{"id":4521,"date":"2015-11-15T01:00:22","date_gmt":"2015-11-15T06:00:22","guid":{"rendered":"http:\/\/www.khpi.org\/blog\/?p=4521"},"modified":"2015-11-17T00:39:00","modified_gmt":"2015-11-17T05:39:00","slug":"free-bound-medical-journals","status":"publish","type":"post","link":"http:\/\/www.khpi.org\/blog\/free-bound-medical-journals\/","title":{"rendered":"Free Bound Medical Journals."},"content":{"rendered":"

Prepare yourself for medicine in the post-apocalyptic world!<\/span>\"bound-journals-1\"<\/a>The evolving\u00a0interface\u00a0with\u00a0the medical literature.<\/span><\/strong><\/h1>\n

They were once one of my most prized possessions, but now I can\u2019t even give them away.\u00a0 Beginning in 1967 with the New England Journal of Medicine (NEJM), I began to bind my medical journals. The fact that the practice was begun for me by my late father-in-law only increased my emotional attachment to these physically and intellectually handsome books. As my career progressed, I added all the major general internal medicine and rheumatology journals to my collection. I was on the editorial board of two of these, wrote articles appearing in them, and reviewed countless articles submitted for publication by others.\u00a0 I carried these books from one institution to another for over 40 years until, following my active medical retirement, they ended up in a Stor-All facility.\u00a0 As I attempt to further downsize now because I no longer physically have room for them, I discover to my naive surprise and disappointment that no one else wants them.\u00a0 My current dilemma stems from the fact that I cannot bring myself to throw them away.\u00a0 Perhaps one of my readers can help me.\u00a0 Details about the collection can be found at the end of this article.<\/p>\n

Access to the medical literature has changed.<\/strong>
\nAs I wrestled the 30 heavy boxes of books from a $125\/month Stor-All unit to my garage last summer; I had occasion to reflect on how I interfaced and used the medical literature over a career that encompassed an exploding volume of medical information; the rise of personal computers and devices; and digitalization of professional publication. \u00a0How I looked for information and incorporated new knowledge into my research, teaching, and clinical endeavors evolved in the midst of these changes.<\/p>\n

A weekly or monthly journal like the NEJM contains several original scientific articles, reviews of individual clinical topics, editorial comment, and a variety of other items thought to be useful to keep a physician current. \u00a0Because my initial subscription to the \u201cJournal\u201d was a gift from the company that sold me my microscope, I began to read it regularly in college even before I started medical school.\u00a0 Despite being a \u201cB\u201d student at best as an undergraduate, I did very well academically in medical school and actually enjoyed it immensely. \u00a0I have often speculated that allowing my curiosity to roam freely in the medical literature was of greater value to me than the high-pressure motivation faced by today\u2019s medical students to prepare for the gauntlet of standardized tests necessary to advance from one year to the next or to graduate.\u00a0 As a medical educator, the only question from students that always disappointed me was: \u201cIs this going to be on the boards!\u201d \u00a0In my opinion, \u201cteaching to the test\u201d robs medical students \u2013 indeed all students \u2013 \u00a0of much of the pleasure if not the potential breadth of their education, but that is a topic for another article.<\/p>\n

Always timely and on point.
\n<\/strong>Early-on, I was struck by the apparent coincidence that whenever I took up a journal issue I found something that addressed a topic I had recently been thinking about or that was relevant to one of the patients I was caring for at the time. \u00a0That observation has never faded.\u00a0 Of course coincidence has nothing to do with it.\u00a0 Important and relevant information is always there \u2013 you just have to be ready to find it.\u00a0 In any event, when I advised even first-year medical students, I recommended that they subscribe to or otherwise follow a general medical journal of their choice such as the New England Journal of medicine, the Journal of the American Medical Association (JAMA), the Annals of Internal Medicine, or American Family Physician. These journals are available in medical libraries, but individual print subscriptions for students can be had for free or nearly so from the sponsoring medical publishers.\u00a0 The best way to learn from the medical literature is to get in the habit of doing so early.<\/p>\n

How do you find what you want?<\/strong>
\nIn those earliest years, most journal issues usually had something I could at least partially understand. The problem was that if you wanted more information about any specific topic you were generally up the creek. \u00a0Except for a table of contents of that week\u2019s or month\u2019s issue, there was no such thing as a cumulative index. \u00a0Only at the the end of the year or in the last issue of a series would a printed index for that volume be appended.\u00a0 This meant that a search of the medical literature involved looking up several indexing terms backwards one year or volume at a time in each different medical journal. You also had to be careful you were using the right indexing terms. In truth, major medical libraries had printed versions of an early Index Medicus, but these covered only a subset of all medical journals and still had to be addressed one year at a time. \u00a0These were not available where I did most of my studying.<\/p>\n

Of course, each individual article has its own references to earlier relevant articles at the end.\u00a0 Following these backwards from one paper to the next was how one could reconstruct the history of medicine.\u00a0 In the medical libraries of Columbia and the University of Pennsylvania, I used to be able trace a topic as far back as 150 years or more in Journals such as the the Lancet.\u00a0 In such searches to prepare for presentations or in writing papers, I rarely failed to discover major misunderstandings or misattributions that had been perpetuated uncorrected. \u00a0Today, as libraries shed their printed volumes for lack of space or in favor of digital collections and coffee shops, I am not sure that my experience could be easily replicated.<\/p>\n

Drinking from the fire hose.<\/strong>
\nDuring my clinical training we had weekly journal clubs where we took an hour to dissect one or two medical articles to learn how to evaluate them.\u00a0 How sound was the design? \u00a0Did they collect relevant data? Was the statistical evaluation of their data appropriate?\u00a0 How well were the conclusions supported? \u00a0For clinical studies, were the results generalizable to other groups of patients? \u00a0I learned in these sessions that virtually no study can be considered perfect and that there are many studies of limited value in the medical literature.\u00a0 Even today, I often find myself taking more than an hour to read a single article.\u00a0 How to keep abreast of the medical literature, even for a narrow specialty, is a real problem.\u00a0 A commonly used phrase is that \u201cit is like drinking water from a fire hose.\u201d \u00a0Neither can be done in a fully satisfying manner.<\/p>\n

Abstracts rock.
\n<\/strong>In response to the difficulty of keeping up, the importance of the abstract has grown.\u00a0 The \u201dabstract\u201d is a summary of the article placed at its beginning.\u00a0 In my early experience and own practice, these would be written last and without the care given to the article itself.\u00a0 In these earlier times, abstracts sometimes functioned more as \u201cteasers\u201d and might even conclude with a sentence such as \u201cthe results will be discussed.\u201d\u00a0 No longer.\u00a0 Abstracts today are highly structured short paragraphs divided into the same sections as the articles themselves: Background, Objective, Design, Patients, Measurements, Results, Limitations, and Conclusions.\u00a0 Contemporary abstracts are mini-articles of their own.\u00a0 Their evolution has responded to and perhaps was even driven by the rise of the machines and digital publication where the abstract functions essentially as a substitute for the article itself.<\/p>\n

Digital medical literature here to stay.
\n<\/strong>Make no mistake, the availability of accessing the medical literature digitally over the internet in a library, at home, or for that matter on the wards has been a wonderful advance.\u00a0 My first experience with a digitized medical literature database was in the early 1990s with the availability of the Index Medicus of the National Library of Medicine on proprietary CD-ROMs. \u00a0I could effortlessly look up my choice of key words and print out dozens of references to articles appearing in several hundred different journals.\u00a0 For example, I could retrieve virtually everything written in a given year in major medical journals about The Gout.\u00a0 The best part, was that the results returned included more than just the name of the journal, authors, and dates, but also the actual abstract of the article. \u00a0I became a \u201csniffer\u201d of the medical literature instead of a leisurely gourmand.\u00a0 For many situations, I was willing to exchange breadth for depth. \u00a0One could gain a useful sense of what physicians and scientists around the world were thinking and to know where best to look for further details. Of course, the disks were always 4 to 6 months behind.<\/p>\n

Help is available \u2013 some more reliable than others.<\/strong>
\nIn our current era of data-driven, evidence-based medical practice [Surprise! It was and is not now always so], we individual practitioners receive valuable help from organizations like the Cochrane Database of Systematic Reviews that use standardized methods of evaluating the quality and applicability of clinical information. \u00a0We have the benefit of \u201cmeta-analyses\u201d that combine smaller studies of limited power into larger assemblies that can be more convincing. Thoughtful reviews or updates on given topics are still being written. \u00a0There has been an emphasis on making the medical literature more useful to the practicing physician and to help sort out the best studies from weaker ones. \u00a0Still, in my opinion, the content of major clinical journals overly reflects the powerful influence of the pharmaceutical industry and not just in the ads.\u00a0 I miss the \u201cpatient-series\u201d article that described the natural history of an illness followed by a single physician or group.\u00a0 I miss (and have never forgotten) the kind of article by Professor William Bean, who for 36 years measured the growth rate of his own finger and toe nails. \u00a0I suspect that article would have a hard time finding a home today.\u00a0 It seems to me that there is much more emphasis today on drug therapy than there is on the pathophysiology and natural history of illness.\u00a0 Of course both approaches are necessary because treatment is best based on knowledge of the cause of the illness.<\/p>\n

Not without limitations or shortcomings.<\/strong>
\nThe switch to a digital medical literature is not without its own concerns.\u00a0 The older medical literature has not been digitized at all and most medical libraries are physically unable to house the bulk of these old books. \u00a0Furthermore, just because the material is in digital form does not necessarily make it more available to the public \u2013 even for research that has been funded by public money! \u00a0Access is still restricted.\u00a0 Most of it is not free.\u00a0 While public databases such as PubMed can be searched without cost and one can often retrieve a useful abstract, the complete article is likely to require a separate purchase on the website of the publisher. \u00a0I had an easier time of it in a comprehensive medical library.<\/p>\n

Can digital knowledge get lost?<\/strong>
\nI recently returned from a trip to Italy where I visited the library of the oldest secular university in the world in Bologna.\u00a0 I confess to feeling a profound sense of reverence in the presence of the old medical books in the library museum. These were physical proxies of my professional ancestors.\u00a0 However, as I looked around the room, I noticed, as I did in the famous monastery library of Melk, that there was no evidence of any sprinklers or fire protection system. \u00a0I was told in Melk, and I suspect it was the case in Bologna, that there was more fear of water damage from a sprinkler malfunction than of fire. \u00a0Despite the best efforts of Google, these books have not been scanned and digitized. \u00a0The fact is that books can burn or get flooded. \u00a0The library of Alexandria burned, and even in my lifetime, irreplaceable collections that have not been digitized have disappeared in smoke.\u00a0 Even worse, books and libraries have been burned intentionally for philosophical, religious, or political reasons. \u00a0What portion of our collective wisdom had been lost to us?\u00a0 I do not know, but it is clear that knowledge is as mortal as we are and can be lost or become unavailable for centuries.\u00a0 We don\u2019t call it the dark ages for nothing.<\/p>\n

Does the fact that printed materials can be digitized imply that their content becomes immortal?\u00a0 It would be nice to think so, but all of us know or have heard of people who have lost their entire collection of digital photographs for one reason or another.\u00a0 Formats of digital material change.\u00a0 I can no longer access much of my own personal research data or papers written on computers or with software that no longer exists. In my opinion is is foolish to assume that our digital libraries are any more immortal than we ourselves or our books. We need both digital and physical means of information preservation. \u00a0So it is that I offer my collection of bound medical journals to someone who will take care of them as a hedge against the possibility of the post-apocalyptic world of Mad Max, the Terminator, or the Matrix.<\/p>\n

To help preserve the work of innumerable contributors to medical knowledge, I offer these volumes at\u00a0no cost to a suitable caretaker who will give them a good home.\u00a0 My preference is for a non-profit educational or service entity that is willing to arrange to pick them up. \u00a0I can help within Louisville. Below is a list is what I have. \u00a0Your help or suggestions gratefully welcome,<\/p>\n

My name is Peter, and I am trying not to be a hoarder.<\/p>\n

\u00a0<\/strong>Bound Medical Journals:
\n\"journals-250\"<\/a>
\n<\/strong><\/p>\n

General Medical:<\/strong>
\nNew England Journal of Medicine:\u00a0 1969 \u2013 2001,\u00a0 V. 281 – 345
\nAnnals of Internal Medicine:\u00a0 1971 \u2013 2001,\u00a0 V. 74 – 135
\nAmerican Journal of Medicine:1971 \u2013 2001,\u00a0 V. 1971 – 2001
\nArchives of Internal Medicine:\u00a0 1971- 1978<\/p>\n

Rheumatology:<\/strong>
\nArthritis & Rheumatism:\u00a0 1972 – 2001,\u00a0 V. 15 – 44
\nJournal of Rheumatology:\u00a0 1982 – 2001,\u00a0 V. 9 – 28
\nAnnals of Rheumatic Disease:\u00a0 1980 – 2001,\u00a0 V. 39 – 60
\nSeminars in Arthritis & Rheumatology (unbound):\u00a0 1977 \u2013 2005,\u00a0 V.4 \u2013 35<\/p>\n

I haven\u2019t decided what to do with these monthly series of books, each a textbook of its own:<\/strong>
\nMedical Clinics of North America:
\nRheumatology Clinics of North America:<\/p>\n

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