Remembering Donald A. B. Lindberg, a visionary giant with a personal touch

Along with the 1,700 women and men of the National Library of Medicine (NLM), I am saddened at the death of Donald A. B. Lindberg, M.D. (September 21, 1933-August 16, 2019), director of the NLM for more than 30 years.  

A world-renowned leader in applying computers to health care and a giant in the field of biomedical research, he was hailed for his visionary and transformative leadership. When people talk about people with such great influence, they often say that those who come after them stand on their shoulders. With Don, it was different. He made sure that we stood beside him.  

Like many of you, I believe I had a relationship with Don that had nothing to do with me as a person, but everything to do with the personhood of “DABL.” Don had a way of making each of us feel chosen to be in his orbit and making you feel as if he singled you out as a winner—and he thought we all were winners!

Throughout the years, Don reinforced the feeling that I stood beside a giant, not on his shoulders.

Let me share a few memories that illustrate this point.

In the mid-1990s, Don recognized the importance of the patient as part of the health information ecosystem. He realized that changing the health care system couldn’t only be the job of health professionals, but that patient engagement was key and that it involved many disciplines, so he created committees to guide NLM’s long range planning efforts. He made sure that young people like me, who had strong research programs to address patient engagement, were part of the process.

In 2002, as I launched my sabbatical at NLM, Don and his wife, Mary, invited me and my son, Conor, to their home. I can still picture Don and my then-nine-year-old son splashing in their pool. The Lindbergs took the time to share their home with me, a kindness that my son and I will never forget.

When I became NLM director in August 2016, Don and Mary hosted a lovely party for me. They introduced me to so many people important to the Library with whom I wouldn’t have met so early in my tenure. Their warm welcome made me feel anointed as a person of importance to them and as a part of the next generation of NLM.

And as I prepared to attend my first Friends of the National Library of Medicine gala later that year, I told Don that I was looking forward to seeing him. His response was that he wouldn’t be attending; He said, “This is your time to shine. I will come back next year.” And so, he did—to the gala and to lectures, celebrations, and many professional events. He and his wife remained a strong presence in the life of the Library. Mary was not only Don’s wife, she was a hospice nurse with a professional practice and a strong advocate in her own right.

Don left his legacy in so many ways, including the annual Donald A.B. Lindberg and Donald West King Lecture to be held September 12 at NLM. Edward Feigenbaum, a pioneer in the development of expert systems in artificial intelligence (AI) and in demonstrating its technological significance, will be speaking. I’d like to think Don would be pleased.  

As I sit in the same office where Don worked, I pledge to take forward the integrity and commitment that Don demonstrated in leading this great institution. It’s not only what he would want, it’s what he would expect.

Dr. Donald Lindberg with grandson, Martin, in his NLM office.
Dr. Donald Lindberg with grandson, Martin, in his NLM office, ca. 1999.

On the Importance of Mentors (and Mentors Who Become Friends)

The best mentors not only provide a sounding board to try out new ideas and thoughts, they also give you the confidence to ride new waves of opportunity. But sometimes mentors become something more: They become your lifelong friends.

That’s the way it’s been for me with Jon White, MD.

I’ve been blessed with many mentors and many friends, but this is a good time for me to reflect on my relationship with Jon because he just announced that he is leaving his post at the Office of the National Coordinator for Health Information Technology (ONC). Jon will become the associate chief of staff of research at the Department of Veterans Affairs Salt Lake City Health Care System.

I’ve known Jon for more than a decade, first in his role as the director of the Health Information Technology (IT) Portfolio at the Agency for Healthcare Research and Quality (AHRQ) and then in his role at ONC. We’ve served on committees together, pushed the national health IT agenda, and commiserated when the promise of automation fell short, once again, of what health care needed.

Jon was ONC’s lead for the Precision Medicine Initiative from 2014 to 2017, and he contributed significantly to the IT provisions of the 21st Century Cures Act. He solicited broad consultative input on the nation’s health IT agenda, engaging the JASON advisory group to inform the direction of artificial intelligence and patient participation, and served as co-chair of the Health IT Standards Committee, which was established in accordance with the Federal Advisory Committee Act.

It would take more space than this blog post to detail Jon’s accomplishments as a federal leader in the health IT space, which would detract from what I want you to know about Jon as a mentor who became my friend.

Like the best mentors, Jon challenged my thinking. During hallway conversations and AHRQ council meetings, Jon pushed me to consider how IT could better support patient participation in health care. He pointed me toward funding opportunities, and before the term “manel” was commonly used to describe all-male speaking panels, he invited me to participate on deliberation panels and key committees.

As I weighed the pros and cons of taking what turned out to be this outstanding opportunity to direct the National Library of Medicine, Jon provided me with sound advice, pointing out the opportunities and challenges I might find in a federal position.

My friendship with Jon is a special gift that reflects not so much the quality of his mentorship but an evolution of our relationship. And when you become friends, there is a mutuality that doesn’t really exist in a mentor-mentee relationship.

As Jon moves on, I hope he carries the gift of this mentorship that turned into a friendship into the next stage of his life, and I hope you’ll be inspired to reach out to the mentors and friends in your life.  

Click here for more Musings on mentors.

Accelerating Innovation in Science

Fast.

Healthcare.

Interoperability.

Resource.

Word about HL7 FHIR—pronounced “fire”—is spreading quickly across the National Institutes of Health (NIH) and scientific community, and for good reason.

The FHIR format is a global industry standard for exchanging health care data between institutions. Most electronic health records systems in hospitals and physicians’ offices already use FHIR to send and receive critical information for patient care and to support billing for patient services. With proper oversight and human subjects’ protection, clinical research and scientific advancement can benefit from FHIR. Data is becoming increasingly important for biomedical research, including predictive phenotyping and the conduct of clinical trials. 

NIH is taking steps to promote the use of FHIR in its funded clinical research to facilitate data access and promote interoperability of research data while protecting patient privacy and ensuring consistency with informed consent.

This afternoon, Clem McDonald, MD, Chief Health Data Standards Officer at the National Library of Medicine (NLM) at NIH, announced two notices issued today by NIH regarding FHIR at the Blue Button 2.0 Developer Conference held at the White House Eisenhower Executive Office Building in Washington, DC.

The Guide Notice on FHIR  encourages NIH-funded investigators to explore the use of FHIR to capture, integrate, and exchange clinical data for research purposes and to enhance capabilities to share research data. The Notice aims to make all NIH-funded researchers aware of the emerging ability to extract data from electronic health records using FHIR and encourage them to use FHIR-compatible formats when sharing data, consistent with privacy restrictions and informed consent. Following this notice, NIH will soon solicit input from the scientific community and other stakeholders about the tools that might be needed to support use of FHIR in biomedical research, as well as implementation challenges and opportunities they foresee in using FHIR. 

To complement the research component, NIH also posted a Notice of Special Interest to inform the small business innovation research and small business technology transfer communities of NIH’s interest in supporting applications that use FHIR in the development of health information technology products and services. NIH is interested in the implementation of the FHIR standard in health IT applications, such as the integration of patient- and population-level data from electronic health records systems, access to and management of electronic health information, the development of clinical decision support systems, the enhancement of recruitment into clinical trials, and improving privacy and security for electronic health information.

These efforts will help implement the NIH Strategic Plan for Data Science and build on activities already under way in individual Institutes and Centers within NIH. The NLM’s new strategic plan positions the NLM as a platform for data powered health, which will lead to the development of new analytics and novel visualization approaches to accelerate discovery-from-data.

As we promote the use of FHIR by our funded researchers and potential developers, institutes and centers across NIH—including the NLM, the National Human Genome Research Institute, and the National Center for Advancing Translational Sciences—are taking the lead in creating and using FHIR APIs in various research domains. Ongoing and emerging efforts aim to improve the retrieval of genomic and phenotypic data from the NIH database of genotypes and phenotypes, integrate data from genetic test results into electronic medical records, and prototype the infrastructure needed to query clinical data from partner organizations. Based on what we learn from our engagement with the scientific community, we anticipate supporting development of other tools and resources that can help scientists make better use of FHIR to enhance their research endeavors.

NIH is in a key position to contribute to the development of the research capabilities of FHIR—and we come ready to combine technology, scientific research, and data to make break-through discoveries to improve health.

We’re interested in your experiences and guidance. Come along with us, and let us know how NIH can help you and your researchers make the best use of FHIR.

The Power of 10: Women Leaders of NIH

For the first time in NIH’s history, we have 10 women leading institutes and centers.

Now, when the directors of NIH’s 27 institutes and centers meet, more than a third of our voices are female.

Individually, we bring to leadership our personalities, professional expertise, and personal power.

Together, we bring what I call the “Power of 10.”

We spoke with each leader to hear about her experiences and insights on being a female director of an NIH institute or center. We heard about advocating for more women and diversity, advice for work-life balance, what’s happening at the center- and institute-level in terms of women in leadership, plus a few telling anecdotes, and the three M’s. At the end of this post, I share some of my own thoughts on the “Power of 10.”


Ann Cashion, PhD from NINR

Ann Cashion, Ph.D., R.N., F.A.A.N.
Acting Director
National Institute of Nursing Research (NINR)

A seat at the table:
I think presence is important—just being there whether at the scientific directors’ table or the institute directors’ table. Even if you don’t say something, you make others accountable by your presence.

Nursing’s unique path:
By virtue of the demographics of the nursing field, our intramural and extramural leaders are primarily women. Yet, I’m always careful with that because I think diversity goes both ways.


Nora D. Volkow, M.D. from NIDA

Nora D. Volkow, M.D.
Director
National Institute on Drug Abuse (NIDA)

Not taking anything for granted:
Being a woman in an academic environment dominated by males has made me incredibly perseverant. For example, to achieve tenure, I had to have almost double the number of publications that my male colleagues had and to get the highest ratings. That leads you not to take anything for granted.

A shift in perspective:
It’s not that in the past males set off their brain to say, “No, we don’t want women.” It was a system that generated conditions that were not welcoming to women and one that was not questioned for there were very few women that could raise their voices and be taken seriously. The increasing presence of women in academia, including those in leadership, is changing the dialogue as the value of their contributions continuously expands. Women also bring a diversity of perspectives that enriches and strengthens institutions.

Women in leadership positions beget more women leaders:  
Women in leadership serve as an example to other women that this is possible. When someone has demonstrated that something is feasible, it becomes a reality and you don’t question it anymore. I think that this is probably one of the most important ways by which having women as directors of institutes or centers has helped advance the leadership position of women in science.


Diana W. Bianchi, M.D. from NICHD

Diana W. Bianchi, M.D.
Director 
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Women leaders are on the rise everywhere:
Having had the privilege of testifying at a House Appropriations Subcommittee meeting in April, it was very noticeable to me that nine of the 13 representatives on the committee were women. And indeed, one of the members of Congress was eight months pregnant. This created a perceptible difference in both the tone and the types of questions asked. . . We at NIH are a reflection of diversity that’s occurring in Congress as well. It’s a very exciting time to be here.

NICHD as a leader in women’s health:
So many people think that we focus exclusively on the health of children. We have made a strategic decision to better articulate our focus on women’s reproductive health. About 30 percent of our research portfolio is in reproductive health, and that is primarily in gynecologic health, contraception, and pregnancy-related issues. From a leadership perspective, we have made a decision to increase the support of science not only on disease or atypical conditions but even on menstruation and endometrial biology—what needs to occur for normal health or typical health.

The significance of more women around the table:
By having more women around the table, there’s clearly an opportunity for women’s voices and women’s opinions, but I think it does connect to more of a focus on women’s health.


Andrea T. Norris from NIH CIT

Andrea T. Norris
Director
Center for Information Technology (CIT)

Progress through diversity:
There has been a concentrated push to increase the diversity at NIH—not just male/female, but other backgrounds and ethnic diversities. It makes for better leadership and better management decisions. I see this every day. I give tremendous credit to the NIH leadership for really valuing that diversity. It absolutely makes a difference. And you can’t make much progress without it.

An exciting time for women leaders at NIH:
I encourage women to look at the role of technology in the health sector and in biomedical research as an incredible career opportunity. This is such an exciting time for innovation at the intersection of biomedical, medical, and technology domains. It’s dynamic and fast moving. Whether you have scientific skills, business expertise or know technology, there’s a role—an important role—for you in this space, especially here at NIH.


Judith Cooper, Ph.D. from OD

Judith A. Cooper, Ph.D.
Acting Director
National Institute on Deafness and Other Communication Disorders (NIDCD)

Approaches that allow for healthy work-life balance:
I support a healthy work-life balance through encouraging flexible work schedules and ad hoc teleworking, allowing the voicing of concerns and grievances via an open-door policy, and creating a work environment and meeting style where all and diverse voices around the table are heard.

Advancing and supporting others:
As I advanced in my career at NIH, I tried to bring up deserving individuals with me by offering leadership training opportunities or activities with the potential for advancement, both within and outside NIDCD. As I step down from my year-long stint as acting director, I appreciate the insights and opportunities this role has provided, and I look forward to continuing as deputy director, sharing my experiences with and paving the way for Dr. Debara Tucci, who will be NIH’s newest female IC director when she arrives in September.


Noni Byrnes, PhD from CSR

Noni Byrnes, Ph.D.
Director
Center for Scientific Review (CSR)

An honor and a responsibility:
I was stunned at how many women came up to me when I was selected as the director and told me that they were just thrilled that I had been chosen. I’ve never thought of myself as a role model, so I consider it to be a real honor and responsibility.

On being a leader and a woman of color:
One of the issues that sometimes minorities, and especially women of color, face is the questioning of credentials. I appreciate that it can be pretty damaging to be qualified with significant accomplishments, but then be questioned as to whether or not you got the position because of the boxes that are checked. There’s always a little bit of that. You can spend your time internalizing those negative thoughts, or you can move ahead to advance science and advance the mission.


Martha J. Somerman, DDS, Phd from NIDCR

Martha J. Somerman, D.D.S., Ph.D.
Director
National Institute of Dental and Craniofacial Research (NIDCR)

Having a family:
I have talked more to women about having a child and a career. I’ve shared how I read my journal articles out loud to my newborn son. They need to hear your voice. One of the interesting things is that now when I talk about having children, I talk to men, too. The conversations are not necessarily based on gender.

 More women in leadership at NIDCR:
In terms of recruiting for our intramural research, I think we’ve done a great job increasing the number of women in leadership positions over the last five years, and we have diverse research teams. Our institute also offers intramural and extramural fellowships that enhance diversity. It’s an area I pay a lot of attention to. We’re being more proactive.


Helene Langevin, MD from NCCIH

Helene Langevin, M.D.
Director
National Center for Complementary and Integrative Health (NCCIH)

Re-entering the workforce:
I’m thrilled with what the NIH Office of Research on Women’s Health is doing to help women re-enter scientific professions and research careers after having taken time off for family reasons. I had personal experience with this. I chose to leave academia for six years when my children were babies and was fortunate that I was able to come back with tremendous support from mentors—some women and some men—who helped me re-enter my academic career. But I know how difficult it is and that not all women are as fortunate as I have been. We need to do more to help. I think this can apply to men as well, but women bear a special burden with pregnancy and the actual bearing of children can physically be very hard.

Managing stress and a scientific career:
One of the things that NCCIH is interested in is helping people manage stress. I think being able to manage stress and stay healthy throughout pregnancy, taking care of small children, and pursuing one’s career is difficult. You need help from all directions, but also help from the scientific and academic environment and the funding agencies. . . Advancing one’s scientific career is important, but staying healthy through that process is very important, too.


Linda S. Birnbaum, PhD from NIEHS

Linda S. Birnbaum, Ph.D., D.A.B.T., A.T.S.
Director
National Institute of Environmental Health Sciences (NIEHS)

On the three M’s:
I think about the three M’s: mentoring, modeling and—you’re going to laugh—mothering.

Mentoring:
In mentoring, it’s extremely important that you mentor more than your students and your postdocs, for example. You mentor people around you and even people above you.

Modeling:
Modeling is setting an example. I’m frustrated by people who think that it’s really great that all they do is work. I can remember years ago when I had three little kids at home and I didn’t take anything home with me because there was no way I could get anything done. I was very efficient when I was at work. I didn’t spend a lot of time chitchatting or going for coffee. The other thing with modeling is taking time off. It’s especially positive for the younger people to see their director out of the office.

Mothering:
And then there’s mothering. . . I really take an interest in the people in my institute. Part of good mothering is knowing when your children need help and letting them make their own mistakes and fly when they’re ready. At work, I let people explore new options.


Patricia Flatley Brennan, RN, PhD from NLM

Patricia Flatley Brennan, R.N., Ph.D.
Director
National Library of Medicine (NLM)

Driving research and discovery:
Engaging with women leaders in partnership with our male colleagues sends a powerful and strong message. It’s not that we stand apart, it’s that we stand among.

We subtly but persistently bring perspective into the conversation at the NIH leadership table. It’s one thing to say that we need to hear the voices of women. It’s another thing to hear them and keep hearing them.

It’s becoming clearer every day that health is a complex interplay of person, environment, biology, and action. Women bring a lateral understanding of how to engage across these four elements to drive research and discovery in a way that improves human health.

The magnificence of magnification:
The “Power of 10” means that each of our contributions to the leadership of NIH are magnified 10 times over.

The More Things Change . . .

Back in January, I shared our plans for aligning the National Library of Medicine’s (NLM’s) organizational structure with the goals and vision in the 2017-2027 Strategic Plan. Now, in the heat of summer, it’s time to tell you about our progress.

We’ve come a long way, while remaining true to our mission and commitment to be a source of trusted health information.

First things first.

We’re guided by a strategic plan that affirms our pledge to support data-driven science, engage with stakeholders, and build a workforce for the future while preserving our essential role as a National Library that collects, organizes, and disseminates biomedical and life sciences information to the public through offerings such as PubMed, the database of Genotypes and Phenotypes (dbGaP), and MedlinePlus.

We examined all aspects of our organization, which encompasses 1,700 people, five key divisions, operational processes and practices related to our technical and physical infrastructure elements, and myriad offerings. Our efforts revealed—and reinforced—the immense talent that exists across NLM. They also identified opportunities for improving efficiency and effectiveness.

Perhaps the biggest transition in 20 years has been the sunset of the Specialized Information Services (SIS) division, with staff and programs being integrated across the Library. We will continue to work out logistics associated with this transition and will provide notice of changes on the SIS home page. In the meantime, I’d like to acknowledge the recently retired SIS leaders, Florence Chang, Acting Associate Director, and Janice Kelly, Acting Deputy Associate Director, for guiding an outstanding, dedicated team through a complex transition. I hope you will join me in thanking them for their service to NLM and wishing them well as they embark on new journeys.

We consolidated our outreach, training, and engagement activities and created an Office of Engagement and Training (OET) within the Division of Library Operations. Headed by Amanda J. Wilson, this office brings together many of the outreach and training staff and services from across the library, along with the National Network of Libraries of Medicine. We’ll be better able to coordinate outreach activities when and where they are needed most, launch national efforts, and institute modern planning and evaluation processes to ensure that our efforts are effective.

We evaluated the quality and sustainability of many NLM public offerings. Some key resources, such as TOXNET and ClinicalTrials.gov, moved to more modern, robust technical platforms to ensure security and sustainability. Some offerings were sunsetted, with the information integrated into more sustainable resources. As we continue to examine NLM’s offerings, we’ll post updates in the NLM Technical Bulletin.

We worked with workforce development experts to better understand the talents and goals of the more than 50 staff members who joined new teams or have new jobs. The creative design staff from our Audiovisual Program Development Branch (APDB) merged with the Office of Communications and Public Liaison, establishing a more powerful team that will use a wider array of video, images, and technology to tell the NLM story. The technical staff from APDB joined the Office of Computer and Communications Systems, affording greater coordination of our information technology, computer, and audiovisual production activities.

Some NLM staff have taken on new roles. For instance, in Library Operations, Stacey Arnesen, who led the Disaster Information Management Research Center, is now Deputy Director for the Public Services Division and Jeanne Goshorn, who led the Biomedical Information Services Branch, is now Deputy Director for the Bibliographic Services Division. Victor Cid joined the Lister Hill National Center for Biomedical Communications’ Cognitive Science Branch and Dan Gerendasy, Chief of International Programs, kept his same role and joined OET.

To prepare staff for a future of data science, we developed the Data Science @NLM Training Program. As part of this program, each staff member completed a self-assessment and received an individual development plan that included activities such as self-study or participation in an in-depth training course.

Everyone’s present or future work will be touched by data science—from our indexers who need to interpret literature using new analytics, to our investigators who employ machine learning to power up natural language processing, to our purchasing clerks who invoice for cloud services. We’ve developed new work groups, sometimes by adding one or two new people to a branch or merging two smaller groups into one.

For better collaboration, some staff teams have moved from the National Institutes of Health (NIH) main campus to larger facilities off campus, allowing work groups that should work together to be together. And some of our meeting rooms have been equipped with better technology to enhance telework and promote staff productivity.

We’re preparing to hire new investigators for our intramural program and ensuring our research labs are equipped for data science. We’ve already renovated part of the Lister Hill Center to bring the ClinicalTrials.gov team together in one place and will be strengthening our physical infrastructure and our technological platforms. We’re planning a four-year renovation of the main Library building. The renovation will create more flexible work spaces for more than 150 people on the first floor and mezzanine, a new integrated reading room for our patrons, and a state-of-the-art training facility, as well as contribute to our ongoing efforts to increase our collection space.

How did all of this happen so quickly?

The outstanding staff at NLM is full of people willing to make plans and try new things despite some uncertainties. I’m grateful to Library staff and NIH leadership for their support as we journey into the future together.

As always, I’ll continue to keep you posted about key developments and milestones that take place along the way!

Democratizing Information Access

When I became director of the National Library of Medicine (NLM), I took an oath of office in which I promised to uphold the U.S. Constitution. As we celebrate Independence Day, I’m reflecting once again on what that oath means to me and how I live out my commitment to it through my work.

This time, I want to reflect on the role of NLM in democratizing information access. As the world’s largest biomedical library, NLM supports health care and biomedical discovery by helping to ensure direct access to biomedical information and research for the scientific community and the public.

NLM delivers scientific knowledge to the nation and to the world. Through MEDLINE and PubMed, we provide a platform for scientists and scholars to share their findings freely and a database that can be used by anyone to explore and discover biomedical and health information. It’s a sound investment of federal dollars; a boon to research; and a reliable resource for patients, families, and caregivers.

The Library has established critical elements essential for journals included in our collection. These include editorial practices that contribute to the objectivity, credibility, and quality of the content. These critical elements let the public know that the information NLM presents is trustable.

NLM is committed to making the biomedical and scientific literature accessible to all. The Library does not decide what gets published; journals and their editorial boards do that. But as a library, NLM is committed to archiving the published literature over time to reflect the state of knowledge now and the ways knowledge grows. For example, sometimes claims published in the biomedical literature are superseded by new discoveries. A lack of reproducibility calls other findings into question. Medical perspectives might change or broaden to encompass the patient’s perspective where the professional’s or clinician’s had been privileged previously. Other published findings might turn out to be flat wrong, due to, among other things, invalid assumptions, improper methodology, or unsupported claims that were not caught during peer review.

It’s often said, though, that the literature is self-correcting. Science takes the long view, and our job at NLM is to let it, documenting where the science stands today and pointing to where it might go in the future, but otherwise remaining neutral about what’s published—as long as the journal’s content shows strong scientific merit; the process for selecting that content is transparent and sound (e.g., external peer review, ethical practices, stated conflicts of interest, prompt corrections or errata); and the journal offers opportunities for comment and dissent.

This recognition of the ongoing process of correction and refinement also drives the education we do with our partners from the National Network of Libraries of Medicine to build health literacy in communities across the country.

The Library further supports access to trustable health information by being a resource for journalists as they convey health information to the general public. NLM annually hosts a group of fellows from the Association of Health Care Journalists, bringing them to the National Institutes of Health campus for four days of training to enhance their use of our many health information offerings and to help them integrate biomedical research into their reporting. The journalists also learn about key topics in health care, such as health disparities, patient engagement, and clinical effectiveness research, better preparing them to report on these and other crucial or emerging issues.

Through it all, NLM collaborates with our sister federal agencies to deliver to the public quality health information and health data, working together to ensure freedom of ideas about biomedical discovery and health care delivery.

That’s worthy of fireworks, wouldn’t you say?

Information Along the Underground Railroad

A couple years ago, I wrote about how the paintings in Jacob Lawrence’s Migration Series inspired me to think about how the National Library of Medicine gets information to people on the move—people displaced by violence, natural disasters, or economic crises. I felt a similar stirring after viewing the Jeanine Michna-Bales exhibition Photographs of the Underground Railroad at the Phillips Collection last month.

The deep indigo and shadowy black of Michna-Bales’ photographs stand in stark contrast to the oranges, greens, and yellows of Lawrence’s paintings, which occupy a room across the hall at the Phillips, but both have things to tell me.

Michna-Bales’ collection of nighttime photographs immediately pulled me in, helping me sense a whisper of the fear and anxiety escaping slaves might have felt as they slogged their way north toward freedom. The dark, shadowed images required me to peer in closely to detect a house or barn that might have provided a safe place to hide—or concealed danger. The Drinking Gourd constellation, isolated in the night sky, guided the travelers north along dirt roads and winding rivers, while cypress swamps, mangroves, and thick vegetation, barely perceptible in the moonlight, slowed passage.

It’s a chilling piece of history brought to life through the photographer’s lens, but as the exhibition curator underscored, slavery still exists today. More than 20 million people are enslaved around the world.  More than 50% are women; 25% are children under the age of 18. These staggering figures cry out for redress.

What can NLM do to help those working to combat this crisis or treat its victims?

We provide information to those on the front lines.

The Library’s literature can help primary care physicians and emergency room staff identify patients at risk and potentially rescue victims of human trafficking. It can help clinicians deliver health care that is both trauma-informed and culturally sensitive, attuned to victims’ needs and backgrounds. It can give educators ways to train health professionals to recognize and help victims, offer policy makers strategies to reduce human trafficking, and encourage the global health community to investigate the social and economic elements that drive such exploitation. The Library also has articles on human trafficking for the horrific purpose of organ removal and others on the relationship between human trafficking and stress-related illnesses and drug use among survivors.

It’s a harrowing collection but a necessary one, if we are to combat this crisis.

To further help those who are fighting this fight, PubMed lists articles similar to the ones initially found, helping to shape a coherent picture of the clinical challenges, health services, and public policies that can counteract this crime or mitigate its effects. We also provide the free full text of publicly funded research on this topic.

We may be able to do even more in the future. I see opportunities to tailor the health information we provide to the personal culture, worries, and recent experiences of the person searching. It’s a bold vision, but reaching the most vulnerable makes it worth the effort.


If you think someone may be a victim of human trafficking, call or encourage them to call the National Human Trafficking Hotline at (888) 373-7888 for help, resources, and information. You may also text 233733.