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Evidence, Bias, and Use…Oh, My! (MLA12 Seattle: Complementary and Alternative Medicine Section)

So at the meeting, librarians present their papers that were accepted to the conference.  These are organized into groups of four sponsored by one of the MLA’s sections.  I’m pleased to say that on Monday I made it to an entire session.  Complementary and Alternative Medicine includes everything from yoga to special diets (veg*nism, gluten-free) to acupuncture to traditional Chinese medicine to etc….  I appreciate CAM because it tends to look at the patient as a whole instead of just the diseased body part.  Plus I was curious as to what the presentations would have to say.  One thing that it is important to know.  Cochrane is a database of systematic reviews.  A systematic review is a study of the studies done.  It then summarizes what we know so far.  Think of it as centralized scientific study information.  The other thing to know is that in Western medicine, a treatment is come up with and then tested before it is used with people.  In CAM, the treatments are already in practice, so traditional randomized control trials (RCTs) used in Western medicine aren’t super-applicable.

“Cochrane Complementary and Alternative Medicine Systematic Reviews: An Analysis of Authors’ Comments on the Quality and Quantity of Evidence and Efficacy Conclusions” by Robin A. Paynter

  • CAM limited by RCT-driven evidence-based practice
  • 10% of database are CAM topics
  • Cochrane has a project to develop a classification scheme of CAM topics.
  • 47 out of 53 Cochrane groups have at least one review on a CAM topics
  • Treatment ares cover everything from vitamins to yoga
  • dietary intervention has 37 studies
  • Cochrane expresses concern over poor study designs.
  • Difficult to determine active content in plant-based meds
  • Significant groupage of comments around insufficient evidence and no effect.
  • cross-cultural issues

“Alternative Research Education in a Post-R25 World: Assessing Acupuncture and Oriental medicine (AOM) Student Attitudes Toward Research and the Scientific Method” by Candise Branum

  • Acupuncture and Oriental Medicine–AOM
  • R25 grants intend to develop research literacy and view research as a bridge between Western medicine and CAM
  • Acupuncture Practitioner Research Education Enhancement (APREE)
  • AOM student interest in research declined with years in school, a 2006 study found
  • Do students recognize the benefits of AOM research? Overwhelming yes.
  • Students at schools without dedicated research departments were very unsure about the impact of research.
  • Feelings about research slope toward the negative over time.
  • Students see the benefits of research but that doesn’t necessarily mean they like it
  • A lot of students want to stay alternative and not become complementary
  • If they don’t want to be attached, they’re not gonna want to use the bridge of research.

“Complementary and Alternative Medicine’s (CAM’s) Research Agenda and Its Unique Challenges” by Jane D. Saxton

  • In 2007: 38.4% of adults used CAM over the previous 12 months.  Also, adults spent $33.9 billion out of pocket on CAM.
  • NIH funding to CAM is only 0.5% of the overall budget.
  • CAM is individualized not standardized.  (It’s adjusted to fit the patient not one standard applied to all patients).
  • Whole Systems Research (WSR) is a term coined in 2002.  It is an approach to studying non-linear, whole systems of care.
  • Use of pragmatic RCTs: measure effectiveness, don’t use placebos, patient-centered outcomes (transformational change)
  • CAM is the opposite of Western meds.  The treatment is already in use, whereas Western medicine is proposed, tried, then used.
  • You don’t need to know the biological mechanism in order to know its effectiveness.
  • MeSH terms currently available: complementary therapies, nonlinear dynamics, systems integration
  • We need more funding, different approaches, Whole Systems Research!
  • Please take a moment to check out the libguide of this presentation.

“Hitchhiker’s Guide to One Corner of the Complementary and Alternative Medicine (CAM) Universe” by  Ron LeFebvre

  • Vitalists are more interested in information (they “know” it works).
  • Empiricists value EBM but may not be great at finding what they’re looking for.
  • Chiropractors don’t like to be associated with medicine.  Use terms like “health care” and “practice” with them.
  • A good chiropractic search string: spinal manipulation OR chiropractic OR manual therapy
  • New graduates are more likely to be EBP savvy.
  • “There’s nothing that makes you more skeptical about research than studying it.”
  • There is no widely-used, well-regarded point-of-service tool to serve chiropractic interests specifically.  They do use Dynamed though.
  • PEDRO–database for physical therapy/exercise therapy that is also useful to chiropractors

Q and A

  • Diet is odd.  Sometimes it is viewed as an alternative medicine, sometimes not.  If it’s a non-western diet, though, it’s considered alternative.
  • NIH funded PROMIS is focused on patient-reported outcomes, particularly in treating anxiety/depression.
  • N-CAM databse has outcome scales and measures

What Librarians Talk About (MLA12 Seattle: Plenary 3: Janet Doe Lecture by Mark E. Funk, AHIP, FMLA)

The first plenary is given by the MLA president, the second by someone who is not necessarily a librarian but has something interesting to say that will aid us in our profession.  The third plenary, however, is given by a librarian.  Mark E. Funk’s presentation was entitled, “Our Words, Our Story: A Textual Analysis of Articles Published in the Bulletin of the Medical Library Association/Journal of the Medical Library Association from 1961 to 2010.”  Here are my notes.

  • An analysis of the words revealed four key areas that librarians talk about: environment, management, technology, and research.
  • Although we talk more about building than people, that gap is narrowing.
  • We are basically almost not talking about books, but we are increasingly talking about journals.
  • Reference is steady.  Searching is increasing.
  • Information is the #2 word.
  • As our information world becomes more complicated, we are talking more and more about teaching.  “I predict teaching will become ever more important.”
  • We are now concerned about what we can do to improve health.
  • New groups we’ve reached out to include: clinicians, consumers, and patients.
  • We use management words to tell our story.
  • We are no longer running our libraries like academic environments; we are running them like businesses.
  • We are early adopters and write about it.
  • Sometimes new technology becomes so embedded in our lives that we don’t mention it anymore.  For example, you say you talked to someone but don’t mention the telephone.
  • Our attention has shifted from automating to digitizing.
  • We don’t talk about the internet.  We talk about the web and navigation.
  • The word with the sharpest rise and fall is: Gopher
  • IMRaDification of our profession.  (IMRaD–Intro, Methodology, Results, Discussion)
  • MLA strategic plan encouraged us to do more research, and we responded.
  • Hockey Stick terms–little to no use, sharp recent uptake.  May indicate future usage but it could be a drastic rise and fall. Only time will tell.
  • EHRs are white hot now. (EHR–Electronic Hospital Record)
  • Why do we study history?  It’s very good at explaining change.  Answers the question, how did we get here?
  • De-emphasis on physical.  Emphasis on information.  Prefer evidence-based.
  • Emphasis on health.  Expanded audience.  Outside the library.   Teaching people.
  • Libraries more business-like. Technophiles. More research articles using IMRaD.
  • History can hint at the future, but it can’t predict it.
  • Our story is being written every day.  We can’t skip chapters to see what happens next.

Statistical Literacy and Techniques in Library Research and Practice (MLA12 Seattle: Research Section)

So at the meeting, librarians present their papers that were accepted to the conference.  These are organized into groups of four sponsored by one of the MLA’s sections.  I was a bit late to the Research Section, since I got caught up at the poster exhibit, but here are my notes for the two presentations I did see that day.

“The Analysis and Translation of Unpublished Health Sciences Data: Extra Innings for the Library Profession” by Wallace McLendon, David Potenziani, and Susan Corbett, AHIP

  • The ability to use data to answer questions brings more work to library.
  • When people say they want to access data, they really want the information that can be derived from it.
  • analytics: reactive vs. proactive
  • Libraries hold and curate data. Expand that to analysis.
  • Do more to reach administrators in terms of competitive intelligence.
  • Don’t define your job too narrowly.

“Hitting a Home Run: Statistician Consults at the AG-VET MED Library Improve Research Design Quality” by Ann Viera

  • Medical libraries are partnering with statisticians.
  • Librarian-statistician partnership to improve research design.
  • The alternatives search was occurring too late in the process to improve animal welfare.  This frustrates the librarian and angers the researcher.
  • Access to statistical reports needs to be happening earlier in the research program.
  • Consulting on stats improves animal welfare.
  • Having the statistician in the library improves the concept of library as space.
  • Providing access to the statistician protects faculty from becoming overburderned.
  • Do it right or do it over (in research and construction).
  • Doing the research before designing the study helps you design the study correctly the first time.

The Slow Hunch (MLA12 Seattle: Plenary 2: McGovern Award Lecture by Steven Berlin Johnson)

After the president’s lecture (and a break) came the John P. McGovern Award lecture.  This was, I have to say, my favorite presentation at MLA12.  Steven Berlin Johnson is the author of popular science books aka science for the layman aka one of my favorite genres!  I was super-excited to get to hear him speak and honestly, his intelligence and wit are even more evident in person.  His books that were referenced in the lecture include: Where Good Ideas Come From: The Natural History of Innovation and The Ghost Map: The Story of London’s Most Terrifying Epidemic–and How It Changed Science, Cities, and the Modern World.  I now present to you my notes from his amazing lecture that I like to call “The Slow Hunch.”

The Eureka Moment Myth

  • Truly disruptive ideas do not have a eureka moment.  The eureka moment is a myth.  The best ideas almost always start as a hunch.
  • Oftentimes, the external conditions need time to catch up to the idea.
  • Darwin had the theory of evolution before he realized it.
  • Commonplace Book–collection of quotes that mean something to the owner.  They’d then reread them and out of this their own intellectual sensibility would take shape.

How Coffee Changed the World

  • What environments support collaboration and fluidity of ideas?  Liquid networks, such as libraries and coffee houses.
  • Almost every key breakthrough in the Enlightenment featured a coffee house.
  • It is no accident that as the population went from imbibing a depressant (alcohol) to a stimulant (coffee), the Enlightenment happened.
  • There is a lot of diversity of people in a coffee house.

The Evolution of Ideas

  • An idea is a network of other ideas brought together in a new configuration.
  • exaptation–some feature/trait/aptitude that evolves for a specific purpose but serendipitously turns out to be good for something else when the environment changes (wings for warmth work for flying)
  • Exaptation often happens when one industry takes something from another industry, adapts it, and uses it in their own. (Use of wine presses for printing)

The Key to Innovation

  • We will be smarter and better as a society if we surround ourselves with those who are different because it provides the opportunity for exaptation.
  • The more innovative group has connections to different careers than their own. (Don’t just be friends with librarians)
  • Make twitter your diverse coffeehouse.  If you just follow people just like you, you get an echo chamber.  Value diversity because of the openings it allows us.

Information Should Be Open

  • Value connecting information over protecting information.
  • 311 is a city concierge.  People can call and report problems and also ask for information from it.  Meanwhile, the city is gathering data from the citizens who call.  The city is sharing information but also is taking in information.  This democratizes and diversifies problem-solving.
  • Open information architecture rives innovation.
  • Chances favors the connector.

Q and A

  • Remind people that surprise and serendipity is happening with the new information tools.  It doesn’t just happen when browsing physical stacks.
  • Core ideas are ideas that were simultaneously and independently discovered within the course of two to three years.  This happens because of the adjacent possible.  The adjacent possible is possible moves you can make at that moment in time.  The possibilities are limited.  You couldn’t invent computer programming before computers.  Thus when something in the world changes, the adjacent possible changes, leading to core ideas.
  • Create a culture of amateur inventors and innovators (lay experts).
  • Release early, release often.
  • There is a non-linear relationship between population size and innovation (10x population size = 17x innovation).  The thing to remember in modern times, though, is that the internet is big-city-like.