You know the feeling when you are looking for a search example and up comes an article advocating a Google search? Irritation! Annoyance! Eye rolls! Big sighs!
Years ago I performed a search demonstration about EpiPens and accidental overdoses. One article that came up was titled: Accidental Epipen injection into a digit – the value of a Google search. Arrggghh! So what happened here? A child accidentally injected himself with his mother’s EpiPen and was rushed to the emergency dept at a UK hospital. Experts were consulted but didn’t know what was the best course of action. Clinicians searched PubMed but didn’t find anything: “a literature search was carried out on PubMed using the following key words: ‘pediatric’, ‘digital artery’, ‘epinephrine injection’. No citations were found.” So they turned to Google and found one article that was very pertinent.
But guess what? The article they found is in PubMed!!!!! And the hospital has a well resourced medical library. So what is going on here? Is it ignorance of search methods? Is it a rapid need for info leading to knowledge of search methods going out the window? I wonder if this hospital has access to the Chasing the Sun service – a service set up between hospitals in the UK and Australia in order to provide 24hr librarian assistance (and this service has been used in out of hours emergencies).
What can we learn from this?
In 2001, a clinical trial participant at Johns Hopkins (JH) died as a result of inadequately researched safety information. Ellen Roche was a 24 year old lab assistant at the JH Asthma and Allergy Center and thought to enrol in the study in altruistic intent (as most clinical trial participants do). Immediately following Roche’s death, research funding was suspended and JH was left scrambling to address the controversy. Medical librarians in the US went into overdrive over the incident. It appeared that the lead researcher did a rudimentary search of the literature. He searched PubMed (Medline records from 1966 onwards were available in 2001 and in order to discover older records (hexamenthonium was used extensively in the 1950s) you would have to have searched print indexes), Google, Yahoo!, LookSmart and GoTo.com. Librarians and researchers said that the literature search was lazy and foolhardy. Not only were the researchers at fault, but the JH Institutional Review Board (IRB) was at fault also for not providing proper oversight. Librarians talked about literature search standards and what should constitute a reasonable search. JH have now included literature search standards in the IRB application form and many other IRBs across the US have too.
JH has well resourced libraries – why didn’t the researcher contact them to ask for assistance? Was this a failing of the library as well? The Welch Medical Library began liaison services in 2000 for a few departments (Asthma and Allergy and the IRB were not included). What does this mean for medical librarians now? Perhaps librarians could try and work closer with their research offices in providing some sort of literature search service – approving search strategies and advising researchers where they can be improved. It could be spun as part of the quality control process of clinical trial management. There also needs to be better reporting of adverse effects. Apparently in a hexamenthonium trial in the ’70s, adverse effects were not included. Adverse effects reporting is still a problem today and also a problem for librarians in searching for adverse effects literature due to inadequate indexing amongst others.
When I first read reports about the death of Ellen Roche and the swirl of commentary about it in the library e-list, it touched me, as it did others. As health professionals, we have a duty to get involved in research activities in order to prevent another incident like this happening again.
The hexamethonium asthma study and the death of a normal volunteer in research
Johns Hopkins’ Tragedy: Could Librarians Have Prevented a Death?
There is occult medicine amongst us. I’m not talking about witchdoctors, faith healers, crystals or miracle cures. I’m talking about Big Pharma.
The definition of occult from the OED is occultare ‘secrete’, frequentative of occulere ‘conceal’, based on celare ‘to hide’; the adjective and noun from occult- ‘covered over’, from the verb occulere. Occult is also used in medicine to describe conditions not readily diagnosed by manifest symptoms meaning that other options will have to be used e.g. blood tests.
Big Pharma regularly occults data, refusing to let the biomedical community access its full store of information. Select information is released, mostly putting positive spins on trials. Negative results are occulted. It is hard to determine how much information revealed to Big Pharma is occult. Is it a bigger percentage than the percentage Big Pharma have published? Who can say. What is known though that governments down to individuals have practiced unknown or secret medicine.
The AllTrials campaign is trying to turn the situation around by forcing Big Pharma to register and report the results of all trials, past, present and future. The Declaration of Helsinki recognised the ethical importance of releasing all clinical trial data but Big Pharma (and other research groups) still resist or ignore it. Efforts such as that of Peter Doshi and Tom Jefferson in wresting information about Tamiflu demonstrate the extent to which Big Pharma resist releasing information.
All results from any sort of clinical trial must be released, be it negative, indifferent or positive. Otherwise, clinicians practice occult medicine and lose the scientific and moral upper-hand when it comes to fighting quack medicine.