E.

Garfield,
the Surgeon
Garfield, E.
E. "Can
"Can the
Surgeon Keep
Keep Up
Up With
With New
New Scientific
Scientific Information?"
Information?" June,
June, 1966
1966 ..
Presented
the Third
the school
medicine of
the
Presented at
at the
Third Annual
Annual Alumni
Alumni Conference
Conference of
of the
school of
of medicine
of the
University of
University
of Pennsylvania,
Pennsylvania, Philadelphia,
Philadelphia, PA.
PA. June
June 17,
17, 1966.
1966.
Can t h e Surgeon Keep up with New S c i e n t i f i c Information?*
by
Eugene G a r f i e l d , F h . D . , R e s i d e n t
I n s t i t u t e f o r S c i e n t i f i c Information
325 Chestnut S t r e e t
Philadelphia, Pa. 19106
The t i t l e of this t a l k reminds m e of t h e o l d c l i c h e '%Ben d i d you s t o p
beating your wife?"
If you claim that t h e surgeon cannot keep up r i t h t h e
growth of knowledge, then you are merely r e p e a t i n g a truism--a
s t a t e of
a f f a i r s , I might add, t h a t has been prevalent ever since t h e i n v e n t i o n of
movable type.
-
If you claim that t h e surgeon can keep up. then you are deny-
l u g , by implication, t h a t t h e problem is serious.
Undoubtedly t h e problem of s c i e n t i f i c information i s a s e r i o u s one.
Most
of you have suffered from t h a t special bibliographic d i s e a s e c a l l e d "piles"-p i l e s of j o u r n a l s that is.
Almost every week I v i s i t a medical colleague who
has s t a c k s of unread j o u r n a l s on his o f f i c e c h a i r s o r tables.
A f e w who can
a f f o r d t h e luxury of storage space and cost of shelving have (bound) volumes
of hundreds of books and j o u r n a l s that have never been cracked.
But don't you f i n d i t s t r a n g e , i n t h i s age w h e r e information abounds plent i f u l l y , t h a t whenever you want t o knoar sanething. you c a n ' t f i n d it?; o r
-
whenever you want t o f i n d t h a t a r t i c l e you once r e a d , you can't remember e x a c t l y
where?; o r somehow you missed an a r t i c l e only t o have one of your f r i e n d s t e l l
you about i t a year t o o l a t e ?
This f e e l i n g , o r s i t u a t i o n , which I have described
elsewhere a s bibliographic poverty i n t h e midst of information plenty ( l ) , is
not an i s o l a t e d one.
*Presented a t t h e Third Annual Alumni Conference of t h e School of Medicine of t h e
University of Pennsylvania, Philadelphia, Pa.; June 17, 1966.
- 2 -
However, I hope I can give you cause t o f e e l that t h e s i t u a t i o n is not comp l e t e l y a s bad a s w e f e e l o r a r e sometimes l e d t o believe.
Nevertheless,
p a r t i c u l a r l y i n t h e case of c l i n i c a l s c i e n t i s t s , t h e r e a r e r e a l problems which
have nothing t o do with the growth of s c i e n t i f i c knowledge per se but which a r e ,
i n f a c t , a f u n c t i o n of t r a i n i n g and motivation.
Undoubtedly you have heard that there are supposed to be some 50,000 scient i f i c j o u r n a l s published i n t h e world today which c o n t a i n s e v e r a l m i l l i o n papers
per year (2).
This is sheer .poppycock.
about 2,500 medical journals.
-
The w e l l known Index Medicus now covers
Truelson r e c e n t l y reported t h a t less than 1/3 of
these a r e ever requested a t Yale Medical Library (3).
Of these, in my opinion,
not more t h a n 200 could be s e r i o u s l y c l a s s i f i e d a s s i g n i f i c a n t .
But even assuming t h a t a l l 2,500 a r e of value t o someone, somewhere-these j o u r n a l s only account f o r about 150,000 medical papers per year.
an order of magnitude lower than t h e multimillion f i g u r e c i t e d .
consider not only medicine but a l l of science and technology.
This is
However, l e t ' s
There a r e s t i l l
only a few hundred r e a l l y s i g n i f i c a n t j o u r n a l s published i n t h e e n t i r e world.
Let us use a s a major c r i t e r i o n of s i g n i f i c a n c e , among o t h e r s , t h e number
of papers published.
I n Figure No. 1, you see a t a b l e l i s t i n g t h e f i r s t 90
journals out of 1147 covered i n t h e 1965 Science C i t a t i o n Index.
j o u r n a l s publish more than a 1000 items per y e x .
items per year.
L e s s t h a n 20
L e s s than 100 publish 500
And t h i s l i s t already includes most of t h e medical jouriials
t h a t i n s t a n t l y cone t o mind when ?reparin::
an off-the-cuff
l i s t of t h e world's
most s i g n i f i c n n t journals.
I don't intend t o labor t h e point w i t h a l o t of s t a t i s t i c s .
Xowever,
Figure No. 2 graphically i l l u s t r a t e s t h i s information and demonstrates a fundamental c h a r a c t e r i s t i c of s c i e n t i f i c puublication--namely,
t h a t a small percentage
- 3 -
of j o u r n a l s accounts f o r a l a r g e percentage of everything published.
Journal
s t a t i s t i c s a r e meaningless u n l e s s one keeps i n mind c h a r a c t e r i s t i c s such a s
Lotka's Law (4) or Bradford's Law ( 5 ) .
Be that a s i t may, there a r e only a f e w hundred s i g n i f i c a n t , and probably
about 2 , 0 0 0 important, j o u r n a l s which produce c l o s e t o 300,000 s c i e n t i f i c a r t i c l e s per year--about
individual reader.
1/3 i n medicine.
This may be s m a l l c o n s o l a t i o n t o t h e
However, for any specific i n d i v i d u a l , there is a minute
f r a c t i o n of t h i s information which is of immediate o r even p o t e n t i a l concern.
How does he get a t i t ? W e l l , t h e r e a r e a number of t h e o r i e s on t h i s , and I
want t o expose you t o a f e w today.
Several y e a r s ago, e.g., Dr. Ethan Allen Brown published a paper i n
Medical Economics e n t i t l e d "How to G e t t h e Meat o u t of 700 Journals."
(6)
I have taken t h e l i b e r t y of enclosing a copy of t h i s paper i n your k i t s .
There a r e thousands of medical s c i e n t i s t s i n t h e world who r e l y on t h i s method-scanning c o n t e n t s pages--to
keep up w i t h t h e l i t e r a t u r e .
(FiguI-88 Nos. 3A and 3B)
Current Contents is used by i n d i v i d u a l surgeons engaged i n r e s e a r c h , both
c l i n i c a l and experimental.
Current Contents is e s p e c i a l l y used by surgeons
who are m e m b e r s of m u l t i - d i s c i p l i n a r y research teams who must, of n e c e s s i t y ,
make a broad sweep of the e n t i r e s c i e n t i f i c l i t e r a t u r e - - n o t
l i t e r a t u r e of surgery.
j u s t the obvious
Indeed, t h e "pure s u r g i c a l l i t e r a t u r e " is a r e l a t i v e l y
minor problem compared t o the " l i t e r a t u r e of i n t e r e s t t o surgeons."
The l a t t e r
has no definable boundaries.
P r e c i s e l y because t h e t r a d i t i o n a l boundaries between medicine, chemistry,
e l e c t r o n i c s , mathematics, e t c . , have disappeared, t h e medical s c i e n t i s t today,
l i k e most other s c i e n t i s t s , needs a means of screening t h e e n t i r e s c i e n t i f i c
l i t e r a t u r e , so t h a t he can be informed promptly of those i t e m s bearing d i r e c t l y
on h i s i n t e r e s t s .
- 4 -
Whlle Current Contents appeals t o t h e headline reading h a b i t s i n which w e
a l l Indulge, a new s e r v i c e called ASCA is a modern computer-based c l i p p i n g ser-
vice that seeks o u t t h e literature one must know about t o perform r e s e a r c h
effectively.
One method, Current Contents, s a t i s f i e s t h e browsing i n s t i n c t .
The o t h e r , ASCA, is an organized systematic approach.
l r d c a l l y "systematic serendipity.
precise and s p e c i f i c .
,t
(7)
Someone c a l l e d it
One method is broad--the
And they complement each o t h e r n i c e l y .
want t o read the newspaper by s t a r t i n g with the index.
o t h e r , more
Very f e w people
On t h e o t h e r hand,
only a d e t a i l e d indexing system can t u r n up j u s t that i t e m you would have other-
wise mlssed if you cannot a f f o r d the luxury of reading every page and column.
The ASCA system I s h a l l d e s c r i b e b r i e f l y does j u s t that.
I n i t , you pro-
vide a "profile" of your c u r r e n t i n t e r e s t s , and t h e computer system does t h e
rest.
If d e s i r e d , ASCAMATIC s e r v i c e can d e l i v e r
automatically t o you a c t u a l
c l i p p i n g s or tear sheets of articles l i s t e d on a t y p i c a l weekly r e p o r t shown
in Figure No. 4.
I n t h i s r e p o r t , I have shown you what you might have received
in 1965 or t h e f i r s t f e w months of 1966 had you been i n t e r e s t e d i n t h e s p e c i f i c
t o p i c of
I,
shock". which you have been d i s c u s s i n g a t this conference.
In the
next f i g u r e , No. 5 , you see a list of papers you might have received i n the
same period had you been i n t e r e s t e d i n t h e highly s p e c i f i c t o p i c of "Atypical
Kernicterus, e t c .
It
and in the next f i g u r e , No. 6, some of the i t e m s you might
have been a l e r t e d t o if your p r o f i l e concerned "Hypoparathyroidism a f t e r
Thyroidectomy.
(1
I n your k i t s we have included sane d e s c r i p t i o n s of medically o r i e n t e d
l i t e r a t u r e searches that u t i l i z e d a new concept known a s c i t a t i o n indexing ( 8 ) .
C i t a t i o n indexing is a method of indexing t h a t is employed both i n t h e ASCA
system and in a published Index c a l l e d t h e Science C i t a t i o n Index which you c a n
- 5 -
examine in most leading medical l i b r a r i e s .
You can understand my i n t o l e r a n c e if
I s t i p u l a t e t h a t a leading medical l i b r a r y is one which, by d e f i n i t i o n , r e c e i v e s
the XI.
Since the SCI is so g e n e r a l l y a v a i l a b l e , I w i l l not spend t i m e during
my t a l k in d i s c u s s i n g i t s use but would g l a d l y answer q u e s t i o n s about it in t h e
discussion period.
The ASCA system is p r i m a r i l y but not e x c l u s i v e l y based on t h e concept of
c i t a t i o n indexing.
Unlike conventional word indexing systems, in ASCA w e c a n
also a s s o c i a t e p e r t i n e n t s u b j e c t matter through c i t a t i o n l i n k s .
In s h o r t , you
d e f i n e your s p e c i f i c i n t e r e s t s by providing a l i s t of o l d e r p u b l i c a t i o n s on
t h a t s u b j e c t ; IS1 informs you of a l l subsequently published works which c i t e
any one of them.
This is i l l u s t r a t e d in Figures 7 and 8 .
Here is a p r o f i l e on t h e t o p i c
11
o r i g i n of l i f e .
tions known t o be r e l a t e d t o t h i s t o p i c .
11
I t is a l i s t of publica-
I n Figure No. 8 is shown an ASCA report
l i s t i n g s e v e r a l papers which, during t h e week of J u l y 30, 1965, c i t e d one or
more of these p r o f i l e items.
It is that simple.
You can read t h e ASCA brochure
f o r more d e t a i l s , but the best s t a r t i n g p r o f i l e i s probably the l i s t of papers
you c i t e d in your l a s t published paper.
There are two major s o c i o l o g i c a l problems that stand i n the way of t h e surgeon keeping up w i t h s c i e n t i f i c information.
(The d e t a i l s of p a r t i c u l a r s y s t e m s ,
-
such a s Current Contents, ASCA, Index Medicus, o r Medlars, can be tackled in t h e
question period.)
I n my experience, t h e major b a r r i e r t o t h e e f f e c t i v e use of
t h e knowledge a v a i l a b l e t o t h e medical s c i e n t i s t is motivation and/or t r a i n i n g .
Anyone who is either overworked or overpaid, o r both, i s not a good candidate
f o r modern information services.
Any professional man must make a d e c i s i o n a s
t o how much t i m e he can devote t o h i s re-education or self-renewal.
t o take refresher courses--others
p r e f e r t o keep up day by day.
Some p r e f e r
Some people
- 6 -
hate education of any kind and t h a t would include any form of reading.
They a r e
obviously not candidates f o r modern infortration s e r v i c e s no matter how w e l l conceived t h e s e r v i c e may be and no m..tter w h a t t h e c o s t .
Nore than 50% of d o c t o r s
wouldn't use a comprehensive medicel l i b r a r y even if i t were given t o them on a
silver platter.
They j u s t don't communicate or l e a r n that way!
this i s training--or
lack of it.
use a conventional library--so
One reason f o r
The average medical man has never learned t o
he i s n o t , by t r a i n i n g or d i s p o s i t i o n , i n c l i n e d
t o take the e f f o r t t o l e a r n how t o use t h e modern information s y s t e m s which s t i l l
mst f r e q u e n t l y lead h i m t o a conventional l i b r a r y .
And when I say the physician
has not learned t o use a l i b r a r y , I not only mean t h a t he i s uni'amiliar with t h e
bibliographic apparatus--the
pedias--I
indexes and c a t a l o g s and d i c t i o n a r i e s and encyclo-
mean t h a t h e is not a literature-minded person.
A research biochemist
g e t s an i d e a and, by t r a i n i n g , h i s f i r s t i n s t i n c t i s t o do a search i n the l i b r a r y
t o see i f i t i s a new i d e a .
he c a l l s a f r i e n d .
When a doctor g e t s what he t h i n k s i s an o r i g i n a l i d e a ,
If h i s friend t h i n k s it is o r i z i n a l . then they agree a paper
should be w r i t t e n o r a paper presented.
Both a r e probably non-library o r i e n t e d .
since b i r d s of a f e a t h e r t r a v e l t o g e t h e r , and they a r e both e q u a l l y shocked t o
-
l e a r n when some j o u r n a l r e f e r e e , who i s l i b r a r y o r i e n t e d , can c i t e a dozen a n t i c i p a t o r y references.
This agonizing experience produces a v i c i o u s c i r c l e .
inadequate t r a i n i n g , he t h i n k s h e cannot cope w i t h t h e l i t e r a t u r e .
would have done a search i n the f i r s t place.
Otherwise, he
H e concludes t h a t his best s o l u t i o n
i s t o see more p a t i e n t s and f o r g e t about w r i t i n g papers.
If he is p e r s i s t e n t ,
he may obtain t h e help of a ghost w r i t e r who can do a l l t h i s
he i s usually d i s t r u s t f u l of non-medical
Through
11
drudge'' work but
personnel.
I don't want t o labor t h i s point any longer, and I am not a b s o l u t e l y c e r t a i n
that i t a p p l i e s t o t h i s audience.
of l i b r a r y l i f e .
If n o t , I apologize, b u t t h c s e a r e t h e f a c t s
They a r e q u i t e d i f f e r e n t t h i n I had expected from my i d e a l i s t i c
- 7 -
l i b r a r y school t r a i n i n g .
L i b r a r i a n s are t r a i n e d i n t h e concept of service.
They
naively assume that when a d o c t o r asks for information. on w h a t he c o n s i d e r s t o
be an o r i g i n a l i d e a , t h a t he is overjoyed t o be given a list of 200 r e f e r e n c e s on
t h e same subject.
His motivation is t o prove h i s o r i g i n a l i t y .
On t h i s occasion,
if t h e doctor uses t h e l i b r a r y , it is more o f t e n than not i n obeisance-and
hopes he w i l l f i n d l i t t l e or nothing.
in
On t h e occasion when he would l i k e t o d i s -
pute t h e f i n d i n g s of a colleague, he is s t r o n g l y motivated.
It is s u r p r i s i n g how
much he is w i l l i n g t o pay i n time, money, or energy e s p e c i a l l y if he g e t s r e s u l t s .
Unfortunately, l i t e r a t u r e searching c a n be an e n e r v a t i n g experience and even a
strongly motivated searcher may give up e a r l y i n t h e game.
this kind of search--finding
-
C i t a t i o n Index--because
refutations-is
Fortunately, p r e c i s e l y
i d e a l l y done by u s i n g t h e Science
-
even a s e c r e t a r y can s e a r c h t h e Index with minimal a s s i s t a n c e
or i n s t r u c t i o n from the doctor.
If your s e c r e t a r y has n o t learned how t o use t h e
SCI, then I suggest it would be worth f i v e or t e n miautes of her t i m e .
f e s s i o n a l medical l i b r a r i a n can teach her t h e SCI system.
Any p r e
You w i l l be amazed a t
the results, and I'll be happy t o i l l u s t r a t e t h i s for you by concrete examples i n
our discussion period.
Thank you.
-
8 -
References
1.
E. Garfield, "IS1 Eases S c i e n t i s t s ' Information Problems; Provides Convenient,
Orderly Access t o L i t e r a t u r e , " Karger Gazette No. 13, March 5 , 1966, p. 2.
2.
F. Bello,
3.
S.D.
1,
How t o Cope with Information," Fortune, September, 1960, p. 160.
Truelson, Jr., What t h e INDEX MEDICUS Indexes and Why.
Paper presented
a t the S i x t y - f i f t h Annual Meeting of t h e Medical Library Association. Boston.
Massachusetts, June 7 , 1966.
4.
'
A.J. Lotka, "The Frequency D i s t r i b u t i o n of S c i e n t i f i c P r o d u c t i v i t y , " Journal
of t h e Washington Academy of Sciences 16(12), 317-323 (1926).
5.
S.C. Bradford, "Complete Documentation," in Report of t h e Royal Society Empire
S c i e n t i f i c Conference (London: The Society, 1946), pp. 729-748.
6.
E.A. Brown, "How I Get t h e Meat out of 700 Journals a Month," Medical Economics
39(6), 128-143 (1962).
7.
J.F. Smith, "Systematic Serendipity, " Chemical and Engineering N e w s 42(35)
55-56
8.
,
(1964).
E. Garfield, "SCIENCE CITATION INDEX--A
144(3619), 649-654 (1954).
New Dimension in Indexing," Science
1965 SCIENCE CITATION INDEX
Source Journal S t a t i s t i c s
Ranked by Number of Source Articles .(Cumulated)
Source
Journal
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
NATURE
BR MED J
coh6PT R W D
LANCET
JAMMEDA
SCIENCE
IYLN SSSR
J.=
PHYS
B S CHIM FR
JAMCAMS
BIOC BIOP A
J C m SOC
J.0RG CHlBl
QIEM IND L
CANMEDAJ
PWS LETPER
J G M CHE R
MECH ENG
J APPL PHYS
PIIYSREVA
ANN H y ACAD
N ENG J MED
DEUT MED WO
PATH BIOL
CIRCULATION
NUCL PHYS
ANGW CHM
P IEEE
J PHYS C W
SOV PH SS R
PHYS REV B
J ACOUST SO
Nuov CIMENT
I N D LAB R
ANAL’IT C m
P SOC EXP M
BIOCHEM J
TETRAHEDR L
NATURWISSEN
ANAT REC
CURRENT S C I
PHYS REV L
SCHW MED WO
ERWL KOHLE
PHYTOPATHOL
Sources
cum. ’b
Sources
4,389
3,715
3,453
3,053
2,568
2,434
2,401
1,758
1,576
1,491
1,481
1.375
1,332
1.287
1,271
1.249
1,140
1,131
1,103
1,079
1,079
1,057
1,018
1,007
939
932
903
903
894
889
880
876
863
862
859
849
833
832
823
819
813
812
791
780
778
1.92
3.54
5.05
6.39
7.51
8.58
9.63
10.40
11.08
11.74
12.38
12.99
13.57
14.13
14.69
15.23
15.73
16.23
16.71
17.66
18.13
18.59
19.04
19.48
19.89
20.30
20.69
21.09
21.48
21.87
22.25
22.63
23.01
23.39
23.76
24.14
24.50
24.86
25.22
25.58
25.94
26.29
26.64
26.98
27.32
Source
Journal
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
FIGURE 1
J BIOL CHW
J MIRY SCI
K L I N WOCH
J ANIM S C I
P ROY S MED
AM zooux;
J OPT SOC
VFP REC
CHW-ING-T
ANN INT MED
CR SOC BIOL
EEG CL NEUR
SOUTH 116ED J
J GEOPH RES
AM CERAM S
AM tdATii HO
AIAA J
J E J A X a SO
CHIM IND M
SOV PH
R
AM J OBST G
ARCH IN MED
REV S C I I N S
A! J MED SC
J BAcr
ARCH DEFIMAT
PRACTITION
B CHW S J
AM J OPHTH
J METALS
P NAS US
FED PROC
PHYS ST SOL
IEEE SPECTR
JAMVETME
J PEDIAT
J CELL BIOL
J PHYSL LON
CHEM C W
CHEM BER
J CHRWT
SURG GYN OB
AM J PHYS
COLL CZECH
GASTROENTY
cum.
x
Sources Sources
751
737
727
706
697
696
691
682
6 74
667
662
661
650
649
645
643
636
633
616
601
599
580
578
578
576
576
571
569
562
557
552
548
547
547
546
546
536
535
532
529
526
526
524
515
511
27.65
27.97
28.29
28.60
28.90
29.21
29.51
29.81
30.10
30.39
30.68
30.97
31.26
31.54
31.82
32.10
32.38
32.66
32.93
33.19
33.45
33.71
33.96
34.21
34.46
34.72
34.97
35.21
35.46
35.70
35.94
36.18
36.42
36.66
36.90
37.14
37.37
37.61
37.84
38.07
38.30
38.53
38.76
38.99
39.21
No. of Journals vs. % Total Sources in 1965' SCIENCE CITATION INDEX
20
60
100
200
300
No. of Journals
4m
5m
JUNE 14, 1966
VOLUME 9, NO. 24
FIGURE 3 A
JOURNAL OF NEUROCHEMISTRY
Volume 13
May 1966
Number 5
L.
1. Cart. S.C. CHNGand H. WAIUEH+:
CO.hrzlion in ihrnenowsyslem-I.
CO, fixation in
the xiatis n e w of Ihc hullfmg .
. . . . . . . . . . .
S.C. CMNO .nd PAUU MEU: CO, Rxalion in the ncnolu s)nlem-lI.
Envimnment.1 e t r c ~on
CO, % l i o n in lohrlri nerve
S.C. C*wo and PAULAMIU: CO, fixation i n the ncnou systan-lll.
Elf- of-lcholencon
CO, Riation in lobiicr ncns
S. BTU and D.P. P U I P U I A : Rlgion.1 dmlopmcnl ofgluumic acid companmet~Utionin immatwc
hnin
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. .
T. Dloruu: An andysir of the action of succinylchdinc on mnrmission in the supeior - w i d
ganglion of the cat
D. M m n and
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