Significant Science

Before we begin, Dean, I’d like to give readers a bit of background as to who you are and why they should know about you. You are already well known and admired by medical and sci/tech librarians, by those in the Open Access community, and by those interested in the subject of search.

But I would like to introduce you to the wider health technology and Open Science communities given your ability to recognize important technologies, tools and trends in the area of scientific and scholarly communication and your skill in explaining their use and recognizing their potential for many tasks. You are an educator and explicator supreme.

I envision as readers of this interview not only medical librarians and sci/tech librarians but anyone in the healthcare industry who needs information from time to time—and that is basically everyone in healthcare. Therefore, readers of this interview might include physicians, nurses, pharmacists, physical therapists, healthcare administrators, healthcare informaticians, those in the fields of biomedical/clinical research, health information management and so on.

Moreover, I think that much of what you have to say will be of interest to the increasing numbers of empowered patients, known as e-Patients, most notably exemplified by people like e-Patient Dave and by readers of the site e-patients.net, which is run by the Society for Participatory Medicine.

E-Patients are a new breed of patients. They are sophisticated, determined seekers of healthcare information and medical librarians are going to encounter more and more of them and you are just the man to help those two groups get to know each other.

Finally, I would like to introduce you to those interested in the area of Open Science and scholarly communication in general. People like Jean-Claude Bradley, Cameron Neylon, Antony Williams, John Wilbanks, and Bora Zivkovic are changing the very nature of how science is done and how research results are disseminated and I would like to get your views on how what they doing is going to affect us in the field of healthcare farther down the pipeline. Could you introduce yourself as if you were addressing this wide audience?

Hi, my name is Dean Giustini; I am a Canadian academic health sciences librarian and blogger living and working in Vancouver, British Columbia. I am a biomedical librarian at University of British Columbia’s main teaching hospital in a new building called the Gordon and Leslie Diamond Health Care Centre. My main responsibilities are to provide library, research and instructional support to UBC faculty and students at Vancouver General Hospital; I am also responsible for managing the onsite staff and collections of monographs and journals that support the academic and clinical activities onsite. Academically, I teach two courses at UBC’s School of Library, Archival and Information Studies; 1) a new course on social media and 2) a traditional course on health librarianship.

My main extracurricular interests are related to web technologies in medicine. I enjoy providing information services to hospital personnel and teaching information literacy skills to medical students, but I enjoy collaborating with physicians using social media and Web 2.0 applications. I am a traditionalist librarian in my views but try to find the potential in digital interaction and web technologies in my work as well.

I first became aware of you around 2004-2005 when I was new to the field of medical librarianship and learning about how the Web was affecting how medical people acquire information. You were one of the first to address this topic in a very public and influential way with your 2006 article in the British Medical Journal, “How Web 2.0 is Changing Medicine.” Could you please tell us a little about what led to the publication of that piece, your reaction to the reactions to it and what has surprised or disappointed you vis-à-vis developments in the years since it was published?

That’s an interesting question. First of all, I was quite amazed by the interest that the BMJ web 2.0 editorial got – and how how often it is cited. It is an opinion piece not research. I had no idea it would be important when I wrote it. It was easy to write because I believed that social media would be important for all of us. And I could see how digital interaction using social media would be important to collaborative science. In retrospect, I can see why web 2.0 was controversial; even now biomedical librarians are debating the importance of web 2.0. The field of medicine and science has moved on from the squabbles around what ‘web 2.0’ means and whether it exists but perhaps the phrase ‘social media’ is more appropriate than the 2.0 suffix in discussing the technologies of the era.

In any case, I keep waiting for the National Library of Medicine (NLM) to create a MeSH for web 2.0. Since the BMJ editorial, Eysenbach has defined medicine 2.0 and the 2.0 suffix is used for everything including for all kinds of marketing purposes. The most important aspect of web 2.0 is that the tools help us to build networks and take advantage of “Metcalfe’s Law” – the network effect – for collaboration. Although physicians are building silos around their networks in private spaces patients are very openly sharing information about themselves. I doubt there is much digital interaction between the two groups yet; I only know what physicians and patients tell me that they are starting to enjoy using the tools. I am not sure that the changes we are seeing in how patients and doctors communicate online comes close to what we see when patients interact with each other. It’ll never be equivalent because doctors operate within very different parameters of practice.

In that article you said, “For me, the promise of open access in Web 2.0—freed of publishing barriers and multinational interests—is especially compelling.” Where are we now in that respect?

When I wrote that line about the synergy between web 2.0 and open access I was referring to the publishing potential of social media and OA journals. Much of this potential remains unrealized. I have been disappointed by the poor performance of wikis versus the surprising growth of open access. Since the editorial, I got involved in Open Medicine – one of Canada’s open access journals. We are making progress and NLM accepted us recently for Medline (PubMedCentral) indexing. It’s been a long, arduous path, but we did it in two years.

You said in that piece, “The rise of wikis as a publishing medium—especially Wikipedia—holds some unexamined pearls for the advancement of medicine. The notion of a medical wikipedia—freely accessible and continually updated by doctors—is worthy of further exploration.” What do you think, then, of the Medpedia Project, other players such as Google’s Knol, and the fact that Wikipedia is experiencing an exodus of editors.

I am happy with the development of HLWIKI Canada (formerly the UBC Health Library wiki). But as a team of writers and health librarians, we are only beginning to use the wiki as a collaborative space and platform. One of the problems is that I write most entries. I continue to believe that medical/physician and librarian-moderated wikis can play a role in biomedical publishing but some wikis have simply not caught on – and no where near what we have seen with Wikipedia. I’m not sure what the reasons are, but PageRank in Google has helped Wikipedia move up to the top of search results. These factors have an impact on whether your wiki will be seen and used.

Occasionally, I check out what is happening at Google’s Knol. I read an article recently and compared it with Medpedia. Despite the support Medpedia has, I am not sure how it is doing. When I go to the site I am left with a feeling of ‘so what’ – can’t we do better? AskDrWiki and Ganfyd are good wikis but again they are not very well-known. I worry that the ‘free’ remix culture espoused by Chris Anderson and Lawrence Lessig has hit a wall of some kind and that people are tired of contributing with no recognition. Perhaps this is Wikipedia’s problem too. At some point, folks bail out and try something else.

Do you see wikis as less useful for medicine than was first thought or are there are wikis run by those in certain medical specialties that are thriving and that it is only the general interest ones that seem to be hitting a wall? How is the Open Medicine wiki project going, for instance, which you wrote about in the post “Can Wikis be Used as a Publishing Platform in Medicine?”

The Open Medicine wiki has suffered from the same fate as the wikis we’ve mentioned above. The main issue is that maintaining a wiki is a lot of work and you need an army of writers, editors and volunteers. The wiki is a labour of love –I do a lot of promotion of it whenever I can. I cannot contribute to the Open Medicine wiki because I am not a physician. I think that the OM wiki is worth a try, but I wonder about its staying power. I often have trouble getting docs to use PubMed properly, so how can I convince them to contribute to building a wiki? It’s uncertain.

What do you see as the future of a user-generated content in medicine in general, whether by patients in such online communities as PatientsLikeMe or by medical people for each other in gated communities such as Sermo or by the quite interesting attempt to enlist both practitioners and patients in the form of audiences and contributors in the Journal of Participatory Medicine.

User-generated content where social tools are used in medicine will continue to evolve in ‘specialized niche areas.’ I worry about these niches because they engender ‘bias.’ Typically, we friend people we agree with and ‘block’ those we don’t agree with; this prevents disagreement. You mention the consumer health social space PatientsLikeMe and the physician social networking site Sermo – generally viewed as two successful examples of social media. The last report I heard, AMA had severed its relationship with Sermo because it did not have enough say about the direction of Sermo. When it started, Sermo was an ‘adverse reporting’ system and it morphed into a social networking site. The lesson is that medicine is still monolithic and apt to change in time. The veil of secrecy cannot be removed overnight; patriarchy will change over time. The ‘wedge’ or tipping point for social media will probably be in the area of online consultations and finding ways to compensate doctors for their time.

Getting back to the matter of the inaugural issue of the Journal of Participatory Medicine, could you comment on one of the most interesting articles in it, “In Search of an Optimal Peer Review System?”

What, for instance, is your reaction to that article given that it is by Richard Smith, someone closely associated with the British Medical Journal, the very periodical that published your own article on the Web and medicine? What do you think of Smith’s comments, for instance, “I think that it would make much more sense simply to publish the paper — on a university website or in an electronic journal with a low threshold — with my comments and those of the other reviewer and let the world decide what it thinks. That is anyway what happens in that many peer-reviewed papers disappear without trace after publication, some are torn to pieces, and a few flourish and are absorbed into the body of science.” And, “Web 2.0, the social web, may hold the key to the future of peer review. Peer review will become the job of the many rather than the few, and we know that the many can solve problems better than the few…”

I enjoy Richard Smith’s ideas and thinking about web 2.0. He is on the Editorial Board of Open Medicine. His views are very progressive. He is trying to make his profession more transparent and accountable to patients. When a high profile person discusses peer review and publishing papers on accessible websites for all to see and critique –I listen. There is a downside to open peer review – poor bibliographic control. What Smith may or may not know is that researchers publishing openly on the web would create chaos – how would we find anything? How would studies be comprehensively indexed? This is a big problem of the information age. When you take advantage of anytime, anywhere publishing — you also fragment the medical bibliography and make it more difficult to organize.

And on a related topic, do you see the recent moves by Harvard and MIT to mandate Open Access policies as momentous vis-à-vis mounting a genuine challenge to the power of the big publishing houses and creating a workable model of Open Access publishing that other universities could follow, thereby creating a world in which scholarly publishing and clinical research could indeed be freed of the fetters of the tyranny of antiquated publishing practices that hinder the advancement of science and impede efforts to help patients farther down the line? Or are the publishers simply too powerful and the forces of tradition vis-à-vis peer review, and tenure and promotion practices simply too entrenched for radical change? Are the Harvard and MIT policies the tipping point for an Open Access world or noble but ultimately fruitless endeavors? Are they harbingers of real change that will affect the day-day-day lives of clinical researchers and, therefore, farther down the line, medical providers and medical librarians?

In an ideal world “Why can’t we all get along”? Universities, multinational publishers and institutional repositories such as PubMedCentral should be working together and building partnerships. I am surprised a public-private hybrid model has not emerged. Academic librarians should take the lead and offer to host journals using open journal systems (OJS). For unprofitable journals, or those with small readerships, publishers should think about good corporate citizenship and help struggling society and university publishers to publish journals.

Now, let’s talk techno tools. The name of your blog, for instance, is The Search Principle blog and on Twitter you categorize yourself as a “bio-medical librarian, renegade, techno-enthusiast.” Let’s parse that a bit. Could you tell us a bit about yourself? What, for example, is a bio-medical librarian versus a plain old medical librarian? A renegade in what respect?

I am all three: a health librarian, a medical librarian and a biomedical librarian. I answer to all. I wrote that on Twitter and on my blog because I had to come up with something. I’m not too much of a renegade, but I admit I won’t tolerate inequities and I stand up for others who cannot stand up for themselves. Perhaps this is what I am trying to do in my profession: stand up for our field, for excellence and high standards.

And as to being a techno-enthusiast, what are your top five favorite Web or search tools and what should we look for techno-wise in the coming year for medical librarians and vis-à-vis Web users in healthcare generally?

Keep in mind that I have to answer your questions from my perspective as a Canadian. Finding as much Canadian content as I can – medical evidence, statistics and local consumer health information — is central in my work. The websites or search tools that I cannot do without are: 1) The BC Health Guide 2) Public Health Agency of Canada 3) Health Canada 4) The Cochrane Library and 5) Medline OR PubMed. I also think that WorldCat is important as are Bing and Google Scholar (and all three have Canadian content).

Do you regard Wolfram|Alpha as a flash in the pan or as something truly promising? What do you think of Rupert Murdoch’s pushback vis-à-vis Google? Dumb move on his part? Is Google the default and any moves to try to shift Web users to Bing doomed from the get-go?

Wolfram Alpha has a lot of promise, but it may in fact be a ‘flash in the pan.’ For laypeople, and non-scientists, it’s not easy to use. We want it to behave like our print tools like the Merck Index and the CRC Handbook to behave – with intelligence and intuition. The only problem is that searchers do not know how to extract the information from it or how to form answerable questions.

As to Murdoch and his rejection or challenge to Google, I think it’s fine. Google needs competition. The more players we have in search the better. I don’t think Bing is doomed and don’t think it will be easy to dethrone Google. Ten or eleven years ago, no one thought Yahoo could be unseated as the most important search tool. The whole area of web searching continues to get attention for the money – but it too will stop flowing if the tools do not produce usable results or become cumbersome to use.

Getting back to Twitter, what are your favorite tools in it, how has its advent changed your work practices, whom has it connected you with that you had not known of before and how do you see it being used effectively by librarians, clinical researchers and front-line clinicians? Can you give us specific real-world instances of its use in clinical settings?

We need a whole conference to discuss Twitter properly. I will say that it has evolved since it was first developed – because we, the users, have seen its potential applications. Twitter suits me (and my needs) on a number of different levels: first, I’m a snoop so Twitter satisfies my need to listen to other people and to access information and gossip in real-time. Second, I enjoy hearing about other people’s working lives, projects and thoughts on world events. Finally, I enjoy myself more when I have information sent to me. Danah Boyd speaks eloquently on her blog about how she was intimidated by backchannels while she spoke at a conference. But Twitter is useful to all kinds of clinical people; I hear some psychologists use it to remind patients to take their medication. For anyone who needs to send tweets in the future, you can use a range of clients to send your ‘network of contacts’ messages at selected intervals.

Whom do you regard as the best tweeters in medicine and librarianship? Any additions to your list here?

I will definitely be adding to this list in 2010. Stay tuned.

Do you see Twitter as eclipsing blogs per se or do you find that Twitter drives traffic to blogs? Do you foresee the RSS button on blogs and Web sites being replaced by Twitter buttons? Or is RSS the perfect tool for leveraging the power of Twitter? Who are your favorite bloggers?

All of the tools you mention such as blogs and RSS feeds are affected by other social media. But I don’t see any tool that you have mentioned being eclipsed or replaced. Blogs are central to our culture now. Twitter has changed some of our behaviours and writing less than 15 words or 140 characters; it too is part of our culture. I like Twitter because there is power in concision and regular posts to your network. All of this is a part of defining your influence in the spaces of web 2.0. But none of that will stop me from blogging which is integral in my work.

You provide here a very useful overview of social media tools and I was interested in this comment, “RSS feeds can potentially replace traditional email lists, reducing email overload.” Have you indeed noticed that some email lists are disappearing or are people simply using tools such as Feed My Inbox
to use RSS a way to create email alerts? Are RSS readers really gaining traction among the general public or are they passé as far as the masses are concerned and are they falling out of favor even with the info-minded cognoscenti?

The level of general interest in RSS feeds and aggregating tools like Bloglines and iGoogle has been disappointing. There are physicians and other health professionals who do not know what “RSS” means or why it might be useful. The dominant form of communication is still e-mail. I maintain accounts on a number of aggregators and have discovered new aggregators such as Netvibes and Ning. The latter is a tool that allows you to create your own network – and it is very easy to use. But its adoption in medicine is minimal.

Thank you for your time, Dean.