Could Librarians' Help Have Prevented Hopkins Tragedy?

Librarians know too well the misperception that everything is available on the Internet-but has that misperception now proved fatal? Perhaps, say medical librarians, after recent reports in the Baltimore Sun suggested that a Johns Hopkins University (JHU) medical researcher failed to uncover published research pointing out the potentially lethal side effects associated with inhalation of the drug hexamethonium. In a case that has garnered worldwide attention, physicians at Johns Hopkins administered hexamethonium to a healthy 24-year-old woman, Ellen Roche, in an attempt to study how the lungs of healthy people protect against asthma attacks. But Roche died weeks later from complications caused by the drug.

According to the Sun, investigators found that supervising physician Dr. Alkis Togias's search for adverse effects of the drug apparently focused on online sources, including PubMed, which is searchable only back to 1960. Previous articles published in the 1950s, however, with citations in subsequent publications, warned of lung damage associated with hexamethonium. Dr. Frederick Wolff, professor emeritus at the George Washington School of Medicine, told reporters Togias was 'foolish' and 'lazy' for not finding the articles. 'Anyone trained in academic medicine knows how to do this research,' said Wolff. 'What happened is not just an indictment of one researcher but of a system in which people don't bother to research the literature anymore.'

'These people should have been speaking to a medical librarian,' says Edward Morman, college librarian and director, Francis C. Wood Institute for the History of Medicine at the College of Physicians of Philadelphia, noting that the tragedy might have been avoided had an information professional been involved. Morman said, 'A manual search of pre-1960 medical indexes should have supplemented any database search' on the drug done by physicians. Medical librarians say the tragedy is a stark reminder that the Internet should not replace either the stacks or the important work of information professionals. In fact, Morman noted, even if the lion's share of medical research does one day make it online, the stacks must be saved, as reliable search engines and digital preservation remain dicey propositions. 'The point is,' said Morman, referring to the tragedy, 'that older medical research must be maintained.'

After accepting responsibility for Roche's death, JHU's School of Medicine has hired an outside consultant to establish a literature search standard for medical researchers. A Hopkins internal review concluded that lead physician Togias made a 'good faith effort' to research the drug hexamethonium, but it was divided over whether Togias's work was sufficient and cited the lack of an existing standard for judging research efforts. Hopkins officials said they would create such a standard.

JHU spokesperson Joann Rodgers said that 'a small committee of three medical scholars and a medical librarian' was in fact being formed for the purpose of establishing a literature search standard. Officials say they expect a draft of the new guidelines as early as September 15 and are 'hopeful that this work may prove useful to researchers at other institutions.' In its internal report, Hopkins investigators concluded that the physicians conducting the research effort 'failed to ensure that the risks to subjects were minimized and reasonable...particularly concerning the published literature concerning hexamethonium.'