29 October 2007

Health research disconnects

Thirsting for clean, clear knowledge

You know, medicine is not an exact science, but we're learning all the time. Why just fifty years ago they thought your daughter's illness was caused by demonic possession or witchcraft. But nowadays we know that Isabelle is suffering from an imbalance of bodily humors, perhaps caused by a toad or a small dwarf living in her stomach.

Steve Martin as Theodoric of York, Saturday Night Live, 1978

When it comes to health research, Canadian lawmakers have shown they don't really know their toads from their dwarfs. A study published last week in the CMAJ (1) identifies "significant knowledge gaps among Members of Parliament" regarding this important issue. The men and women who set government funding priorities and vote annually to determine the budget of the Canadian Institutes of Health Research (CIHR), "were poorly informed about health research activities, benefits and costs in Canada." In fact, only 22% of participants were aware that CIHR is Canada's leading federal funding agency for health research, supporting the work of more than 11,000 researchers and trainees in universities, teaching hospitals, and research institutes across the country — and 32% knew nothing about its role. Although they valued health research in the abstract, participants did not seem to appreciate fully the impact of health research on the economy, nor did they understand research's role in the promotion of healthier lifestyles and the improvement of health care delivery. The study concludes: "Many of these knowledge gaps will need to be addressed if health research is to become a priority."

A Canadian Press article which appeared on the same day quotes one of the study authors, Patrick McGrath of Halifax's Dalhousie University (who chose his words carefully): "I feel that their knowledge of health research wasn't as good as I'd like it to be." The MPs ranked health care as the most important issue facing the country — topping security issues, economic growth and employment, the environment, and the war in Afghanistan. They also rated health research as the second most important funding priority, giving it an 8.2 rating on a scale of 10. However, they felt voters placed far less value on health research funding, and estimated voters would give it a 3.8 rating out of 10.

Christopher Paige, the Vice-President of Research at the University Health Network in Toronto and a professor in the Departments of Medical Biophysics and Immunology at the University of Toronto, wrote a commentary for the same issue of CMAJ (7). He perceives a "disconnect" between the MPs' acknowledgment that funding health research is important and their perception that Canadian voters don't care much about the issue. Paige told the media, "I think the voting public in fact does want health research to be well supported in Canada." He noted that a recent survey of the general public found 91% of respondents wanted more government investment in health and medical research.

Patrick McGrath told Canadian Press: "Here we have our members of Parliament thinking it's a wonderful idea to support health research. The voters think it's wonderful. And yet there's a disconnect there — the members of Parliament feel that the public doesn't think it's a good idea. Won't get them votes." According to Christopher Paige, the findings should be "a call to arms" for the scientific community. He sees policy-makers' lack of knowledge of health research funding as "a real barrier to progress" (7). As he told the media, "I think it just reinforces something that we do know in our community, that we have to be more effective at communicating how research is funded and what the key issues are. It's really as simple as that." He recommends a series of changes to funding regimes, including establishing a national system of credentialed research hospitals which would be eligible for federal and provincial funding to deliver health care innovations.

Health research in Canada is not yet sunk, but it is taking on water, according to a 1 Feb 2007 report in the Globe and Mail:
David Colman, director of the Montreal Neurological Institute, says huge investments are being made up front and then researchers are nickel-and-dimed on operating grants. If the best researchers can't get adequate funding, then the whole funding system is broken and the future of medical research is in peril, he warns. His exasperation is shared by many scientific and business leaders. After years of investment in health research (long overdue), the federal government has allowed budgets to stagnate, leaving not nearly enough money for operating grants. (And investments from provincial granting agencies and foundations are not making up for the shortfall.) ... [T]he situation recalls an old English proverb: "For want of a halfpenny of tar, the ship was lost."
In a situation in which there are more disconnects than even Ernestine on a roll could manage, health sciences librarians see yet another. On the one hand we have repeated pleas for increased research funding, including a national network of research hospitals to deliver health care innovations. On the other the glaring lack of a national network of libraries to support that research. The Canadian Health Libraries Association has long been championing a National Network of Libraries for Health, whose vision is to ensure that all health care providers in Canada will have equal access to the best information for patient care (2,4,6).

Part of the difficulty in achieving any kind of national solution is the way health issues often fall between the cracks in Canada's fragmented federal system, a situation in which achieving reform makes solving Rubik's Cube look easy. This is the subject of John Lavis's study of political elites and their influence on health care reform:
Who are these political elites, and how do they influence the prospects for change and for improved cooperation in bringing about change? The elites can include government officials at both the federal and provincial level who are engaged in constant finger pointing over health care, with federal government officials repeatedly saying to their provincial counterparts "administer the system better" and with provincial government officials responding "give us the money we need to run the system properly." Meaningful reform of any kind is difficult to achieve amidst such a dynamic, which some have called the "politics of blame avoidance." (3)
With such a dynamic holding sway, and with the now better understood knowledge gap in Ottawa, it may be some time before CHLA's vision can be realized. In a 2006 editorial in CMAJ, Sir J.A. Muir Gray, Director of the UK's National Electronic Library for Health, lent his support, calling for the provision of "clean, clear knowledge," centralized and made available through a national initiative:
I have watched with admiration and have benefited from Canadian developments, from the introduction of evidence-based medicine to the advances in knowledge translation and implementation. It has always seemed paradoxical that Canada, a country that is the fount of so much good work in these areas, does not have a national library. No new building is needed; simply a national network using the tools that are made available through the e-health revolution. Creation of the Canadian Health Libraries Association's proposed National Network of Libraries for Health would allow for coordinated, centralized access to evidence-based knowledge as well as support by librarians to all health care providers, researchers and policy-makers, regardless of their location or institutional affiliation. This network will capitalize on existing resources and networks. We look forward to learning from yet another Canadian initiative (5).
For this to happen Canadians must increase the importance of health research on the political agenda, and we health librarians must continue to work towards the goals set forth by our national association. At least we know our toads from our dwarfs.
Wait a minute. Perhaps she's right. Perhaps I've been wrong to blindly follow the medical traditions and superstitions of past centuries. Maybe we barbers should test these assumptions analytically, through experimentation and a "scientific method." Maybe this scientific method could be extended to other fields of learning: the natural sciences, art, architecture, navigation. Perhaps I could lead the way to a new age, an age of rebirth, a Renaissance! ... Naaaaaahhh!


1. Clark DR Bsc, McGrath PJ Phd, Macdonald N Md Msc. Members' of Parliament knowledge of and attitudes toward health research and funding. CMAJ. 2007 Oct 23;177(9):1045-1051.

2. McGowan J, Straus SE, Tugwell P. Canada urgently needs a national network of libraries to access evidence. Healthc Q 2006;9(1):72-4.

3. Lavis, John N. Political elites and their influence on health-care reform in Canada. Discussion paper no. 26. [Ottawa]: Commission on the Future of Health Care in Canada; 2002. Available: http://www.hc-sc.gc.ca/english/pdf/romanow/pdfs/26_Lavis_E.pdf (accessed 29 Oct 2007).

4. McGowan JL, Ellis P, Tugwell P. Access to the medical literature. CMAJ. 2007 Jul 17;177(2):176-7.

5. Muir Gray JA. Canadian clinicians and patients need clean, clear knowledge. CMAJ. 2006 Jul 18;175(2):129, 131.

6. National Network of Libraries for Health. Vision. Toronto: Canadian Health Libraries Association; 2007. Available: www.chla-absc.ca/nnlh/vision.html (accessed 29 Oct 2007).

7. Paige CJ. The future of health research is hanging in the balance. CMAJ. 2007 Oct 23;177(9):1057-58.

23 October 2007


Fly the freak flag high

Truman Capote is said to have remarked about Jack Kerouac: "That isn't writing at all — it's typing." What would this acerbic man of letters and talk show gargoyle have made of the profundities to be found on Twitter and Facebook, or the excessively agitated scribblings on millions of blogs like this one? Perhaps as the badly written third act of a moderately good play? On the other hand, Capote had a good ear for slang and might have taken pleasure in expressions like "Jack's got a 404 look on his face." Would the Internet's strange linguistic artefacts have been taken as answered prayers, or would Capote merely have uttered one of his disdainful bat squeaks? Would he have googled himself, LOLed, tasted del.icio.us, or poked someone? (On the subject of poking, of course it was inevitable that we would be invited to experience the Zen of Poke, by a blogger who probably doesn't know the difference between a bodhisattva and body piercing.)

It is conceivable that Capote would simply have found more music for chameleons in the web's weird word play. Consider this comment on Apple's new OS X Leopard from Engadget: "Time Machine is like, zomg, so rad." (Zomg? See Wikipedia's List of Internet slang phrases.) Here is typical, unzippered web English: a pop-cultural allusion to classic science fiction, a universal but meaningless space filler, a ludic variation on a chat neologism, a dollop of surfer slang — all providing a solid basis for the impression one gets of Netspeak as a genuine language variety. Given the profusion of such semantic shape-shifting and lexico-graphological invention, the question must be asked: where is language going in the myriad corridors of the Internet, which reverberate with the zomg-like incantatory enthusing of cybergeeks, the meretricious discourse of our political and economic elites, the technical incomprehensibilities of experts, and the colourful argots of the diverse web community?

Being creatures of language, we create a world for ourselves that is both formed by and expressive of words. As we spend more of our lives jacked into the web, our language will change, is changing now. Our linguistic environment is digitalizing. The writer who invented the word cyberspace said this in a recent newspaper interview:

Fifteen or 20 years ago, the time we spent in digital systems was a special time. We spent less time there and we noticed it more. Now that's reversed. The increasingly rare time we spend is that which is not in the system. That's how it turns itself inside out.
The digital system we live in, the World Wide Web, or as David Crystal suggests it should be called, the Word Wide Web, has given us Netspeak. And the Orwellian ring to that term shouldn't go unanalyzed. The web is changing the way we think about language because it is a linguistic singularity — a genuine new medium. Published last year in a second edition, Crystal's Language and the Internet (1), examines the often bizarre and always inventive ways the English language (and every other world language too) is massaged, manipulated, mangled and mashuped in various digital transmogrifications. Is the Internet bad for the future of language? Will creativity be lost? Are standards diminishing? In clear and non-quirky prose, Crystal addresses all of these questions from a linguistic perspective. In his opinion the Internet is in fact enabling a dramatic expansion to take place in the range and variety of language, and is providing unprecedented opportunities for personal creativity. In this post I want to do some of my own exploring, experience some of the spiralling linguistic free fall of my digital world, and get my socks and shoes wet in the metaphor-mixing process.

Before the web there was email, there were listservs, MUDs, and MOOs. In the tradition of the telegram, language was already evolving as it began appearing in ASCII text on primitive monitors. In his novel Yellow Dog, Martin Amis takes wicked delight in spoofing the language of cyber chat and mobile twittering, which shares its DNA with those earlier forms of discourse. The despicable Clint Smoker, a London tabloid hack with phallic anxiety (phalanx?) who writes a column for The Daily Lark, receives a text message from a mysterious online admirer known only as "k8":

dear clint: r u as other men r?
(i ask because u ask: about size m@tering.)
well if u're not as other men r: don't worry.
my current 'other', orl&o, wields a big 1, of
which he is inordin8ely proud. but take my
word 4 it, clint, u don't want a bloody great 2l.

A bloody great ... twenty-one? he thought. Oh: the 1's an l.

they're overr8ed! i h8 them! & what an un4tun8
effect it has on the ego: he thinks he's the b's
knees. it's not size th@ m@ters, clint. it's love
th@ m@ters. (2)

Taken to such absurd limits, Netspeak would seem to represent the extirpation rather than the efflorescence of English. However, to anyone who has a passing acquaintance with medieval Latin palaeography, computer chat is not as innovative as one might think. Perversely silly as Amis' wicked satire makes them out to be, at least the distorted words are saying something humanly intelligible. That is frequently not the case on the web, where language, especially when infected with the Web 2.0 hype virus, easily morphs into computer-assisted forms that surpass even Orwell's inventive imagination. Web 2.0 B.S. I regard as I do the other severe facts of life: something to be faced with philosophy and investigated by science.

"An overwhelming sense of ickiness"
We're all familiar with it. A quick browse through one of the leading tech blogs, like Scobleizer, reveals an extraordinary range of web-laced English that would be largely unintelligible even to many native speakers. Here, taken more or less at random from a 22 October 2007 post, is a typical example:
Lunch 2.0 at Oracle (CTIA gadgets coming tonight)
I love the Lunch 2.0 movement. Every few days there’s a different Lunch 2.0 event around the world. Today was one at Oracle’s headquarters. These are great events to network at and see some new stuff (Oracle was showing off how it is Web 2.0-izing some of its Enterprise-focused stuff and privately I got a demo of how Oracle is building its own internal social network which is very cool).

Anyway, here’s some quick videos I shot at the lunch.

1. Matt Galligan told me about his company, Socialthing, which will aggregate all sorts of friends networks. Alpha coming later in October, public release expected later this year. He called it a “digital life manager” and compared it to Jaiku.
2. Justin Kestelyn gave me a little tidbit of why Oracle was hosting Lunch 2.0. His blog with reports on the event is here.
3. Dominik Grolimund of Wua.la shows me this very cool Peer-to-Peer online storage service. I’m going to try this one out. He’s visiting Silicon Valley from Switzerland.
4. Jeremiah Owyang just came back from Hong Kong and explains Cyworld’s homepi to us. Rich Mangalang, of Oracle, was showing us their internal social network (sort of like Facebook, but only for Oracle employees). He wasn’t able to demonstrate it on camera, unfortunately.
The net effect of this kind of discourse is simply to tire the mind. Inundated by such a continuous and constantly changing stream of expression-coining, name-dropping, acronym-spewing data fragments and paradigital bits, the cerebral cortex struggles to cope. I'm sure I'm not the only person suffering from Web 2.0 fatigue. Describing a first trip to Hollywood by Xan Meo — now there's a Name 2.0 — Martin Amis writes in Yellow Dog:
He stopped and thought: that feeling again. And he sniffed the essential wrongness of the air, with its fucked-up undertaste, as if all the sequiturs had been vacuumed out of it. A yellowworld of faith and fear, and paltry ingenuity. And all of us just flying blind. (4)
He could have been describing the linguistic underside of Web 2.0, its capricious and corrupting twisting of language to the point where a burst of web puffery or a simple list of website names can remind you of the platitudes of a soap commercial, or, just as easily, the sinister euphemisms of the police state. Do I exaggerate? Click over to The Web 2.0 B.S. Generator by Michael Calore. With every page refresh a new media release for a fictional Web 2.0 start-up appears. I looked at a few, my gorge rising. I was struck by a fictional media release for "Yixo" with its new coinage: the "$untappedDemographic."
MOUNTAIN VIEW,Calif. - Yixo is proud to announce a new social networking site for $untappedDemographic, the result of its continued expertness in friendly research.

"Our customers, if we had any, would tell us our overwhelming allure in the field of reading the papers and googling stuff is pre-eminent," said Carissa Vetch, Chief of Network Technology. "With lengthy papers and expensive reports, we continue introducing innovative products that make life easier for our consumers."
I found another mock release from "Twaba," a company "committed to providing the uniquest communications and data sifting for our customers." It goes on to say, "Our collaboration and espionage amount to a unique combination of patriotism and value." Real-life variations on this kind of amorally animated twaddle are de rigueur on the web, and far from unique.

For anyone on the hunt for the right buzzword or marketing angle, they couldn't go wrong to consult Bullshitr: the Web 2.0 Bullshit Generator. I had little trouble dredging up the following almost-all-too-familiar expressions:
  • engage semantic mashups
  • beta-test undefined communities
  • post A-list widgets
  • aggregate data-driven ad delivery
  • enable podcasting widgets
  • reinvent peer-to-peer tagclouds
  • create embedded weblogs
  • incentivize social communities
  • harness citizen-media weblogs
  • create social folksonomies
Not to be outdone, the Buzzphrase Generator provides a bewildering cloud of Web 2.0ish jargon that sounds like bits of conversations overheard at a Palo Alto coffee bar:
Podcasts. Tag me. The words aren't what they were. We shall transcend borders. On-demand streams. Clustering. Social is the new push. Folksonomy. This is newer media. Cry out, blogosphere! Faster. Faster! Always be launching. Hack it. Roll your own roll-your-own. We're about what Web 2.0 is about. News clouds. MSM just doesn't get it. Splog is an aggregate noun. An AJAX-driven GUI. You need someone who gets it. It's all changing. Single. Word. Sentences! "ASL" is geezer speak. It's all about community. The new is old. Clear that. Float this. This will change everything. We are on the brink of a new age. 2.0 is the new New. The buzz is loud and clear.

Folksonomy. Single. Word. Sentences! Faster. Faster! This is newer media. This will change everything. Podcasts. Tag me. You need someone who gets it. We're about what Web 2.0 is about. The buzz is loud and clear. It's all about community. An AJAX-driven GUI. Float this. MSM just doesn't get it. News clouds. On-demand streams. Clustering. Social is the new push. Hack it. Splog is an aggregate noun. Cry out, blogosphere! Clear that. It's all changing. The new is old. Always be launching. Label what defies categorization. The words aren't what they were. "ASL" is geezer speak. 2.0 is the new New. We are on the brink of a new age. Roll your own roll-your-own. We shall transcend borders.
Need a name for that new Web 2.0 product? Try the Web 2.0 Name Generator. True to its name, this tool generates lots of unusual compound or foreign-sounding words. I chose the following, but there were always more like them to come:


Or just create random names at MakeWords.com. I'm sure there are many others, highly valued if you are in the profession of inventing a new laundry detergent, underarm deodorant, surveillance operation, or excuse for torture.

I recently discovered The Name Inspector, a blog devoted to the weirdness of web language. One hilarious post expresses his unease about Utterz, a new mobile microblogging platform. The Name Inspector remarks:
You have to have some respect for a name that knows it’s ridiculous and flies its freak flag high. And yet… There’s something about the whole teat/cell phone/web connection that’s a little unsettling. A little Matrix-y. Everyone knows web use can be obsessive. Addictive even. This name plays right into that idea: our cell phones are our own personal connections to the great life-giving, milk-giving webcow in the sky. It’s enough to give a person, as Cher Horowitz from Clueless might say, "an overwhelming sense of ickiness."
There is a long tradition of using unusual words or expressions to delight, divert, frighten, annoy, bamboozle or educate an audience. Think of Rabelais' grotesques, the peculiar nations of Gulliver's travels, fairy tale characters like Rumpelstiltskin, Dickens' endlessly imaginative cognomens: Squeers, Bumble, Gamp, Dartle, Veneering, Scrooge, Podsnap (perfect for a Web 2.0 podcast and photo site), the Circumlocution Office. But think also of Ingsoc, Gestapo, Gulag, Private Security Contractor, The Mission, The Barrier. The difference now is that we have computer programs to invent names for us, and money or might can be made by finding a suitably catchy website label, logo and look for anything from a school project to a prison camp.

What of the world of health information? Healia is a good example of a doubtless computer-produced company name. David Rothman has given us a brief description of this new search engine. In typical Web 2.0 fashion, Healia's main page announces in large print that it's all about "YOUR search for health." The pastel blues, greens and oranges are trendy, and the website's overall style is a patently obvious salute to Google's peerless look. "Healia" as a name attempts to create a sense of well-being — "We'll heal ya, Cecilia" — although it tends to bring the Simon & Garfunkle song to mind a bit too often, not to mention the hallelujahs, forehead slaps and fervent swoons of a Benny Hinn crusade.

I note that Healia's "President & Founder" (does he have a chest full of medals and a riding crop?) attended the recent Health 2.0 Conference in San Francisco, which I discussed in previous posts. One cannot resist reviewing the names of some of the other new companies that were represented there:

WeGoHealth (rah-rah, marching, pompoms, brass band)
Daily Strength (scripture readings and mirror affirmations for the feckless)
OrganizedWisdom (Buddhist Tripitaka online)
Sophia's Garden (trellises and trowels for philosophers)
Inspire (new pit perfume)
Digitas Health (working the classical angle to sound sophisticated)
Enhanced Medical Decisions
(CIA front)
DNADirect ("Friendly injections at your convenient local salon!")
Vimo (comes with A/C and stereo and other assorted bling, as well as a Latin dictionary)
HealthEquity (that's cash equity, in case you were thinking the other kind).

This selection of smart little company designations gives us partial insight into how language is prinked, preened, pruned and exploited in the marketing strategies of the super-clever, always-plugged-in high-tech business set. The names smack mightily of computer-aided cogitation: the Web 2.0 Name Generator mentioned above, or some other tool like the 2 Robots Random Business Name Generator. On second thought, it couldn't be the latter, since it produces totally lame product such as "Agility Networks Group" or "Lightning Renditions." The Health 2.0 letterheads are playful, allusive, and suggestive, containing multiple potentialities of interpretation. In other words, little is said, lots is promised, less is more. They keep one slightly off-balance. They elude simple explanation, tamper with our fixed notions while relying on our cultural assumptions, and slip out of our hands even as we seem to grasp them. Heidegger would have admired them as a subtle economy of reference, a capitalist version of aletheia, of a truth that conceals itself in the very process of disclosure. Esther Dyson, a well-known industry pundit, sat on the "closing reactor panel" representing her radioactive consulting business, whose expensively provided, impossibly pretentious, and predictably slick name is EDventure, a brilliantly conceived evocation of exclusive adventure and top-dollar education for venturesome executives issuing convertible debentures on the advent of their successful capture of the market. How allusive is that. This tricksy sobriquet has more connotations than a Shakespeare sonnet.

The sequiturs vacuumed out
My interest in such trendy monikers fades quickly. But there is one case where I think immediate action is needed, where all the above tools should be applied and the most brilliant minds of the English-speaking world should be put urgently to work. I refer, of course, to the hideous My NCBI. No more fatuous, colourless, insipid, and abortive appellation has ever been fabricated than this pallid semblance of a brand name. I would like to see a massive competition to come up with a good Web-2.0-worthy descriptor for PubMed's little bag of tricks.

Sidebar: What's in a K?
On the subject of the importance of naming, I came across a "news" item from North Korea, dated 3 June 2003, entitled "Movement for regaining English name of country." (Source: http://www.nk-news.net/index.php). Apparently the Pyongyang government would prefer that English publications refer to their country as "Corea," a traditional spelling used in most western languages for hundreds of years. "Korea," according to the article, was an invention of Japanese imperialists after their colonization of the country in the early 20th century. The restoration of the older spelling would help "to eliminate another leftover of Japan's colonial rule." Ironic this, given that I remember the provocative use of the letter 'k' in the spelling of Kanada and Amerika (sometimes Amerikkka) in the student rebellions of the 60s. There is much in a name.

"Tiny doses of arsenic"
Where is language going on the web? How is it changing and what will the ultimate effect be on how and why we communicate? "The sheer scale of the present Internet," says David Crystal, "let alone its future telecosmic [sic] incarnations, has convinced me that we are on the brink of the biggest language revolution ever. . . . [T]he arrival of new, informal, even bizarre forms of language extends the range of our sensitivity to linguistic contrasts. . . . The human linguistic faculty seems to be in good shape, I conclude. The arrival of Netspeak is showing us homo loquens at its best." (4)

Crystal is quite upbeat about the webification of English (and other languages). Yet surely it is also true that languages can get better or worse, that they can coarsen over time, be deliberately perverted, and can contribute to the corruption of human thought and sentiment. While taking pleasure in the inexhaustible variety of web language, it is important to guard against the growing use of the web to promote cruel and intolerant ideologies, as well as the constant trivialization and commercialization of speech and the written word. In his monumental The language of the Third Reich : LTI, Lingua Tertii Imperii : a philologist's notebook, Victor Klemperer demonstrates how language was systematically degraded and debased in Nazi Germany. A Professor of Literature at the Technische Universität Dresden until his dismissal in 1935 under the Nuremberg Laws, Klemperer was stripped of his academic title, job, citizenship and freedom and eventually condemned to forced labour. Miraculously, he survived the war, and the incredible diary he kept during this ordeal has been published to great acclaim.

"What was the most powerful Hitlerian propaganda tool?" writes Klemperer. "Was it the individual speeches of Hitler and Goebbels . . . their rabble-rousing against the Jews, against Bolshevism? . . . Certainly not. . . . Nazism permeated the flesh and blood of the people through single words, idioms and sentence structures which were imposed on them in a million repetitions and taken on board mechanically and unconsciously. . . . Words can be like tiny doses of arsenic: they are swallowed unnoticed, appear to have no effect, and then after a little time the toxic reaction sets in after all."

Klemperer's words (quoted from a review of two books by David Crystal in The Guardian of 11 February 2006) are a sobering reply to Crystal's own frothy rhapsodizing. But my web life must go on. I have to make a living, like other librarians, immersed in its use and misuse of language. And the clever or clunky neologisms and word play just keep swarming up from the web's fertile depths. Only yesterday I discovered hooeey, a new bookmarking and tracking service from India which records your complete browsing history, allowing you to share interesting web pages with others easily and to manage your browsing time more efficiently — sort of a del.icio.us plus Google Web History combined. Where on earth did they find that name? Hoo knows? What does it all mean? More Web 2.0 word weaving. I see a lot of hooey in the future. But as William Gibson has remarked, we can't do futures anymore.

Non-digital references

1. Crystal, David. Language and the Internet. 2nd ed. Cambridge; Cambridge University Press, 2006. (David Crystal has his own website and blog: davidcrystal.com and DCBlog.)

2. Amis, Martin. Yellow dog. Knopf, 2003, p. 102-103.

3. Ibid. p. 10.

4. Crystal, op. cit., p. 275-276.

14 October 2007

Take 5

Bringing research and library services to front-line staff in a community hospital

My colleague Christine Shaw-Daigle, librarian at Victoria General Hospital in Winnipeg, has co-published with that hospital's director of research a paper on bringing library services to front-line staff. "Take 5" appeared in the September 2007 issue of Canadian Nurse.

It describes a six-month pilot project in which the authors made themselves available to two busy acute care units for a 45-minute period twice a month. Staff were encouraged to take five minutes from their schedules to discuss their library needs and research ideas. In addition to handouts and recent books and journals, the authors provided competency packages they had developed for nurses. Each package contained a bibliography of current articles, book chapters, books, and websites.

Hospital staff responded positively to this form of outreach. One of the primary benefits of the Take 5 project was the development of a relationship marketing strategy for the library. Interaction with the staff in their place of work improved their knowledge of library resources and services.

The project continues and has expanded to include other hospital units. The competency packages were "a definite hit" with the staff. Library use has increased. Success at Victoria General Hospital has led to the implementation of similar projects at other community hospitals in Winnipg, all of which are served by the University of Manitoba Health Sciences Libraries. The most recent project has been the creation of a Nursing Toolkit, which brings together appropriate resources in a handy format.

Congratulations to Christine, who managed to get the first library-related article into Canadian Nurse in 26 years. "It's lonely in the library" appeared way back in October, 1981. Given the length of time it took to get such recognition for a hospital library's usefulness to nurses, it would have been nice if Christine's article had been listed in the online table of contents.

And that's not the Canadian Nurses Association's only web tangle. The site devoted to their journal, Canadian-nurse.com, is where mid-nineties web page design came to die. Bad enough that it loads sluggishly and that the look is dated. The problem is that there really is little useful information to be had here. No back issues are available online. Why bother having a journal website at all! The same goes for the French-language version, Infirmière canadienne. We find an "Indexes" page (English) and an "Archives" page (French), each offering meagre fare: nothing but PDF versions of the journal's annual indexes for 2004-2006. One is forced to turn to PubMed or CINAHL to find a decent list of articles to be found in Canadian Nurse. Of these, only a few have abstracts, which seem to be rarer than mangoes in Manitoba. Please, CNA, do something about your website. It's badly in need of an overhaul.

11 October 2007

Still scratching

I have received comments, one of them lengthy, from two individuals who appear to be involved in the creation of the video A Brief History of Medicine, which I lambasted in my post of 4 October, Scratching an itch. I replied rather tartly to "matthew" in the comments section, but this longer reply to Bungle M (who signs as "michael") deserves its own separate post. Besides, I haven't figured out whether it's possible to add illustrations to comments in this software. And I like illustrations.

Dear Michael (or is it Bungle M ?),

I seem to have caused a bit of a flap in the ScribeMedia pigeon loft with my blog post of 4 October. How else to account for the rush to reply to a satirical morsel of invective by an obscure, curmudgeonly hospital librarian in a remote Canadian outpost? Have you no sense of humour? Have you no sense of perspective? It's just a video after all; and I'm just a library guy who isn't always on top of every trend but who nevertheless has an axe to grind when the trend is rightwards. At least for my generation, short videos such as yours are at worst a vexing irritant and at best a trifling entertainment, not unlike
radio jingles, urinal advertisements, movie trailers, and elevator music. I have observed with interest and some alarm the growing importance of videos as a means of communication for a new generation less interested in the printed word. YouTube up, library circulation down. It's not that I object to the short video on principle. Videos can be brilliant, inventive, disturbing, and informative. I enjoyed Web 2.0 … The Machine is Us/ing Us, whose style you so studiously copied. I just didn't think your video was all that good, in contrast to the fawning comments in praise of its awesomeness. And that infernal soundtrack! I'm still scratching. But, as you say, we won't get anywhere arguing about video and audio aesthetics.

I accept your claim that you did not intend to be partisan. I, on the other hand, freely admit to being one, although of the World War II variety I take no prisoners. I didn't call anyone a Clintonite. I just thought it somewhat humorous that the Clintons got the good visuals in the video while nary a Republican was to be seen. Believe me: I am the last person to be making accusations about a "liberal agenda." The very term is foreign to Canadians, but I could fairly be labelled as having one. We actually like liberals up here, and frequently elect them to Parliament and to provincial legislatures. What I did appreciate about your video was its attempt at a statement of liberal values around health. Something goes terribly wrong at the end, however, when, as I have noted, the acme of health care is touted as a series of lavishly designed and highly remunerative websites.

To restate my point, what I chiefly object to about A Brief History of Medicine is how it allows itself to become a shill for a gathering of plutocrats and entrepreneurs who see the web as a means to make a killing in the health care biz. I would object to the use of the word "cabal" to describe such a group. This is not a conspiracy in the usual sense of the word. I'm sure they see themselves as good corporate citizens simply responding to consumer demand. They are only doing what any business would do when given the opportunity. That is the problem. It's all arranged; the market is targeted; the strategies for growth are being discussed in oak-lined boardrooms and on thousands of humming Blackberries. I would dearly love to be proven wrong in my suspicions. I would really like to be assured that Google's Product Marketing Manager, Kaiser Permanente's Senior Advisor [sic] & Medical Director, and Medstory/Microsoft's CEO have only the best interests of the public at heart, that they truly care about US. But I remain unconvinced. As George Eliot remarked in her novel Felix Holt, "the foxes have a sincere interest in prolonging the lives of the poultry."

For all its enfolding and rhapsodic idealism, your video actually does end up being partisan. Certainly, it seeks to avoid politics by emphasizing the personal; but the personal is political also. So, for example, the vacuous inclusiveness you praise in the video's self-congratulatory summing-up, "Health Is... Men. Women. Children. Mothers. Fathers. Brothers. Sisters. Doctors. Patients. Caregivers. You... Health is US," acknowledges despite itself the unmentionable yet clamorous need for all these atomized individuals to work together for a political solution to soaring health costs, the plight of the uninsured, unethical practices, and the general plunder and pelf of a corporatized health care system.

I recognize that when it comes to health care the United States has a particularly difficult set of circumstances. As you state yourself, American politicians and "thoughtleaders" have not been willing or able to offer solutions that would bring real change. But it is not my intention to launch a political critique of the American system. There is plenty to criticize in my own country. I simply maintain that universal, sustainable, not-for-profit health care, however infinitely debatable its successes and failures, is a workable solution with measurable outcomes. (For a good example of what I mean, see the much-praised but regrettably neglected Romanow Report of 2002, Building on values: the future of health care in Canada.) Yet such a notion beyond liberal, even "socialist" in the view of many is incompatible with and cannot even be easily articulated within the specific form of discourse around health that is dominant in the United States and growing in strength on this side of the border (see my discussion of the latest salvo from the Canadian Medical Association).

Would you not agree, my dear michael, that it is a sign of just how bad things are when even the modest proposal that everyone has a right to decent health care brings on howls of righteous indignation and mindless red-baiting? What is all the commotion about? Only extremists could argue against the equitable provision of health care to all, just as only extremists could endorse a global economic system that condemns billions to lives of poverty and desperation. Who are the real reds under the bed? Who are threatened with the loss of wads of money if universal health care is adopted? The peddlers of Health 2.0 and their ilk are counting on the continued survival of privatized medicine, gambling with some confidence that it's too good a show to shut down. They're itching for action.

Finally, in defence of my position I submit the agenda of the Health 2.0 Conference (San Francisco, 20 Sept. 2007), cut and pasted from the conference website itself. The presenters and panelists: almost exclusively company CEOs, COOs, VPs and Presidents. Their purpose: "to confront the decision of how to interact with ... new technologies and networks, and potentially adopt and integrate them into their strategies for growth." Translation: to figure out how to make money and then to make more money.

I submit that health for these "stakeholders" is a commodity like any other, to be packaged and sold for profit. My purpose in the blog post, aside from having a bit of fun at your expense, was to lift up a corner of the sequined curtain of Health 2.0 and expose what Ambrose Bierce described as the strife of interests masquerading as a contest of principles, and the conduct of public affairs for private advantage. I would be quite happy to see the Health 2.0 meme scratched off the parchment, now that it has been appropriated by the entrepreneurial seigneurs of the new feudalism.

Pruritically yours,


Health 2.0 User Generated Healthcare Conference Agenda

8:00-8:30 INTRO Health2.0: User-Generated Healthcare
Matthew Holt/Indu Subaiya

8:30-9:30 OPENING PANEL:
The Role of the Consumer Aggregators
Missy Krasner, Product Marketing Manager, Google
Wayne T. Gattinella, CEO, WebMD
Peter Neupert, VP Health Solutions Group, Microsoft
Bonnie Becker, Director, Health Category, Yahoo!
Moderator: Jane Sarasohn-Kahn, THINK-Health

Special Perspective from: David J. Brailer
Former National Health IT Coordinator
& Founder, Health Evolution Partners

9.30-9.40 STRETCH BREAK, Bio Break & Coffee refill

9.40-10.40 DEMO PANEL & Discussion: Search in Healthcare
Alain Rappaport, CEO, Medstory/Microsoft
Venky Harinarayan, Co-Founder, Kosmix
Tom Eng, President & Founder, Healia/Meredith
Dean Stephens, President & COO,Healthline Networks
Moderator: Jack Barrette, CEO WeGoHealth (ex-Yahoo)

10.40-11.15 NETWORKING Break with Demonstrations

11.15- 12.15 DEMO PANEL & Discussion: Social Media for Patients
Ben Heywood, CEO, Patients Like Me
Doug Hirsch, CEO, Daily Strength
Steve Krein, CEO, OrganizedWisdom
Karen Herzog, Founder, Sophia's Garden
John de Souza, CEO, MedHelp International
Brian Loew, CEO, Inspire
Moderator: Amy Tenderich, Blogger/Journalist DiabetesMine

12:15-1:00 REACTOR PANEL Payers, Providers, & Pharma….and Health2.0
Paul Wallace, Senior Advisor & Medical Director, Kaiser Permanente
Joe Gifford, Chief Medical Officer, Regence BCBS
Jeff Rideout, Managing Partner, Ziegler HealthVest Fund
Bruce Grant, SVP, Digitas Health
Ted von Glahn, Director, Performance Information and Consumer Engagement, PBGH
Moderator: Doug Goldstein, eFuturist

1:00-2:00 LUNCH with "Unconference" issue tables
& more demonstrations

2:00-3:00 DEMO PANEL & Discussion: Tools for Consumer Health
Mike Battaglia, VP Healthcare Strategy, Intuit
Marlene Beggelman, CEO, Enhanced Medical Decisions
Dave Hall, VP of Innovations, HealthEquity
Joseph Villa, COO Employer Division, Revolution Health
Ryan Phelan, CEO, DNADirect
Moderator: Scott Shreeve, CrossOver Healthcare (founder Medsphere)

3:00-3:30 NETWORKING Break with Demonstrations

3:30-4:30 DEMO PANEL & Discussion: Providers and social networks
Daniel Palestrant, CEO, Sermo
Lance Hill, CEO, Within3
Chini Krishnan, CEO, Vimo
Gale Wilson Steele, Founder/CEO, Careseek
Patricia Ball, VP Product Development Consumer Aware/BCBS Minnesota
Doug Goldstein, eFuturist & President, Medical Alliances
Moderator - Enoch Choi MD, MedHelp/PAMF

4:30- 5:30 CLOSING REACTOR PANEL: Health2.0 - Looking Ahead
Lee Shapiro, President, Allscripts
David Kibbe, American Academy of Family Physicians
Bob Katter, Senior VP, Relay Health (McKesson subsidiary)
Jay Silverstein, Chief Imagineer, Revolution Health
Steve Brown, Founder Health Hero Network, Entrepreneur in Residence, Mohr Davidow Ventures
Esther Dyson, EDventure
Moderator: Marty Tenenbaum, Commercenet

5:30- 5:45 Wrap-up - Matthew Holt/Indu Subaiya

5:45- 6:45 Wine and Cheese Networking

04 October 2007

Scratching an itch

In the new fashion of trying to explain our world to us with short, frenetic video clips, ScribeMedia.org has produced a typically upbeat piece called A Brief History of Medicine. As they say in their website puff: "We could/should add, 'American Style.'"

Heavily influenced by Michael Wesch’s Web 2.0 … The Machine is Us/ing Us and itching to get under our skin, this video was used to open the Health 2.0 Conference in San Francisco last month. It immediately demands eyeball attention and is hyperkinetically entertaining with its rapid cuts, fades, blends and dissolves. Our battered retinas barely have time to register the Gatling-gun spray of images as the jerky trail of the typescript cuts across the screen. The accompanying electronanotechbeat music, by the well named Luxxury, is aggressively irritating, like the soundtrack to a scabies infestation. If this were the 60s, someone with a head-band and dilated pupils would be emerging from the theatre waving a cigarette and exclaiming: "Far out, man."

Graphic hijinks aside, this is a tendentious, tauro-scatological and technologically obsessed treatment of the history of medicine. The video is divided into eight sections, each introduced with the caption, "Health is ... " The sections are engagingly entitled History, Education, Body, Global, Activists, Insurance, Information Technology, US — sounding better as a rundown of current fads and phobias than of medical history.

Is it petty to criticize what is so obviously a for-the-nonce throwaway? Well, watch out. I'm going for the throat. Nurses, not to mention the important contribution of religious orders in medieval Europe, are invisible in the onward march of male doctors with large scalpels. The discoveries of the smallpox vaccine, insulin and the x-ray are ignored, as is the introduction of asepsis, anesthesia and antibiotics. From the onset of AIDS we are rushed along to a 10-second liberal dig at the lack of proper health care insurance in the United States, with flattering photographs of Bill and Hillary Clinton. Some AIDS organizers and others working hard for reform may not be amused to find the Clintons featured so prominently in the Activists section. Finally, inevitably, and I suppose appropriately for this well-heeled California gathering, the acme of health care is touted as a series of lavishly designed and highly remunerative websites. We are peddling "Health 2.0" after all.

ScribeMedia.org, which produced the video, hypes itself as travelling the U.S. to capture and deliver speeches, lectures, round tables and interviews of "thoughtleaders" across a broad range of subject areas that include current events, technology, media, business, health care and the arts. Its self-described goal is to be "a neutral forum for intelligent dialog and debate, uncluttered by soundbytes, instant punditry and shoutfests."

Hence their wacky video. Take five, hold on to your seat, and plunge into this gyrating, ululating manifesto. Not a soundbyte or pundit in sight. It's informative, in the way that a bungee jump is a lesson in Newton's law of universal gravitation. While the message is relentlessly positive and glitteringly Clintonesque — of course it's all about YOU and US — what it actually is all about is the manifold ways that WE are going to make a lot of money out of YOUR problems, and YOUR growing need to deal with every ailment by purchasing a costly commodity from US in the new web-based economy. The only noise not heard in this clever little propaganda Kunstwerk is the ringing of the cash register. The only itch not scratched is that for a just health care system.

If this is how our "thoughtleaders" are thinking about health care, then we'll just have to keep on scratching.

02 October 2007

AMWA Awards 2007

The American Medical Writers Association, founded in 1940, is the leading professional organization for biomedical communicators. Its mission is to assist authors and extend their professional expertise. It promotes excellence in biomedical communication and provides educational resources and networking opportunities to its members.

At its October annual conference AMWA presents a number of awards, among them its medical book awards and the Eric W. Martin Award for excellence in medical writing by an AMWA member. The awards have just been announced. For librarians who are making acquisition decisions this is a valuable resource.

Book Award Winners for 2007

(For books published in 2006)


Physicians Category
Title: Mayo Clinic Cardiology: Concise Textbook, 3rd Edition (Shelved in the W's at the St. Boniface General Hospital Library, Winnipeg, Manitoba: WG 18.2 M4726m3 2007)
Authors or Editors: Joseph G. Murphy, MD, and Margaret A. Lloyd, MD
Publisher: Mayo Clinic Scientific Press

Trade Category
Title: Unplugged: Reclaiming Our Right to Die in America
Author or Editor: William H. Colby
Publisher: AMACOM


Trade Category
Title: Heart Care for Life
Authors or Editors: Barry L. Zaret, MD, and Genell J. Subak-Sharpe, MS
Publisher: Yale University Press

Trade Category
Title: Hot Flashes, Hormones, and Your Health
Authors or Editors: JoAnn E. Manson, MD, with Shari S. Bassuk, ScD
Publisher: McGraw-Hill


Trade Category
Title: The Flu Pandemic and You: A Canadian Guide
Authors or Editors: Vincent Lam, MD, and Colin Lee, MD
Publisher: Doubleday Canada

(An award was not given in the Allied Health category for 2007. )

2007 Eric W. Martin Award winners:

Professional Audience Article
Florence M. Witte, MA. Stories from the Field: Students' Descriptions of Gender Discrimination and Sexual Harassment During Medical School (Academic medicine 81(7):648-654, July 2006.)

Lay Audience Article
Debra Bradley Ruder. Life Lessons (Harvard magazine Jan-Feb 2006)

Diane Shannon, MD. Helping Your Patients Decide: Making Informed Health Choices about Hormonal Contraception (ARHP clinical proceedings. Electronic edition: July 2006)

AMWA has a number of chapters in the United States, and there is a Canadian chapter too: http://www.amwa-canada.ca/

There is a website for the European Medical Writers Association: http://www.emwa.org/