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Statement by Donald A.B. Lindberg, M.D.
Director, National Library of Medicine
National Institutes of Health
U.S. Department of Health and Human Services

Before the House Committee on Government Reform
Wednesday, March 10, 1999


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


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