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What a remarkable year it has been for those of us monitoring changes in the global information landscape. Since last Christmas, there has been a flurry of activity: the digitisation of the world's libraries began in earnest (despite the copyright fracas); open access publishing gained much-needed support internationally (especially in science and medicine); and Google, MSN Search, and Yahoo introduced a number of customisation tools for desktops and mobiles, podcasts, blogs, and video searches.
Google's influence and power is writ large in the search field—so large that librarians are asking themselves some difficult questions. With all of this technology and freely available digital information, what will happen to physical libraries? Google's mission is to provide access to the world's information—but this is librarians' mission too. Will they be needed in the new information age?
For all the benefits technology provides, it does provoke anxiety. In a recent letter in the New England Journal of Medicine, a New York rheumatologist describes a scene at rounds where a professor asked the presenting fellow to explain how he arrived at his diagnosis. Matter of factly, the reply came: "I entered the salient features into Google, and [the diagnosis] popped right up." The attending doctor was taken aback by the Google diagnosis. "Are we physicians no longer needed? Is an observer who can accurately select the findings to be entered in a Google search all we need for a diagnosis to appear—as if by magic?" In a post-Google world, where evidence based education is headed is anyone's guess. Googling your diagnosis; Googling your treatment—where is all this leading us?
Google has won the battle of the search engines, at least for the time being (see example in table), and its more serious minded offspring, Google Scholar, is rapidly gaining ground. Within a year of its release Google Scholar has led more visitors to many biomedical journal websites than has PubMed (J Sack, personal communication, 2005). Once they discover it, many medical students and doctors prefer Google Scholar. Although both tools benefit from Google's trademark simplicity, Google Scholar indexes more peer reviewed research and is especially quick in locating highly cited items and the proverbial needle in a haystack. Doctors are encouraged to consult Google Scholar for browsing and serendipitous discovery, not for literature reviews; and they should use the advanced search page to find words and names that occur often in the medical literature.
Scholar's mode of presentation hinders its usefulness and may take up valuable time. Google's algorithm—which weighs the significance of articles—may be partly to blame. The quantity of search results is acceptable, but quality is often not. Using some of the subject tags in advanced mode may offer some assistance, and more precision. Because current articles are not displayed first, and cannot be sorted, downloaded, or emailed—expect to do a lot of sifting.
Still, Scholar does simplify basic searching for doctors, and it's free, like PubMed (www.pubmed.gov). For anyone not affiliated with a large medical centre or university, the ability to search for and access research material that is available free on the web is a boon.
As scientific societies and associations consider moving their journals to open access models, Google Scholar and Elsevier's Scirus (www.scirus.com/srsapp/) will likely provide a reliable gateway to this information. The most useful feature to come out this year on Google Scholar is "cited by" referencing. This free tool links searchers to other scholarly papers that have cited the paper being viewed. Scholar also provides links to local library catalogues through its library link program and through an international database called WorldCat.
In searches for clinical trials and systematic reviews, Google Scholar should of course never be used in isolation. However, it is a useful addition to PubMed, Cochrane, and other trusted sources of information, such as the TRIP or UpToDate databases, or a good medical librarian. For hard to find government or conference papers, don't forget to search regular Google in addition to Google Scholar.
Some basic questions remain for Google Scholar. What does Google consider "scholarly"? Will Google ever tell us exactly what is in the database? Could the Google algorithm present the most current research at the top of the results display? And how often will Google update the database?
What do we make of Google's future? Google's past success seems predicated on a simple business principle: do no evil. Founders Sergey Brin and Larry Page are said to be interested in using Google's computers to advance the cause of medical science. Apparently, Google's data mining techniques are well suited to analysing gene sequences in the human genome project. It may even be possible for patients to "google their own genes" one day.
But "do no evil" is a far cry from "do what's best for humanity." Google is still a business. However, if it wishes to do something for medicine, Google should consider creating a medical portal. Call it Google Medicine; design an interface with medical filters and better algorithms; lead to the best evidence (just don't forget to consult with librarians about where the evidence is located). This kind of all purpose tool is badly needed in medicine, particularly for developing countries.
Build Google Medicine. The benefits to human health would be immeasurable.
Now Time are reporting: When the Patient Is a Googler
We had never met, but as we talked on the phone I knew she was Googling me. The way she drew out her conjunctions, just a little, that was the tip off — stalling for time as new pages loaded. It was barely audible, but the soft click-click of the keyboard in the background confirmed it. Oh, well, it's the information age. Normally, she'd have to go through my staff first, but I gave her an appointment.
Susan was well spoken and in good shape, an attractive woman in her mid-40s. She had brought her three-year-old to my office, but was ignoring the little monster as he ripped up magazines, threw fish crackers and Cheerios, and stomped them into my rug. I tried to ignore him too, which was hard as he dribbled chocolate milk from his sippy cup all over my upholstered chairs. Eventually his screeching made conversation impossible.
"This is not an acceptable form of behavior, not acceptable at all," was Susan's excruciatingly well-enunciated and perfunctory response to Junior's screaming. The toddler's defiant delight signaled that he understood just enough to ignore her back. Meanwhile, Mom launched into me with a barrage of excruciatingly well-informed questions. I soon felt like throwing Cheerios at her too.
Susan had chosen me because she had researched my education, read a paper I had written, determined my university affiliation and knew where I lived. It was a little too much — as if she knew how stinky and snorey I was last Sunday morning. Yes, she was simply researching important aspects of her own health care. Yes, who your surgeon is certainly affects what your surgeon does. But I was unnerved by how she brandished her information, too personal and just too rude on our first meeting.
Every doctor knows patients like this. They're called "brainsuckers." By the time they come in, they've visited many other docs already — somehow unable to stick with any of them. They have many complaints, which rarely translate to hard findings on any objective tests. They talk a lot. I often wonder, while waiting for them to pause, if there are patients like this in poor, war-torn countries where the need for doctors is more dire.
Susan got me thinking about patients. Nurses are my favorites — they know our language and they're used to putting their trust in doctors. And they laugh at my jokes. But engineers, as a class, are possibly the best patients. They're logical and they're accustomed to the concept of consultation — they're interested in how the doctor thinks about their problem. They know how to use experts. If your orthopedist thinks about arthritis, for instance, in terms of friction between roughened joint surfaces, you should try to think about it, generally, in the same way. There is little use coming to him or her for help if you insist your arthritis is due to an imbalance between yin and yang, an interruption of some imaginary force field or a dietary deficiency of molybdenum. There's so much information (as well as misinformation) in medicine — and, yes, a lot of it can be Googled — that one major responsibility of an expert is to know what to ignore.....