Table Of Content4'
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NLM: The
World's
Largest Medical Library
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WLM
Black Bag LNIABTRIAORNYAOLF
MEDICINE
A
Message from the Director of the
W
National Library of Medicine
elcome to your library, So enjoy your"tour" of the National
the National Library of Library of Medicine and should you
Medicine (NLM). It may ever be in Bethesda, MD,you are most
well turn out to be one of the most welcome to visit us here at the library.
important tools in your medical prac-
We
tice. not only house millions of
journals and books (some going back
,000years),butwe're the originatorof
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MEDLINE, the world's major medical
information database.When you face a
puzzling medical problem, you'll find
our family of databases at your service.
Of course you have access to the liter-
ature at medical libraries. However
there's a twist: your patient now has
access to the same information you do.
was recentlyagueston the National
I
Public Radio show/Talk ofthe Nation."
The subject of the broadcast was the
tremendous growth in the use of med-
icalWeb sites. One ofthe callers during
the show was a woman who has an
autistic son. She said that her online Dr. DonaldA. B. Lindberg, director ofthe
searches of MEDLINE helped guide her National Library of Medicine teaches a new
doctors in improving her son's care and generation about the Library's databases.
that his health has improved as a result
of information gleaned from those
searches.We frequently hear such sto-
ries about patients doing much better
sometimes lives even being saved
because they or their loved ones have
searched NLM's databases for the latest
reliable medical information.
PLNIApBTRIjAORNiYAOjLF Black Bag
MEDICINE
The National Library of Medicine
TheWorld of Medicine atYour Fingertips
Go to:www.nlm.nih.gov der in ways that were not possible in Internet, but patrons can also obtain
The practice of medicine changes the past, which brings us to the medical journal articles through a
with each generation ofphysicians. But National Library of Medicine (NLM), national network of medical libraries
while technological advances in health the world's largest medical library. (4,500 ofthem). This national network
care are the norm, one of the biggest The Library got its start in the early also maintains a variety of outreach
changes your generation of practicing 1800s with just a handful of books. programs geared toward the health
physicians will face is this: Patients will Today,its collection encompasses 6 mil- professional community.
have easy access to much of the med- lion items and houses the most com- In the past, the Library's collections
ical information thatonly physicians his- plete databases of medical information were consulted primarily by physicians
torically have had access to. The in the world. We disseminate this and other health professionals. Search
patientwill be looking over your shoul- information not only directly via the fees, limited access to computers and
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cumbersome search engines precluded recent report by Media Metrix,it's baby and ClinicalTrials.gov receives some 30
widespread public use. But all that has boomers and seniors that make up the million hits.
changed. In 1997, searching NLM's fastest growing Internet population. While MEDLINEplus and Clinical-
databases was made free, and with the According to the same report, the Trials.gov are aimed to meet the needs
explosive growth of home computers older age group comprises 20 percent of consumers, MEDLINE is the data-
and easier search mechanisms,the gen- of total online users, outpacing 18-24- base more geared towards physicians.
eral public has embraced searching for year-olds who lag at 17.5 percent. Its extensive data base of over 4,500
medical information with gusto. Older Americans have embraced this medical journals makes ita mustforthe
As a practicing physician,you will find "new" technology. practicing physician.
that more and more people are logging The following search statistics give The Library's newest wrinkle in the
online for their health information. you some indication of how many peo- search engine world is"one-stop shop-
While you might assume that the ple search our databases: MEDLINE ping" for all of NLM information
largest group ofWeb surfers are those receives approximately 400 million hits resources. Known as the NLM
under 30 years of age, according to a annually; MEDLINEplus, 70 million hits; Gateway (http://gateway.nlm.nih.gov) it
O
it
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I NUNaITtEDiSToATnIal Library of Medicine
Black Bag
searches within and across all NLM History of Medicine, plus the other the Library's director.
databases. Type in the word,"diabetes" myriad databases that the National While the Library is probably best
and immediately, up pops a screen that Library of Medicine maintains. known for its medical literature data-
tells you what's available on thatsubject "This sophisticated search capability bases, it also houses GenBank, the
in PubMed, MEDLINEplus, LOCATOR- makes itvery handyforthe physician to world's most complete collection of
DNA
plus (the Library's "card" catalog of get the latest information from diverse public and protein sequences.
books, manuscripts, and videos), sources on a particular disease or dis- More than 100,000 species are repre-
ClinicalTrials.gov, images from the order," says Donald A.B. Lindberg, M.D. sented in GenBank including data from
MEDLINE: The Physician's Silent Research Partner
Go to: www.pubmed.gov care system, and the preclinical sci- basedonaword-weighted algorithm.
It's the physician's own personal ences. Itcontains more than 12 mil- A special clinical query feature facili-
bibliographic research tool and with lion bibliographic citations and tates searches for studies based on
it,heorshecanhaveinstantaccessto abstracts and is continually growing. etiology, diagnosis, prognosis, or
all the world's medical journals with- MEDLINE also contains links to treatment of a particular disease,
out having to visit the local medical the full-text versions of articles at Search results can be viewed in vari-
library. PubMedprovidesfreeaccess participating publishers' Web ous formats, including formats suit-
to MEDLINE, the Library's premier sites-the LinkOut Service. In addi- able for downloading .into biblio-
bibliographic database of 4,500 bio- tion, MEDLINE provides access and graphic reference manager software,
medical journals published in the linkstotheintegratedmolecularbiol- Publishers participating in the
United States and 70 foreign coun- ogy databases maintained by the LinkOut service may display links to
tries dating back to the mid-1960's. National Center for Biotechnology sites providing the full-text of arti-
"If there's a published medical Information (NCBI).Thesedatabases cles.Notethatthesesitesmayrequire
journal outthere, no matterhowfew contain DNA and protein sequences, users to register or pay a fee before
subscribers or how remote the coun- genome mapping data, and 3-D pro- being able to view the full-text,
try in which it is published, you can tein structures. Currentlythere are over2,500 online
beprettysurethatithas beenconsid- MEDLINE is a powerful yet easy- journals accessible through the
ered for inclusion in MEDLINE," to-use search tool for finding journal LinkOut program,
said Sheldon Kotzin, the executive articles of interest in the health and The NLM offers several resources
editor ofMEDLINE. medical sciences. A search screen to aid MEDLINE users, including a
MEDLINEhaseven beenakeyele- allows users to search by entering "Loansome Doc" feature that
ment in a plot in an episode of the wordsorphrases.Asetofitems (title, enables users to request copies of
prize-winning TV drama, ER. author, and journal citation data) is articles from a medical library. The
During one scene, Nurse Hathaway retrievedandassociatedabstractscan MEDLINE sidebar contains links to
used MEDLINE to help diagnose a be selected for viewing. aWeb-basedinteractivetutorial, help
rare disease. A unique feature of MEDLINE is documentation, and frequently asked
This web-based database covers the ability to instantly find articles questions page,
the fields of medicine, nursing, den- that are related to any given article,
tistry, veterinary medicine, the health Related articles are pre-computed
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the Human Genome Project. ,600 licenses to organizations and (NGI) telemedicine projects focus on a
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"GenBank is an extremely valuable individuals all overthe world to use the wide variety of health projects. For
tool for 21st century medicine," said Visible Human data sets for all kinds of example, a system is being designed in
David Lipman, M.D.,the director ofthe medical and educational applications. New Haven to help the pathologist
National Center for Biotechnology For example, physicians at the Mayo make a diagnosis of cytologic specimen
Information, an arm of the National Clinic used data from the Visible from lymph nodes and thyroid. To use
Library of Medicine. "The growth is Humans to practice patient-specific the tool, the pathologist creates digi-
amazing,doubling every 15 months,and prostate and brain surgery before per- tized images of a selected set of cells
providing an ever richer source for forming real surgery. Research physi- from a specimen and submits these
gene discoveries." cians have come up with a new screen- over theWeb. Each image will then be
We also are home to the "visible ing method where they can do a virtu- compared to a database and the analy-
humans," NLM's virtual cadavers. A al colonoscopy for a fraction of the sis will produce ranked sets of images
man and woman donated their bodies cost, time, and discomfort of a real from specimens whose diagnosis is
to science, and their cadavers were colonoscopy. These are onlytwo ofthe known.
frozen, electronically scanned, digitally many, many medical applications that The National Library ofMedicine will
photographed, and then reformatted have resulted from the visible humans. continuetoexplorethefrontiers ofmed-
into a vast computer file. In the future, some aspects of medi- ical informatics-it's a promise that both
Their legacy has been spectacular. To cine may even be practiced over the physicians and patients can count on.
date, the Library has granted over Internet. Next Generation Internet
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An Interview with Dr. Henry (Hank) W. Foster
Chairman of NLM's Board of Regents and Health Activist
Editor's Note: HenryW. Foster, M.D., has How has the Internet affected the medical practice? A positive
led a distinguishedmedicalcareer. He has practice ofmedicine? effect? Negative? Or both?
been a practicing OBGYN since 1965 and Well, it's certainly made the practice of On balance it's been very beneficial.
is Professor ofObstetrics and Gynecology medicine easier in terms of helping us Let's face it: overall, knowledge is a
at Meharry Medical College. He was for- stay abreast of current medical good thing. One detail I've noticed in
mer dean at that medical school, and was research which I think has helped make my medical practice is that patients use
a senior advisor to President Clinton on us better physicians. When I first start- medical databases on the Internet to
teen pregnancy reduction and other youth ed practicing medicine I can't tell how find out about drug interactions and
issues. Not only has Dr. Foster been long it took to search for particular drug side-effects. When patients visit a
engaged in clinical practice atMeharry,he information in medical journals-or how doctor they often forget to inform the
has also been the principal investigator in high the stacks ofjournals could get on doctor ofall the drugs they may betak-
several research projects and the author one's desk. I also think the specter of ing. But in the comfort of their own
ofnumerousjournal articles. Dr. Foster is litigation has encouraged physicians to home they go online to search about
particularly concerned about the problems keep abreast of the latest in medical possible drug interactions. I've also dis-
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ofteen pregnancy especially among low- research and the Internet hasfacilitated covered that patients will do these kind
income and minority women. Dr. Foster is this updated status. ofsearches early on in their treatment.
the chairman of the National Library of How has patients' great access That means they can catch potential
Medicine's Board ofRegents. to medical information affected mishaps before they happen.
HenryW. Foster, M. D.
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MEDLINEplus: Just What the Doctor Ordered
Go to: MEDLINEplus.gov tions. Thenewestadditiontothesite can I recognize Alzheimer's Disease?
There are now two ways your is daily health story articles from the What does melanoma look like?
patients can obtain the latest medical news services. It's a very busy site and has caught
information. They can visit the local MEDLINEplus was launched in onwith the general public.
library or they can go online. With 1998 with the general public as the "We currently average over 5 mil-
MEDLINEplus, theNationalLibrary main audience. On MEDLINEplus, lion page hits a month and thatnum-
of Medicine's database geared NLM's librarians lead patients to the ber increases all the time," says
towards consumers, all patients need literature bydoing searches ofMED- Lacroix.
is Internet access and they can search LINE on each health topic to retrieve Arecentsurveyofnearly3,000 users
the medical literature to their heart's articles thatgive a reviewofthe latest showedwhythissiteis soheavilyused.
content from their own home. researchanddetailsofclinicalstudies. The majorityofthe userswere patients
While MEDLINE (see the other "It saves the consumer a lot of or friends or relatives ofa patient who
boxed article) has been and is the time-and perhaps, frustration that were looking forinformation on a par-
source for medical research literature comesfromsearchingthehugeMED- ticular disease or medical condition.
for physicians, MEDLINEplus lists LINE data base for information. Seventy-one percent of those surveyed
information especially written for Basically, we do all the search work said they were extremely or very likely
consumers and patients by the for the consumer and just list the key toreturntothesite;thevastmajorityof
National Institutes of Health and medical articles on a particular dis- the users said they found what they
other trusted sources. ease or disorder," said Eve-Marie were looking for. Eighty percent were
On MEDLINEplus, for example, LaCroix, who heads up very or extremely satisfied with the
your patients can search for informa- MEDLINEplus. healthinformation.
tion in the online medical encyclope- MEDLINEplus can answer such Interestingly, many physicians also
dia or medical dictionary, get infor- questionsas, HowcanItellthewarn- use MEDLINEplus because it's an
mation on more than 9,000 prescrip- ing signs ofteen violence? How can easy and efficient way to keep up
tion and over-the-counter medica- I learn about bike safety? Is there a medical areas outside their expertise.
tions provided by the United States newsletter that tells me about And, of course, many doctors also
Pharmacopeia (USP), obtain informa- Alzheimer's disease? How do I treat recommend that their patients use
tion on local physicians and dentists someone who has been poisoned by MEDLINEplus, since it's an authori-
from the online directories, and hook bleach? What.are the current treat- tative site that can best trusted to
up with consumer health organiza- ment options for brain cancer? How have credible medical information.
What I thinkyou'regoingto see is that quickly, and the sheer volume of infor- quently get questions from women on
increasingly the practice of medicine is mation means that I have access to hormone replacement therapy. As you
going to be one of partnership between pretty much everything that's written know, there's a lot of controversy out
the doctor and the patient. In a sense, out there. I also can't emphasize there: Many women are confused and
that's not new. Good doctors have enough how important it is that there's there's no one right answer for every
always considered their patients as part- no conflict of interest as pertains to woman. Despite this confusion, now
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ners. But you will see a greater number NLM's medical databases. These are find that most women are far better
ofdoctors who now practice thatway. the straight, objective facts. There are informed about the pros and cons of
Do you use NLM's databases in no hidden agendas. HRT And rather than me preaching to
your practice? How might NLM's databases a patient, I find that she and I now
Absolutely! use MEDLINE, MEDLINE- specifically help in a medical prac- engage in an informed dialogue.
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plus, and ClinicalTrials.gov frequently. I tice? Anotheradvantage ofNLM's databas-
can get timely medical information, Let me give you an example. I fre- es is that I'm able tofind credible med-
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ical information outside my specialty. What might you predict for the and faith institutions. The numbers add
For example, with HRT, we now know future of information technology up. Greaternumbersofpeoplearegoing
that prescribing it to a woman who has and its impact on patient care and to be usingthe computertoget informa-
had a heart attack is not a good prac- practice? tion about medicine and health.
tice. Obviously, heart questions are We've gotayoungerpopulation raised My advice to beginning physicians is
usually directed to a cardiologist. And on the Internet, and the baby-boomers to become adept at using NLM's med-
while I still encourage physicians to are also heavy users. We've got increas- ical databases. It's an excellent way to
consult with specialists outside their ing numbers of home computers across keep up with advances in their particu-
areas of expertise, it sure is convenient the nation. And while there is a digital lar specialty and to get educated in
to be able to quickly consult the med- divide-individuals who are too poor to medical areas outside their field. It's
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ical literature online. own a computer their children have also agreatwayto stayahead with your
In fact,quitefrankly,I don'tknow how learned how to use computers in school patient,becauseyou can be surethathe
I practiced medicine before easy and the underprivileged have access to or she is using the Internet to get
Internet access to medical databases! them in school settings, public libraries, health information!
ClinicalTrials: Linking Patients to Medical Research
Go to: ClinicalTrials.gov directaccesstoinformation onclinical treatment, orsponsoring institution.
When Margaret McFarland discov- research studies. Manypatientsare Recruitmentstatus isalso shown
eredshehadthyroidcancerseveral morewillingtotake anactiverolein whethertheresearcheris recruitingor
yearsagosheturnedtoafriendwho theirowntreatment. And, says ifthestudyhas beencompleted.
workedattheNational Institutesof McCray, an informedpatientismore Thewebsite also provides back-
Healthtogetthe latestinformationon likelyto beacommittedpatient. ground information onclinicaltrials
research studies aboutcancer. Butnow "Increasedpublicaccesstohigh quality andlinkstoMEDLINEplusandMED-
McFarlandaswell asthousandsof health informationwill changethe doc- LINE. McCraynotesthatnotonlydo
otherpatientscansearchforthis infor- tor-patientrelationship," shepredicts. patientsfindthesitehelpful, butmany
mationvia theInternetontheirown. Therearenearly5,700clinicaltrials practicingphysicians alsovisitona reg-
Clinical trials fromallovertheworld at59,000 locationsworld-widecur- ular basistokeep up-to-dateoncurrent
arelisted intheNationalInstitutesof rentlylistedonClinicalTrials.govwith clinical research.
Health's mostrecentdatabase, morebeingaddedeachmonth. Visitorstothe site have madehighly
ClinicalTrials.gov. The sparkforthis Subjects includeeverythingfromsickle- favorablecomments. Oneuserwrote,
databaseresultedfromcongressional cellanemia to mental healthproblems, "Itallows meto seewhatresearchis
legislation in 1997thatmandated a fromdiabetesto rarerdiseasessuch as ongoingthatmayholdsome hope for
registry for both federallyandprivately Lafora DiseaseorFanconi'sanemia. me inthe future." Anothersitevisitor
fundedtrials. The National Libraryof While mostofthe sponsoringorganiza- wishedthat ClinicalTrials.govhad been
Medicine developedthe database and it tions arethe21 researchinstitutesof onlinethreeyears agoand expressed
was launched in Februaryof2000. theNational InstitutesofHealth,there gratitudetothosewhogotitup and
ClinicalTrials.govhas been a huge suc- arealsoclinical trials from other running. Andyetanothersaid, "it's
cess: about5,000people logontothe Federal agencies,teachinghospitals, niceto see a benefitfrom some ofmy
siteeach dayand itgets morethan2 andpharmaceutical companies. taxmoney."
million hitspermonth. The ClinicalTrials.govweb siteis McCraysaystheyare always look-
Dr. Alexa McCray,who headsthe easyto navigate. Youcan searchfora ingforwaysto improve and add new
project, notes thatpatientgroups have clinicaltrial bydisease, location (a features to help strengthenthe site.
become morevocal in demanding nameandphonenumberare included),
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