The Search Principle blog

One of the most thought-provoking plenaries at the UofA’s PEP conference was Dr. John Hoey’s “Editorial and Scientific Independence: Misreading the Evidence, Misleading the Public“.

The presentation encouraged reflection for delegates who’d come to the conference to explore ways of getting medical evidence into practice, but who may not have thought about medical publishing’s role in aiding and abetting that process. Dr. Hoey clearly gets the importance of transparency, integrity and openness in scientific publishing.

During his time as Chief editor at the Canadian Medical Journal (CMAJ), Hoey stood for high standards, took the journal into open-access, and improved its once weak impact (1.6) factor to more than 9.0. With readership up and the quality of articles submitted reaching new highs, Hoey had brought the CMAJ into a new century.

But, principled leadership isn’t always enough; in 2006, Dr. Hoey disagreed with his publisher, and was fired (along with Senior Editor, Anne Marie Todkill) much to the dismay of many in medical circles. Hoey, however, said that he and others are starting a new open-access Canadian medical journal called Open Medicine, and was remarkably good-humoured (and self-deprecating) about his CMAJ experience.

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Dr. Hoey put the CMAJ’s problems into a broader social, economic and scientific perspective. In discussing the validity of research, literally what is true in medical science, he mentions numerous factors that devalue validity, and not just obvious commercial or political interests. To this end, he presented what he called his Pyramid of misleading evidence which included issues like falsification of data, opacity, human error, sloppiness in study design and even incompetence. He also suggested that the pyramid of evidence is affected by confounding factors and that RCTs (think the VIGOR trial) are not always what they appear to be.

Hoey’s main message? Some of the best evidence stands the test of time. Clinical studies that demonstrate long-term validity (truth) may be a worthwhile goal. To that, I will only add that the organization and access to evidence (by librarians and physicians) are also critical dimensions to practicing EBM over the long term.

The University of Alberta’s Fourth Annual Putting evidence into practice (PEP) conference is off to a nice start. I’m in the pediatrics group, facilitated by the knowledgeable Kent Stobart – a teacher! (The clearest PICO description I have ever heard.)

Tomorrow one of the UofA’s librarian interns, Trish Chatterley (also a blogger), and I are delivering a session on searching to a group of physicians. She’s tried to pin me down several times to discuss what we’ll present, but I think I’m going to freestyle my sections. We have two hours.

EBM is really good medicine for a health librarian’s soul. The health librarians here are really a great, collegial group; and, we’re having a good time. The UofA is beautiful at this time of year, and the sun is shining. I call this my mini-sabbatical. Sabbatical-ette?

More later about the sessions. Tomorrow, we hear Dr. John Hoey discuss the CMAJ problems (and the importance of editorial independence). Should be good for more blogging. I will also let you know about Trish’s and my search session. Chilly cheers!

Guest blogger: Greg Rowell – for tonight’s LIBR534 class on management:

First law: Know your organization
a) Structure
b) The executive
c) Your boss*****
Second law: Know your business
a) Trends – external, internal
b) Collections
c) Marketing
d) Managing a budget*****Third law: Know your people
a) Skill levels
b) Needs
c) Concerns
d) Performance evaluation *****
Fourth law: Know yourself
a. Communication Skills
b. Conflict Resolution Skills
c. Leadership Style
d. Essential Behaviours
i. Emotional fortitude
– authenticity, self-awareness, self mastery, humility
ii. Models: 7HHEP vs CASTLE vs ?*****
Fifth law: Know your colleagues
a) Collaboration
i. Teaching – adult learning
ii. Conference Committees
iii. Consortia :
e-HLbc, BC-ELN, HKN, SHIRP, CRKN, SALUS
iv. Conferences
b) Organizational committees
c) Professional Organizations
– HLABC, CHLA/ABSC, MLA, PNC/MLA, SLA
d) Mentors

The fracas re: the British Medical Journal “study” about Googlediagnosing has led me to consider the best sites for diagnosis, and especially differential diagnosis. What’s your assessment of wrongdiagnosis.com? It is useful? Remember how librarians warned against dot.com sites ten years ago? Does this assessment still apply?

What do you think of the video content on aortic aneurysm at Wrong Diagnosis? Are these professionals’ opinions useful? Under what circumstances would librarians recommend these, if at all? What do physicians think of these videos? If Google points to them, are they useless? Do the annoying ads negate the content?

We need to examine our long-held biases about dot.com sites. The truth is the old arguments don’t hold the same water anymore. We need to be more open to search engines, what they can do better than our commercial tools (or PubMed) – and finally be more open to all content.

At the very least, to know a bad website in health, you have to see one. To know a bad idea (a commercial, fraudulent, misleading, inaccurate one) you have to see one. To examine it and critique it. And teach our users what to look for, efficiently.

Today’s headlines: Google ‘aids doctors’ diagnoses. Google gives better diagnoses than GPs. Doctors urged to Google their diagnosis. Is this deja vu, or is the birthday muse playing tricks on me?

Google is the largest, fastest, most-used search tool ever conceived. After MEDLINE, Google is my desert island search tool; in the reference interview it produces answers for health librarians, fast. Simply put, Google has helped to advance the practice of medicine, even if you merely look at its role in promoting consumer health.

This week’s study in the British Medical Journal is indicative of just how large Google has become. 3-5 billion searchable medical pages, and 50 billion web pages in total. Used properly, the size, power and speed of Google makes it an important clinical tool for doctors [neither emphasis nor words are mine].

A Toronto physician, Dr. Vincent Lam, who works in emergency medicine, has won the biggest prize in Canadian fiction, the Giller Prize, with his book of short stories, Bloodletting & Miraculous Cures. Based on two of the stories, “How To Get Into Medical School,” and “Take All of Murphy,” I’m going to buy the collection.

The latter story (read it here) is about three medical students who face their first dissection of a cadaver together — and face the odd situation of deciding whether following Netter’s or keeping the corpse’s tattoo intact is more important. Bloodletting is indispensible reading for insight into the mindset of physicians, and medical students. (The last physician’s writing leaving me this breathless was over at intueri.org).

By the way, check out these recent articles on bloodletting.

I have been chatting with Larry Sanger, and will be posting our interview – soon.

From last night’s class:

1) What is belladonna? Any interactions to watch for? [e-answer]

2) Is prayer seen (ie. RCT) as a treatment for chronic illness?

3) Are “Devil’s Claw” and “White Willow Bark effective in treating osteoarthritis? [compare PubMed and Google scholar]

4) Is there such a thing as a toxic dose of vitamin D? [possible e-answer]

5) I’d like to find some clinical trials on acupuncture. [clinicaltrials.gov]

6) Who uses CAM therapies more in Canada, men or women? [possible e-answer]

7) I’ve heard that chiropractic medicine is a form of ancient medicine. Is that [true?]

8) Find a licensed naturopathic physician in BC. Vancouver? [possible e-answer]

9) Is Chaparral tea used in cancer treatment? Is it safe to use? [possible e-answer]

10) Kevin Trudeau’s book on “Natural Cures” – should you have it in [your library?]

My opinion is that this is a collection decision each health librarian should make (based on budget, clientele and collection parameters), but that we should be able to speak to our library committees if the controversial issue arises.

Or, should I say the ghosts on halloween? See witch hazel.

Tonight, is our class on searching in complementary and alternative medicine (CAM) – see our handout.

Andrea Freeman, a former student, who now works as a librarian at the Centre for Integrative Healing is our speaker. An MLIS student, Rob Stibravy, who has a keen interest in CAM is doing his talk. Stay tuned for an exploration of issues – and evidence (of ghosts and witches?) – tomorrow.

UBC Google scholar blog is going on hiatus. Well, let’s just call it a sabbatical. As of January 2007, a sign will go up saying Gone fishing – see you in 2008. I am going to be immersing myself in learning theory for my 2007 sabbatical, and that means I won’t be tracking trends in search. What will happen to GS blog? What about the wiki? All good questions.

It’s time to let the students in LIBR534 take over. Several student bloggers will go on to write entries in their own blogs. Still others will contribute to and keep the wiki going. For me, I am pondering what to do next. Will I return here? Time will tell.