From Our Community to Yours, Happy Healthful Halloween!

Guest post by Jeffrey S. Reznick, PhD, Chief of the History of Medicine Division (HMD) at the National Library of Medicine (NLM).

I have always associated Halloween with community and health.

My family and I appreciate the holiday for the way it brings together our neighborhood of individuals and families with diverse backgrounds, creativity, and interests, all celebrating the occasion safely and meaningfully. Some of our neighbors don’t observe the holiday, and we certainly respect their choice by interacting with them in other ways that bring us together as neighbors. But for me, Halloween is very much about community, family, and friends, and the benefits of gathering supportively.

When I was growing up in Rochester, New York, I participated in the trick-or-treat program for the United Nations Children’s Fund, learning how the coins I collected from my neighbors could help vulnerable children. After I arrived home, I tallied the money before placing it in a special mailing envelope. I also sorted my candy while my parents simultaneously—and paradoxically—reminded me not to eat too much and asked me to set aside some for them to enjoy.

In the weeks following Halloween, certain pieces of my saved candy would disappear; my memory of this fact is tied to understanding now that whoever helped themselves was still enjoying the holiday well into Thanksgiving. Candy is still a big part of Halloween, but now parents have better access to information about candy labels and food safety tips to consider before they and their children indulge. It should come as no surprise that I now simultaneously—and paradoxically—remind my daughters not to eat too much and ask them to save pieces of candy for me to enjoy, right up to and sometimes even beyond Thanksgiving.

Every Halloween, I also looked forward to the annual television broadcast of It’s the Great Pumpkin, Charlie Brown, based on the Peanuts comics by Charles M. Schulz. With its humor, interesting cast of young characters, melodious music, and vibrant colors, the whole special gave meaning to the day. It also made me think about parts of the story involving Snoopy dressing himself in a World War I flying ace costume and imagining scenes behind the Western Front. Something bigger was going on here. That something—Schulz channeling his experiences as a combat soldier as well as his pride as a World War II veteran—partly inspired my interest to study and publish on wartime humanitarianism and experiences of soldiers wounded in World War I.  

I’ll confess that I still enjoy It’s the Great Pumpkin, Charlie Brown. I watch it every year with my younger daughter who has come to enjoy it also. It makes the holiday special for both of us. I hope our time together today around the program will be transcendent and inform her future memories of the holiday, indeed time well spent laughing, appreciating the humor, wondering about Snoopy’s interest in dressing up like a World War I flying ace, and how precisely he sat comfortably atop his doghouse-turned-Sopwith Camel airplane.

Like Snoopy and the gang, and as my talented NLM colleagues have shared through their expertise of our collections, many people enjoy occasions like Halloween when they can don creative costumes and masks, think about the lore around black cats and skeletons, and regale each other with stories of ghosts and other frightful subjects. The timeless vulnerability and mystery of the human body form the basis for many of these observations and stories. Apropos, therefore, is the NLM’s newly redesigned online exhibition Dream Anatomy, which draws on collections of our library, along with work of 20th- and 21st-century artists, to explore how what lies beneath our skin has scared, amazed, entertained, fascinated, and inspired us.  Ultimately, Dream Anatomy demonstrates how art and the artistic imagination have always been an essential part of the science of anatomy and the fun of Halloween.

I join with my NLM colleagues to wish you and your family a truly healthful Halloween, one complete with experiences of togetherness in your community, treasured memories of past holidays and the creation of new memories to treasure in the future, and inspired learning through NLM’s globally appreciated collections, trusted health information resources, and the exciting and updated Dream Anatomy online exhibition.

Dr. Reznick leads all aspects of HMD and has over two decades of leadership experience in federal, 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 the author of three books and numerous book chapters and journal articles, including as co-author with Ken Koyle of History matters: in the past, present & future of the NLM, published in 2021 by the Journal of the Medical Library Association

NLM’s Library Operations is Reimagining to Better Serve You

This blog was authored by staff who serve on the National Library of Medicine (NLM) Library Operations (LO) Strategies Working Group.

NLM is nearing its 200th anniversary in 2036, and NLM’s Library Operations (LO) is reflecting on its continuing mandate to acquire, organize, preserve, and disseminate biomedical information. LO is one of NLM’s largest divisions and comprises over 400 talented staff committed to furthering NLM as the world’s largest biomedical library and a leader in research in computational health informatics. We are re-envisioning our products, operations, and services for NLM’s diverse users around the world.

Last year, we created a “3Cs” framework—Collect, Curate, and Connect—to describe the work we do.

Each component represents the critical work LO performs, but the components do not function in isolation. They are interconnected and move together to achieve operational success.

Illustration shows 3 gears in the middle of various sizes. The gear on the left is titled “Collect” with text below that says acquire and preserve unique and trusted collection of biomedical information. The gear at the bottom is titled “Connect” with text below that says link our global audience to biomedical data and resources to make informed health decisions. The gear on the right is titled “Curate” with text below that says make biomedical information findable through data normalization, metadata, and data standards.
Embracing a Future of Data-Driven Discovery

Our 2021–2036 Long-Range Plan is strategic, thoughtful, and forward-thinking. It will address the challenges that come with the accelerated pace of changing technology, the rise and spread of health misinformation, evolving user expectations, and need for equal and inclusive access to unbiased information.

In support of the three pillars of the NLM Strategic Plan, LO will work collaboratively across NLM and the National Institutes of Health (NIH) to build a data-driven workforce and with global partners to ensure our work accelerates biomedical discovery while reaching as many people as possible.

The five goals of our long-range plan will enhance LO’s mission and prepare us for the future as NLM reimagines its work post-pandemic and moves into its third century.

Illustration shows a 5-step process with numbers on top, description of  steps in the middle, and simple illustrations at the bottom. Step 1 says create a modernized organizational structure. Step 2 says unify and transform NLM collections. Step 3 says support and promote the use of health data standards and terminologies. Step 4 says customer design experience support. Step 5 says know and equitably engage our users.

Goal 1: Create a Modernized Organizational Structure. We will focus internally on our organizational structure, work processes, and the workforce expertise necessary to meet the future needs and expectations of our global users.

Goal 2: Unify and Transform NLM Collections. We will redefine and manage NLM’s diverse collection of both historical and modern content as “one collection,” valued by the world for the knowledge it holds to advance data-driven discovery. We will accelerate digitization, increase digital acquisitions, improve the discoverability of collections data, and continue investing in the physical collection space for future preservation.

Goal 3: Support and Promote the Use of Health Data Standards & Terminologies. We will position LO as a centralized leader in the production of and access to the terminologies, policies, data, and tools needed for wide-scale public use and research.

Goal 4: Provide Customer Design and Experience Support. We will support customers’ needs and translate them into product development and life cycle management by putting the principles of digital government strategy into practice.

Goal 5: Know and Equitably Engage Our Users. We will engage stakeholders to facilitate access, delivery, and dissemination of NLM’s collection and trusted NLM/NIH health information resources through community-driven engagement, training, and capacity-building programs.

The first phase of implementation for all five goals is currently underway, and we plan to continuously measure and assess our progress, evolve as needed, and continue to engage our stakeholders.

Our Commitment to Our Users

The interrelated 3Cs and five goals will allow us to continue to collaborate across our institution to serve NLM’s diverse users, enhance our role as a national library, maintain stewardship of the world’s largest biomedical collection, and serve as a key NIH institute. LO is committed to our continuous improvement, innovation, and data-based decision-making to support biomedical research discovery and integrity. Our core values of user focus, service, knowledge sharing, quality, and trustworthiness continue to serve as our beacon to confidently deliver on the goals outlined in this bold 15-year plan.

Libraries continue to evolve as their users’ needs and expectations change. How are you responding to the changing needs of your users?

Top Row (left to right):
Dianne Babski, Associate Director for Library Operations
Amanda J. Wilson, Deputy Associate Director for Library Operations
Jennifer L. Marill, Chief of the Technical Services Division
Jeffrey S. Reznick, PhD, Chief of the History of Medicine Division

Bottom Row (left to right):
Margaret A. McGhee, Chief of the Public Services Division
Deborah Lockett-Jordan, Senior Administrative Officer for Library Operations
David Gillikin, Chief of the Bibliographic Services Division

When You Stand on the Shoulders of a Giant, What Do You See?

This blog contains my remarks from the 2022 Lindberg-King Lecture and Scientific Symposium: Science, Society, and the Legacy of Donald A.B. Lindberg, M.D., which took place on September 1, 2022. Watch a recording of the event here.

I had the great fortune of becoming the director of the National Library of Medicine immediately following the 30-plus-year tenure of Donald A.B. Lindberg, MD. I am sure that each of you here today treasures your own recollection of Don, maybe from a conversation or a laugh you may have had with this great leader, teacher, visionary, and colleague (and husband to Mary, father, grandfather, and friend). I am both proud and humbled to stand on the shoulders of this giant as I lead this incredible organization.

I know more viscerally than most about Don’s legacy as NLM director. I sit in the office he occupied, I walk the halls he walked, I work with the people he hired, and I see and experience the fruits of his judgement, investments, and vision.

I now sit where Don once sat, representing NLM at the leadership table of NIH with the other Institute and Center directors. With Don paving the way, I have a platform to extend NLM’s thought leadership and technical knowledge to guide NIH’s continued efforts to advance data-driven discovery. The good will and collaborative spirit engendered by Don across NIH opened doors for me and helped me continue his legacy to deliver on the promise of science accelerated by broad access to literature and data.

Don and I share a deep commitment to ensuring that the public benefits from NLM’s efforts to assemble, organize, preserve, and disseminate biomedical knowledge for society. It was his early vision that made MedlinePlus a trusted resource for consumer health information and ensured that the PubMed citation database and the PubMed Central full-text literature repository were open and accessible to everyone, everywhere, with an Internet connection, at any time and place.  

Don’s commitment to the public was also evident in his efforts to educate the next generation of biomedical informatics scholars. Frankly, I believe that of all of the aspects of his job, engagement with trainees was his favorite!

When you stand on the shoulders of a giant, you have a great advantage. The foundation Don built and the relationships he established provided me, the 4th appointed director of NLM, with a playbook right out of the gate. It is not enough to solely rely on his vision to guide our future as Don also inspired innovation; in one of our last conversations, he said to me, “This is your game—make sure you play it well!” In order to do that, I cannot simply stand on the shoulders of a giant; I must also keep my head up and my eyes forward to the future to envision new pathways and find new opportunities to bring forward the riches of NLM to the future benefit of science and society.

I close by inviting all of you to stand on the shoulders of this giant and meld your sights with his, for it is not by holding tight to that which he could see, but by using his vision as a stepping-off point for our own that will serve his legacy.

The Next Normal: Supporting Biomedical Discovery, Clinical Practice, and Self-Care

As we start year three of the COVID-19 pandemic, it’s time for NLM to take stock of the parts of our past that will support the next normal and what we might need to change as we continue to fulfill our mission to acquire, collect, preserve, and disseminate biomedical literature to the world.

Today, I invite you to join me in considering the assumptions and presumptions we made about how scientists, clinicians, librarians and patients are using critical NLM resources and how we might need to update those assumptions to meet future needs. I will give you a hint… it’s not all bad—in fact, I find it quite exciting!

Let’s highlight some of our assumptions about how people are using our services, at least from my perspective. We anticipated the need for access to medical literature across the Network of the National Library of Medicine and created DOCLINE, an interlibrary loan request routing system that quickly and efficiently links participating libraries’ journal holdings. We also anticipated that we were preparing the literature and our genomic databases for humans to read and peruse. Now we’re finding that more than half of the accesses to NLM resources are generated and driven by computers through application programming interfaces. Even our MedlinePlus resource for patients now connects tailored electronic responses through MedlinePlus Connect to computer-generated queries originating in electronic health records.

Perhaps, and most importantly, we realize that while sometimes the information we present is actually read by a living person, other times the information we provide—for example, about clinical trials (ClinicalTrials.gov) or genotype and phenotype data (dbGaP)—is actually processed by computers! Increasingly, we provide direct access to the raw, machine-readable versions of our resources so those versions can be entered into specialized analysis programs, which allow natural-language processing programs to find studies with similar findings or machine-learning models to determine the similarities between two gene sequences. For example, NLM makes it possible for advocacy groups to download study information from all ClinicalTrials.gov records so anyone can use their own programs to point out trials that may be of interest to their constituents or to compare summaries of research results for related studies.

Machine learning and artificial intelligence have progressed to the point that they perform reasonably well in connecting similar articles—to this end, our LitCovid open-resource literature hub has served as an electronic companion to the human curation of coronavirus literature. NLM’s LitCovid is more efficient and has a sophisticated search function to create pathways that are more relevant and are more likely to curate articles that fulfill the needs of our users. Most importantly, innovations such as LitCovid help our users manage the vast and ever-growing collection of biomedical literature, now numbering more than 34 million citations in NLM’s PubMed, the most heavily used biomedical literature citation database.

Partnerships are a critical asset to bring biomedical knowledge into the hands (and eyes) of those who need it. Over the last decade, NLM moved toward a new model for managing citation data in PubMed. We released the PubMed Data Management system that allows publishers to quickly update or correct nearly all elements of their citations and that accelerates the delivery of correct and complete citation data to PubMed users.

As part of the MEDLINE 2022 Initiative, NLM transitioned to automated Medical Subject Headings (MeSH) indexing of MEDLINE citations in PubMed. Automated MeSH indexing significantly decreases the time for indexed citations to appear in PubMed without sacrificing the quality MEDLINE is known to provide. Our human indexers can focus their expertise on curation efforts to validate assigned MeSH terms, thereby continuously improving the automated indexing algorithm and enhancing discoverability of gene and chemical information in the future.

We’re already preparing for the next normal—what do you think it will be like?

I envision making our vast resources increasingly available to those who need them and forging stronger partnerships that improve users’ ability to acquire and understand knowledge. Imagine a service, designed and run by patients, that could pull and synthesize the latest information about a disease, recommendations for managing a clinical issue, or help a young investigator better pinpoint areas ripe for new interrogation! The next normal will make the best use of human judgment and creativity by selecting and organizing relevant data to create a story that forms the foundation of new inquiry or the basis of new clinical care. Come along and help us co-create the next normal!

A New Frontier: The Impact of a 1959 Board Meeting

Guest blog by Ken Koyle, MA, Deputy Chief of the History of Medicine Division (HMD) at the NIH National Library of Medicine. This post celebrates the important work performed by our archival professionals and the archival collections held by the library, from which the source material was drawn, as NLM celebrates International Archives Week #IAW2022.

In November 1959, when construction of NLM’s current building at NIH was still underway and digital computing was in its infancy, the NLM Board of Regents convened on the third floor of the Old Red Brick building for a demonstration of the indexing process. When Board Chairman Michael E. DeBakey, MD, asked if computer technology could be used in indexing, NLM Director Col. Frank B. Rogers, MD, was ready with an answer. Dr. Rogers, clearly interested in the emerging technology of automated data processing (ADP), described an article by Robert S. Ledley, DDS, in that month’s issue of Science and noted that Dr. Ledley was already contracted with NLM to report on using computers in indexing.

Black-and-white photo of Dr. Rogers leaning on a stack of books with bookshelves in background.
Dr. Frank Rogers at NLM, 1962.

Dr. Rogers was instrumental in NLM’s first explorations of automated processes and had a clear vision of the potential of electronic computing, including how it could improve efficiency at NLM, but his optimism was tempered by prescient realism. Dr. Rogers recognized—and conveyed to the Board—that the potential benefits of ADP would require a commensurate investment of staff time and labor. “We should not forget that ‘automatically’ means ‘because we told it to do so beforehand,’ and this in itself may turn out to be quite a trick.” Dr. Rogers made it clear that the computer age would bring a change in work, but not necessarily a reduction in work. “Remarkable as the capacity of the computer may be for sustaining a long sequence of operations, it is nevertheless ultimately only the end-phase of that still longer sequence which must include as a first phase the human labor of input.”

Acknowledging the upfront labor investment in ADP was only part of Dr. Rogers’ insight. He also explained that the human work was not only substantial and necessary, but also incredibly complex: “The instructions [for a computer] are a thousand times more detailed, for the simplest task, than those required to be given to the . . . clerk.” Unleashing computers’ potential would require staff to think in new ways, conceive new methods of organizing data, and embark on a new journey of continuous learning and professional development.

Black-and-white photo of members of the NLM Board of Regents posing for a photo. Four members sit behind a table stacked with papers. 13 members stand in the background. Dr. Rogers is featured on the far right.
Dr. Frank Rogers (far right) with the NLM Board of Regents meeting in the “Old Red Brick,” 1957.

Along with the challenges of training staff to work with ADP equipment came the interminable problem of cost. Much as today’s public institutions are grappling with the costs of cloud computing, digitization, and increasing storage requirements, Dr. Rogers had to balance the potential benefits with the considerable costs of computer equipment. The type of computer necessary to realize Dr. Rogers’ vision would cost about $1.5 million in 1960—98% of NLM’s total budget of $1,566,000.

Undeterred, Dr. Rogers found an answer to the funding problem by collaborating with another agency that would benefit from the increased processing speed of scientific literature that the envisioned system could provide: the National Heart Institute. They provided the initial funding, NLM did the legwork, and in 1963, the new MEDLARS computer went into service. Dr. Rogers had realized his vision of bringing automated indexing to NLM. As Surgeon General Luther Terry said at the Board meeting in April 1961, “If any institution ever stood on the borderland of a new frontier it is the National Library of Medicine.”

Computer operators working with the Honeywell 800 mainframe computer, originally acquired by NLM in the 1960s.

Dr. Rogers was very clear about the issues of cost, labor, and expectations in his 1960 presentation to the Board, including his overarching concern about balancing NLM’s core mission with these potential new directions:

[The] purpose of the Library is not to operate a particular machine system, however great an acrobatic achievement that might be in itself. It is not to publish and distribute a particular index in a particular way, however ingenious and successful that operation may be deemed to be. It is not even just to be a good library, however great and distinguished that library may be. It is rather, by virtue of being a library, to use every available bibliothecal means to promote awareness of and access to the subject content of recorded medical knowledge, to the end that the science of medicine will advance and prosper.

More than 60 years later, NLM still holds fast to that purpose. As stated in our statutory mission and reiterated in our current strategic plan, we are here “to assist the advancement of medical and related sciences and to aid in the dissemination and exchange of scientific and other information important to the progress of medicine and to the public health.” Our continued pioneering work in data science is just one way we accomplish that mission.

Mr. Koyle joined HMD in the NLM Division of Library Operations in 2012. Before joining NLM, Ken served as a medical evacuation helicopter pilot and a historian in the U.S. Army. He is the co-editor with Jeffrey Reznick of Images of America: U.S. National Library of Medicine, a collaborative work with HMD staff.

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