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It is increasingly a familiar picture: the patient walking into the physician's office clutching a sheaf of computer printouts from the Internet. It quickly becomes apparent that the patient spent the previous evening surfing the Internet for the latest information on a particular disease and is now prepared to barrage the physician with questions. The National Library of Medicine (NLM) is responsible for much of this scenario. Quite possibly the patient obtained this information from MEDLINE, or the newer MEDLINEplus. It is also possible that the patient brought some of the misinformation promulgated on the Internet.
The Index Medicus, from which MEDLINE was derived, began in 1879. The NLM first employed computers in 1964, to prepare the Index Medicus for printing. Online searching of the MEDLINE database was introduced in 1971. In the years that followed, medical librarians (and the occasional physician) came to the NLM to take a class in how to search MEDLINE. GratefulMed was introduced in 1986 to permit searching MEDLINE directly from personal computers. Today, hundreds of millions of MEDLINE searches are conducted each year by users around the world.1 At least 30% of users are the general public, some of whom may be your patients.1
In November 1998, the NLM decided to change its century-old practice of providing databases primarily for the use of health care professionals. The result is a new service, MEDLINEplus, which is different from MEDLINE in that it connects the user to information written especially for the general public on more than 400 health topics. The information comes from the US National Institutes of Health (NIH) and other federal agencies, professional associations and nonprofit health organizations. Using strict guidelines, NLM's librarians select Web pages that are educational, appropriate to the audience, well organized, easy to use, and do not promote a product or service. The source of the information must be dependable, with an advisory board whose names are listed. The Web site must be consistently available and its links reliably maintained. In addition to health topics, MEDLINEplus also connects the user to medical dictionaries, hospitals, directories of physicians and dentists, an extensive medical encyclopedia, and consumer information about thousands of prescription drugs. In the last year usage has increased from 650 000 to 2.3 million "page hits" per month.
MEDLINEplus health topics also contain 1 or more links to preformulated MEDLINE searches focused on various aspects of each topic. These searches yield a manageable number of current references (usually 20 to 50). The references are English-language articles from journals that are generally available from a local medical library. The search is formulated to retrieve articles likely to be of interest to the general public. In the extensive MEDLINEplus section on diabetes, for example, a user without any knowledge of how to search MEDLINE can retrieve useful medical information. Planned improvements to the site include a daily medical news feature and local sources of health information and assistance, and more Spanish and other non–English-language materials.
The efforts of the NLM to keep the public informed about medicine have not stopped with MEDLINEplus. In February 2000, in cooperation with the NIH, a new Web-based database, ClinicalTrials.gov, was launched. The catalyst for this site was a 1997 law2 that required a registry for both federally and privately funded clinical trials for serious diseases or conditions. More than 5200 such studies are currently listed in ClinicalTrials.gov. For each clinical trial, the database includes a statement of purpose, the recruiting status, criteria for patient participation, location, and contact information. An important feature of the database is an extensive series of links to other online health resources that help place clinical trials in the context of patients' overall medical care. As with MEDLINEplus, no registration is required to use ClinicalTrials.gov, and complete privacy is assured to all users.
Additional information available online and supported by the NLM include:
The "Visible Humans"—two very large datasets of submillimeter anatomical data that are being used (without charge) by 1,240 licensees in 41 countries.
"Images from the History of Medicine"—a viewable file of the 60,000 images from NLM's historical collection.
"Profiles in Science"—a digital recreation of the scientific findings and unpublished writings, letters, photographs, and laboratory notes of great scientists.
While medical misinformation on the Internet is plentiful, the NLM provides physicians and their patients a central resource for authoritative health data. The most comprehensive database of the medical literature, MEDLINE, has been joined by MEDLINEplus. Now health care providers and the general public alike have access to an unbiased, noncommercial source of medical information.
Lindberg DAB. The National Library of Medicine's Web Site for Physicians and Patients. JAMA. 2001;285(6):806–807. doi:10.1001/jama.285.6.806-JMS0214-3-1
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