The Miles Conrad Lecture

The Miles Conrad lecture has been a highlight of NISO conferences, and NFAIS meetings. It was established to honor the memory of G. Miles Conrad who was director of Biological Abstracts, (now BIOSIS Previews). In 1957 he organized a meeting of 14 abstracting and indexing providers to discuss the effects of government investments in science following the launch of Sputnik, and this meeting led to the formation of NFAIS in 1958. The Miles Conrad Lecture began in 1964 following Conrad’s death. This year’s Miles Conrad Award was presented to Dr. Patricia Flatley Brennan, Director of the National Library of Medicine (NLM). Dr. Brennan received her Bachelor’s degree in nursing from the University of Delaware, and her Master’s degree from the University of Pennsylvania. She then entered clinical practice, studied the connections between nursing and information systems, and received her Ph.D. degree in industrial engineering from the University of Wisconsin-Madison. In 2016, she became the first woman, first nurse, and first industrial engineer to become Director of NLM.

Dr. Patricia Flatley Brennan Dr. Brennan’s Miles Conrad lecture was entitled “The Role of a Library in a World of Unstructured Data”: Libraries will persist, but the digital objects that must be connected will constantly change, so we will have jobs for a long time. NLM cannot operate alone. We must partner with publishers, authors, distributors, technology companies and our stakeholders. Connecting people with information is a critical and important role in our society, and standards are an important part of that because they bring order to complex information.

The Mission and History of NLM

NLM focuses not only on acquiring, collecting, preserving, and disseminating scientific communications, but also on the tools to ensure that it is available. Here are some of the major highlights in its history:

Serving Science and Society Since 1836

NLM’s collection began on a shelf in a field surgeon’s tent and is now located on the campus of the National Institutes of Health (NIH). Dr. AB Lindberg, Dr. Brennan’s predecessor and also a Miles Conrad Lecturer brought a strong focus on innovation into NLM, which developed into the 21st Century library of today.

NLM Today

NLM is the world’s largest medical library. It has 8,000 points of presence in the country and answers a million inquiries a day which gives it access to communities. PubMed has 23 million citations. Here is a photo of the NIH campus.

Obviously, COVID has changed the nature of research at NIH. Quick planning of research quickly requires a balance between science and society. NLM has learned much from the COVID pandemic: • Medical information must be complemented by an understanding of the person. • Community norms and privileges intersect with research principles and federal requirements. • Research at the speed of a pandemic goes best when it leverages existing community investments and established research assets, including standards. • We must improve the reproducibility and rigor of research to accurately characterize the experiences of all people in the pandemic and promote a better understanding of the clinical experience by leveraging information. Terminology and messaging standards play an important role. NLM has spearheaded new forms of scientific communication: preprint pilots, a public health emergency COVID initiative in which more than 50 publishers participated, making PubMed articles available without charge, and a global health events web archive which contains over 12,000 items of born-digital resources.

NLM has 3 pillars in its strategic plan: accelerating discovery and advancing health through data-driven research, reaching more people in more ways through enhanced dissemination and engagement, and building a workforce for data-driven research and health. NLM is a research organization with an intramural program having branches focusing on computational biology and computational health research, and an extramural national research program. Much of its research focuses on text mining, AI and machine learning, search, retrieval, and presentation of literature. Studies of search results showed that a typical search could retrieve from 20 to 40 pages of results, but usually only the first few pages are read, so efforts were made to list the best results first. Some research in the extramural program goes into the community: • Google Street View images were examined to characterize built-up environments and determine health outcomes. • The Bridge2AI project promotes the widespread adoption of AI in complex challenges. • AIM-AHEAD is a program to advance health equity and researcher diversity. • The DSI-Africa program will harness data science for health discovery and innovation in Africa and develop solutions for the continent’s most pressing medical and public health problems.

Products and Services

NLM is known as a provider of trustworthy health information resources and is the central point of data and information at NIH. It houses and creates high-value genomic, bibliographic, and literature repositories, health data terminologies and standards, and value sets of clinically meaningful indicators that allow hospitals to do quality management and quality improvement. NLM serves millions of people 24 hours a day 7 days a week. It cannot rest even if it has a drop in funding or a sequestration because the world needs it. It uses standards to make data FAIR, promotes access to controlled data sets, and conducts research developing and refining new ways to interrogate data. NLM’s products are widely known: • Clinical trials.gov has data on over 400,000 trials from 50,000 studies. • PubMed and PubMed Central (PMC) are literature repositories. PubMed has over 30 million citations, and PMC has 7 million full-text articles. PMC’s holdings grew over 300% in a 9 year period. • dbGaP is a database of genotypes and phenotypes. • GenBank supports fully computed and annotated gene sequences. • NLM had the first SARS-CoV-2 sequence available within a month of the first case appearing in China. • NLM’s Sequence Read Archive has over 30 petabytes of data and is the largest publicly available repository of high throughput sequencing data. It is now available on the cloud. NLM builds some standards such as RxNORM which provides normalized names for clinical drugs, but it more often curates and disseminates standards and promotes their use in the research community. Its Medical Subject Headings (MeSH) are widely used to classify and organize the literature. Similar functions for clinical terms include Standard Nomenclature of MEDicine (SNOMED), Logical Observation Identifiers Names and Codes (LOINC), and RxNORM.

The MEDLINE 2022 upgrade is designed to make processes more efficient and responsive by automating collection and curation. MeSH citations will appear in PubMed within 24 hours of being indexed, and the automated indexing algorithm is being continuously improved. The most significant challenge today to NLM as a library is novel unstructured data. We will need to think about standards in a new way in the future; they are how we make sense of phenomena. NLM believes that its primary purpose is to enable knowledge building based on core data. Its responsibilities are and will continue to be the acquisition, organizing, preservation, and dissemination of information relevant to health and biomedicine. Partnerships and engagements are necessary to accelerate discovery and make resources available, which cannot be done alone by NLM. It is challenged to help people find meaning from data that is driven by users’ needs.

How do we create standards based on ephemera and make them meaningful to more people? We cannot use the same structures that we have used in the past. The answer to a question is one hallmark of a trusted resource. We must evaluate the impact of algorithms on search to be sure we are remaining true and trustable. Trust must rely not only on the correctness of an answer but also on the strategies used to arrive at it.

Dr. Brennan writes a blog each Wednesday morning called “View from the Mezzanine” that covers many of the issues she addressed in her lecture.