Please Join Us in Honoring Milton Corn, MD

This blog post is based on remarks given at the May 17 Milton Corn Memorial Concert.

Yesterday, I was honored to join in a beautiful celebration for the life of Dr. Milton Corn, an amazing man who I regarded as my adviser, colleague, and—most importantly—my friend. I would like to thank his wife Gilan and all of Milt’s friends and family for creating that wonderful moment of togetherness. Many of us knew Milt when he was Dean of the School of Medicine at Georgetown University or in his role with the National Library of Medicine, and I suspect that some even knew him as a bon vivant around town!

While I’m sure many of you can remember the moment you met Milt, I actually can’t—in my mind, it seems like he was an ever-present professional of the big data and scientific technology community! As a newly minted PhD in the late 1980s/early 1990s, I remember Milt as eminent in our field… and that was 30 years ago! I got to know Milt as part of the medical informatics community that was just emerging as a research powerhouse. Milt was a mentor to me; he reached into the visions I had for—and breathed life into—the ways technology could support patient engagement. He was always supportive, but he was also a hard questioner who wanted to know the value of the community’s investment.

Milt brought so many gifts to the field of biomedical informatics. He brought his wisdom as a physician executive to a fledgling field, applying his gentle but direct guidance to inspire research in the domain. Milt also funded my research; I remember a phone call one August afternoon over 20 years ago when Milt said, “Do you still need money for this project? Because we have some end-of-year money for you, and it’s available if you want to use it,” which of course let us advance our original ComputerLink project.

Interestingly enough, I actually know very little about Milt’s role at NLM, although I know a lot about his contributions! He joined our beloved NLM in 1990 during the first decade of applying computer technology to health care, in support of Don Lindberg’s visionary leadership. Milt served as NLM’s ambassador to the broader academic and research community as both their instigator and a supporter of many novel research ideas. Milt was in love with ideas, but he never let that love cloud his judgment or interfere with his expectation that emerging fields needed good science. He was as enchanted with a novel approach to genetic analysis as he was with securing proposals to write important books that detailed the history of medicine.

Milt became a colleague, a trusted advisor, and someone I could talk with about biomedical informatics. We could laugh about the field while enjoying its growth. Later, Milt became my friend. We shared family stories, our love for our children, and the challenges we faced with them. I loved his humor—he had the best sardonic laugh in the world. And then, surprise of all surprises, Milt became my employee, which had nothing to do with his actions, but with my actions! I remember being very mindful of Milt during my first NIH interview, where one of the committee members asked what it was going to be like for me, and I said I’m now going to be the boss of someone who I felt that I have learned from my whole career… it’s going to be fabulous!

Not that it wasn’t daunting; for 25 years, my career success depended on Milt! And he was wise: on my first day on the job, Milt stopped by with a little gift—a bag of peanut M&Ms! What a way to level the playing field. Sometime during those first few weeks, Milt came to my office and said, “Anytime you need my desk for someone else, you just let me know, and I’ll go home.” Every year he would say that sentence, and every year I thought not yet, I need you here. I couldn’t be without Milt, the magic maker.

After working more closely with Milt, I realized his judgment, discernment, and incredibly keen sense of what was a good investment—and, more importantly, what wasn’t—were critical to how NLM functioned. Later in our time at NLM, we needed a single scientific director to unify our intramural programs, and Milt took this responsibility on. Adding the title of Acting Scientific Director to his already stretched ambit, Milt aligned our two very strong intramural research groups: one addressing computational biology, and the other, clinical health informatics. He guided these two very disparate groups of investigators into a single structure… not totally unified, but respectful of each other and clearly willing to meet halfway across the bridge.

I turned to Milt many times as counselor to my position. Navigating the federal waters as director of a venerable institute like the NIH National Library of Medicine was a challenge—even for someone who thought herself quite sophisticated in dealing with complex organizations. Periodically, I’d walk over to Milt’s office, settle into one of his nice leather chairs, and lay out whatever issue I was confronting or a personality that perplexed me. Through a question or a brief comment, he led me to solutions, insights, and confidence, but none more so than the day he said, “Your job is important, and you deserve to have fun—so make sure that you do that!” I am brimming with tears as I remember how his strength made me strong!

In October of 2020, Milt told me that the pandemic was good for him. What an odd statement, I thought. However, he revealed that our maximum telework posture, with everyone working from home, eliminated the need for him to make the long commute from Virginia to Bethesda. Working from home made it possible for him to continue to engage. And engage he did! He remained a mentor all the way up until his very last weeks at the National Library of Medicine. I remember the night he called me and said, “I don’t think I can come back to work anymore,” but he reminded me, “You can call me if you need me.” I took his generous offer to heart and took it up as often as I could.

Above all, Milt was important to me, to the National Library of Medicine, and to the entire scientific and clinical world. Thank you.

Recognizing Women in History All Year Round

Women in history — and women making history — featured in this post.
From left to right in the top row: Mary Lasker, Elizabeth Blackwell, Hope Hopps, Florence Sabin, Margaret Pittman, Patricia Palma, and Selma DeBakey. Middle row: Faye Abdellah, Deirdre Cooper Owens, Rosalind Franklin, Inez Holmes, Alice Evans, and Lois DeBakey. Bottom row: Maxine Singer, Virginia Apgar, Barbara McClintock, Sarah Stewart, Bernadine Healy, and Rana Hogarth.

Guest post by Susan L. Speaker, PhD, Historian for the Digital Manuscripts Program of the History of Medicine Division (HMD) at the NIH National Library of Medicine (NLM), and Jeffrey S. Reznick, PhD, Chief of HMD at NLM.

One important role of NLM staff is to research, curate, explain, and make available historical collection materials. In doing so, our historians, librarians, archivists, and exhibition specialists prioritize the history of underrepresented groups, stories of advocacy and change, and materials that demonstrate the relevance of history to current events. Although this Women’s History Month will soon conclude, we recognize women who have made a difference in the history of health care and medicine — as well as women who make history — year round.

NLM’s collections span ten centuries, encompass a variety of digital and physical formats, and originate from nearly every part of the globe. For many years, through a constellation of research, curation, and public programs connected to these collections, we have shared the stories of women — healers, naturalists, midwives, nurses, physicians, scientists, artists, advocates, and patients.

These individuals have included — among many others — Faye Abdellah, who became the first nurse to achieve the rank of Rear Admiral, Upper Half, a two-star rank, in the U.S. uniformed services, as well as the first nurse and woman in the 200-year history of the United States Public Health Service to hold the distinguished position of Deputy Surgeon General; Virginia Apgar, the neonatologist who developed the Apgar scoring system for evaluating newborns; and Elizabeth Blackwell, the first woman to receive a Doctor of Medicine degree from an American medical school, overcoming many obstacles and establishing a foundation for American women physicians. We have also featured Selma and Lois DeBakey, icons of both medical literature preservation and communications; Bernadine Healy, the first female Director of the NIH, and Inez Holmes, World War II veteran and nurse who trained at the Piedmont Tuberculosis Sanatorium for the treatment of African American patients in Virginia.

Among the others we have recognized through our curation are geneticists Barbara McClintock and Maxine Singer; chemist and crystallographer Rosalind Franklin, whose X-ray diffraction images of DNA revealed its helical structure; embryologist, cell physiologist, and public health administrator Florence Sabin; and philanthropist Mary Lasker, whose public health advocacy helped to spur a vast expansion of NIH.

Through our curation we have also brought forward historical knowledge about many groups of women and their wide-ranging experiences, expertise, interests, and roles in medicine and science. These groups have included women of the Frontier Nursing Service, women who composed unique, handwritten “receipt” books in which they noted, tested, and revised formulas for household remedies for common medical problems, as well as women physicians and nurses in the armed services of World War I and World War II. We have also told important stories about women who changed the face of medicine through their leadership and expertise, and those who confronted domestic violence and improved women’s lives.

We have also shown how women’s historical presence is sometimes obscured in larger accounts and must be made visible through careful reading and piecing together textual and visual evidence. Such curation enables us to reveal the stories of women who worked in labs at NIH, like Hope Hopps, as well as lab workers who worked in the California State Hygiene Lab in Berkeley just before World War I, and medical students who gathered tuberculosis patient data at Johns Hopkins University at the turn of the last century. NLM is also steward of the papers of early twentieth-century women bacteriologists whose important work is not widely known, including Alice Evans, Sarah Stewart, and Margaret Pittman. We collect and make these papers available to interested investigators, preserving their stories for future research.

Along with our many efforts focused on highlighting the experiences and voices of women in our collections, we also amplify the voices of today’s women historians, especially those from underrepresented backgrounds, who have studied our collections to advance their research. This month, we welcomed to our NLM History Talk series Patricia Palma, PhD, Assistant Professor in the Department of Historical and Geographic Sciences at the University of Tarapacá, Arica, Chile. Dr. Palma spoke about her research on homeopathic therapies in Peru during the late-nineteenth and early twentieth centuries, drawing on unique materials held by our institution. Last month, we welcomed Deirdre Cooper Owens, PhD, the Charles and Linda Wilson Professor in the History of Medicine & Director of the Humanities in Medicine Program, University of Nebraska-Lincoln. Dr. Cooper Owens spoke about women whose stories of enslavement are part of the history of gynecology in the United States. In April, we will welcome Rana A. Hogarth, PhD, Associate Professor of History at the University of Illinois, Urbana-Champaign, who will speak on how people of African descent became targets of eugenic study during the early decades of the twentieth century. 

Notably, many of these curatorial efforts are themselves brought you by the women of NLM —archivists, librarians, historians, and exhibition and technical specialists. So, as we work year round to recognize women in history and connect with women making history, we also recognize each and every one of our colleagues who are themselves making history through their public service here in the world’s largest biomedical library!

Dr. Speaker has been Historian for the Digital Manuscripts Program since 2002. She conducts research, selects documents, and writes in-depth contextual narratives for the Profiles in Science project, and she carries out other historical work for HMD including articles, blog posts, presentations, and oral histories on a variety of topics. She is also the historical consultant for the NLM Web Collecting and Archiving Working Group. Dr. Speaker is a graduate of the University of Pennsylvania.

As Chief of the NLM HMD, Dr. Reznick leads all aspects of the division in cooperation with his colleagues and has over two decades of leadership experience in federal, national-nonprofit, and academic spaces. As a cultural historian, he also maintains a diverse, interdisciplinary, and highly collaborative historical research portfolio supported by the library and based on its diverse collections and associated programs. Dr. Reznick is author of three books and numerous book chapters and journal articles, including, as co-author with his colleague Kenneth M. Koyle of “History matters: in the past, present & future of the NLM” published by the Journal of the Medical Library Association in 2021.

Learn more about many more women in medical history—and women making medical history—through the NLM HMD blog Circulating Now, Profiles in Science, @nlm_collections on Instagram, and the free NIH Videocast archive of NLM History Talks

Please Join Me in Thanking our NLM Veterans

Every year at this time, I take advantage of Musings from the Mezzanine to share with you some of the things for which I am thankful. In my 2020 blog, I reflected on how far we’ve come together since I joined the NLM in 2016. In my 2019 blog, I mused about the people, professionals, and personnel for whom I give thanks. This year, I want to give thanks for all veterans in the United States, but particularly for those NLM staff members who are also veterans.

There’s an official legal definition of a veteran – according to Title 38 United States Code, a veteran is a person who served in the active military, naval, or air service, and who was discharged or released under conditions other than dishonorable. Also included as veterans under certain circumstances are National Guard members and members of the uniformed services such as the Public Health Service.

Left to right: My grandfather, Michael Flatley, and my father, Thomas Michael Flatley.

I come from a strong veteran family – my dad, my uncles Bill and Ed (who were military chaplains in WWII and Vietnam, respectively), my cousin Joey, and my nephew Chris.

At NLM, we are fortunate to count many veterans among our numbers. Some of our staff are not only veterans of active-duty service, but they also continue to serve through the reserves or through membership in the National Guard.

It’s good for NLM to have veterans among our workforce. Veterans bring well-developed skills that can effectively be applied to our operations and research enterprise. While each veteran is unique, and entered uniformed service for very personal reasons, veterans bring a commitment to the country refined through their assignments. And veterans strengthen NLM’s commitment to serve the public through government service.

I think that working at NLM is also good for our veterans. NLM allows them to continue in public service and provides them with a world class enterprise environment that makes effective use of their talents and skills honed through previous service. And working at NLM enjoins the efforts of these veterans with the remaining 1,600 plus people who work every day to bring information to the public, make genomic information safely and securely available for science and public health, and help reach communities across the country with trusted health information.

I am pleased and proud to honor these select members of our outstanding workforce. Thank you for your military service and thank you for your continued service at NLM!

Clockwise from top left:  Dianna Adams (U.S. Army), Alvin Stockdale (U.S. Army), Velvet Abercrumbie (U.S. Navy), Ken Koyle (U.S. Army)
Clockwise from top left: Dianne Babski (U.S. Army), Kevin Gates (U.S. Air Force), Bryant Pegram (U.S. Army)
Left to right: Todd Danielson (U.S. Army) and Peter Seibert (U.S. Army)

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 17, 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 volunteer 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 11 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.

Larry Weed’s Legacy and the Next Generation of Clinical Decision Support

Guest post by Lincoln Weed, son of the late Dr. Lawrence L. Weed and co-author with him of the book Medicine in Denial  and other publications. Dr. Weed, who died June 3, 2017, was the originator of “knowledge coupling” tools for clinical decision support and the problem-oriented medical record, including its problem list and SOAP note components.

“Patients are sitting on a treasure trove of data about their own medical conditions.”

My late father, Dr. Lawrence L. Weed (LLW), made this point the day before he died. He was talking about the lost wealth of neglected patient data—readily available, richly detailed data that too often go unidentified and unexamined. Why does that happen, and what can be done about it?

The risk of missed information

From the very outset of medical problem-solving, LLW argued, patients and practitioners face greater risk of loss and harm than they may realize. The risk arises as soon as a patient starts an internet search about a medical problem, or as soon as a practitioner starts questioning the patient about the problem (whether diagnostic or therapeutic).

This gap creates high risk that information crucial to solving the patient’s problem will be missed.

Ideally, these initial inquiries would somehow take into account the entire universe of collectible patient data and vast medical knowledge about what the data mean. But such thoroughness is more than the human mind can deliver.

This gap creates high risk that information crucial to solving the patient’s problem will be missed. And whatever information the mind does deliver is not recorded and harvested in a manner that permits organized feedback and continuous improvement.

Guidance tools set standard of care

The only secure way to proceed, LLW concluded, is to begin investigation of medical problems (the “initial workup”) using guidance tools external to the mind. These tools must couple patient-specific data with general knowledge as follows:

  • Link the initial data point (i.e., the patient’s presenting problem) with (1) medical knowledge about potentially relevant options and (2) readily available data for identifying those options (see the outer circle in the diagram below);
  • Link the data in (2), once collected, with the knowledge in (1) to show how well the data match up with the combinations of data points defining each relevant option—this matching indicates which options are worth considering for the individual (see the middle circle in the diagram below); and
  • Organize this information (data coupled with knowledge) into options and evidence—that is, diagnostic possibilities or therapeutic alternatives, the combined findings (positive, negative, or uncertain) on each alternative, and additional knowledge useful for assessing the best option to pursue (see the inner circle in the diagram below).

Three concentric circles showing (outside) potentially relevant options; (middle) options worth investigating; and (center) best options for this individual
For further explanation of the above diagram, see pp. 72-74 of the book Medicine in Denial.

Tools to carry out these steps would define best practices and make them enforceable as high standards of care for the initial workup (i.e., patient history, physical exam, and basic lab tests). That threshold task is pivotal. It lays the informational foundation for follow-up thought and action by the patient and practitioner. That foundation is also needed for feedback activities to and from third parties. (See the diagram on p. 13 of Medicine in Denial.)

Patient-driven tools

In carrying out the initial workup, the patient’s role is always central. The tools should enable patients to enter history data, which is often the most detailed component of the initial workup. Moreover, the patient necessarily participates in the physical exam conducted by the practitioner, and reviews history, physical, and lab findings with the practitioner.

Tools for the initial workup must thus be used by patients and practitioners jointly. But patients must be able to initiate use of the tools unilaterally. They can’t rely on practitioners to recognize when serious medical investigation is needed. Patients are the ones who experience symptoms—who notice changes from what feels normal. To investigate whether these symptoms might be medically significant, patients need web-based tools for problem-specific inquiries. So do healthy persons who may simply require periodic screening checkups for unidentified problems (plus initial workup of any problems discovered).

Overcoming the medical Tower of Babel

Whether it is patients or practitioners seeking guidance for the initial workup, traditional medical practice leaves them both in a vacuum. Once that vacuum was filled solely by practitioners’ idiosyncratic judgments. Now the vacuum is also being filled with a plethora of practice guidelines and clinical decision support tools, not to mention internet search engine tools.

But the very multiplicity of all these resources defeats the purpose of defining generally accepted, enforceable best practices for initial workups. And the multiplicity is increasing with new patient-generated health data from sensors, wearables, and smartphone-connected devices for physical exam data.  Moreover, the universe for needed guidance is expanding with vast new genomic/molecular data and knowledge.

The outcome of this multiplicity is not useful diversity but a Tower of Babel.

What we need instead are information tools with a unified design and trustworthy medical content, tools that guide users through the basic steps for inquiry into all medical problems, tools that take into account relevant information from all specialties without intellectual or financial biases. Users should not have to switch back and forth among different tools and interfaces for different medical problems, different specialties, different practice settings, different data types, different vendors, and different classes of users. The medical content captured in the tools must be problem-specific, but the tools’ basic design (see the three bullets above) should generalize to all problems in all contexts, as much as possible. This generality enables intuitive ease-of-use at the user level and powerful synergies at the software development level.

NLM’s role for the 21st century

LLW saw NLM as key to developing tools of this kind.

Drawing on its uniquely comprehensive electronic repository of medical content, NLM could create a new repository of distilled, structured knowledge. Drawing on its connections with the NIH research institutes and federal health agencies such as the CDC and FDA, NLM could rapidly incorporate new knowledge into that specialized repository. Outside parties and NLM itself could use that repository to build user-level tools with a unified design for conducting initial workups on specific medical problems.

Drawing on its uniquely comprehensive electronic repository of medical content, NLM could create a new repository of distilled, structured knowledge.

By enabling creation of such a knowledge infrastructure for the public, NLM would seize an “opportunity to modernize the conceptualization of a ‘library.’” Beyond its current electronic repository, NLM could be “demonstrating how information and knowledge can best be developed, assimilated, organized, applied, and disseminated in the 21st century.”  [NIH Advisory Committee to the Director, NLM Working Group, Final Report, p. 12 (June 11, 2015).]

This new infrastructure will encounter a barrier to its use—the medical practice status quo. Not all practitioners (or their overseers) will accept the data collection demands defined by the tool.

Patients at the center

Here we return to the central role of patients.

Patients who unilaterally use NLM tools to complete the history portion of the initial workup can then seek out practitioners who are willing (and permitted) to use the same tools for the physical exam and basic lab test portions. By creating demand for those innovative practitioners and using the tools jointly with them, patients can drive medical practice toward a foundational reform.

* * *

book cover for Medicine in Denial by Lawrence and Lincoln WeedReaders who have questions about the above are referred to the fuller discussion of these ideas in the book Medicine in Denial (PDF | published work), especially parts IV.E, F, and G, pages 192-194, and the diagram on page 13. The author also invites comments below.


Lincoln Weed, JD, Dr. Lawrence Weed’s son, practiced employee benefits law in Washington, DC for 26 years. He then joined a consulting firm where he specialized in health information privacy. He is now retired.

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