Vol. 9 No. 9 October 2001
The Blame Game
by Barbara Quint Editor, Searcher Magazine
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A young, healthy woman died this year because of a poor literature search. Whose fault was it? And, more important, is she the first and the last?

The details of the tragic event were covered in the national press, as well as a Newsbreak written by Eva Perkins and published on Information Today Inc.'s Web site ["Johns Hopkins Tragedy: Could Librarians Have Prevented a Death?,"]. (In next month's issue of Searcher, searcher Perkins will do a follow-up on that incident as part of a broader look at the subject.)

Basically, what happened, however, is that a healthy, 24-year old woman named Ellen Roche was given a large dose of hexamethonium as part of a project at Johns Hopkins University, one of the nation's most prestigious medical research establishments. The study was designed to show how healthy lungs coped with problems that asthmatics face. Apparently, the amount of hexamethonium administered led to lung and kidney failure. The principal investigator, Dr. Alex Togias, had conducted a literature search, but his search failed to find the literature that would have warned of the dangers from hexamethonium. Internal investigations at Johns Hopkins included attempts by other physicians to locate relevant literature. After the fact, medical librarians testing the same files searched by Dr. Togias, along with others, quickly found relevant literature online. Fortunately, at press time, we had heard that medical librarians had been added to the committee set up at Johns Hopkins to establish protocols for medical literature searching.

What went wrong? How can we prevent this from ever happening again? What lessons can this teach all of us, including those of us whose online searching only affects lesser issues, such as money, jobs, or living conditions, not to mention truth, justice, and the American way?

First, we must all step up with our hands in the air to take our share of the blame. All of us information professionals, physicians and medical researchers, database producers, and search services had to fail for this to happen. Professional searchers in this case, medical librarians apparently have not made the potential and actual value of their contribution to the quality of searches visible enough to their clients for the clients to recognize the risks of working without them. Physician researchers overestimated their effectiveness as literature searchers and didn't compensate for any defects in their searching abilities by using professional networking to double- and triple-check their research. Database producers failed to build files and interfaces that would have found the needed information.

Bottom line: All of us must recognize that we now live and will forever live in an end-user searching world. We searchers can neither expect nor demand that people come to us to perform intermediated searches to guarantee quality results. We can and should urge and warn clients. We can and should train clients in critical, effective searching techniques. But, ultimately, these are all stopgap measures. The true solution to the problem lies in building better end-user interfaces, finding the best data, and accommodating its delivery to the needs of our users. As professionals, we must also plan to share the work we do in creating better systems. Our professional ethics require that we do our best to make information safe for as many people as possible, even outside our own client constituencies.

The database industry must come to the same realization. The industry has to stop giving us "not what we need, but what they've got a lot of," in the immortal words of Eugenie Prime, Hewlett-Packard's library director. Dr. Togias used PubMed, the National Library of Medicine's Medline service aimed at end users. Apparently, it wasn't enough. Did he know that it takes two searches to push the search back to the mid-1960s? Some of the original research on hexamethonium came from the 1950s. Did he know that other access points for Medline, e.g., Medscape, take it back to 1960? Even if he did reach the entire file, would he have known that the earliest literature would require him to use the descriptor "Methonium Compounds"?

I doubt he knew all this. And the answer to the problem is NOT to teach him. One cannot expect the entire community of physicians, whether medical researchers or practitioners, to acquire the exotica of Medline searching. And what about the people searching the file who have no medical background, namely patients or their concerned friends and families?

The database industry must face the fact that its data is being and will be used by people who know little or nothing of the details of its construction. Nor will these end users take instruction in those details. The industry must identify what users seek when they approach the databases and arrange the data to meet those expectations.

NLM is not the only player on the line here. In the course of checking out hexamethonium myself for curiosity's sake, I fooled around with PubMed first. Then I turned to the PDR, the Physicians Desk Reference, a pharmacological bible for identifying negative side effects. Not possessing a copy of the printed text, I went online to Yahoo! and found a link to For a mere $9.95, I bought a month's worth of access and searched on hexamethonium. No results. I am not a medical or pharmaceutical searcher. So I poked around on the files included in my $9.95 and finally figured out that these sources covered mainly prescription drugs in use. Hexamethonium is mainly used experimentally. offered a set of databases like Medline, Toxline, etc., which required premium access where I might have found the broader literature sources and basic research. But once thrown into those files, I was back to where I started when it came to tools. would not pre-slice the premium files it did not produce to pull out the "adverse effects" or "side effects" or identify the experimental nature of drugs not included in its main reference works. But in this age of end-user searching, that is exactly what must do to maintain its effective role as an authority on negative side effects of drugs.

All database providers must concentrate on establishing what their users expect from them and then meet those expectations. The linkability of resources through the Web has made end users believe that everything is available if only the Web site they use has the will and wit to find it. Of course, we information professionals industry or consumer all know that this is a lot harder to do than it looks to amateurs. But this doesn't matter. We can no longer ignore those false expectations. We must build systems to meet them. Ultimately, the users naïve though they may seem by our professional standards are right. It is possible to link just about everything off the Web. There are no implacable technological barriers. It is a question of will and wit.

But first, we must know what our users expect. Many years ago, I wrote an editorial called, "Was It Good for You?" (Database Searcher, vol. 5, no. 7, July-August 1989, pp. 4-6; available in Gale Group's Trade and Industry database on Dialog, Factiva, LexisNexis). In that editorial, I chided the online industry for failing to have feedback forms attached to every search result, forms that could help the industry assess user satisfaction and success in dealing with their products. This is no longer a matter of improving customer relations and tweaking system design. This has now become essential for database providers to insure the effectiveness of their systems. Professional searchers should design these feedback mechanisms into intranet interfaces, collect and analyze the input, and then pressure vendors to respond, acting both as representatives of their individual institutions and as a profession through working and sharing with colleagues to present a united front.

It's no longer just a matter of getting our money's worth. It's now a matter of life and death. And now when it comes to the blame game, if any of us are not part of the solution, we're part of the problem. 
Barbara Quint's e-mail address is
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