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Conference Blogging

Clare has been continuing to post updates on the MCMLA/Midwest conference blog, even though we've all been home from Omaha for a couple of weeks.  As I said earlier, she's done an exemplary job, and I'm enjoying having my memory of some of the excellent presentations refreshed by going back to review some of the slides or photos that she's posted or linked to.

I was particularly delighted to see the photo that Mark took of me with Bob Braude at the welcome reception at the McGoogan library.  Bob has been such an important mentor for me and even though that library has changed so much as to be pretty much incompatible with my memories of it, being back there for an evening, and strolling around the place with Mark, was a great experience.  The conference blog keeps it from fading into bleary memory too quickly.

Not surprisingly, several of the bibliobloggers that I follow are at Internet Librarian 2007 in Monterey, and there's a fair amount of liveblogging going on.  I confess that I'm sceptical of the value of it, although, having done a bit of live conference blogging myself, I'm somewhat in awe of the focus and attention that it requires.  I'm just not sure how useful it is.  Trying to get a feel for what a presentation was like from reading somebody's raw notes doesn't do much for me.  It strikes me as one of those things that gets done simply because it's possible to do, not that it really has much value.

Summaries and analysis of presentations are another matter entirely, of course, but they're a little harder to come by.  To do that well requires taking some halfway decent notes and then finding the time to reflect a bit on what's been presented so that you can craft a piece that presents the essence of it in some useful fashion.  Aside from the reportorial skill required, the typical conference-goer's schedule makes finding those times for reflection difficult, to say the least.

Friday, we leave for DC for the AAMC/AAHSL meeting.  We'll go straight to Charleston from there for the Charleston Conference, and then stay through the weekend for the SCMLA annual meeting which starts the following week.  As usual, I'm imagining getting at least a short post written daily.  But I suspect that, also as usual, I'll be hard pressed to get one or two done during the entire two week sojourn.

It surely won't be for lack of things to write about.  Aside from the conference content itself (including a couple of presentations that I'll be doing), there's the time spent with friends & colleagues, a variety of committee meetings and other association business,  a trip to the Shakespeare theater on Friday to see their new production of Taming of the Shrew, museums in DC, art galleries in Charleston, a bit of guitar playing somewhere along the line and, most certainly, at least a handful of fine meals.  Lots to write about, but will I find the time?


Ethical Boundaries for Medical Librarians

A question popped up on MEDLIB-L earlier this week, from a hospital librarian who is concerned that one of her docs is selectively using the information that she is providing.  He's a proponent of a number of alternative psychiatry therapies (she mentions T-touch, reiki and suicide assessment scales, in particular) and, in the librarian's view, " the best evidence overwhelmingly points to a lack of efficacy in using any of these techniques".

She goes on to say,

Here's the dilemma.  Although I have no way of knowing what this person does with the information I provide, my suspicion is that by the time it gets to people in charge of decision-making, the best evidence is played down, or not addressed at all.

And she wonders if there is something that she ought to do about this.

The follow-up discussion has been pretty good and most of the messages express caution about taking action that might be seen as interfering with the physician's decision making.  In response to some of the comments, the original poster says, in part,

I've come to realize that perhaps this discussion is about defining the role of the medical librarian in EBM.  Do we believe in it and support it?  If so, shouldn't we be concerned about patients being subjected to, and billed for, therapies of any kind, not limited to alternative therapies which just happened to be the topic in my case,  that have not borne up under scientific scrutiny?

It's a great question, and I have a great deal of sympathy for this librarian's concerns.  But I fear that she is veering close to practicing medicine without a license.   While librarians in general are big supporters of EBM, it is worth noting that there is still considerable discussion within the physician community about how one best makes use of evidence, and what role intuition, art, and the fact that the patient in front of you is not a statistic, all play in making treatment decisions.  In many cases, the evidence base is weak (or nonexistent) to begin with, and physicians routinely find themselves in situations where the particulars of their case seem to defy a straightforward application of what the evidence seems to imply.   This is likely to be particularly the case with alternative therapies which have not received as much objective, systematic study as more conventional therapies.

All librarians are faced with situations in which the information that they provide may be used to do harm.  This is probably more often the case for hospital librarians than for those in any other sector.  Certainly if a hospital librarian is aware of a situation in which he or she has reason to believe that someone is making treatment decisions that are harming a patient, this should be brought to the attention of the appropriate administrators in the hospital.  But that doesn't seem to be the case in this example.  In this case, the librarian is putting her judgment about how clinical decisions should be made (based on her evaluation of the evidence base in the literature) ahead of that of the requester.   But she is doing this without knowing any of the specifics about the actual cases that may be affected.  As a librarian, these are not her decisions to make.  She can be an advocate for EBM and strive to provide the best and most comprehensive information resources available on a particular topic.  But the judgment of how to make use of the resources, what to consider and what to ignore, and what other factors to bring to play, remain the responsibility of the physician, even in those cases where the librarian is sure that she is right and the physician is wrong.

It's tough one.    And it makes me think of the dilemmas that we may find ourselves in where our professional ethics and personal ethics turn out to be not quite aligned, or even in conflict?  Consider the situation of pharmacists who are opposed to abortion and feel an ethical responsibility to refuse to provide the morning-after pill?  Does this conflict with their professional responsibilities?

In 1993, I was a member of the task force that developed the current MLA Code of Ethics. Even this many years later I think of it as one of the most satisfying experiences of my professional life.  It was a wonderful group of people to work with, the discussions were rich and complex and rewarding, and I'm very proud of what we came up with.

But ethical issues aren't necessarily set in stone, and the challenges that we face (both as professionals and as individuals) shift over time, so I was very happy to hear, at the fall Board of Directors meeting, that president-elect Mary Ryan is thinking of including consideration of some ethical issues (in particular those involving conflicts of interest) among her presidential priorities. We'll find out more about that at the February board meeting, but I, for one, would be happy to see it happen.

It Started in Omaha

In March of 1984, I made my second visit to Omaha.   The first had been in 1962, a family vacation to visit my mother's sister, whose husband was a colonel in the air force -- a trip, incidentally, during which my youngest sister was conceived, according to family lore.

I had very little notion of what I was going to do with the rest of my life.  I was in my late twenties and had spent the previous eight months at NLM as a Library Associate, a circumstance that I would never have believed possible barely a year earlier.  I was a sponge at NLM.  I'd gone into library school with only the vaguest notion of maybe being a reference librarian in a small college library, and then found myself with free rein to explore the largest specialized library in the world, filled with some of the most fascinating and influential characters a tyro librarian would ever have the opportunity to meet.  It had been an astonishing time, but I still didn't know what I wanted to do  once my year as an Associate was up and I had to start thinking about finding a real job.

My mentors at NLM had me pegged for a management career.  What they saw in me in those early days remains a mystery to me yet, I was so shy and uncertain, and at the same time so arrogant and pompous.  Fairly insufferable most days, I'm sure.  I knew practically nothing and my work experience was almost all in factories.  I was a pretty good fork-lift driver and I'd built a modest reputation as a guitar player on my college campus, but that was about it.

Nonetheless, it was decided that for my March practicum (a standard part of the program in those days) I should spend a week with Bob Braude and his crew at the McGoogan Library of Medicine in Omaha.  Bob was (rightfully) considered to be among the very best library directors of the day and he had gathered around him an astonishing group of innovative and creative and engaged young librarians.  If one wanted to see the potential for what a library could be as we moved into the end of the 20th century, this was one of the best places to check it out.

I stayed at Bob's house and from the moment I groggily came down to the kitchen where he'd be fixing breakfast for us, until late in the evening after his wife had fixed another wonderful dinner, we'd talk about libraries and what was happening with them and how you could make them better and more effective and what it meant to try to pull together a crew of great librarians and turn them loose.  During the day, I'd sit in on his meetings, I'd listen to all of the discussion.  The meeting would end and Bob would say, "So, now you've heard the situation.  What do you think we should do?"  And we'd talk through his decision making process so that I could begin to get a grasp of the impossible balancing act that is required to juggle all of the competing interests that come into play for almost every decision that a director ends up making on any given day.

During most weeks, not much happens to change the course of one's life.  On any given Sunday, you're pretty much the same person that you were the previous Sunday, and the contours of your life haven't shifted perceptibly.  Some weeks, though, are clear turning points, and this was one of them.  I remember, late on Friday, exhausted but happy, slumped in my seat on the metro, riding from National Airport up to my stop in Silver Spring, thinking back on the week.  "That's where I want to be.  I'm going to be the director of one of those libraries one day."   Six years later, I was.

In the years since, it's happened that I've been to Omaha many times.  While I was living in St. Louis, I would go up once or twice a year for the Regional Medical Library advisory meetings.  I've always had a great time, and it's been fun to watch the downtown area grow and develop into a really great conference location.   Even if it wasn't full of great memories for me, I'd be looking forward to the trip.

I've crossed paths in Omaha with a number of the women that I've loved, but the most important encounter was when I accepted Lynn's invitation to have dinner with her when we were both attending the Chapter meeting in 1993.  I'd been to group dinners that she'd hosted two or three times before, but this was the first time that it was just the two of us, and even though it was a business dinner and neither of us could have imagined how our lives would become intertwined, I think back on it as one of the finest evenings I've ever had at a conference.  We went to Vivace, a great little place in the Old Market.  We have a reservation there for dinner tonight.

In the many times that I've been back to Omaha these twenty-three years, I think I've only been back to the McGoogan Library once.  But I'll be there tomorrow night for the welcome reception.  Mark Funk will be there, too.  He was one of those incredibly bright and passionate young librarians that Braude had gathered around him a quarter-century ago.  Now he's the President of the Medical Library Association, coming to the meeting to give an update on the work and workings of MLA.  The reception will be loud and fun and there'll be lots of conversation and greetings of old and new friends and all the rest.  But I suspect that Mark will be doing some of what I'll be doing as well -- looking around the corners, seeing his younger self here and there, remembering what it was like when that building played such an important role in his life, and all of the changes that have happened since.

Debating OA at the Charleston Conference

I'm looking forward to my debate with Rick Anderson at the Charleston Conference in another few weeks.  We did a session at the North Carolina Serials Conference a couple of years ago and it was great fun.  Rick is one of the most creative thinkers in libraryland these days, he's got an entertaining style, and he's very quick on his feet.  I'd be happy to hear him speak on any topic in any venue, so when he contacted me early in the summer to see if I wanted to reprise our NC debate in Charleston I was quick to agree.

We titled the session, "Open Access: Good for Society, Bad for Libraries?" and sent in this abstract:

Resolved: As open access becomes more widespread, and more scholarly material becomes available either in open access journals or institutional repositories, libraries will become more marginalized in higher education institutions as funds formerly devoted to collections are diverted to other institutional priorities.

It's intended to be hyperbolic, of course, and in reality I don't think there's a tremendous difference in Rick's and my actual views on the issues.  But that's kinda the fun of doing this sort of a debate -- you can push a particular proposition further than you might otherwise and perhaps in doing so unearth some ways of looking at the issues that might otherwise remain unexplored.

As the inveterate librarian optimist, I think that expanding OA presents some great opportunities for librarians, but there are plenty of potential hazards along the way.   It's been a disappointment that there's been so little substantive discussion (at least that I've seen) about the possible consequences for libraries. 

One of the last manuscripts that I read as editor of the JMLA was an article by Karen Albert, Open access: implications for scholarly publishing and medical libraries, which was subsequently accepted and published by my successor.  It's a good survey of the state of the open access debate as of two years ago (it was submitted in August 2005) and I have no doubt that I would have taken it as well, but I might have negotiated a slight change in title because it doesn't really have much to say about "implications for medical libraries."

What Rick and I will try to do, in what I hope will be an entertaining and lively fashion, is explore some of those potential consequences, good and bad.  One thing that I am pretty sure of is that those librarians who see their primary role as building collections may want to consider signing on to the PRISM principles, 'cause they're in trouble.  In an OA world, "collection development" is an anachronism.

Of course, I've long maintained that building collections is simply a means to a greater end for librarians, so this doesn't trouble me much.  Nonetheless, the reality in many of our institutions is that the people who control the funds see the collection building function as primary as well, and it is going to be very tough to convince them that they need to continue to fund our other activities, and that we have critical contributions to make beyond purchasing or licensing content.

And it just occurred to me that I don't think that Rick and I have sorted out who is taking the pro and who is taking the con position in our debate.  I'd better give him a call....

Midwest & Midcontinental Chapter Meeting Blog

I've been enjoying following Conference Call 2007, the blog for the joint meeting coming up in Omaha at the end of the week.  I remember that just a few years ago, having a blog as part of the pre-conference preparations was a new and radical experiment, and they're still not as common as I might expect.    The MLA annual meeting sites have had one the last few years, but a quick look at the websites for the fall chapter meetings doesn't turn up any others.  But I'll bet that by next year most of them will be doing one.    And since I'm overseeing conference arrangements for next year's SCMLA meeting in Birmingham, I'm particularly keen on observing how Conference Call is being used. 

Clare's done an excellent job, and I'd recommend it to people who are thinking about running a pre-conference blog.  The travel tips that she's posted in the last few days are particularly useful, and the interview with Mark Funk that went up today is quite nice.    It's such a sensible and easy way to get last minute information to potential conference attendees.

Of course, there'll be plenty of live blogging from the conference itself.  I'd hate to miss the opportunity to hang out with all of those people in person, but for those who can't get to Omaha, it's going to be a great way to open the meeting up virtually.   And even those of us who are there won't be able to get to everything, so I'll be using it to keep me caught up while I'm there as well.

Making Music Means Listening

It may have been somewhere in The Bear Comes Home, that remarkable novel about music and life and transcendance, that I was struck by how important listening is when you're making music with other people.  Since my re-emergence as a performer some fifteen years ago I've had the opportunity to play with a remarkable range of players, and the best experiences are those where everybody is doing as much listening as they are picking out their own notes.

The Bearded Pigs are a challenge because there's eight of us going at once and with four guitars it'd be easy to be tripping over each other.  And since we're always playing without a net, and building our arrangements as we fly, the listening is critical.  When it works, as it does astonishingly often, it's a blissful thing. 

Liquid Prairie presented a similar challenge, because it was a big band as well, but much more aggressive and punk than the Pigs.  We played loud and fast and liked it messy, even though we spent much more time working out actual arrangements.  It was less improvisational that the Pigs, but that didn't make the listening any less necessary.

Duos are a very different thing.  My favorite musical experiences have come from playing with Ranger Dave, when we would step out from Liquid Prairie and perform together as the Prairie Dogs.  Ranger is an exquisite flat-picker and we blend in a way that I've never quite found with anybody else.  Several years ago, I was back in St. Louis for a visit, and Ferd hosted a party at his place.  I rode out early with Lonnie and Emily and when we got there found that Dave & Merry had already arrived.  I hadn't seen him in three years and other than maybe one brief phone conversation hadn't had any contact.  We shook hands, spent about five minutes on idle chit-chat, and he said, "So, you want to play some guitar?"  And we played just about nonstop for the next ten hours, sometimes just the two of us, but with the other musicians who came to that party chiming in as well.  If you'd walked in, you'd've assumed that Dave and I played together a couple of times a week, we were that tight.  And I know it'll be like that the next time I get a chance to play with him.

This coming Sunday I'll have a chance to play with one of the finest musicians I've ever had the privilege of listening to.  Kenny O and I will be holding forth during the "musical nightcap" at the Midcontinental/Midwest joint chapter meeting in Omaha.   I've known Kenny for a long time and I've had the chance to listen to him play in a wide variety of settings.  Personally, I don't know any musician who is so versatile.  I've seen him sit in with everything from a house blues band, to a resort lounge band, to a Caribbean steel drum band, to a very serious hard bop trio and every time he does, he finds the places to fit in and he makes the whole band sound better.  Musicians love having him sit in for just that reason.  He is an exquisite listener.

He and I did a set at a reception at a Midcontinental meeting in Sioux Falls a couple of years ago and it is one of my favorite duo memories.  I know we're going to have a fine time on Sunday.  I can't wait.

Means, Not Ends

Some years ago, I wrote an editorial for the Journal of the Medical Library Association in which I tried to make the point that libraries only exist to make other things possible.  In my particular case, it's the work of my university, but the principle remains, no matter what the library.  As long as the library is serving a need, it will be valued, but it has no value as an end in itself.

In part, the editorial was a response to some of the angst and anguish I see among my colleagues as they worry about the future of libraries and librarians.  Despite my own belief that this is a fabulous time to be a librarian, and that the future for librarians is quite bright, I recognize that I seem to be in the minority and doom and gloom prevail.

For example, consider a few posts from the past week (and it would be easy to find other examples):

In a post on the ACRLog, Brett Bonfield worries:

I love the profession because of the talented librarians around me who share my delight in assisting patrons. But, as a new academic librarian, I worry that our profession may retire before I do.

In Karen Schneider's farewell post to ALA Techsource, she sounds the alarm:

One thought is that some of us are worried that librarianship has a very narrow window of opportunity for survival--maybe a decade, maybe more, maybe a little less.

And again on ACRLog, StevenB comments on the announcement of a new taskforce that's been established to, once again, consider the place of academic libraries in higher education.  Hoping that the task force will provide us some clues, he says,

We need libraries that are highly integrated into and tightly connected to what happens in the classroom, both physical and virtual.

The sceptical contrarian in me reads this last quote and wonders, "Why?"

So much of the rhetoric in this vein is focused (unintentionally, I think) on us, on librarians, and on what we want and what we think we need.

Suppose Karen is correct, and suppose that we don't do the things that she, and those who see things the way that she does, think we ought to do.  Suppose that a decade from now, librarianship no longer exists as a profession.  No more library schools, no more librarians (except a few civil servants or tenured faculty who can't be fired).  No more new jobs, libraries shuttered and turned into dormitories, study halls and rest homes.

So what?

Does it happen because people truly no longer need us and what we can provide?  That, by using the internet wisely, by relying on the big technology companies (Amazooglesoft), and the smart publishers who've figured out how to organize and provide information directly to people while bypassing libraries, the people in our communities (be they universities, schools, companies, or society in general) are able to connect with the recorded knowledge that they need even more effectively than they could in the age of libraries?

If that's the case, wouldn't it be a good thing?

Sure, it'd be a bummer for those of us who like our library jobs, but it's not like we -- the actual individual persons -- are going to wink out of existence.  We'll figure out something to do.  And we may be nostalgic for what we've lost, but if society has figured out better ways to achieve what we used to help them achieve, aren't we all better off as a whole?  So I don't get to be a librarian anymore.  I don't have the option of being a blacksmith, or a riverboat captain, or the guy who delivers milk in glass bottles from a horse drawn wagon, either.

The point is, I don't think we're telling the right story, and I don't think we're worrying about the right stuff.  I don't want to hear anymore about what we need to do to make ourselves relevant so that our libraries can survive.  I want to hear people telling the stories about why we're essential, about how society can't thrive without us, about how students and teachers won't have the kinds of experiences that they deserve if we, well-trained, passionate, technologically-savvy librarians aren't working with them in the classrooms and the labs.  I don't want to hear about how "we need libraries that are well integrated..." if the "we" refers to librarians.   I don't care what we think we need.  I want to hear us explaining why the students and the faculty need us to be tightly integrated into what happens in the classroom.  I want to be told why a town without good public librarians is impoverished and why we're here to save the day.  I don't want to hear about what we need to do to be relevant -- I want to hear the story about why our communities so desperately need us.

If we can't tell that story, then we should wink out of existence, and a decade is longer than we deserve.