Embracing the Future as Stewards of the Past

A View from NLM’s History of Medicine Division

Occasionally, I’ll be asking colleagues to offer their perspectives on the Library and what we do. In addition—given my particular interest in anticipating our third century—I might ask them to describe what that means for them, as Dr. Jeff Reznick, Chief of the NLM History of Medicine Division, so eloquently does in his guest post below.

For several years now, the NLM’s History of Medicine Division has been embracing the future as we continue our mission to collect, preserve, make freely available, and curate for diverse audiences the NLM’s treasured historical collections, which span ten centuries. I’ve described this mission as stewardship of the past, and I have argued that it is not mutually exclusive of embracing the future, because to be the best steward of history during times of change, it is important to anticipate, explore, and chart the paths toward many possible futures. So what do I mean by embracing the future?

Embracing the future means facing change. It means engaging and grappling with it, because studying history can contribute meaningfully to contextualizing and shaping change.

Embracing the future means supporting open and “citizen-centered” government. It means enabling access to all, not just a few. It means engaging new audiences, not only the traditional ones. It involves engagement across the disciplines, and across the spectrum of the public, to ensure that scholars, educators, and interested people of today and tomorrow can have access to the world’s historical medical heritage for research, teaching, and learning.

A collection of headshots of those who have written for the Circulating Now blog in the past year
A Chorus of Voices. Through its blog Circulating Now, the NLM is giving voice to our patrons from a variety of disciplines and backgrounds, who—each in his or her own way and together—recognize the research and educational value of our world-renowned historical collections.

Embracing the future means embracing fair use and supporting robust digitization as a means of both access and preservation, and achieving these goals through mutually supportive public and private partnerships. Moreover, embracing the future means appreciating and understanding that digitized historical medical collections exist in a format appealing not only to those focused on deep reading and close study of individual works, but also to scholars and to entirely new audiences interested in mining these digital surrogates and their associated metadata data for more data-focused research. The evolving digital world is producing an ever-increasing volume of digitized physical material and born-digital resources. The worlds of “big data” and data science are meeting a longstanding world of persistent physical objects that contain records of the human condition. As these worlds collide and coexist, opportunities abound to advance interdisciplinary collaboration and expand cooperation among institutions and organizations that preserve history and support current and future medical research, and research in all disciplines.

Embracing the future means pursuing exhibitions and otherwise giving voice to the research and educational value of our historical collections as they speak to important contemporary and historical topics like domestic violence, AIDS, health care professions, and slavery.

And finally, from a leadership perspective, embracing the future means meeting individuals where they stand, treating them as colleagues and as part of a team. It means supporting mentorship to advance careers, continuous learning to advance interdisciplinary research, and teaching focused on historical and contemporary issues of health and the human condition. These initiatives are not only keys to embracing the future of challenges and opportunities. They are keys to succeeding in that future.

More by Dr. Reznick
Embracing the Future as Stewards of the Past: Charting a Course Forward for Historical Medical Libraries and Archives  Article | Lecture
Joining Together for a Win-Win (with co-author Simon Chaplin)

The Future of Health and Health Care

I want to say one word to you. Just one word.

In the movie The Graduate, Benjamin receives one word, whispered in hushed tones, as guidance to a successful future: “plastics.” Today, the National Library of Medicine, and the NIH as a whole, would whisper “data.”

The future of health and health care rests on data—genomic data, environmental sensor-generated data, electronic health records data, patient-generated data, research collected data.

Why is data worth our attention now? Because data generated in one research project could be analyzed by others and help grow knowledge more quickly.

The data originating from research projects is becoming as important as the answers those research projects are providing. Various kinds of data originate from research, including genomic assays, responses to surveys, and environmental assessments of air quality and temperature. Making sure these data are effectively used in the original study is the responsibility of the investigators. But who will make sure that relevant parts of these very complex and expensive-to-generate data will remain available for use by other investigators? And maybe even more important, who will pay for making those data discoverable, secure, available, and actionable?

We believe the NLM must play a key role in preserving data generated in the course of research, whether conducted by professional scientists or citizen scientists. We know how to purposefully create collections of information and organize them for viewing and use by the public. We can extend this skill set to the curation of research data. We also have the utilities in place to protect the data by making sure only those individuals with permission to access data can actually do so.

We have much to learn along the way, for handling data is not straightforward, and the analytical methods that help us best learn from data await future development, but we have the foundation on which to build, the knowledge to get us going, and the tradition of service-inspired research that enables us to learn as we go.

Over the next few months I will outline NLM’s plan to become what the ACD report recommended—the “epicenter of data science for the NIH.” I look forward to your comments.

Musings on the Mezzanine

The history of this soaring space

A couple of you have asked about the title of my blog. A mezzanine? Am I working in a restored theater or something?

Since I’m new to the place myself, I thought a bit of research might be in order. As the minutes of a 1958 NLM Board of Regents meeting reveal, “mezzanine” is the term that has always been used for the second floor of the main National Library of Medicine, Building 38, where the Office of the Director and NLM administrative offices are located.

The history of the Mezzanine is interesting.

“Characteristic of the age we live in, particular consideration had to be given to bomb blast effect where it might influence structural design.”
Walter Kilham, Jr. | 1961, Bull Med Libr Assoc

When the Philadelphia firm of O’Connor and Kilham was drawing up the blueprints, they had serious concerns. The late 1950s were marked by Cold War tensions, and our beautiful geometric roof was put in place so that, in the event of an attack, it would collapse, creating a seal over our vast collection, housed on three underground levels. This fear is also the reason for our foot-thick Indiana limestone walls and other fortifications.

It might not be common to build a library that can withstand a bomb blast, but the architects pulled it off with style.

With a big open space called the Rotunda forming its core, the Mezzanine is graced by a large ring of windows under the roof. At times, geese fly by, their loud honking distracting us momentarily from our computers. I’m told that during winter storms, it feels like we’re inside a snow globe. We also have a 15-foot model of the DNA double helix, suspended from the ceiling, which is simply beautiful.

The library space below, housing casual seating and small exhbitions, opens above to the soaring expanse of the rotunda, featuring a large ring of lights and a model DNA strand hanging in the center.
The view from the Rotunda looking up toward the Mezzanine highlights the double-stranded model of DNA which hangs in the center. (Credit: Stephen Greenberg / NLM)

I invite any of you who are in the DC metropolitan area to come and see the Mezzanine. (You can even take a tour of the Library.)

This building opened its doors to the public in 1962. We remain open to the public today. And now we are building an open-access library, where PubMed Central‘s 4.1 million articles are used by over one million people every day.

I’m honored to be one of the more recent occupants of an office on the storied Mezzanine.

As we work on strategic planning for the next decade and beyond, all of us on the Mezzanine and beyond want to make sure you get the medical information you need, when and how you need it.

And we invite your thoughts on how we can best provide that service. Please share your comments and your audacious goals for NLM’s future.

Looking Back to Look Ahead

Nina Matheson’s words inspire and inform.

I recently prepared two big talks: the Matheson Lecture at the AAHSL/AAMC conference in Seattle on November 10, and the Plenary Keynote at the AMIA 2016 meeting in Chicago on November 15. The challenge—to be witty, insightful, visionary, knowledgeable, and inspirational—ABOUT DATA SCIENCE! To do so, I reached back to the words of one of the great women thinkers of our field, Nina Matheson.

I re-read Matheson and Cooper’s 1982 report on “Academic Information in the Academic Health Sciences Center” [J Med Educ 1982; 57 (10 II)]. Go back and read it again, and each time you encounter the phrase “information resource” think DATA! You will find that much of it is still relevant after 34 years.

For example:

  • The major barrier to change is often not a love of the status quo but the lack of a clear picture of where technology leads.


  • Some futurists underestimate what can be accomplished in one year and overestimate what can be accomplished in 10 years.


  • Without a vision of the goal and a concrete demonstration of feasibility, fruitful change is difficult to initiate.


  • Books will not disappear, but their uses will concentrate in those areas where their portability, relative low cost, and ease of production for stable information in incontestable.


  • As more and more information is available only to those with the financial means, fears grow about potentially disenfranchising those less affluent.

So how does this inform data science? It will take me a while to develop the same level of wisdom as Nina, so you can expect to see this list again, but here’s a start:

  • Data as an information substrate shares many features with bibliographic information—it’s just more granular—but the same challenges of how to harness, curate, store, and disseminate are still present.
  • Assuming a democratic perspective about health data—that it is potentially as useful to the scientist as the school teacher, to the clinician as the parent—will lead us to build utilities that avoid privileging the wealthy and professional over those less affluent or less educated.
  • Libraries, including our great National Library of Medicine, must ADD data to their complement of information resources, neither supplanting books and journals nor deeming them satisfactory.
  • Vision helps avoid the determinancies of the present and the over-promising of the future.

The NLM is in the process of establishing a strategic plan. Data science will form a key part of this strategic plan. Reflect on Nina’s words, and let me know what guidance they impart to you!

More Information
Nina Matheson Oral History (NLM Lister Hill Center, 2005): Abstract | Full transcript

Anticipating NLM’s 3rd Century

Seeking guidance, vision, and audacious goals.

I recently returned from the AMIA 2016 meeting in Chicago. What an exciting few days! Over 2,000 medical informatics professionals spent hours listening to developments in patient-generated data, edits to the SNOMED taxonomy, new directions in public policy, and solutions to the challenges of interoperability and decision support. The atmosphere was, as usual, filled with excitement and hard work. Logo for the American Medical Informatics AssociationBut not all hard work. The outstanding AMIA staff made sure there were celebration dinners and dance parties and first-timer receptions to attend to the social and networking aspects so important in these meetings.

Dr. Brennan gestures while standing behind a podium.
I was honored to deliver a keynote at the AMIA Annual Symposium in Chicago, November 12, 2016. (Credit: AMIA/FABPhoto-Chicago)

I was honored to present a keynote message (PDF | 5 MB) on Tuesday morning, bringing forth a perspective on NLM at present—how we are building on its history, celebrating its present, and anticipating its future. I traced our history from a bookshelf in the Army Surgeon General’s office in 1836 to a vast, worldwide network of biomedical science knowledge—the largest in the world. To me, the library represents the dynamic interplay between medicine and information, and while we’ll always maintain our commitment to archival knowledge of books, journals, and manuscripts, our future will include data and virtual information resources. I encouraged the attendees, as I will encourage readers here, to respond to the Request for Information to help us chart NLM’s third century.

We are in the midst of a strategic planning process and YOU CAN PARTICIPATE! We are looking for guidance, vision, and audacious goals addressing the role of NLM in:

  1. advancing data science, open science, and biomedical informatics;
  2. advancing biomedical discovery and translational science;
  3. supporting the public’s health: clinical systems, public health systems and services, and personal health; and
  4. building collections to support discovery and health in the 21st century.

Come along and help us craft the future of NLM and of data-driven discovery in the service of health!

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