Related to the previous post, I wondered aloud at journal club whether the unavailability of an article is a bias. I can imagine that people looking for articles will opt for free first, then (if they have turned on their Google library link) see if their library has it. If it is unavailable, I can imagine that people skip that article and go to the one they can access.
Scenario: someone is preparing for a journal club and is looking for evidence for treatment of a certain condition. They search Google or PubMed (not accessing it via their library’s website – not knowing that the library enabled their collection to show in the results), and their article of choice which is of the highest evidence available is 1) not free and 2) when they click on the publisher’s link, they find out that they have to pay for the article. This person then goes to their university library which they still have access to, to see if they have it. The uni library doesn’t (neither does the hospital library) but the university library offers an ILL service (as do hospital libraries). But the person decides it is too much bother and goes back to the search results to look for something readily accessible.
Is this bias?
I think it could be. If you have time before your meeting to order and be sent the article, you could be looking at the best article with the highest level of evidence available. People involved in writing systematic reviews should (and do) utilise ILL services for included articles. If a rigorous search has been done which naturally would include articles not immediately available, inclusion and exclusion criteria should not include article availability.
So what I am I saying here? As well as being biased by flashy titles, people also are biased by availability: if it isn’t immediately accessible, people will move to 2nd or 3rd choice.
I have to say I’ve been biased this way. Bias surely can be a minefield!
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?