shaped by political and economic realities. If newspaper and journal coverage of the Reagan administration actions outlined above are any indication, neither the public at large nor the professional community is well informed about this situation. As information brokers and specialists, we are in a unique position to make an important contribution here. First, we can monitor government policy regarding information creation and dissemination. Second, we can speak for, and defend, the public interest. Finally, we can take action, when necessary, to protect our right of free and equal access to government information. NOTES
AND
REFERENCES
and Budget, “Report on Eliminations, Consolidations, and Cost Reductions of 1. U.S. Office of Management Government Publications,” Washington, D.C: Office of Management and Budget, 1982, p. 4. Policy and Information Dissemination: An Analysis of the Reagan Moratorium 2 Florance, Valerie. “Presidential on Govermnent Publishing,” Government Information Quarterly (in press). “Control Plan and Planned Reof HHS’s control plan are printed in an internal document, 3. The parameters ductions for Periodicals, Pamphlets and Audiovisuals. Response to OMB Bulletin No. 81-16.” Washington, D.C.: Health and Human Services Department, 1981. Periodicals,” Circular A-3, Revised. Washington, and Budget, “Government 4. See U.S. Office of Management D.C.: Office of Management and Budget, 1972. Weekly Compilation of Presidential DocuAids and Publications,” 5. Reagan, Ronald. “Federal Audiovisual ments 17 (April 1981):447. For implementation instructions issued by the Office of Management and Budget, of Wasteful Spending on Government Periodicals,” see: U.S. Office of Management and Budget, “Elimination Bulletin 81-16. Washington, D.C.: Office of Management and Budget, 1981; and U.S. Office of Management and Budget, “Elimination and Consolidation of Government Periodicals and Recurring Pamphlets,” Bulletin 81-16, supp. 1. Washington, D.C.: Office of Management and Budget, 1981. p. 8. and Budget, “Report on Eliminations,” 6. Office of Management Printing Office’s Adminis7. Two useful sources have provided these examples: recent issues of the Government trative Notes, and monthly issues of the American Statistics Index. p. 12. and Budget, “Report on Eliminations,” 8. Office of Management Consumer Information Catalog. Pueblo, Colorado: Consumer ln9. U.S. General Services Administration, formation Center, Summer 1983). Printing Office, Government Periodicals and Subscription Services, 10. Figures compiled from U.S. Government Price List 36. Washington, D.C.: Superintendent of Documents, Summer 1981, Summer 1983. pp. 8-9. and Budget, “Report on Eliminations,” Il. Office of Management
Copyright
in the USA. All rights reserved.
THE REAGAN ADMINISTRATION HEALTH INFORMATION: A SUMMARY OF TRENDS VALERIE Documents,
Librarian
0277-9390/84 $3.00 + .OO D 1984 Pergamon Press Ltd
AND
FLORANCE
and Editor, MEDOC, Eccles Health Sciences Utah, Salt Lake City, UT 84112
Library,
University
of
This issue’s column has several purposes. First, I want to describe the way in which government information is produced and disseminated, particularly with regard to the distribution of responsibility among offices of the federal government. Second, I want to illustrate some of the ways a president can affect this process, to illuminate the connection between formal structure and political reality. Finally, I want to recommend some ways this knowledge can be used to make the complicated process of acquiring federally produced health information less intimidating. You’ve probably all heard the statement that the U.S. government is the most prolific publisher in the world. A considerable portion of that effort is dedicated to materials on health and medicine. The Health and Human Services Department (HHS), the second largest publisher within the government, spent over 23.9 million dollars on publishing during 198 1 [ 11. My analysis of the publishing patterns of HHS shows that about 60% of HHS publications are devoted to reporting research results or providing practical information for health professionals. Another 15% are flyers aimed at advertising the various programs administered by HHS; 11% are informational materials directed at the general public and 14% are administrative reports and manuals [2]. Clearly, the federal government is an important source of information in health and medicine. However, because the complexity of government organization is reflected in its publishing process, lack of familiarity with the nature of government publishing can inhibit our efforts to gain and provide access to federally produced materials. To illustrate the federal publishing process, let’s create a hypothetical periodical to be sponsored by the National Library of Medicine; we’ll call it Medical Library Notes. To get Medical Library Notes off the ground, we’ll have to complete an internal publication clearance form describing the purpose, intended audience, approximate cost, number of copies and estimated life of our publication. This request will go through the 17-step control sequence within the Health and Human Services Department. The approval cycle will spiral our request upward in the bureaucracy, through the National Institutes of Health, the Public Health Service, and on to the Office of the Assistant Secretary for Public Affairs where final departmental approval will be awarded or denied [3]. Now that Medical Library Notes has made it through the internal review cycle, we must convince the Office of Management and Budget (OMB) of its merit. Since the early 197Os, OMB has had final say on the production of all government periodicals [4]. We must make a written request to OMB that includes a justification for Medical Library Notes’s existence, the projected costs, audience, and so on. The OMB examiner assigned to Health and Human Services will sit down and negotiate with us about cost, alternatives and such, and will make 71
12
VALERIE
FLORANCE
a final decision about the life or death of our journal. If Medical Library Notes is approved, a letter will be issued authorizing publication for up to five years; at its expiration, we must rejustify the publication. With departmental and executive approval in hand for Medical Library Notes, we now notify the Government Printing Office (GPO) in writing of our intent to publish. From this point, we turn over the mechanics of production to GPO. GPO will set a price for the journal and decide how many additional copies it wants for depository and subscription distribution. The issues will be printed by GPO at its own plant or, more likely, will be contracted out to a private printer. We will receive our copies, which we may distribute on mailing lists or use for filling individual requests. We may even send copies to NTIS for single copy sales. GPO will handle depository distribution and subscription fulfillments. We’ve gone through quite a laborious process to get Medical Library Notes off the ground, a process which involves both the executive and legislative branches of the government. With minor modifications, every government publication works its way through a similar cycle. The complexity of the system provides us with several potential access points for ordering copies of Medical Library Notes. That’s why it’s important to understand which part of the system has responsibility for which aspect of the publication. For example, there’s no point in writing to GPO for a free copy of Medical Library Notes, because it is in the sales business. Likewise, a similar request sent to the Public Health Service or even National Institutes of Health is not likely to receive the kind of attention you want; aside from their part in the approval cycle, these departments have nothing to do with Medical Library Notes. Your best chance of obtaining a free copy is to write directly to NLM and hope that your letter gets there before their stockpile of freebies is exhausted. Don’t bother writing to them for a subscription, though; all paid distribution is handled by the Government Printing Office. Knowing the general form that publishing takes in the federal government is only part of the challenge. The changing philosophy of presidential administrations can affect the accessibility of publications at any point in the process. Though government publishing seems immutable, policy decisions made by the president can have dramatic effects on the quantity, cost, format and content of publications issued. I will use actions of the Reagan administration to illustrate some of the ways this occurs. Though my examples are from Health and Human Services, the restrictions and changes I’m talking about have affected all agencies in the executive branch. The most drastic measure a president can take is to bring government publishing to a halt. President Reagan did this in April 1981, declaring a moratorium on the production of new pamphlets and periodicals that lasted about two years for HHS. Though some items continued to be printed, any new publication had to be approved by OMB, the agency assigned to implement and oversee the moratorium [5]. Short of shutting down the machinery, the president can take action to reduce the number of titles produced. The implementation of Reagan’s moratorium required HHS to submit a list of all its current publications, along with suggested cuts and consolidations. According to OMB figures, 87 HHS titles were cancelled during the moratorium period, representing about 8% of current HHS publications [6]. Sources within the department suggest that the real figure was much higher. According to one report, the Office of Human Development Services cancelled more than 100 titles, including the bestseller, Your ChildFrom One to Six. Other titles that got the axe: Poison Control Center Bulletin, annual reports of the Administration on Aging and the Child Abuse and Neglect Office; statistical sources like Facts at Your Fingertips, and Health Resources Statistics; and grant listings from several bureaus [7].
Reagan
administration
and health
trends
13
Another significant pressure point is the organization’s publishing structure. President Reagan required all departments to institute fairly rigid publication control plans which included top-level management evaluations. At HHS, Reagan appointees at the top form a panel with final say on all publication requests, a responsibility which was previously assigned to a career public employee. This “political” review board can (and does) manipulate both the number and subject matter of departmental publications. In this way, the president can be sure that publications issued during his term of office reflect his official position on a subject. Thus, we see an increase in publications from HHS which deal with personal responsibility for disease and a decrease in those which detail environmental and occupational hazards. Another Reagan thrust into government publishing has been in the area of cost recovery. Though existing legislation bars departments from setting prices or handling sales, they are being encouraged to “follow the Department of Agricultural model” and review their publications for increased user fees [8]. This usually takes the form of handling charges. The most recent Consumer Information Catalog states, “Please note: There is now a $1 .OO user fee for processing an order for two or more free titles” [9]. Another budget reduction tactic has been to eliminate or drastically curtail the distribution of free copies to individuals. The National Center for Health Statistics will no longer provide free copies of the Vital and Health Statistics Series. The National Library of Medicine has adopted a similar approach, making its publications available for purchase from both GPO and NTIS. Some departments have also dispensed with free mailing list distribution to institutions. In conjunction with the disappearance of individual free copies, pricing and distribution policies at the Government Printing Office have changed to reflect the Reagan philosophy. Hundreds of titles were dropped from the GPO Sales inventory for being “slow-movers” and in the future, titles which do not generate $1000 in sales in a year will be dropped. At present, GPO sells only about 10% of all government-produced publications; NTIS makes some small additional percentage available. GPO has instituted a minimum charge of $1.75 per document, and subscription prices have been adjusted upwards. For HHS periodicals available by subscription from GPO, price increases averaged 82.4% between 1981 and 1983, including the following price increases in familiar titles: a 91% increase in Abridged Index Medicus, a 75% increase in Cancer Treatment Reports, a 30% increase in Index Medicus, and a 58% rise in FDA Consumer. The National Library of Medicine’s Current Catalog increased 72%) Psychopharmacology Bulletin went up lOO%, and the Registry of Toxic Effects rose 192% [lo]. Public pressure and an internal study have caused the Public Printer to reconsider some of these actions; an across-the-board 10% price increase was rescinded and some promise is being held out for further reductions. Yet another focus of Reagan publishing policy is the format of documents produced. For some publications, this has meant consolidation, either cutbacks in frequency or the merger of individual titles into a single publication. For example, Health Care Financing Trends was merged with Health Care Financing Review. Design changes in Public Health Reports, the FDA Consumer and the Journal of the National Cancer Institute testify to the effectiveness of pressure to use fewer colors and cheaper materials. According to OMB, 195 HHS titles, about 18% of HHS’s inventory, received this treatment [ 111. All of you who purchased the National Library of Medicine’s recent cumulation of the Current Catalog are aware of another trend in format modification, the move toward publishing on microfiche. For titles like this one, no paper format will ever be available. At the Medical Library Association annual meeting in Houston this spring, we were warned that more NLM publications will be following this path.
74
VALERIE
FLORANCE
Political and philosophical ramifications aside, if we survey the current government publishing situation as it relates to our efforts to provide timely, useful medical information, we find: (a) fewer titles being produced; (b) fewer free copies of the titles which are produced; (c) fewer titles available for sale; (d) modifications in format, especially the shift to microfiche; and (e) price increases and user fees. As you know, information is becoming the single resource upon which our economy is based. As you also know, battle lines are being drawn between private and public publishers regarding the control of this valuable resource. Because the federal government underwrites the production and dissemination of so much medical scientific research, this battle has some serious implications for us as librarians. It is no longer enough just to know that the government publishes important information in the medical sciences. It’s not even enough to know where to go to get those publications. Librarians must also be aware that government information policy is shaped by political and economic realities. If newspaper and journal coverage of the Reagan administration actions outlined above are any indication, neither the public at large nor the professional community is well informed about this situation. As information brokers and specialists, we are in a unique position to make an important contribution here. First, we can monitor government policy regarding information creation and dissemination. Second, we can speak for, and defend, the public interest. Finally, we can take action, when necessary, to protect our right of free and equal access to government information. NOTES
AND
REFERENCES
and Budget, “Report on Eliminations, Consolidations, and Cost Reductions of 1. U.S. Office of Management Government Publications,” Washington, D.C: Office of Management and Budget, 1982, p. 4. Policy and Information Dissemination: An Analysis of the Reagan Moratorium 2 Florance, Valerie. “Presidential on Govermnent Publishing,” Government Information Quarterly (in press). “Control Plan and Planned Reof HHS’s control plan are printed in an internal document, 3. The parameters ductions for Periodicals, Pamphlets and Audiovisuals. Response to OMB Bulletin No. 81-16.” Washington, D.C.: Health and Human Services Department, 1981. Periodicals,” Circular A-3, Revised. Washington, and Budget, “Government 4. See U.S. Office of Management D.C.: Office of Management and Budget, 1972. Weekly Compilation of Presidential DocuAids and Publications,” 5. Reagan, Ronald. “Federal Audiovisual ments 17 (April 1981):447. For implementation instructions issued by the Office of Management and Budget, of Wasteful Spending on Government Periodicals,” see: U.S. Office of Management and Budget, “Elimination Bulletin 81-16. Washington, D.C.: Office of Management and Budget, 1981; and U.S. Office of Management and Budget, “Elimination and Consolidation of Government Periodicals and Recurring Pamphlets,” Bulletin 81-16, supp. 1. Washington, D.C.: Office of Management and Budget, 1981. p. 8. and Budget, “Report on Eliminations,” 6. Office of Management Printing Office’s Adminis7. Two useful sources have provided these examples: recent issues of the Government trative Notes, and monthly issues of the American Statistics Index. p. 12. and Budget, “Report on Eliminations,” 8. Office of Management Consumer Information Catalog. Pueblo, Colorado: Consumer ln9. U.S. General Services Administration, formation Center, Summer 1983). Printing Office, Government Periodicals and Subscription Services, 10. Figures compiled from U.S. Government Price List 36. Washington, D.C.: Superintendent of Documents, Summer 1981, Summer 1983. pp. 8-9. and Budget, “Report on Eliminations,” Il. Office of Management