How Pediatricians Can Use the National Library of Medicine, 1966
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HOW PEDIATRICIANS CAN USE THE NATIONAL LIBRARY OF MEDICINE by Martin M. Cummings, M.D.* Books are the legacies that a great genius leaves to mankind, which are delivered down from generation to generation, as presents to the posterity of those who are yet unborn. -- Joseph Addison The enormous investment of national resources devoted to the health sciences has stimulated the publication of basic and applied knowledge to a degree which has overloaded all components of existing information channels. By conservative estimates, there are more than 6,000 serial publications in the field of medicine alone. These periodicals contain approximately 250,000 articles written annually in 40 different languages. The medical literature grows exponentially, doubling every twelve years. Price, (1) has shown that the number of abstract journals alone is experiencing the same exponential growth as the journal literature itself. These increases are most clearly demonstrated in this graph taken from Vickery & Simpson (2) (Fig. I). The despair of Ploucquet (3) contemplating the increasing flood of medical literature at the beginning of the 19th century has gradually become a universal lament. Yet, it is obvious that communication among all members of the biomedical community is an essential link in improving health. Without effective communications, the progress of research and the time lag [*Director, National Library of Medicine, Public Health Service, Department of Health, Education, and Welfare. Presented at the Annual Meeting of the American Academy of Pediatrics, October 25, 1966, Chicago, Illinois.]

Page  2 between discovery and application of new knowledge and techniques will grow worse. This is already reflected by the difficulty facing the average practitioner whose efforts to maintain awareness of recent medical findings are being thwarted by a maze of information sources. While the clinician's needs for continued self-education may be minimally served by selected general and specialty periodicals, these publications, too, continue to increase in number. Eventually, he can only despair of keeping abreast of modern medicine. Our task is to have all information needed by physicians and scientists and to provide it upon request. The National Library of Medicine, with its collection of nearly 1,300,000 books, journals, theses, photographs, and other records relating to the health sciences, constitutes the ultimate source of the world's published biomedical information. In fact, NLM is the largest and most comprehensive specialized research library in any field of science. Medicine is blessed with a resource which no other discipline enjoys. Pediatricians have access to this collection directly, in person, by phone, by TWX, by mail, or through local libraries. Through its Interlibrary Loan Program, NLM lends materials or provides copies of its materials to other libraries for their local users. Each year, we respond to more than a quarter of a million requests for copies of articles or for references to the journal literature. NLM provides over two million pages of photocopy to members of the biomedical community annually and the demands increase by 20% per year. 80,000 readers use the library each year.

Page  3 As a "library's library," NLM provides backup assistance to other libraries in the form of specialized reference and bibliographic services. NLM has performed these services for more than a century. Today NLM produces indexes, bibliographies, and other guides to the biomedical literature by means of its computer-based Medical Literature Analysis and Retrieval System (MEDLARS). Most of you are familiar with the monthly Index Medicus, a comprehensive listing of current articles from 2,400 of the world's leading biomedical periodicals, and the annual Cumulated Index Medicus. More than 175,000 medical articles are analyzed and indexed annually - an awesome task. A computer is used to prepare specialized demand bibliographies on request from individual users. These bibliographies are the products of machine searches of the literature. The MEDLARS computer file now contains more than 500,000 subject and author classified citations to journal articles. In cooperation with other segments of the biomedical community, the Library also uses MEDLARS to compile recurring bibliographies in specialty fields, bibliographies on such subjects as cerebrovascular research, rheumatology, dentistry, medical education, and nursing. These are produced regularly for widespread distribution by professional societies. MEDLARS also provides access to information of interest to pediatricians. Of the 2,400 journal titles now being indexed by the Library for publication in Index Medicus, 75 deal primarily with pediatrics. In addition, many articles in other journals indexed for Index Medicus contain materials pertinent to child health. A recent, typical monthly issue of

Page  4 Index Medicus (for June 1966) contained a total of 14,642 citations. 3,680 of these citations bear subject headings relating to pediatrics. Thus, you would have to read one thousand articles each month to know what has been published in your field - an obviously impossible task. During the course of this session today 35 new papers in your field are being printed. For the past 2 years the Library has been providing on request selected demand bibliographies derived from the mass of literature to focus on subjects of relevance to the user. New search titles are announced regularly in the Journal of the American Medical Association, in the Book Forum section, Public Health Reports, Drug Research Reports (the Blue Sheet), and the Library's monthly newsletter, NLM News. Single copies of the listed bibliographies may be ordered by title and number from NLM. Many of these computer-generated Literature Searches deal with subjects of interest to pediatricians. For example, we have produced searches on the following topics: Chromosome studies in human leukemia; Streptococcal infections and glomerulonephritis; Battered child syndrome; Mental retardation; Juvenile rheumatoid arthritis; Hospital-acquired infections; Rubella virus; Phenylketonuria and many others. January 1966 marked the beginning of a new Library publication, the NLM Current Catalog, representing the latest application of computer technology to library services. Issued biweekly with quarterly cumulations and a hardbound annual edition, the NLM Current Catalog

Page  5 is designed to fulfill two functions: (I) to provide up-to-date cataloging information for the Nation's medical librarians and catalogers, and (2) to serve as a current acquisition tool. Although of primary value to medical librarians, the Current Catalog affords pediatricians and other members of the health professions a means of keeping up with the latest published monographic literature in the biomedical sciences. In addition to NLM's services to the medical community, a key role in the more comprehensive dissemination of biomedical information must be assumed by local libraries. These libraries, in hospitals, medical societies, and research organizations should serve the vast majority of health practitioners. They should be a primary base for the continued education of physicians, thus keeping Osler's "book to bedside and back to book again" practice alive. We believe that with investments in new resources and facilities, the local library can be developed into a responsive biomedical communication resource as an integrated part of a comprehensive information service network. Such a network should include regional libraries as well as specialized information centers. A strong national network built on such a broad base should provide equal and rapid access to all types of published biomedical information. Conversion from passive library service to an active biomedical communications network will necessitate important changes in outlook, resources, and direction of current medical library efforts. Provision of adequate information services through the national biomedical library network will require a new emphasis on accumulating, controlling,

Page  6 and disseminating broad categories of information in new forms, in addition to the traditional forms of published information. Information in the form of graphic images, audiovisual materials, and perhaps even unpublished information should be made available to the user at all levels. Increased library responsiveness must be developed to provide information to the user when and where it is needed. Recognizing that the Nation's medical libraries are a vital link between medical education, practice, and research and that medical libraries have too long been neglected, the Congress passed and the President signed the Medical Library Assistance Act of 1965. This new legislation authorizes a program of grants-in-aid and contracts in support of the Nation's medical libraries. The Act provides for support of construction and renovation of medical libraries, upgrading of library resources, research and development in library science and information handling, training of medical librarians and other information specialists in the medical sciences, publication and translation of bibliographic aids, compilation of critical reviews, and the establishment of regional medical libraries. These new programs, while aimed at bolstering medical libraries' resources and facilities, will have a definite impact on the whole field of biomedical communications. By strengthening our medical library system, we will be facilitating the flow of biomedical information among scientists, physicians, and educators.

Page  7 The conceptual framework for a national biomedical library network has been under development at NLM for the past two years. Our study has led us to the view that library services require both geographic and mission-oriented outlets for the dissemination of biomedical information. The NLM network concept is shown in this diagram. (Fig. 2) An essential ingredient of a viable communications network is a strong central element. In the case of the U.S. national biomedical library network, the National Library of Medicine constitutes the central element. NLM serves as the ultimate backstop to all local and regional medical libraries and provides archival, bibliographic, indexing, cataloging, and dissemination functions for the entire national network. (Fig. 3) The following charts depict the information flow patterns projected for the biomedical communications network. This diagram (Fig. 4)-Geographic Dissemination--shows the centralized function of NLM in acquisition, preservation, processing, and effecting dissemination of information in response to requests through regional libraries or, in some cases, directly to local libraries. This chart (rig. 5) illustrates dissemination of information to specialized information centers. Computer tapes and specialized recurring bibliographies are produced for use by Federal agencies and public or private professional groups. The Federal agencies have their own communities of users as shown in this next chart (Fig. 6). Specialized recurring bibliographies produced by MEDLARS are published periodically by private or public professional groups for wider distribution to their memberships, as shown here (Fig. 7).

Page  8 It is now technically feasible to extend and augment information resources to better serve the needs of physicians. Information in machine-readable form can be transmitted electronically to printing devices or to consoles located at distant sites. Humans may interact with computer information stores by access to terminals located at distant sites. Time and distance may be foreshortened through information networks linking users and mechanized data banks. Although the costs of such linkages may still be too high for universal use, direct access, on-line communication between users and information resources will undoubtedly be available for high priority areas in the very near future. The economy of duplicating magnetic tape information stores and sharing them with user groups has already been demonstrated in the United States by the National Aeronautics and Space Administration and the National Library of Medicine. NLM has instituted sharing of the information contained in the MEDLARS computer file by providing university medical libraries with duplicate computer tapes which can be used on the universities' computers to provide search service on a local basis. As shown in (Fig. 8), decentralized MEDLARS facilities are now in operation or becoming operational at the University of California in Los Angeles, the University of Colorado in Denver, the University of Alabama in Birmingham, the University of Michigan in Ann Arbor, and Harvard University. Overseas MEDLARS centers are being established by the University of Newcastle-upon-Tyne in England and at Karolinska Institutet in Sweden.

Page  9 Thus, pediatricians engaged in clinical practice, research, or teaching may obtain assistance and various services from the NLM, either directly or through their own library facilities. We are optimistic that in the not too-distant future improved services will result from formalized information networks which are user oriented. The National Library of Medicine's mission is to assist the advancement of medical and related sciences, and to aid the dissemination and exchange of scientific and other information important to the progress of medicine and to the public health. We intend to devote our best efforts to this task. We welcome your suggestions and your support.

Page  10 BIBLIOGRAPHY (I) Price, Derek John de Solla. Science since Babylon. New Haven, Yale University Press, 1961. p. 97-98 (2) Vickery, B. C. and Simpson, D. J. Future of scientific communication. Science J 2(7): 80-85, July 1966. (3) Ploucquet, Wilhem G. Literature medica digesta ... T. I. Tubingae, 1808, P. V. ILLUSTRATIONS Fig. I. Scientific Journals Fig. 2. Biomecial Library Network Concept Fig. 3. Centralized Activities Fig. 4. Geographic Dissemination of Biomedical Information Fig. 5. Mission-Oriented Dissemination of Bibliographic Information Fig. 6. Mission-Oriented Dissemination of Bibliographic Information (Federal Agencies) Fig. 7. Mission-Oriented Dissemination of Bibliographic Information (Professional Groups) Fig. 8. Decentralization of MEDLARS