Knowledge and Information for Better Health in the Americas, 1982
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580-106-4 8/30/03knowledge and information for better health in the americas martin m cummings m d director national library of medicine mr president dr macedo guests and friends i am pleased and honored to receive the abraham horwitz award of the pan american health and education foundation i accept it on behalf of the many individuals who have been involved in the effort to improve biomedical communications through out the americas foremost among them is dr horwitz who gave leadership and support for the development of the paho regional medical library during and subsequent to his tenure as director general he continues his interest in disseminating knowledge and information serving as a visiting scholar at the national library of medicine modern advances in medicine and public health evolve from previous empirical experience creative research and systematic implementation of formalized planning it is the responsibility of scientists and others involved in creating new knowledge to record their work in a form that will ensure that it is widely available research that is not carefully recorded and disseminated is research that is not completed the role of biomedical communications is to share the knowledge gained in one environment with others who can apply it in many distant settings for the benefit of the public this process takes place in many forms through personal communications meetings and conferences informal and formal publications and through the educational process generally the pan american health organization provides the most important forum for all communications involving public health in the americas

Page  2 2 as in society generally we who are concerned with health and disease need to be kept well informed we need both the latest information on a subject and some assurance that the information is based on knowledge - or truth public health today involves more than interrupting the means of transmission of contageous diseases classic public health methods previously were concerned with sanitation food and water control and immunization against infectious agents today prevention of heart disease cancer and other major illnesses depends on specific knowledge of disease processes and human behavior in an age when devastating effects on community health can be traced to our predecessors indiscriminate handling of toxic chemicals or misuse of powerful drugs it is crucial that we transmit new medical knowledge as soon as it is developed and verified to prevent damaging effects on man and his environment the flow of medical information among the nations of the americas should remain free and rapid so that it may contribute to better health for all our citizens such information is not a political instrument to be used selectively public health organizations and officials need to have reliable and efficient mechanisms to acquire and disseminate information medical libraries are powerful societal instruments to serve the needs of public health research education and health care delivery thus their establishment and maintenance should be a high priority throughout the americas in her excellent book on international health mary e corning has described the development of the paho regional medical library she pointed out that twenty years ago the paho advisory committee on medical research reviewed the deficiencies of latin american libraries and biomedical communications shortly thereafter representatives from the national library of medicine the rockefeller foundation and paho met to discuss these problems after a study of the library resources in various latin american countries was made by a team of experts the paho advisory committee on medical research recommended in 1965 that paho establish a regional library of medicine in south america

Page  3 3 dr abraham horwitz who wisely accepted this recommendation and dr marti nes da silva were instrumental in exploring with the government of brazil the possibility of using the library at the escola paulista school of medicine as the new home for the regional medical library they acquired initial funding from the brazilian ministries of health and education the commonwealth fund and the kellogg foundation the national library of medicine provided its book credits at the u s book exchange in addition to 50,000 paho made available its administrative and organizational support in addition to a budget provision of 25,000 this modest beginning led to the creation of one of the world's most important medical libraries in 1968 a scientific advisory committee to bireme was established and dr amador neghme distinguished former dean of the faculty of medicine at the university of chile was appointed as the first full-time director of the library responding to an immediate need the library first assumed the function of providing loans of books and journals to health professionals throughout latin american later it established the first computer based medlars service in south america and organized training programs for librarians and information specialists subsequently it offered specialized bibliographies and reference services in important fields related to medicine and public health since its beginning bireme has provided more than 2 million services to latin american health professionals yet the need continues to extend its services even further throughout south and central america corning also pointed out that at a meeting of latin american ministries of health in 1972 it was recommended that national documentation systems be linked to bireme to form an inter-american biomedical communications network this network was designed to satisfy the needs of biomedical libraries in fifteen latin countries where on the average only 137 journal titles and four reference books were owned by each library the bireme survey clearly pointed out the need to improve medical information services and resources today some 10

Page  4 4 years later much still remains to be done to improve these essential information linkages particularly an increased supportive role of the various member governments is clearly needed new communications technologies make it possible for health professionals in developing countries to access information which may reside in distant communities physicians and public health officers confronting epidemics or previously unrecognized health problems such as acquired immune deficiency syndrome aids now may easily request and rapidly receive references biliographies and the full text of reports and publications which may be located in the regional medical library or at some other national center it is in this context that i applaud paho's farsighted decision to develop and support a regional medical library for latin america bireme it is in my judgement a most important international resource poised to serve the public health needs of latin american society only financial constraints limit its ability to fully exploit the opportunities to acquire organize and share biomedical knowledge bireme should be viewed as a treasure house of medical knowledge obtained from the world at large like all libraries it has the unique feature that one can continuously draw upon this store of knowledge without depleting its volume or value because unlike material products such as food and clothing the use of medical information never depletes the raw materials knowledge can be used over and over again without diminishing the stock in addition the tradition of the free library makes it possible for the poor as well as the rich to obtain knowledge and information libraries by tradition and etymology have been concerned with books and journals increasingly however librarians see their role not as collectors storers and disseminators of published works but as providing access to information this information may be in books and journals but it also may be in microform on videocassettes or discs and in computer files at the national library of

Page  5 5 medicine we have large collections of medical data that exist only in a computerized form with no printed counterpart the reason for this of course is that most library patrons seek information in whatever form the past accomplishments of the national library of medicine in applying computer technology to handling large volumes of biomedical information have aided virtually all library operations - from selecting and ordering the literature to indexing and cataloging it and to making the resulting biblio graphic information available worldwide however remote searching of large centralized online data bases is now an old technology during the remaining minutes i would like to acquaint you with what i think future new technologies may do to improve information services in attempting to assess the potential impact of new technology it is helpful to identify the relevant technologies as well as the specific information services to be affected the two most salient technologies in the near future are the microcomputer and laser-based technologies microcomputers of course are already in widespread use and will increasingly be found in every facet of information use under the term laser technologies are found high resolution digital scanning optical storage and computer-driven laser printing the application of these technologies has tremendous potential not only for biomedical communication but for all library and information services i will briefly describe a few applications the first has to do with that most basic library function archival storage it will soon be possible to achieve prospective preservation — that is capturing and storing the printed literature in machine-readable form at the time of publication and with only one videodisc 100000 pages of text or the total annual output of some 100 scientific journals can be stored

Page  6 6 a second application is what is called demand publication by which we mean the ability to retrieve documents stored in a digital form and to reprint them on demand with a quality comparable to the original this will be possible by electronically scanning document pages at high resolution and storing the electrical signals on an optical digital disc under computer control the disc may then be accessed to display and retrieve the pages at the same high resolution another is the electronic journal — those that will exist and be delivered exclusively in an electronic format a number of important scientific publishers are now experimenting with these driven by the seemingly inexorable rise in publishing cost as electronic access becomes more common the number of journals on paper will decrease behooving users as well as librarians to learn how to search the new electronic publications the delivery of randomly accessible graphics via optical videodiscs is another potential application such graphics capability will make feasible the concept of online encyclopedias that contain not only text color plates and halftones but also randomly accessible audiovisual motion sequences under the control of the viewer there is the exciting possibility of replicating billions of characters of scientific information on digitally encoded optical discs and then providing low cost copies to local regional and national information centers one potential application of this technology would allow the entire medline file some 800000 references from the last three to four years to be stored on two or three videodiscs the data bases could then be made available inexpensively for use on equipment at local institutions

Page  7 7 what will be the effect of these new applications on libraries and on users regardless of how technology impacts the format of information and the technical operation of libraries i believe the traditional role of the library as a permanent archive of recorded knowledge will remain basically unchanged libraries will continue to perform their traditional functions of organizing information providing assistance for locating information and serving as a source of material for scholarly efforts they will however be required to provide increasing access to machine-readable information as well as computer-based tools to aid in the production of derivative products the computerized data bases used in medicine today as extensive and valuable as they are represent only the beginnning it took 400 years from the introduction of printing in the 15th century to the development of comprehensive medical indexes in the 19th century only thirty years after the introduction of computers we have massive online reference and bibliographic data bases available worldwide i have tried to give you a glimpse of what the new technologies will make possible in the future but it is difficult to see ahead very clearly however this much i can say with confidence the only limitation we will face will be imposed noese new applications on libraries and on users regardless of how technology impacts the format of information and the technical operation of libraries i believe the traditional role of the library as a permanent archive of recorded knowledge will remain basically unchanged libraries will continue to perform their traditional functions of organizing information providing assistance for locating information and serving as a source of material for scholarly efforts they will however be required to provide increasing access to machine-readable information as well as computer-based tools to aid in the production of derivative products the computerized data bases used in medicine today as extensive and valuable as they are represent only the beginnning it took 400 years from the introduction of printing in the 15th century to the development of comprehensive medical indexes in the 19th century only thirty years after the introduction of computers we have massive online reference and bibliographic data bases available worldwide i have tried to give you a glimpse of what the new technologies will make possible in the future but it is difficult to see ahead very clearly however this much i can say with confidence the only limitation we will face will be imposed not by tecese new applications on libraries and on users regardless of how technology impacts the format of information and the technical operation of libraries i believe the traditional role of the library as a permanent archive of recorded knowledge will remain basically unchanged libraries will continue to perform their traditional functions of organizing information providing assistance for locating information and serving as a source of material for scholarly efforts they will however be required to provide increasing access to machine-readable information as well as computer-based tools to aid in the production of derivative products the computerized data bases used in medicine today as extensive and valuable as they are represent only the beginnning it took 400 years from the introduction of printing in the 15th century to the development of comprehensive medical indexes in the 19th century only thirty years after the introduction of computers we have massive online reference and bibliographic data bases available worldwide i have tried to give you a glimpse of what the new technologies will make possible in the future but it is difficult to see ahead very clearly however this much i can say with confidence the only limitation we will face will be imposed not by technology but by our own imagination and creativity daniel boorstin the librarian of congress in remarks delivered at a white house conference on library and information service s described the spectacular growth of the modern information industry however he expressed a serious concern about the vitality of the knowledge generating process ' meanwhile what has become of our knowledge-institutions they do not deal mainly in the storage and retrieval of information nor in the instant flow of today's facts and figures which will be displaced by tomorrow's reports and bulletins rather they deal in the enduring treasure of our whole human past they include our colleges and our universities - and of course our libraries while the information industry flourishes and seeks new avenues of growth while people compete to buy into them our knowledge-institutions go begging

Page  8 8 medical leaders and public health officials need to maintain support for the institutions which generate new knowledge through research while at the same time maintaining the information apparatus to preserve organize and disseminate information derived from knowledge the library remains the most efficient and democratic institution for knowledge transfer we need to use it more frequently as a weapon against disease and illness everywhere

Page  9 references 1 corning mary e a review of the u s role in international biomedical research and communications international health and foreign policy washington d c u s government printing office 1980 2 boorstin daniel j gresham's law knowledge or information ab bookman's weekly 1982 feb 22 1379-88