Tuesday, March 24, 2009

Medicine in context

Today's meditation has arisen from a series of reference questions (formal and not) brought to our doorstep this week, all of which seem to be gelling around a common theme: the inability to discuss, in any worthwhile manner, a single event or publication in medicine without a consideration of the context (or milieu, if you prefer, and you're a little bit snobbish) in which that event/publication occurred.

Three completely different angles on this truism/conundrum have presented themselves in the past 24 hours:

1. Physician trained to write for medical/scientific journals now seeks to expand his writing to the historical press. His initial "draft"--which he calls done--is concise, direct, and without description of extraneous factors. It makes little sense to the historically-minded editor, who wants him to "flesh it out." He asks: what else would they want to know? Well, for starters: Why do we care about this event? Why was it significant? Why did it happen in Oregon? What became of the key players afterwards? Was the chair of Pharmacology wearing those god-awful plaid pants you always see him in in photos? If so, what did the folks from Washington DC make of his getup? Of course, I digress, but the point is that there are a wealth of details that could inform this historical report, none of which immediately occurred to our very intelligent and capable physician friend, because he's been trained to focus only on proximate causes. Good medicine, bad history.

2. Historian seeks information on "impact factor" of medical articles published in the 1930s. Oh, if I had a penny for every time I wished, along with a patron, that all the citations from the old Index Medicus volumes were available in PubMed, I'd have enough pennies to award NLM a grant to do just that. In the meantime, we can gather data on journals indexed during the 1930s from the printed volumes, to try to establish whether the articles in question came from reputable sources. If the article became a true classic, it might be listed in Morton's medical bibliography (refer to Friday's rant) or a specialty bibliography. We can look for obituaries and other biographical pieces on the articles' authors, to see whether someone else has done the legwork for us ("Dr. Miller's most significant contribution to medicine came in his 1932 publication of the first case report..."). The historian, who is not a physician, wanted to know how you can tell when a medical fact/procedure/theory becomes "common knowledge." I think it's safe to say that medical education is about the most conservative of medical arenas, and that if a fact has made it into textbooks, the medical community has come to some consensus on it. And luckily we do tend to keep runs of textbooks, unlike lab manuals (refer to Monday's rant).

3. Patient seeks information on potential treatment, developed in the 1920s and subsequently abandoned. Without formal medical training or extensive experience in historical research, a patron looks for information on a technique from the 1920s. One paper has been identified as the "pearl" to which other relevant information should accrete. But what are the underlying assumptions in the selection of that one article, and the assumptions then used to expand the search? If a researcher is listed as lead author among a group of three or four, does that mean he did the work? Does it mean he conducted the tests? If another article cites this pearl, is it a citation of method or result? How was the information on the technique disseminated, if not through the peer-reviewed literature? Was it too insignificant to devote space to in the published article (refer to #1 above)? If so, was it perhaps submitted as a report at a conference? A presentation to a faculty group? Did the developer of the technique show it to a student who subsequently joined the faculty at Wisconsin, where he showed it to another student, who then came to Oregon and conducted more tests? Under what circumstances, in what venue, in what format might a description of the technique have been captured?

The key to finding and understanding any information is knowing how, when, why, and where it was produced. And you thought it was easy being a librarian....

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