Skip to Content
United States National Library of Medicine National Institutes of Health

The Bowker Annual Chapter on NLM, 2003

National Library of Medicine
8600 Rockville Pike, Bethesda, MD 20894

Phone: 301-496-6308, 888-346-3656
Fax: 301-496-4450

E-mail: publicinfo@nlm.nih.gov
World Wide Web: http://www.nlm.nih.gov

Robert Mehnert, Director
Office of Communications and Public Liaison

The National Library of Medicine (NLM), a part of the U.S. Department of Health and Human Service's National Institutes of Health in Bethesda, Maryland, is the world's largest library of the health sciences. NLM has two buildings with 420,000 total square feet. The older building (1962) houses the collection, public reading rooms, exhibition hall, and library staff and administrative offices. The adjacent 10-story Lister Hill Center Building (1980) contains the main computer room, auditorium, audiovisual facility, offices, and research laboratories.

The Library's collections today number more than 6 million books, journals, audiovisuals, and historical materials. From primary responsibility for a physical collection, however, the Library's mission has been expanded over the years and today encompasses:

The Library's constantly expanding collections and extensive responsibilities (and rapidly growing staff) in the area of molecular biology have combined to create great pressure on its existing physical plant. Plans have been drawn up for an expanded facility and NLM is hopeful that relief from overcrowding is in sight.

Databases

The Library's major database, MEDLINE®, contains more than 12 million references and abstracts from the worldwide journal literature from early 1960s to the present. The database expands at a rate of about 500,000 citations a year. Available free on the Web, MEDLINE is searched using NLM's unique access system, PubMed®. Each day the database is queried more than 1.3 million times by 220,000 unique users. This, when combined with the use of other NLM databases, amounts to more than a half billion searches per year, making them the most widely used medical information resource in the world. The Library provides many additional information resources through its Web site-for example, unified access to its catalog holdings, a database of historical images, and a variety of information services in such areas as toxicology, environmental health, and molecular biology.

To make MEDLINE/PubMed even more useful, NLM has introduced links between the references and publisher Web sites so users can retrieve the full text of articles. Today, more than 3,400 of the 4,600 publications indexed for the database have such links. Where links are not available, PubMed allows libraries to display information about print holdings available to their institutional users. Users far from a library can use the feature known as "Loansome Doc®" to order an article from a library in the National Network of Libraries of Medicine®. A recent improvement is a text version of PubMed for users who require special adaptive equipment to access the web. This has had the additional benefit of making the system much more friendly for those using hand-held devices.

The NLM is extending its reference databases back in time. "OLDMEDLINE" contains hundreds of thousands of citations to articles from international biomedical journals published from 1957 through 1965. There is important research in these articles, on smallpox and tuberculosis to take just two pertinent examples, and to have this information available through online searching is a great boon to today's scientists and public health officials. NLM has also converted to electronic form the mammoth Index-Catalogue of the Library of the Surgeon General's Office, the premier resource for the history of medicine in the 19th century.

Another NLM web information service, intended primarily for the general public, is MedlinePlus®, introduced in October 1998. This is an easily consulted and authoritative source of health information from the NIH and other reliable organizations. MedlinePlus usage has been growing rapidly, doubling in the past year to a rate of more than 120 million page hits per year. The main features of MedlinePlus: almost 600 "health topics," from Abdominal Pain to Yeast Infections, consumer-friendly information about thousands of prescription and over-the counter drugs, an illustrated medical encyclopedia and medical dictionaries, directories of hospitals and health professionals, a daily health news feed from the major print media, 150 interactive and simply presented tutorials (with audio and video) about diseases and medical procedures.

The MedlinePlus health topics also have links to a database of ongoing and planned scientific studies-ClinicalTrials.gov. Developed by NLM for the National Institutes of Health, this database is a registry of some 6,600 protocol records sponsored by NIH and other Federal agencies, the pharmaceutical industry, and nonprofit organizations in over 70,000 locations, mostly in the United States and Canada, but also in some 70 other countries. ClinicalTrials.gov includes a statement of purpose for each study, together with the recruiting status, the criteria for patient participation in the trial, the location of the trial, and specific contact information. The clinical trials site hosts over 8,000 visitors daily.

The NLM has been working with the National Institute on Aging to create NIHSeniorHealth.gov. Accessible from MedlinePlus, the new site contains information in a format that is especially usable by senior citizens. At present NIHSeniorHealth.gov contains information on topics like Alzheimer's and exercise for older adults, but it will soon be expanded to include more topics of special interest to seniors as other NIH institutes contribute to it. NLM is working on adapting special software that would allow the visually impaired to exercise control and hear Web pages read to them. This would also be a boon to some senior citizens.

Like MEDLINE, MedlinePlus is a constantly evolving system. Links are checked daily and new health topics added weekly. In the days following September 11, entries on anthrax, smallpox, and other bioterrorism-related subjects were quickly compiled and for a while were even more heavily accessed than cancer information. A Spanish-language version of MedlinePlus was introduced in September 2002. In 2003 MedlinePlus will carry links to local resources in North Carolina. "NC Health Info," as it is called, was created at the University of North Carolina with funds provided by NLM. It may serve as a prototype for other states that want to provide local links to Web sites for hospitals, physicians, nursing homes, support groups, health screening clinics, and other services.

Another information resource for the public is the Profiles in Science Web site. This uses innovative digital technology to make available the manuscript collections of prominent biomedical scientists. The documents have been donated to NLM and contain published and unpublished materials, including books, journal volumes, pamphlets, diaries, letters, manuscripts, photographs, audio tapes and other audiovisual resources. Presently the database features the archives of nine prominent American biomolecular researchers. Added this year were Linus Pauling and Donald Fredrickson. NLM also recently made available the Reports of the Surgeon General (1964-2000).

A new offering by NLM in 2002 is Tox Town. This is a Web site (toxtown.nlm.nih.gov), intended for a general audience, that uses color, graphics, sounds, and animation to add interest to learning about connections between chemicals, the environment and the public's health. In its first release, Tox Town gives information about eight chemicals and eleven locations (for example, home, office, school, park) in an imaginary small town. Among the chemicals are asbestos, lead, and radon. Plans are to include more chemicals and add new scenes, such as an urban community and a farming region.

Outreach

A major challenge to the Library is in reaching both the scientific community and the general public to let them know that the tax dollars devoted to biomedical research has resulted in information that can be applied to clinical care and to the general health of the public. To help bring this about, NLM has funded hundreds of outreach projects with members of the National Network of Libraries of Medicine. The network was created by NLM in the sixties to ensure that all American health professionals had good information services available to them. Today it includes nearly 5,100 regular and affiliate members. The regular members are libraries with health sciences collections, primarily in hospitals and academic health sciences centers; the affiliate members, including some small hospitals, public libraries, and community organizations, provide health information service, but have little or no physical collection of health-related literature.

Eight Regional Medical Libraries are funded by NLM as the backbone of the National Network of Libraries of Medicine. In 2002, NLM and these eight libraries decided to define uniform national measures of the network's success in reaching two outreach objectives: (1) improving health information access via public libraries and (2) connecting local public health departments to health information services. Individual outreach projects will continue to have project-specific evaluation measures. In addition to basic contracts with the eight RMLs, NLM funds subcontracts for four centers that serve the entire network: the National Training Center and Clearinghouse at the New York Academy of Medicine; the Electronic Funds Transfer System at the University of Connecticut; the Outreach Evaluation Resource Center at the University of Washington; and the National Outreach Mapping Center at Indiana University in Indianapolis.

Today, many network members are also serving the general public, and the NLM is supporting them as they work with their public library counterparts and with churches, municipal and state agencies, and other organizations that have frequent contacts with consumers. They will provide new electronic health information services for all citizens in a community, from middle schools serving low income and educationally underserved students to shopping malls and senior centers. There are special outreach projects to underserved groups such as Native Indians, isolated rural populations, and African-American communities.

Exhibitions

Late in 2002, NLM installed Dream Anatomy, an exhibition focusing on anatomy, medicine, and the artistic imagination. The exhibition, which run through July 2003, features rare anatomical books and illustrations from the NLM collection, as well 20th and 21st century art, holograms, and interactive displays that draw upon the Visible Human datasets. NLM is pleased by the amount of publicity generated by this exhibition: the New York Times, Washington Post, Lancet, and Journal of the American Medical Association, among others, have carried extensive stories about it. The next major exhibition at NLM will be Changing the Face of Medicine: the Rise of America's Women Physicians, now scheduled to open in the fall of 2003.

Frankenstein: Penetrating the Secrets of Nature, a popular exhibition created by and originally displayed at the NLM several years ago, has been recreated in a traveling version that the American Library Association is showing around the country. Funding for this was received from the National Endowment for the Humanities. ALA solicited proposals from public, academic, and medical libraries interested in displaying the exhibit and was surprised by the number of applications. Four copies of the traveling exhibit will be shown at more than 80 libraries, beginning in October 2002. Hosting libraries will present a variety of public programs related to science, medicine, and the humanities in conjunction with the exhibit. Rutgers University Press published the catalogue of the exhibition.

NLM worked with the British Library to add Vesalius's Humani Corporis Fabrica as the second medically significant book to "Turning the Pages," a remarkable program developed by the British Library that uses computer-animation, high-quality digitized images, and touch-screen technology to simulate that action of turning the pages of rare books. Both the original work by Vesalius and the "Turning the Pages" version, augmented with interactive links to additional related resources such as the Visible Humans, are featured in the Dream Anatomy exhibition. "Turning the Pages," with Elizabeth Blackwell's A Curious Herbal and De Humani Corporis Fabrica, is on display in the NLM Visitors Center and also in the History of Medicine Reading Room. Several more rare volumes will follow. It makes works come alive that would otherwise never be seen by the public.

Research and Development

The National Library of Medicine remains at the cutting edge of research and development in medical informatics-the intersection of computer technology and the health sciences. It does this both through a program of grants and contracts to university-based researchers and through R & D conducted by the NLM's own scientists. The Library was a leader in the High Performance Computing and Communications initiative of the nineties and is presently working to ensure that the health sciences are prepared to take full advantage of the Next Generation Internet. The Library has two R & D components: the National Center for Biotechnology Information and the Lister Hill National Center for Biomedical Communications. Research and development conducted by the Library has resulted in many advances in biomedical communications-the original development of MEDLINE in the late 1960s, document preservation techniques, innovative methods of providing copies of journal articles to remote users, development of a Unified Medical Language System®, sophisticated databases and algorithms for searching gene sequences, and projects related to telemedicine and to the development of an Electronic Patient Record.

One project that has been much reported in the public media is the Visible Human Project-the creation of two immense datasets (50 gigabytes) data sets, one male and one female, of anatomical MRI, CT, and photographic cryosection images. These data sets, licensed to more than 1,700 individuals and institutions in 43 countries, are being used in a wide range of educational, diagnostic, treatment planning, virtual reality, artistic, mathematical, and industrial applications. A Web site version of a head and neck atlas titled "Functional Anatomy of the Visible Human: Version 1.0 The Head and Neck," has been developed with support by the NLM. The atlas is designed in educational modules covering the topics of mastication, deglutition, phonation, facial expression, extraocular motion, and hearing. A number of tools have been developed for using the atlas, including basic anatomic structure identification, a model builder, orthogonal plane browser, and links to the PubMed Web site for automatic key word searches of the literature.

Another project, this one in the area of telemedicine, is the National Digital Mammography Archive that NLM has funded as part of the Next Generation Internet initiative. Under this program, doctors at four university hospitals can retrieve and view digital mammography images online. The hospitals each hope to save up to $1 million a year by not having to depend on film. If this project succeeds, the hope is to spread it to other hospitals throughout the nation. Because the digital images are large files, the total volume of data being transferred would be staggering and would constitute a real challenge for "next generation" data networks.

The newest initiative is to develop a "Scalable Information Infrastructure." The purpose is to encourage the development of health-related applications of scalable, network aware, wireless, geographic information systems, and identification technologies in a networked environment. The initiative focuses on situations that require or greatly benefit from the application of these technologies in health care, medical decision-making, public health, large-scale health emergencies, health education, and biomedical, clinical and health services research. Projects must involve the use of testbed networks linking one or more of the following: hospitals, clinics, health practitioners' offices, patients' homes, health professional schools, medical libraries, universities, medical research centers and laboratories, or public health authorities. NLM is now reviewing a number of applications for support and will make awards in 2003.

In the area of molecular biology, NLM's National Center for Biotechnology Information creates and maintains systems for storing, analyzing, and retrieving information on molecular biology and genetics. The Center produces the largest database of public DNA sequence information, GenBank. This database is growing rapidly with contributions received from scientists around the world and now contains more than 15 million sequences and more than 14 billion base pairs from over 100,000 species; it is accessed on the web 200,000 times each day by some 50,000 researchers.

In 2002 the NCBI introduced a new, clearly written "About NCBI" section to its home page. This is noteworthy because, at a level that can be understood by a lay person, the site introduces researchers, educators, students, and the public to the Center's role in organizing, analyzing, and disseminating information in the rapidly growing fields of molecular biology and genetics. One popular section is "A Science Primer," which introduces genome mapping, molecular modeling, and other topics. Another is the "Model Organism Guide, which explains key NCBI model organism resources, mammalian and non-mammalian. "Databases and Tools" gives a concise descriptions of all publicly available NCBI resources.

Administration

The director of the Library, Donald A.B. Lindberg, M.D., is guided in matters of policy by a Board of Regents consisting of 10 appointed and 11 ex officio members. Appointed as Regents in 2002 were Dr. Ernest L. Carter of Howard University, Dr. A. Wallace Conerly, Sr. of the University of Mississippi, and Dr. Thomas Detre of the University of Pittsburgh. The most urgent subject discussed by the Regents continues to be the need for more space for the Library's increasing collections and the expanding programs associated with the National Center for Biotechnology Information.

Table 1 / Selected NLM Statistics*
Library Operation Volume
Collection (book and nonbook) 7,255,000
Items cataloged 21,400
Serial titles received 20,350
Articles indexed for MEDLINE 502,000
Circulation requests processed 711,900
For interlibrary loan
373,300
For on-site users
338,600
Computerized searches (all databases) 382,000,000
Budget authority $283,792,000
Staff 684

*For the year ending September 30, 2002

Last updated: 18 August 2003
First published: 18 August 2003
Metadata| Permanence level: Permanent: Stable Content