Mr. Chairman, members of the Committee. It is a pleasure to be here this
morning to tell you about how the National Library of Medicine selects material for its
indexes and databases. This subject goes to the heart of what the NLM does and I am glad
to have this opportunity to explain our method of operation.
The National Library of Medicine has been indexing the medical journal literature for
exactly 120 years. The first Index Medicus was published in 1879. Dr. John Shaw
Billings, who was the Director at that time, used a laundry basket to take medical
journals home with him to be indexed in the evening. We have pictures of him sitting
contentedly in his living room marking each article with subject headings. I am happy to
say that since then we have introduced a few modernizations in our indexing methods.
Today the National Library of Medicine receives 22,247 periodical publications, of
which some 14,000 could be labeled "journals."Of these, we index 3,982 for MEDLINE, our primary
database of journal article references and abstracts. The published version of MEDLINE,
the Index Medicus, now runs to 18 volumes and 35,000 pages in its annual bound
form. Library shelves (and budgets!) around the world are finite. The electronic MEDLINE
database contains 11 million references from the sixties to today and increases by more
than 400,000 entries each year. One of our goals in accepting this relatively high volume
of new entries each year is to include publications that present significant differences
in opinion on important topics, and to reduce the chance of missing important new
discoveries. All journals, whether included in Index Medicus or not, are available
to be read or copied by library patrons, whether on site in Bethesda or at a far away
library.
The Selection Process
The users of MEDLINE and Index Medicus are many and varied, including
researchers, health care practitioners, educators, Administrators, and students, in this
country and abroad. Now that MEDLINE is easily accessible via the World Wide Web, we also
count the general public among our audiences. Our database, therefore, must reflect this
diversity and include journals in many disciplines related to the health sciences broadly.
Because much important research is done in other countries, and published in languages
other than English, our scope must be worldwide.
To select the journals that NLM will index, the Library depends on a Committee of
outside experts, the Literature Selection Technical Review Committee. The Committee, which
meets three times a year, is composed of medical scientists and Administrators, health
practitioners, and librarians. At each of their meetings they review about 120 new titles
and others that are nominated by publishers, health professionals, and librarians.
The Committee looks to see that a journal's
contents are predominantly on core biomedical subjects. Most journals are indexed cover to
cover. Most important, they assess the scientific merit of a journal's contents and consider its contribution to the
subject field. The reviewers look also at the quality of the editorial processesCfeatures that give assurance as to the objectivity,
credibility, and quality of the contents, for example: external peer review of articles,
adherence to ethical guidelines, retractions and correction of errors, and dissenting
opinions. Both print and electronic journals are considered. Of the titles reviewed at
each meeting, the reviewers generally recommend about 20 percent for indexing. Sometimes
the Committee feels it needs the advice of additional experts in special areas. In fact,
this is what happened in the area you are especially interested in, Alternative Medicine.
Coverage of Complementary and Alternative Medicine
In September 1997, Dr. Wayne Jonas, then head of the NIH National Center for
Alternative and Complementary Medicine (CAM), was invited to the NLM Board of Regents
meeting to talk about the work of his organization. After that meeting the Center compiled
a list of 695 journals that published most of the articles in the field. NLM then sent the
list to 14 organizations specializing in complementary and alternative medicine for their
recommendation. (A list of these organizations is in Appendix A.) Of the 695, it was found
that the NLM already held in its collection 79 percent of the titles. Six more titles were
added to the Library's collection as a result of
the review.
It should be noted here that many articles on various alternative therapies are
published in traditional journals. Just last fall, for example, the Journal of the
American Medical Association devoted most of an issue to alternative medicine. But if
one considers journals that specialize in complementary and alternative medicine, there
are 74 now being indexed in MEDLINE. To give this figure some meaning, there are 38
journals that specialize in ophthalmology, 21 in gastroenterology, and 26 in orthopedics.
That NLM's coverage of complementary and
alternative medicine is substantial may be seen in the fact that the National Center for
Alternative and Complementary Medicine has a reference database called CAM Citation Index
(CCI) of 180,000 articles in that field; all are from MEDLINE.
I understand that this Committee is interested specifically in chelation therapy. There
is in fact much material in MEDLINE on this subject. The term CHELATING AGENTS has existed
in our controlled indexing vocabulary since 1966, and many specific agents are also
included. The term CHELATION THERAPY was introduced in 1990. Searching MEDLINE broadly
under the several specific chelating agents results in 59,632 references being retrieved.
If one narrows the search to the therapeutic use of chelating agents in CARDIOVASCULAR
DISEASES, there are 762 references.
I have sought to accomplish two things in my testimony this morning. First, I wanted to
shed some light on how we at the National Library of Medicine select the journals we
index. Second, I hope I have demonstrated to your satisfaction that there is much material
in MEDLINE relating to complementary and alternative medicine, and that we are always
receptive to considering new journals. We believe that the integrity of MEDLINE demands
continued emphasis on quality.
Appendix A
Complementary and Alternative Medicine Review Organizations
The Complementary Medicine Program at the University of Maryland School of Medicine
The Center for Addiction and Alternative Medicine Research (Minneapolis)
The Center for Complementary and Alternative Medicine Research in Asthma, Allergy and
Immunology at the University of California, Davis
A specialist in chiropractic medicine
The Stanford Center for Research in Diseases Prevention
Projekt Muncher Model at Ludwig-Maximullism-Universitat, Munich, Germany
The Center for the Studies of Complementary and Alternative Therapies at the School of
Nursing, University of Virginia
The Center for Alternative Medicine Research, Houston
The AIDS Research Center at Bastyr University, Bothell, Washington
Kessler Research, West Orange, New Jersey
The Center for Alternative Medical Research at Beth Israel Deaconess Medical Center,
Boston
The Research Council for Complementary Medicine, London
The Center for CAM Research in Women's Health, Columbia University
The Institute of Information on Traditional Chinese Medicine, Beijing
