Channeling My Inner Betsy

A few of the lessons she imparted to me

In just a few days Betsy Humphreys, MLS, will officially retire from the National Library of Medicine after 44 years of outstanding service.

Over the past two weeks we have been celebrating her and acknowledging her incredible contributions to the nation’s health through her many roles at NLM. Currently NLM’s deputy director, Betsy served as the first woman and first librarian to lead the Library (2015-2016 Acting Director) after many, many years in various leadership positions here, including as associate director of Library Operations. Over the years, Betsy received many accolades for her work, including the Medical Library Association’s Carla J. Funk Award, the Morris F. Collen Award from AMIA, and even an honorary LOINC code, 86466-0: Maestro of scalable info infrastructure. And though I could go on at length about Betsy’s accomplishments and all that she has done to advance access to medical information—for the good of NLM and the country—I’ve been pondering instead how I’m going to keep Betsy with us after she retires by channeling my “inner Betsy” as I lead NLM toward its third century.

Humphreys holds a plaque while standing next to Vreeman
Betsy Humphreys accepts a plaque from Dr. Daniel Vreeman of the Regenstrief Institute acknowledging her enduring contributions to health data standards.

First, I will draw on the amazing storehouse of knowledge Betsy developed over decades about how best to deliver the scientific literature to researchers, clinicians, and the public. That knowledge significantly exceeds what she managed to transfer to me over the 10 months we worked together, but fortunately, it exists in the work processes and practices of the 1,700 women and men at NLM and in the national bodies shaped by Betsy’s influence. Whether it’s an efficient and effective way to apply the MeSH terminology to citations or the importance of making SNOMED CT freely available, Betsy not only knew what to do but made sure it was done in a sustainable manner.

Next, I will conduct myself with generosity, grace, and good will. Betsy can discern the best talents within everyone, and she consistently noted those talents when she introduced someone or described his/her work to a new colleague. More than once I heard Betsy say, “You know, we have just the best person for handling…” whatever task needed to be handled. Obviously, she knew the players, but it was her ability to hold her colleagues in unquestioning positive regard that enabled the most effective partnerships to flourish and got the best people to address complex tasks.

I will channel a commitment to accountability—to science, to society, to patients, to partners, and to the authors who entrusted their works to NLM for archiving and distribution. Betsy didn’t wait for someone to ask for follow-up; she provided it as part of the workplace discourse. Maintaining accountability to our diverse stakeholders sometimes meant describing to one set of stakeholders why a decision apparently in support of a different set of priorities needed to be made and was most likely the best course. Betsy took that on and did it with tact and skill.

I will try to channel Betsy’s loyalty to her colleagues, to NLM, and to NIH. Betsy’s sense of accountability arose from this loyalty—her commitment to make possible a scientist’s research, a work team’s new process, a colleague’s investment in one of NLM’s services. Betsy didn’t often speak of loyalty; she simply demonstrated it.

Still from the video of a smiling Betsy Humphreys
Click to watch the tribute video to Betsy Humphreys.

Finally I will channel Betsy’s commitment to personal health and work-life balance. While many of us are sipping that second cup of coffee as we peruse the Sunday paper, Betsy and her husband/hiking partner, Glenn, are out traversing some trail, whether somewhere in the mid-Atlantic region or across the globe in the Italian Dolomites. Many a Monday was enriched by Betsy’s enthusiastic, bright-eyed description of how she and Glenn enjoyed a vista or found new flowers on a familiar path.

Betsy imparted these and many other lessons I’m sure I can put to good use, and I hope to channel my inner Betsy throughout my entire tenure at the National Library of Medicine.

How you will channel your inner Betsy? Chime in below.

The Hōkūleʽa Worldwide Voyage Comes Full Circle: The NLM Connection

Guest post by Dr. Fred Wood, Outreach and Evaluation Scientist in the Office of Health Information Programs Development.

On June 17, the ocean-going, double-hulled canoe Hōkūleʽa (named for Arcturus, the Star of Gladness) successfully completed its historic Worldwide Voyage.  The Hōkūleʽa departed Honolulu, Hawaiʽi, on May 18, 2014 and over the last three years traveled more than 60,000 nautical miles, stopping at 150 ports in 27 nations, while completing its circumnavigation of the globe.

Launched in 1975, the Hōkūleʽa recreates the type of ocean-going canoes used by Polynesians for thousands of years to traverse the Pacific Ocean and to discover other Pacific islands, including Hawaiʽi.  Hōkūleʽa’s original mission was to prove that traditional double-hulled canoes “powered” only by native knowledge of the wind and swells, as well as the sun, moon, stars, and ocean wildlife, could voyage across the 2,500 miles each way between Hawaiʽi and Tahiti. Once accomplished, this initial mission expanded to include voyages to other islands throughout the Pacific, west to Asia, and east to the US mainland.

Building on this voyaging success, the Hōkūleʽa transformed into a symbol for a broader revitalization of Native Hawaiian culture, pride, ecological sustainability, and health, messages that remain at the heart of its global voyage.

When that voyage reached Washington, DC in May 2016, NLM hosted Nainoa Thompson, one of only a handful of Native Hawaiians trained in the traditional navigation methods referred to as wayfinding. Thompson spoke passionately about the history and role of the Hōkūleʽa in promoting Hawaiian culture and health, and in advocating for environmental protection, sustainability of the oceans, and world peace.

Even before the Worldwide Voyage and Thompson’s lecture, NLM had closely followed the Hōkūleʽa and honored its importance in NLM exhibitions and associated websites and apps.

model of a double-hulled sailing canoe
A scale model of the Hōkūleʻa graced the entrance to the Library from 2011-2015.

For the NLM exhibition Native Voices: Native Peoples Concepts of Health and Illness, the Library commissioned a one-sixth scale model of the Hōkūleʽa built by Hawaiian artisans to the exact specifications of the full-sized canoe. The model was on display for several years in the NLM rotunda. In addition, Native Voices included interviews with Thompson, and with several of Hōkūleʽa medical officers, including Drs. Ben Young, Ben Tamura, and Marjorie Mau, who served on various legs of the Hōkūleʽa’s 40+ years of ocean voyaging.

The Hōkūleʽa and the ancient arts of navigation and voyaging were also at the center of the NLM exhibition A Voyage to Health, which looked at how the resurgence of Native Hawaiian culture helped heal the soul of the community. When the canoe and her crew returned to Honolulu last week, A Voyage to Health was there as part of the welcoming celebration.

Both traveling exhibitions have visited dozens of venues across Hawaiʽi and the rest of the US. And NLM’s scale-model Hōkūleʽa is now on display at the Disney Aulani Resort, in West Oahu, under auspices of the Friends of the Hōkūleʽa and Hawaiʽiloa.

NLM celebrates the accomplishments of the Hōkūleʻa and the entire Hawaiian voyaging community that participated in the Mālama Honua (“Care for the Earth”) Worldwide Voyage.  As that voyage comes to a close, NLM acknowledges once again its significance as an icon of Hawaiian culture, values, and health.

More Information
Native Voices Exhibition: NLM Hōkūleʽa microsite
Video: Nainoa Thompson’s Special Lecture on the Hōkūle’a and Native Hawaiian Health (May 23, 2016)
NIH Record: “For Native Hawaiians, Canoe Instills Pride, Healing”

Remembering Judith Caruthers

Joining a new community with ties to my past

The threads of my life are coming together in unexpected ways.

As you read in last week’s post, I delivered the Leiter Lecture at the Medical Library Association’s annual meeting. I opened the lecture with a brief introduction to me—nurse, industrial engineer, consumer health information advocate, technologist. Sensing those in attendance needed to better understand my bona fides for serving as the NLM Director, I also spontaneously reflected aloud on my own graduate school experience and the librarians I knew then.

It was a fortuitous and meaningful tangent.

During my graduate studies at the University of Wisconsin-Madison, I hung out with librarians. And not just any librarians. These were some heavy hitters: Charley Seavey, Bob Martin, Wayne Wiegand, and the indomitable Judith Caruthers.  Judith, Charley, and I (and a few others) met in Frank Baker’s class on statistics in educational psychology. We bonded together to interpret regression coefficients, calculate variance explained, and absorb the mysteries and utilities of the general linear model. Beyond beers and homework sessions, we shared the philosophies and mysteries of our chosen disciplines: me from industrial engineering, Judith and Charley from library science, and Diana Pounder from educational administration.

Little did I know those Friday afternoons on the terrace were helping to form the basis upon which I would build a career leading the National Library of Medicine.

Judith came to graduate school as a grown up. She was already the research librarian for the Louisiana State University Medical Center in New Orleans and had taken a leave of absence to work on her doctorate.

To those of us waiting to start our careers, Judith was a sophisticate, and she taught me many things. Her dissertation exploring metadata in what was then known as ProCite introduced me to the systematic study of curation. She helped me to reason through how information engendered perspective and to see that the job of an information professional, whether librarian or engineer, was to preserve meaning and afford access. She also taught me to think of my career and my job as intertwined but never identical.

Judith and I became great friends, establishing a deep connection forged from mutual affection and compatible intellects. Judith taught me to eat crawfish, and I introduced her to Wisconsin brats. And every year, as the Mardi Gras krewes gathered in New Orleans, Judith oversaw the northern version of the king cake celebration, making sure her southern traditions warmed our Wisconsin winters.

Judith died in 2001 after a valiant battle with cancer. She left me before I was ready to let her go, and I think of her often—her gorgeous smile, her southern drawl, and her engulfing hugs.

So what a great surprise and gift it was to me that my spontaneous reminiscences at the start of the Leiter Lecture were greeted with tweets and hugs from members of the MLA community who also knew Judith—one of her LSU colleagues, a librarian whom Judith had guided to graduate school, another friend and colleague who worked with her.

I came away from the MLA meeting realizing not only have I encountered a new and vibrant professional community but also an amazing and welcome connection to my past. I can’t help but look forward to the tapestry created from the weaving of these long-connected threads.

Postscript: Judith’s good friend and LSU colleague Wilba Swearingen wrote more about her in a lovely tribute following her death.

Big Shoes to Fill

Joe Leiter and the lecture that bears his name

Last week I attended the Medical Library Association Annual Meeting in Seattle, where I gave the Joseph Leiter Lecture, one of the most prestigious named lectures in the medical library community.

Joe Leiter served as the National Library of Medicine’s first Associate Director for Library Operations from 1965 through 1983.  Joe, as he preferred to be called, was—like me—not a librarian. A biochemist by training, he came to the NLM from the National Cancer Institute, where he was chief of NCI’s Cancer Chemotherapy Service Center, investigated environmental carcinogens and developed drug therapies for cancer.

Automation, the promise of information systems, and the chance to expand private-public partnerships lured Joe to the NLM under Director Marty Cummings.  Joe was credited with developing MEDLINE (teaming up with the late Davis McCarn) and DOCLINE, expanding the Regional Medical Libraries, rejuvenating the NLM Associate Program, introducing contracts to boost library services, and increasing the efficiency and effectiveness of the training offered on NLM’s specialized databases. Through it all Joe never lost sight of the library’s end users, appraising every investment, every new initiative, and every advance in terms of how it would meet the needs of health science librarians and the people they served.

A man of amazing energies and intellectual generosity, Joe single-handedly inspired, cajoled, and in some cases badgered NLM staff to operate at the top of their game. Ever the passionate advocate, he also worked to advance women and minorities in the profession. As former Associate Director for Library Operations Sheldon Kotzin noted, Joe “never wavered in his commitment to the principles of equal opportunity.”

As Joe approached retirement he endowed a lectureship to be given annually: every odd year at the MLA meeting; on the even years, at or near NLM.

Many notable people have delivered the Leiter Lecture, among them Nobel Prize winner Joshua Lederberg; renowned heart surgeon Michael DeBakey; Tony Fauci, director of the National Institute of Allergy and Infectious Diseases; and Francis Collins, NIH Director and a pioneering geneticist who led the effort to map the human genome.

I had big shoes to fill.

I listened to some of the earlier lectures and thought of the innovations portended by those visions. The future—or futures—my predecessors envisioned is the present we are living now. Their stories became our stories, and I hope the story I contributed will blossom into a shared vision of how the National Library of Medicine can and will serve society—as the NIH hub for data science, and as a platform for discovery and a pathway to engagement in the development and expansion of data-powered health.

It’s a vision that ultimately holds the individual at the center and imagines a future I like to think Joe Leiter would support.

Go as Far as You Can See. Then See How Far You Can Go.

Be ready for the next part of the journey.

It’s that time of year when the esteemed and well-known are asked to give graduation addresses. You remember those addresses—simultaneously inspirational, compelling, and entertaining and all in ten minutes or less!

This year, somehow, I have become one of those people, or by virtue of my position as the director of the National Library of Medicine, I am a good stand-in for one. I was invited to speak to the graduates of the School of Nursing at the University of Pennsylvania and the Frances Payne Bolton School of Nursing at Case Western Reserve University.

It’s an extreme honor to be invited, of course, but what was I going to say?

A recent book, The Sixteenth Rail: The Evidence, the Scientist, and the Lindbergh Kidnapping by Adam Schrager, provided my jumping-off point. The book itself—a look at how Arthur Koehler, a wood forensics expert, helped capture the kidnapper of the Lindbergh baby—is fascinating, but that expert’s personal story is what inspired me. His adherence to the scientific process and his willingness to serve made me think that in another incarnation he could have been a nurse or a librarian!

Koehler himself was inspired by the adage, “Go as far as you can see, and then see how far you can go.” When I read that, I knew I had the beginnings of my commencement address.

And so, to the new graduates, particularly those in the helping professions, I offer these comments.


Our work is action focused. No one gets to be a good nurse or a good librarian simply by watching.  And yet we must often take the initiative to make clear to others where and how we can be of service. The moments where a nurse or a librarian may be of assistance might not even be recognized by the person in need, who may be baffled by a problem, worried about some health concern, or just overwhelmed into inactivity.

As a dictum, “go” also places control of your career solely in your hands—a reminder that as skilled and educated professionals we have the freedom to direct our efforts and shape our futures.

As far as you can see.

At graduation, each graduate has his or her eyes on a unique horizon. For some it may be the start of graduate school in a few months. For others, it’s a new job in a new city. Still others may see family, volunteer service, or travel.

Pay attention to what you see and to what you see along the way. And for those in the helping professions, pay attention as well to how you see those who need your service. What do you notice about them—appearance, action, behavior? Cultivate your curiosity but always maintain your respect. See others the way you’d like them to see you—your strengths, your good will, your desires.

Use that input and that knowledge to guide your movements, to go forth purposefully, and to be fully engaged in whatever pursuits you deem important. But remember, even as you enter this phase of life, “as far as you can see” is nowhere as far as you can actually—and are likely—to go.

Once you get to that place— that as-far-as-you-can-see place—you will be a new you, with new confidence, new ideas, new desires, new lenses, new frameworks, and new goals. You will then have a new platform to launch into whatever is about to happen next.

See how far you can go.

As you stand in that new place, pause, look around, and don’t forget to glance backwards—even briefly. Your future isn’t defined by your past, but your past is what prepared you for it.

Take stock of what you need with you in that future—friends, finances, humility, humor, knowledge. And what you don’t have, build, acquire, borrow, or buy, so you’ll be ready for the next part of the journey.

Because the beauty of the journey is that there is always a new horizon to see, to move toward, and then to move on from.

How far will you go?

Health Disparities: Big Data to the Rescue?

Guest post by Dr. Fred Wood, Outreach and Evaluation Scientist in the Office of Health Information Programs Development.

Socially disadvantaged populations have fewer opportunities to achieve optimal health. They also experience preventable differences when facing disease or injury. These inequities, known collectively as health disparities, significantly impact personal and public health.

Despite decades of research on health disparities, researchers, clinicians, and public health specialists have not seen the changes we were hoping for. Instead many health disparities are proving difficult to reduce or eliminate.

With that in mind the National Institutes of Health (NIH) National Institute on Minority Health and Health Disparities (NIMHD) launched a Science Visioning Process in 2015 with the goal of producing a scientific research plan that would spark major breakthroughs in addressing disparities in health and health care. NIMHD defines health disparities populations as including racial or ethnic minorities, gender or sexual minorities, those with low socioeconomic status, and underserved rural populations.

Through a mix of staff research and trans-NIH work groups—of which the National Library of Medicine is a part—NIMHD is gathering input on the current state of the science on minority health and health disparities.

Prompted in part by the NIH All of Us precision medicine initiative, one key visioning area—methods and measures for studying health disparities—includes big data.

We expect big data to bring significant benefits and changes to health care, but can it also play a part in reducing health disparities?

Last month the journal Ethnicity & Disease published a special issue focused on big data and its applications to health disparities research (Vol. 27, No. 2).

The issue includes a paper co-authored by the current NIMHD director, several NIH researchers (including me), and several academic partners. Titled “Big Data Science: Opportunities and Challenges to Address Minority Health and Health Disparities in the 21st Century,” (PDF | 436 KB) the paper identified three major opportunities for big data to reduce health disparities:

  1. Incorporate social determinants of health disparities information—such as race/ethnicity, socioeconomic status, and genomics—in electronic health records (EHRs) to facilitate research into the underlying causes of health disparities.
  2. Include in public health surveillance systems environmental, economic, health services, and geographic data on targeted populations to help focus public health interventions.
  3. Expand data-driven research to include genetic, exposure, health history, and other information, to better understand the etiology of health disparities and guide effective interventions.

But using big data for health disparities research has its challenges, including ethics and privacy issues, inadequate data, data access, and a skilled, diverse workforce.

The paper offered eight recommendations to counteract those challenges:

  1. Incorporate standardized collection and input of race/ethnicity, socioeconomic status, and other social determinants of health measures in all systems that collect health data.
  2. Enhance public health surveillance by incorporating geographic variables and social determinants of health for geographically defined populations.
  3. Advance simulation modeling and systems science using big data to understand the etiology of health disparities and guide intervention development.
  4. Build trust to avoid historical concerns and current fears of privacy loss and “big brother surveillance” through sustainable long-term community relationships.
  5. Invest in data collection on area-relevant small sample populations to address incompleteness of big data.
  6. Encourage data sharing to benefit under-resourced minority-serving institutions and underrepresented minority researchers in research intensive institutions.
  7. Promote data science in training programs for underrepresented minority scientists.
  8. Assure active efforts are made up front during both the planning and implementing stages of new big data resources to address disparities reduction.

Big data, it seems, is the classic double-edged sword. It offers tremendous opportunities to understand and reduce health disparities, but without deliberate and concerted action to address its inherent challenges and without the active engagement of minority communities in that process, those disparities could widen, keeping the benefits of precision medicine—including improved diagnosis, treatment, and prevention—from millions of those who need them.

How do you think big data will inform health disparities research? And what else might we do to ensure the disparities gap continues to close?

Head Nurse of the Library?

How a nurse’s way of knowing helps me do my job.

Many of you know I am a nurse. I began my career with a BSN from the University of Delaware (1975) and then completed an MSN at the University of Pennsylvania (1979). I also hold a license as a registered nurse.

I think of myself as a psychiatric nurse, although I spent a few years in the mid-1970s on the 3-to-11 shift in a busy surgical shock-trauma ICU. I have also served on the faculty of nursing at Case Western Reserve and at the University of Wisconsin-Madison.

It helps to understand nursing to see why being a nurse is such a great asset in my role as director of the National Library of Medicine.

To me nursing is fundamentally the diagnosis and treatment of the human response to disease, disability, and developmental challenges.

Note that phrase “human response,” i.e., how people react to the challenges in their lives.

Nurses focus on the human response, while the biomedical knowledge we have, like pathology or anatomy, helps us understand what a person is coping with and what kinds of complementary or supplementary supports are needed.

As noted nurse and author Virginia Henderson observed, nurses must actively engage with the patient to help him or her perform “those activities contributing to health or its recovery (or to a peaceful death) as he [or she] would do unaided had he [or she] the necessary strength, will or knowledge,” with independence from the nurse the common goal.

Nursing addresses the whole person and helps that person live to the fullest extent.

Along the way, nurses come to know people differently than the other clinical disciplines. And that knowledge, I’ve discovered, helps me as Library Director.

It affords me special insight into the public patrons who use our services. I can imagine a young mother using MedlinePlus in the middle of the night to figure out how to comfort a feverish child. I can anticipate the information needed by someone with a late-stage cancer diagnosis and recognize the need to complement journal articles on treatment options with literature on comfort measures and death with dignity. And I can appreciate the challenges of navigating the health care environment, from its specialized vocabulary to its unique culture.

A nurse’s way of knowing helps me set policies for integrating into the Library’s formal standards and language systems the terminologies that address the social and behavioral domains of health. Nurses live in those domains, as much if not more than the technical or scientific.

Perhaps most importantly, my experience as a nurse has taught me that each person has his or her own strengths, and that the Library’s resources should build upon those strengths to help the person make healthful choices, not just explain deficits.

But the benefits of being a nurse and a library director do not run only one way. Directing a library also lets me fulfill my nursing role, as I help others achieve the highest level of wellness possible.

As NLM director, I advocate for those in need, ensuring the literature is sufficiently inclusive. I improve patient care by guiding the fields of data science and biomedical informatics toward a future where professionals and patients interact to achieve care goals. And I model for younger nurses a career path that engages all that I am as a nurse while collaborating meaningfully across disciplines.

Being a nurse is not a job requirement for directing the National Library of Medicine, but it certainly is an asset. Advanced education as a health professional gives me an appreciation for how complex health care is and how important it is to engage all disciplines toward addressing that complexity. Engaging patients as partners in care motivates me to build resources that foster full participation of people in health. And experience as a team player in psychiatric services enables me to join with my colleagues from library science, information and computer science, linguistics, medicine,  and other disciplines to make the NLM the foundation of the future of health and discovery.