Do you remember Index Medicus? Ramblings of an old fool

Having passed the halfway mark of my career in science I realise that the scientific community is deeply divided – and those sitting on my side of the fence are dying out. I refer to the difference between scientists who are digital natives and those who are digital immigrants. What does this mean and what can we learn from each other before it is too late?

Nowhere has this had more bearing (perhaps) than in the way we perform background research. Scientific projects require extensive background research to obtain a thorough understanding of the field of study, enabling us to postulate theories, relate our findings to past observations and justify conclusions. Today, this task would be performed at the desk, and the pertinent papers downloaded instantly, in less time than it took me to write down these thoughts. In the pre-personal computer/internet era the way in which we sought this understanding was very different. 

In the 1980s, research required a different set of skills. You would begin by identifying the appropriate key words used to catalogue references in Index Medicus. Index Medicus epitomises research in the 20th century, founded in 1879, it remained in continuous print publication until 2004. Ultimately, it evolved into the National Library of Medicine and all references may now be accessed electronically via PubMed (for a brief history of the Index Medicus, click here). At my institution, a small London teaching hospital now long gone, Index Medicus was kept in the library. It was published as annual volumes, printed on paper that resembled hard (and rather ineffective) toilet paper of the time (Izal). Our volumes dated back to 1910 and were kept deep in the bowls of an oak-shelf lined testament to a bye gone age of luxurious learning(The Reading Room). To perform a literature search, you had to physically take each bound copy from the shelf, look up your key words, intuit from the article titles (recorded therein) whether they were pertinent to your topic and (if so) write down the details of the reference. You then repeated that task for the previous year…and the year before… and the year before… until you were satisfied you had searched far enough back into the literature. 

Once you had created your list of candidate articles you needed to find and review them. Depending on your project, you might have a list of a dozen references to review or, in the case of kicking off something like a PhD, more than a hundred. With your references scribbled on a pad or piece of scrap paper, you entered the library stacks… multiple floors of bookshelves, usually dimly lit, with the unmistakable odour of old books. You would need to find the appropriate shelving unit, pull each bound journal, locate the article and scan it to see if it contained information of interest. If it passed muster, you might add it to a wheeled cart and proceed to the location of the next journal. Since the stacks were often on multiple floors a geriatric elevator would normally be involved in the process. Attempting to save time you might have a brief look at the bound volume while standing by the shelf. This was considered poor library etiquette and might be greeted with hard stares from other users and, in extreme cases, a disapproving tut. Returning to your desk to review your booty you might, at times, find that the bound copy of a particularly important article was missing, or torn out of the journal by some academic miscreant. In these cases, you had to meet with the librarian to request that a copy be mailed (that is, using a stamp and a postman) from another library. 

With your overflowing cart in tow, you then proceeded to the photocopy room to make copies of your collected articles. This sometimes involved standing in a long queue, as others were also copying dozens of articles; in later years there was the added complication of completing copyright documentation. Once you had your copies it was considered good etiquette to return the various volumes to their place in the stacks – repeating your ‘stack zombie’ womble in reverse. The entire process took at least several hours – often days, or even weeks and might be performed at several different libraries. Then, simple as that, your initial literature review was complete. You were finally ready to read, synthesize and write.

The ability to search the entire medical literature, nearly instantaneously, from virtually any device, is clearly a quantum leap from the old method. It is a leap that we all now take for granted (and there is a brilliant free guide on search the literature available here). But was there anything valuable lost in the transition? Can any lessons be learned from the old ways? Possibly:

Planning: As outline the process of literature review was incredibly labour intensive, and could not be easily delegated a good plan was essential. The potential for lost time forced you to plan your literature review in advance detailing even the order in which you would visit certain shelves (as you would invariably run out of time and so you needed to triage your searches). Occasionally, you might get access to a medical librarian who could impart knowledge on the development of search strategies that were systematic, thorough and time efficient. Modern searchers should still invest in time to plan an important search in advance. Although time efficiency is no longer such an issue, it is still essential to be systematic and thorough.

Quality versus quantity: The modern search generates a tremendous volume of references. It is easy to use the first couple of key words that come to mind, cross reference them and generate what seems to be an plentiful supply of references. It is my opinion that the old search methods tended to produce a more thoughtfully assembled list (if only because you couldn't afford to photocopy everything). The old methods felt more like being a collector of stamps – where the collector, over a long period of time, searches for and acquires a particular piece that helps to augment the collection. It is possible that modern searchers would benefit from treating their efforts more like the assembly of a treasured collection.

Focus: The old search process was incredibly inefficient. There was a great deal of what might seem unproductive time, rifling through the Index Medicus and combing through the stacks. However, it was also a peaceful experience. The information came slowly, in bits and pieces, allowing time to contemplate its value and how it fitted to your developing theories. There was time for your mind to wander, and to ruminate on something you just read. If ideas tend to come to you in the shower, you would likely have the same experience in the stacks. Modern searchers would be well served by actively working to create quiet, reflective time, free of distractions.

The last 30 years have seen the way that we undertake our background research change beyond all recognition. Stack wandering has been replaced by elegant Boolean search strategies performed on multiple data platforms and generating comprehensive candidate articles to review and rank for relevance and importance. Younger researchers, born into these systems now adopt a learn-as-they-go approach, adapting their searching strategy ‘on the fly’. In the present age, with the reduction in the number of institutional libraries and explosion in the number of journals (to review) it would probably be impossible for today’s students to undertake the same research as we did 30 years ago. What we have lost in elegance has been replaced by efficiency. But for me there is one aspect of research that would not be possible today. In my regular searches in the library at Westminster Hospital in the 1980s I came across the medical librarian, Reinhard Wentz. A most wonderful fellow, he not only instructed me on how to use Index Medicus (the paper version) but also how to construct and perform elegant literature searches. More importantly, he also introduced me to several other researchers in the wider community who he knew to be working in a similar field. Thanks to those introductions I formed several life-long collaborations, friendships and publishing partnerships that would otherwise not have happened.

Dr Tim Hardman is Managing Director of Niche Science & Technology Ltd., a bespoke services CRO based in the UK. He is also Chairman of the Association of Human Pharmacology in the Pharmaceutical Industry and an occasional commentator on science, business and the process of drug development.