Context:

Historical perspective of medicine for health librariansThe 21st century Canadian context

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• The span of time before recorded history; before invention of writing

• We know a little about hunter-gatherers who were herbivores• Study of medicine in this period relies on artefacts, human remains

& anthropology• Trepanning can be proven• Some other ‘evidence’ in art, mummification

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Pre-historic period

• ~3000 BC forward

• Greeks refute claims disease caused by demons/spirits

• science based on logic, reason, philosophy

• Empirical observation

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Ancient world

• Hippocrates 460-377 BC

• Galen, AD 129-216

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Greek physicians, antiquity

• Fall of Rome precipitates dark ages

• Political & religious turmoil; diseases “God sent”

• Arabic medicine thrives

• Bubonic plague, massive loss of life

• Madness, insanity, leprosy; hospitals in 11th C.

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Dark ages / ~1400 AD

Renaissance of scientific inquiry & learning• Human dissection & cadaver studies

• Paduan anatomy• Andreas Vesalius (1514-1564) • Giovanni Morgagni (1682-1771)

• Blood circulation theory• William Harvey (1578-1657)

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Medicine’s rebirth, 1500+

• Rene Descartes (1596-1650)• Mind-body duality theory

• Scientific revolution 16/17th centuries• Bacon, Copernicus, Galileo, Newton• Invention of microscopy • Birth of demography • First “clinical trials”

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Medicine’s renaissance

Laboratory research • Rudolf Virchow (1821-1902) “German school”• Louis Pasteur (1822-1895)

• paved way for antisepsis - Joseph Lister (1827-1912)

• Bacteriology as a scientific discipline• Robert Koch (1843-1910)

• New Science: Darwin, Freud, Einstein

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19th Century lab

• Biomedical models emerge• Health defined as “absence of disease”• Disease caused by pathogens • Behavioural sciences; health interdisciplinarity• Post-Freudian integration

• Economics of providing health care• Rise of information – its role in providing care• Evidence-based practices in late 20th century LI

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20th century medicine

Sulfa drugs (1930s), penicillin/antibiotics (1940s)•Pharmaceutical companies & profits •Patient want the magic pill•Resistance & superbugs

Technological advances & specialization in 21st C.•But in early 21st C., medical systems seen to be failing

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20th century rise of pharma

Quick tour of history of medicine shows: • medicine’s roots back in antiquity• accelerated growth in knowledge from renaissance• history of medicine closely linked with science• science and medicine are interdependent• medical knowledge built on previous evidence

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Review

• Major medical libraries established in 19th C.• Early libraries grew out of private collections

Hospitals established in US & Canada• Health libraries followed• Flexner report 1910

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1875 medical libraries

• Helped establish medical libraries in 19th C

• William OSLER, Canadian physician, on evidence:• “We doctors have always been a simple, trusting folk! Did we not believe

Galen implicitly for fifteen hundred years and Hippocrates for more than two thousand years?”

• [Speech given to Ontario Medical Association, Toronto, June 3, 1909]. Canada Lancet. 1909; 42:899-912

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Physicians & libraries

• John Shaw Billings, MD - His Role• Led U.S. Surgeon General’s Library - 1865-1883

• Medical Library Association founded 1898• MLA founding executive: Margaret Charlton (Canadian medical librarian),

William Osler & George Gould (American physician)• Largest medical library association in the world• Offers a credential for medical librarians called AHIP

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America & medicine

Margaret Ridley Charlton (1858-1931)

US National Library of Medicine • National Network of Libraries of Medicine (NNLM)

• Established by legislation in 1956• Today, NLM coordinates a wide array of information services for

libraries worldwide...

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Medical library movement, 20th c.

• No health library act• No national library of medicine• CISTI (Canadian Institute for Science & Technical Information)

officially 1966/1974 • Since 1970, CISTI worked closely with health librarians• In 2010, some CISTI services were outsourced

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Canada, medical libraries

• Origins traced back to early 20th c.• 1824: Canada’s 1st medical school• Father of Canadian medicare is …who?

Canada Health Act (1984)• National standards of care; publicly-financed, privately delivered• Merged hospital & medical insurance as one statute• No extra-billing; no user fees

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Canadian health care

Canada’s five (5) health act principles:1. universality2. accessibility3. portability4. public administration5. comprehensive

• UBC Health Libraries Network• largest network of its kind in Canada • serves UBC health community at multiple locations

• HLABC (Health Libraries Assoc. of BC)• ~100 members• College of Registered Nurses of BC (CRNBC), BC Cancer Agency,

BC College of Physicians & Surgeons Library (CPSBC)• Government ministries & public libraries• Both library technicians & librarians

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Medical libraries – British Columbia

• National & provincial influences • Health care reform ongoing in 21st century• Triggered by Romanow Commission 2002• Expansion of medical, nursing, pharmacy programs• Provincial premiers in Victoria January 2012

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Summary