I just renewed my MLA membership and registered for the annual meeting in Chicago. While my annual meeting expenses will be reimbursed, my membership is not. Quite frankly it always hurts to see that much money leave my account at one time regardless of whether it is work related or fun like a vacation. I am cheap. My kids know all too well I am always looking for deals or ways to save money.
First: If there is no way on God’s green Earth that you can afford or physically be able to attend MLA in Chicago, seriously consider attending online by registering with the e-Conference attendance. At $120, it is a pretty good deal and is half the cost of one night in the hotel.
Second: Find a roommate. Even though my institution reimburses me, I am asked to find a roommate. I find the majority of the meeting expense is the hotel and splitting it with at least one person helps a lot.
Third: While I love staying at the conference hotel, I also realize that isn’t always an option. Sometimes the rooms are too expensive or sometimes they are sold out. Find a cheaper hotel or go on AirBnB. I found several places to stay on AirBnB in Chicago from $10-$150.
Fourth: Get a conference only registration. This saves about $160 off of the registration price. Now that means you will not be able to attend some of the receptions that include food and networking opportunities. So you will need to figure out your own cheaper food and networking opportunities to make the savings count. Don’t let your conference package savings get lost on the cost of getting meals that the receptions normally would provide.
Fifth: There are a lot of ways to eat well and save money at MLA. Buy snacks and breakfast stuff at CVS, Walgreens, or a nearby grocery store. That food is always cheaper than what you pay for at a restaurant or in the hotel. Go to Sunrise Seminars. Not only are they informative but they often have food. There are also some vendor seminars that are during lunch time that have food. There aren’t a lot of them and they are trickier to find and often require an RSVP in advance. Go to vendor parties for your dinner. I love food, I don’t skip meals and I found I have never gone hungry at MLA and my food budget is very very small. I also have stopped buying snacks and breakfast stuff at the local grocery store. I found I often didn’t eat it because there were other food events for me to attend that sounded more appetizing than my CVS bagel.
Sixth: Apply for a travel award from every section, group, etc. that you belong to. Many travel awards are graded based on the applicants’ need to be at MLA. So submit a paper or poster to MLA to show that you are contributing to MLA as well as needing financial assistance. Obviously it is too late to submit a paper or poster for this MLA, but do it for the next one. If it gets accepted and you still can’t go (btw institutions are more apt to fund somebody presenting) then you can ask to be removed. It sucks but it isn’t the end of the world.
Seventh: Try budgeting a year in advance. I have Browns season tickets…they cost me a pretty penny each year. Every May like clockwork the Browns organization wants their pound of flesh. If I had to come up with that money all at once I would be dead. Instead I have created a Browns account that I put $200 in every month. By the time May rolls around I have $2400 ready to send and while I hate to see it leave my account, I don’t feel the pinch. If people buy my tickets, I direct the deposit to that account. I have also created an MLA account that operates much the same way as my Browns account. I auto deposit a relatively small amount every month into that account and by the time MLA rolls around I am set.
I love going to MLA. Not only do I consider it a professional activity but it is also fun. While it isn’t a vacation exactly, I find I am refreshed and looking at librarianship in different ways….almost as if I was on a real vacation. OK I’m a nerd…I kind of think of it as a vacation.
Share on Facebook
Annual Meeting Tags:
Hospital librarians are asking how they can show their value to administration and how they can show that they are more than just the keepers of the books. The answer is to branch out and get out of the library and do something that is related to the library but is not always thought of by others. Participating with EHR team to provide information to caregivers is a great example. This webinar not only will discuss librarians, EHRs and Infobuttons, but it will also highlight successful approaches for getting relevant information into the EHR and librarians can round with caregivers to help at the point of care.
Not only is this webinar interesting but it is also FREE! So you have little to lose by attending it.
Title: Adding Value to EHRs: Librarians and Infobuttons
Time: March 19, 2014, 10:00 – 11:30 am EDT.
Course length: 1.5 hours
(description from the NN/LM NER website)
This webinar is being planned as the first in a series sponsored by the NN/LM, NER on ways librarians can add value to electronic health records.
Additional webinars are in development. The overall goal of this webinar is to give medical librarians an understanding of clinical decision support mechanisms in electronic health records (EHRs) and to increase awareness of the ways that librarians can contribute. An understanding of the ways that library resources can be integrated into clinical decision support will empower librarians to pursue this in their own institutions.
Guilherme Del Fiol, MD, PhD, University of Utah, School of Medicine will present results of a systematic review on clinical questions raised by clinicians and tools that help answer these questions by integrating EHR systems with online knowledge resources. He will also discuss how these tools are being disseminated via the “HL7 Context-Aware Knowledge Retrieval Standard” (a.k.a., Infobutton Standard) and the EHR Meaningful Use certification program.
Taneya Koonce, MSLS, MPH, Eskind Biomedical Library will share the Eskind Biomedical Library’s successful approaches for integrating highly relevant evidence into the institution’s electronic medical record, outpatient ordering systems, and online patient portal.
Lauren Yaeger, MA, MLIS, St. Louis Children’s Hospital Medical Library will talk about clinical librarianship/rounding with the patient care team, Evidence Based Medicine Quality Initiative Project with the residents, and integrating clinical decision support at the point of care.
Share on Facebook
I am starting very early on my priorities as President. I am not yet officially President elect (that happens at this MLA) and the current President elect (soon to be President) Linda Walton has not officially released her priorities. But, ever since I was nominated I have been thinking about my priorities.
As I mentioned I am early to the Presidential priority party, but I want to start early because I think it will take me a while to refine them.
Here is very unofficial rough timeline of the Presidential priorities.
- President Elect year – Attend MLA Board meetings to get familiar with current issues happening within MLA. Work with the rest of the Board to help the current President and with his/her priorities. Start thinking of and create my own Presidential priorities and present them to the Board.
- Presidential year – Present the priorities to the membership and create task forces or have committees assigned to help achieve the priorities.
- Past Presidential year – The priorities work from the task forces, committees, etc. either wind down or evolve. With the help of the rest of the Board, work with the task forces or committees as they wind down or evolve.
In a nutshell I have one year to think of my priorities, one year to get them started and see them to their completion or evolution. In reality not every Presidential priority is able to finish in that timeline. It would be difficult and unwise to abandon unfinished priorities from previous Presidents. Some priorities can be finished within a year, but others require several years to finish, or they evolve into regular, ongoing MLA activities (committee charges, HQ staff assignments, etc.)
While I am looking at my predecessors’ Presidential priorities I want to also take into account the MLA membership’s thoughts on what my priorities should be.
I am asking MLA members to think about what my Presidential priorities should be as they relate to MLA’s mission. Please keep in mind, I will also be working on previous priorities AND there is a bit of time crunch unless I go mad with Presidential power and throw the bylaws out the window and declare myself the Monarch of MLA. (Just kidding…but it is a catchy name)
Rome was not built in a day. My ultimate goal, independent of any priority, is to help others and inspire them to be active and work to better MLA and medical librarianship. I think of it a bit like this…. One snow flake is small and easily melts by itself, but when it is packed in a snowball with other snow flakes as it rolls down a hill, it becomes a stronger force to be dealt with. I cannot do it alone.
Share on Facebook
(cross posted in a lot of places)
Virtual Projects for JMLA Column by March 15, 2014
The Journal of the Medical Library Association (JMLA) Virtual Projects Committee is seeking innovative and notable projects for the upcoming JMLA Virtual Projects column. The annual column which was launched in October 2013 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3794676/) focuses on library virtual spaces that extend the library “presence” outward to support users in their digital spaces, wherever and whenever needed.
The JMLA welcomes submissions of recent projects for the Virtual Projects column that will be published October 2014. To be considered for this column, please submit a 200 word abstract of your virtual project or a link to your project web page that describes the project and why it is innovative/notable. Send your submissions to Susan Lessick, AHIP, FMLA, [email protected], by MARCH 15, 2014.
Some examples of virtual library projects :
- projects that demonstrate the integration of evidence and/or digital content and library services into the institution’s Electronic Health Record (EHR) as part of the treatment and care process
- projects related to providing new technologies, such as libraries providing collections and tools to support 3D printing or offering 3D services (‘makerspaces’)
- projects that improve the quality of the library’s web presence through the implementation of a new web design, feature, or tool, such as animation, user interactivity or webpage/site builders
- projects that facilitate information discovery and content delivery (e.g, use of web-scale discovery or knowledge bases)
Please consider sharing your knowledge and experiences with implementing virtual projects in your library to inspire and encourage your peers, partners, and communities!
JMLA Virtual Projects Committee:
Share on Facebook
Janis Brown, AHIP
Michelle Kraft, AHIP
Susan Lessick, AHIP, FMLA
Elizabeth Whipple, AHIP
A friend of mine on Facebook posted a link to this post, “NASCAR knows more about Twitter than you do.” A title like that just begged me to read it. You know what? Stephanie Foster’s post is right on the money. NASCAR is doing everything right with Twitter while so many companies, organizations, and sporting leagues have failed.
Some of NASCAR’s keys to success:
- A very open and liberal Twitter policy.
NASCAR not only allows their people to tweet they want them to do it. Foster states, “Unlike other professional sports leagues, NASCAR allows — even encourages — its drivers to tweet, right up until “game time,” the moment the driver gets in the car. In a November 2012 interview with ESPN, NASCAR spokesman Kerry Tharp said, “We encourage our drivers to participate in social media. We feel we have the most liberal social media policy in all of sports, and the access we provide is the best in all of sports.”
I am very curious as to whether they have some sort of Twitter boot camp available to their drivers, teams and specialists. NASCAR is not adverse to fining drivers or others for inappropriate behavior or tweets, but it seems with their very open policy we would be more controversy and inappropriate tweets compared to other leagues that have stricter policies.
- Full scale integration of Twitter.
NASCAR didn’t just say it was OK to tweet, they assimilated it into their sport. Foster writes, “NASCAR became the first professional sports league to sign an official partnership with Twitter. The largest initiative was the launch of a platform that collected tweets from drivers, media and fans that allowed even faster engagement on the site. NASCAR also made Twitter a real marketing priority, painting drivers’ Twitter handles on the cars, hosting Twitter-only contests and race day “tweetups,” and allowing fans to tweet questions to race analysts during pre- and post-game programming.” (Read an article about NASCAR’s Fan and Media Engagement Center on race day…kind of interesting.) Now compare that with MLB’s social media policy prohibiting the linking to or use of images, MLB sites, etc. without obtaining MLB’s permission. MLB missed the mark entirely, you want people to go to the MLB sites, you want them to see your product. Twitter is a conversation, if you must get permission to link to an MLB site then the conversation is stunted. I get MLB’s thinking, they are worried about brand association. However, I would think NASCAR is equally concerned about their brand, yet the two organizations approach to their bran on social media is vastly different.
One thing that Foster doesn’t directly mention but is the whole driving force between successful Twitter campaigns and languishing ones is engagement. Foster describes the engagement with the fan when she discusses NASCAR’s policies and integration with Twitter. The liberal policy opens up the opportunity to engage people. The integration is important but not everyone is NASCAR and have the ability to integrate so fully with Twitter. The engagement with the fans is the reason why NASCAR went for full integration with Twitter. Engagement is such a tricky area for many companies, hospitals, librarians, and others to master. Until recently, engagement with consumers was not so immediate and usually did not lend itself to be so public at the press of an enter key. Companies, hospitals, universities, and regular people were used to having far more control over the discussion and message. Not so on Twitter. Twitter is all about engaging with people and also giving up some control on how your message is disseminated and perceived. That is why organizations or people who only promote their activities fail at getting their message. They are no better than spam. Organizations or people who don’t RT or respond to tweets, whose Twitter or Facebook accounts are black hole where only messages are posted but never replied to miss the point. You must engage with people for them to stay interested and keep following.
While the post talks about NASCAR’s use of Twitter to engage its users, the principle of engagement is still applicable to librarians, hospitals, universities and library vendors.
Share on Facebook
Social Media, Twitter Tags:
(post duplicated on http://medlibschat.blogspot.com/)
One day you are Katrina and the Waves and you are “Walkin’ on Sunshine” everything is good and falling into place. Your searches are matching up just perfectly with MeSH, patrons are writing thank you emails, the CEO just praised you, and a new project is going like gang busters. Life in the library is perfect.
BUUUT the next day (or week) you are Joan Jett growling, “I Hate Myself for Loving You” as nothing you do seems to be working. PubMed keeps crashing, patrons are upset because you can’t get the article from the Journal of Big Toe Science written in Hindi rushed the same day and translated into English, your budget was cut more than expected, and administration or IT (take your pick) throws cold water all over your pet project. Life in the library is like a bad relationship.
Like any career, medical librarianship has its ups and downs. Friday is Valentine’s Day and to get in the spirit the #medlibs Twitter chat group will be having fun discussing our love/hate relationships with medical librarianship.
So grab some wine and chocolate, after all it is the day before Valentine’s Day and curl up with your laptop and chat with us this Thursday 9pm eastern. Don’t forget to follow the word #medlibs to watch and participate in the discussion. Lurkers and late arrivals are welcome. Nikki Dettmar and I will be moderating and we look forward to seeing you online.
For more information or questions tweet @eagledawg or @krafty or drop us an email.
Share on Facebook
#medlibs chat Tags:
I haven’t done a Friday Fun post in a really long time. These last two weeks have been rough. Discussions about library closings and the weather playing havoc with work and school days, we are overdue for some fun.
This has nothing to do with libraries, but it puts a smile on my face and that is all I am trying to do. So enjoy.
Share on Facebook
Friday Fun Tags:
Many have been wondering what MLA has done for them regarding government lobbying and trying to advocate for the profession.
IF you are a member of MLA, it isn’t hard to find out what MLA is doing in this area. Simply go to the Annual Reports and look for the Government Relations Committee (GRC) report. I have posted edited versions of their full report (edited due to space) here. Check out their entire report, which shows how much more they are doing.
In the 2009/2010 report they…
- Published public policy updates in MLA Focus (lots of Focus issues listed) including NIH funding, patient safety, health information technology, etc.
- Distributed three action alerts urging support for NIGH funding and FRPAA.
- Planned a legislative update day for the 2010 meeting. Where MLA’s Washington representatives and Health Medicine Counsel of Washington provide key issues and information to members participating in MLA’s Capitol Hill Day.
- Planned Capitol Hill Day for 2010 Annual Meeing. MLA members were given briefing packets, fact sheets and other information resources to use in their Hill visits.
- Connie Shardt wrote Senators John Cornyn and Joe Lieberman expressing support for S. 1373
- Requested opportunity to present testimony in Washington DC on behalf of MLA in support of NLM’s Fiscal Year 2011 appropriation
- Hope Barton co‐chaired, along with J. Michael Homan, a working group of the task force to develop the statement, “Health Sciences Libraries and Health Care Reform: Providing Quality
Information for Improved Health.” http://www.mlanet.org/government/gov_pdf/2009_july_hlthcarerefrm.pdf
- Educated Congress and relevant federal and international agencies about importance of maintaining fair use in digital environment in support of health care, education and research
In 2010/2011 they some of the things they did were…
- Published public policy updates in MLA Focus (lots of Focus issues listed) including NIH Public Access Policy, America COMPETES, meaningful use of electronic health records.
- MLA and AAHSL prepared testimony in support of NLM’s appropriation which was submitted to the House and Senate L-HHS Appropriations Subcommittees
- Requested opportunity to present testimony Washington, DC on behalf of MLA in support of NLM’s Fiscal Year 2012 appropriation
- Educated Congress about the role that funding for the National Library Medicine plays in support of our nation’s health care, education and research and the role health sciences librarians play
- MLA sent a joint letter to the chairs and ranking members of the Senate Committee on Commerce, Science and Transportation and the House Committee on Science and Technology expressing concern about the public access provision section 123 of the America COMPETES Reauthorization Act of 2010.
- In response to GAO September 2010 report (GAO-10-947) MLA, AALL and SLA wrote a to the Senate Committee on Environment and Public Protection Agency (EPA) library network.
In 2011/2012 the GRC reported they…
- More than 30 public policy updates have been distributed through the GRC and Legislative Task Force listservs
- Published public policy updates in MLA Focus (lots of Focus issues listed) including NIH and NLM funding, EPA’s Strategic Plan for its library network, Rederal Research PUblic Access Acts
- An Action Alert was distributed on the Research Works Act
- Submitted House testimony in March and Senate testimony in April on NLM Fiscal Year appropriation
- Developed of the association’s annual testimony to the House Labor -HHS-Education Appropriation Subcommittee and distributed current fact sheets, statistics, and anecdotal information with Congressional staff during Legislative Task Force Capitol Hill meetings each year.
In 2012/2013 the GRC reported they…
- Published public policy updates in MLA Focus (lots of Focus issues listed) including NLM funding, impact of sequestration, Orphan Works, Meaningful use of Electronic Health Records.
- Provided updates on FRPAA legislation, the Research Works Act, and OSTP initiatives related to public access policies
- MLA and AAHSL submitted a joint statement to the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies in March and to testimony to the Senate in April supporting NLM funding
- Signed two group letters to Congress expressing concern about the impact of continued cuts on the NIH, urging Congress to support a balanced approach to deficit reduction that avoids further cuts.
- MLA and AAHSL wrote to the chairs and ranking members of the House and Senate Committees on Appropriations; Labor -HHS-Education and Related Agencies Submicommittees, etc. over concerns about the sequestration.
- MLA signed onto an Ad Hoc Group for Medical Research letter expressing the research community’s concerns with several provisions related to the NIH appropriations bill
- MLA signed onto a Coalition for Health Funding letter to Congress
As I mentioned this is just a snap shot of their submitted reports. My fingers could not type everything and this blog is too small for the reports in their entirety. To read the GRC’s complete annual reports, detailing their activities go to MLA’s Annual Reports page, click on a year then click on Committees and look for the Government Relations Committee. Also click on Add Hoc Committees and Task Forces to see what the Joint MLA/AAHSL Legislative Task Force is also doing in this area as well. To get a better idea of what MLA had done in ways of advocacy and policy check out their Information Issues and Policy page.
All of the MLA staff work to help advocate for medical libraries and librarianship, but they do have one staff person who is responsible for government relations and she works with the Government Relations Committee and MLA/AAHSL Legislative Task Force. If you are concerned about medical libraries and librarians and would like advocate for them to the government and other political agencies then I am sure the Government Relations Committee would love to have your help. Although the deadline to officially join a committee has past (October 31st), perhaps you can contact somebody on the committee for more information on how you can be of help advocating for the profession.
Share on Facebook
Behind the Scenes Tags:
Recently there has been a lot of discussion on the medical library email listserv about the closure of another hospital library. Also in the news the CBC reported on the reprehensible state of their Health Canada library.
“Health Canada scientists are so concerned about losing access to their research library that they’re finding workarounds, with one squirrelling away journals and books in his basement for colleagues to consult.”
Not only are the collections missed by researchers but the librarians as well. Multiple researchers commented to the CBC on how important the librarians are to their research.
“My staff can do so much in sort of Googling around and trying to find this and that or stuff that may come into us. But being able to use the experts and to get their assistance makes a world of difference.”
Like the cuts made to hospital libraries, Health Canada states the cuts were made to save money. However there is a question as to whether those cuts indeed saved Health Canada any money. The CBC reports, “One of the stated goals of Health Canada’s contracting out of library services was to save money. According to the report, though, the new arrangement is more expensive.”
I have seen this happen in American hospitals that cut libraries AND American hospitals that don’t understand how to work with their librarians. A hospital cuts the library believing it is a way to save money. They often end up licensing duplicate online databases, journals, or delivery services. Fail to understand the nuances of negotiating library resources and end up with a poor deal. They fail to to get a decent ROI because they haven’t properly supported and integrated the resource into the system. Why pay thousands of dollars for an online journal that nobody knows exists because you didn’t set up the IP addresses and just handed out the username and password to a few physicians that asked? Another favorite of mine is a department buying a database for several thousand dollars, hoarding it among their employees in their department and then wondering why it was only used once a month.
The discussion on the medlibs listserv seemed to center around the question about what can be done about the situation and who should be doing it. What can individual librarians do and what should MLA be doing to get hospitals, administrations, governing and standards organizations to keep libraries in hospitals. Several people wrote that MLA should be doing more for hospital librarians and work to get the library back in the JCAHO standards or other accreditation organizations.
First I want to say that any medical librarian that believes the our salvation lies with getting JCAHO to reinstate the library as a requirement in hospitals is waiting for something that will never happen. JCAHO has moved on. It is a dead issue. It isn’t even going to be re-animated as zombie issue. It is dead, dead.
So now that we have cleared the air of the JCAHO thing….
I will bring up the issue that some librarians think MLA should be doing more to ensure our survival. Let me just say MLA staff (all 16 of them) are doing as much as the cany for the MLA members including advocating for them. The MLA President and Board are doing as much as they can too. However it is unfair to compare the advocating clout of ALA (which has a staff of over 300 and over 56,000 members) to that of MLA.
The only way I see medical librarians continuing on is to work together to get our message out. As many said on the listserv, medical librarians are too often preaching to the choir about our value and benefit. We need to take our message out to our patrons. Not only do we need to do this locally but nationally. As much as I am in favor of our medical library journals, we need to stop publishing about the value of library services in them and start publishing those kind of studies in our patrons’ journals which is what they read. Our patrons don’t read our professional journals. We need to attend and present at their meetings.
One librarian noted that publishing articles and attending their meetings is a little lofty of a goal for the part time librarians who are just struggling. I get it, you don’t have a lot time and some of that can be difficult. But we aren’t asking everybody to do everything. Work to your strengths. I am not good at research but I am good at social media and I am think of ways to get our word out via social media. (BTW at the suggestion of a person on the list, I have already tweeted Dr. Besser MLA’s 2013 speaker about the plight of medical libraries. It isn’t perfect but it is a start somewhere.) (*update* Dr. Besser responded and retweeted my message to his 33,000 followers. It is a baby step, but you have to take steps before you walk.)
Just because you are part time doesn’t mean you can’t do something when you aren’t in the library and you are at home. I am a working mother of 3 young children. My work on my blog, tweeting on #medlibs, writing journal articles, teaching MLA CE classes, and some of my work on the MLA Board often is done during my PERSONAL time. Almost everything I write is done when the kids are in bed and I’m watching TV. I have often had to take my own vacation time to teach CE classes or attend some meetings. Believe it or not I still find time to have a normal life with my family for vacations, kids activities, movies, and life.
If you doubt what regular ol’ working librarians can do please do a little looking into Ohio Public Libraries, 2009, budget cuts, and Governor Strickland. In 2009, out of the blue the Ohio governor proposed a 50% cut funding to public libraries. This type of cut would close many public libraries and leave many irreparably devastated. Within 1 hour of the announcement the story hit Twitter and the hashtag #saveohiolibraries was created to categorize the Twitter messages. A Facebook site was created and had over 50,000 followers in less than 3 weeks. Another librarian created a website, www.saveohiolibraries.com. Not only did they get national attention but the Ohio legislature received between 37,000-45,000 emails in one week regarding the budget cuts.
(I live in Ohio so I remember much of this but I was able to find the specifics in the Introduction of Laura Solomon’s book the Librarian’s Nitty Gritty Guide to Social Media)
The thing to note was that ALA didn’t get involved within an an hour of the announcement. Much of the ground work was done by regular librarians like you and me who saw the immediate need to advocate for their jobs. Given the differences between the funding of medical libraries and public libraries, I think we medical librarians can’t afford to wait for the budget cut announcement. We need to advocate for ourselves now! MLA is helpful and they will do what they humanly can to support us. But we need to stop looking to them to make everything all better, we need to get the message out in whatever way possible.
I understand, we all are worried about the future of medical and hospital libraries. Just because I have a full time job and and I’m active in the organization doesn’t mean I am not worried. In fact it makes me more worried because I have seen how easily it can turn. But I refuse to sit back and subscribe to what some of the “realist” librarians have said, “It doesn’t matter how proactive we are; it doesn’t matter who gets involved; it doesn’t matter how many people come to our defense; it doesn’t matter how much evidence we have to justify our positions; it doesn’t matter how much time we save for others; it doesn’t matter that after we are gone there will be problems for people who need our services. All of that weighed against the decision of the ‘powers that be’ that they can cut the librarian will not help. They will not change their minds.” To those realists I say, “There’s no fate but what we make for ourselves.” I see you what you have made for your fate. Your fate is not mine.
Share on Facebook
Yesterday I read an interesting piece by Oliver Obst, “Trust no guideline that you did not fake yourself.” (Journal of EAHIL. 2013. v9 (4) p25) Obst references the German newspaper Frankfurter Allgemeine Zeitung, which reported several cases of fake practice guidelines. I don’t read German and it appears you must pay to access FAZ’s article archive, but if you read German and have access to the archive, the link to the article is here. According Obst’s summation of the article and Google Translate’s translated version of the abstract, the newspaper attributes thousands of deaths in Europe due to guidelines from the European Society of Cardiology and scientific misconduct.
Unfortunately this is not a single incident, Obst reports “many more examples can be found in a disturbing report by Jeanne Lenzer in the British Medical Journal, ‘Why we cannot trust clinical guidelines.” Lenzer’s article reports that doctors with ties to pharma companies are writing the guidelines. Since most guidelines are written by a large group of doctors you would think it would be difficult to have financial bias make any sort of impact on the guidelines. However, Lenzer discovered a survey showing that it is entirely possible.
“A recent survey found that 71% of chairs of clinical policy committees and 90.5% of co-chairs had financial conflicts.12 Such conflicts can have a strong impact: FDA advisers reviewing the safety record of the progestogen drospirenone voted that the drug’s benefits outweighed any risks. However, a substantial number of the advisers had ties to the manufacturer and if their votes had been excluded the decision would have been reversed.13“
The Cochrane Collection is not immune either according to Lenza.
Early 1990’s-Reinforced by a Cochrane review, high dose steroids became the standard of care for acute spinal cord injury. The Cochrane Collaboration, permitted Michael Bracken, “who declared he was an occasional consultant to steroid manufacturers Pharmacia and Upjohn, to serve as the sole reviewer.”
The standard was just reversed in March 2013 with the Congress of Neurological Surgeons new guidelines. They found, “There is no Class I or Class II medicine evidence supporting the benefit of [steroids] in the treatment of acute [spinal cord injury]. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death.”11
Lenza believes another example of biased guidelines is beginning to emerge regarding stroke and the use of alteplase.
“American College of Emergency Physicians with the American Academy of Neurology (jointly)18 and the American Heart Association,19 separately, issued grade A level of evidence guidelines for alteplase in acute stroke. The simultaneous recommendation by three respected professional societies would seem to indicate overwhelming support for the treatment and consistent evidence. However, an online poll of 548 emergency physicians showed that only 16% support the new guidelines.20“
Lenza points out that “claims of benefit rest on science that is contested. Sceptics say that baseline imbalances, the use of subset analyses, and chance alone could account for the claimed benefit.24 26 31 32 33 They also note that only two of 12 randomised controlled trials of thrombolytics have shown benefit and five had to be terminated early because of lack of benefit, higher mortality, and significant increases in brain haemorrhage.”33 Lenza also notes that “13 of the 15 authors had ties to the manufacturers of products to diagnose and treat acute stroke; 11 had ties to companies that market alteplase.”19
So what does this mean for librarians as we try and find the best research out there for our doctors, nurses and patients? This is a problem. Even if you take out the pharma bias, bio-medical scientific literature rarely publishes work on failures. Add the pressure from pharma wanting and promoting positive outcome research to published, we have even fewer examples of “what didn’t work” research articles and quite possibly what we thought was good evidence isn’t as good as we thought.
As Obst notes, librarians must be aware of this issue and to keep our patrons informed. Unfortunately this may be the only thing we can do and even then it might not be enough. Lenza ends her article by saying;
“Yet these and other guidelines continue to be followed despite concerns about bias, because as one lecturer told a meeting on geriatric care in the Virgin Islands earlier this year, ‘We like to stick within the standard of care, because when the shit hits the fan we all want to be able to say we were just doing what everyone else is doing—even if what everyone else is doing isn’t very good.”
Share on Facebook