As long as I’m spouting off opinions on topics that have little substance other than opinion, I may as well go whole-hog and respond to some of the reponses.

Marcus Banks writes:

“…David goes too far in his highly conservative defense of the English language…this idea that we need to keep a tight lid on the language, or even that this is possible, is foolhardy.”

I’m not attempting to defend the English language.  A beast as powerful as the English language doesn’t need me to defend it. Besides, I happily torture the language when it suits me. I use silly semi-words like ‘geekery’ and ‘libraryfolk.’¹

This comment from Marcus, though, underlines a problem I saw in the post shortly after I published it.

It isn’t the word, it’s the way the word is used

I didn’t intend to say that the word “transliteracy” has no place in the world², just that I have yet to see libraryfolk using it in a way that adds something previously missing from discussions in librarianship and LIS³. Thus far, it seems to me that the (admittedly cool-sounding) term is thrown around by libraryfolk who (1)admit that they can’t define it, (2)define it so vaguely and variously that it fails to have any coherent meaning, or (3)define it in a way that makes it redundant to a wide assortment of existing terms.

What I find baffling is that librarians would use words they cannot define. I had thought (perhaps mistakenly) that librarians tended to be lovably pedantic and semantic nitpickers.

I’d like to see some clear indication that libraryfolk are talking about this word for any reason other than novelty or self-promotion. I have nothing against self-promotion per se, but some of the libraryfolk advocates of this term are telling us there’s a revolution going on. I don’t see a revolution, just an evolution. If they’re going to cry ‘wolf’, I want to see some fur and teeth. Or at least, for pity’s sake, some wolf footprints. So far, though? Nothing.

Marcus goes on to explain what he sees as the problem with ‘information literacy.’

“I’d argue that our conceptual notion of information literacy remains stuck in time. Sometimes we come dangerously close to suggesting that people blow the 1/2 inch of dust off the top of the Britannica and then read it, because this, dear students, is an ‘authoritative resource.’

Yes, I jest. And yes, I exaggerate. But not by as much as I’d like. We still lionize peer reviewed articles despite their manifold flaws, and keep an arms length view of Wikipedia and communally developed resources in general. Of course I support sharp and incisive critique of Wikipedia entries. But I don’t support the idea that Wikipedia is something other, alien or foreign.”

I agree that some libraryfolk are not adapting as fast as we might hope. That demonstrates a problem with some libraryfolk, not that ‘information literacy’ has ceased to be a useful term. As information changes (it always has, always does, and always will), information professionals need to adapt to keep their skills up-to-date and maintain their information literacy (and their value…and their jobs). Again, where’s the need for a new word?

Marcus continues:

“In that light, it seems to me that transliteracy, as a concept, is an attempt to label what we are already doing–linking up traditional notions of authority with the realities of how people obtain information today. This is valuable, and much less overblown than the Library 2.0 hooha back in the day.”

Right! “…an attempt to label what we are already doing.” As we already have labels for this, why slap on a new one?

Diane Cordell writes:

“Medical librarian David Rothman questions whether this concept is any more than a new buzzword for the same type of information literacy with which librarians have always been concerned.”

No. What I said was that the definition of information literacy is easily flexible enough to continue to serve nicely as technology changes. I did not say that changes in technology don’t matter. I’m pretty well on record stating my belief that little should matter more to libraryfolk than the changes technology is making in our world.⁴ I am, however, amused by Diane’s repeated implications that I am somehow change-resistant or that I threaten the future of libraries because of my rejection of this buzzword. Remind anyone else of the “Library 2.0″ hysteria?

So you just don’t like buzzwords?

I have to admit that I feel similarly (though less strongly) about EBLIP and ‘Blended Librarianship’.

Here’s a definition for EBLIP that I think summarizes well how most people think of it:

Evidence Based Library and Information Practice (EBLIP) seeks to improve library andinformation services and practice by bringing together the best available evidence and insights derived from working experience, moderated by user needs and preferences. EBLIP involves asking answerable questions, finding, critically appraising and then utilising research evidence from relevant disciplines in daily practice. It thus attempts to integrate user-reported, practitioner-observed and research-derived evidence as an explicit basis for decision-making.

That’s great. Libraries SHOULD apply the best available evidence in making decisions about the practice of their profession- but don’t good libraries already do this? Is the purpose of the term just to underline the importance of these activities? Collecting usage data, tracking reference encounters, doing needs analyses, keeping up with the literature of librarianship…these things were all a part of good practice long before “EBLIP” was talked about, weren’t they?⁵

As for Blended Librarianship, I love the idea of communities of learning and I agree that technology skills and instructional design are essential (especially for instruction librarians). But learning communities (online or offline) aren’t new ideas and incorporating technology skills and instructional design into one’s work is what any good instruction librarian should be doing. Unless it is just for the purpose of naming an online community (which is perfectly sensible), why make up a new term for what good instruction librarians should obviously be doing?

Theoretically Speaking

John Jackson writes:

“Great post, David! But I was sorry to see that you concluded by writing off theory in lieu of practical concerns for libraries. I know this doesn’t apply for all libraries, but for academic librarians, having a concise definition and theoretical framework is necessary not only for the work they do on a daily basis, but in the scholarly activities that they try to pursue both through publishing and through on-campus research… not to mention it can serve as a legitimizing factor when working with faculty.”

Sure, academic librarians may need to understand theoretical frameworks of particular topics if they support programs that rely heavily on critical theory.⁶ After all, I can’t imagine a Women’s Studies department that doesn’t rely heavily on critical theory and the subject specialist that serves that program’s needs should understand that body of theory and be able to speak in the terms that are familiar to scholars of that discipline.

To paraphrase a librarian friend, theories from other academic fields can be (and are) applied to information services…and librarianship/LIS can be said to have a set of values/ethics/principles that is different from other professions, but there’s no unified/unifying theoretical framework for library practice that I can see.

I agree with Neil Postman that “social sciences” (including Postman’s own field of Media Ecology) are not sciences.⁷

“To put it plainly, all of the so-called social sciences are merely subdivisions of moral theology. It is true, of course, that social researchers rarely base their claims to knowledge on the indisputability of sacred texts, and even less so on revelation. But you must not be dazzled or deluded by differences in method between preachers and scholars.”

I can only guess how maddening scholars find this statement, but even just guessing makes me smile.

Insufficiently Academic

Maybe I’m insufficiently educated and don’t properly understand the academic world of LIS, but I think that theories outside of the hard sciences are, at best, interesting ideas with which to think. I think that Very Smart People are most valuable (and most valued) when they solve problems, not when they wax intellectually about them.

Changes in technology create all kinds of new and interesting challenges for libraries. All comers who have something coherent to say about how to go about tackling these challenges should be welcomed- but while matters of epistemology (like learning theory, neuroscience, or media ecology) should be important to libraryfolk, let’s not pretend to be scholars of those disciplines⁸.

‘Scholarly’ Language

Kudos and full credit to Lane Wilkinson for blowing off his previous “academic” style of writing and writing a post describing his perspective in English, but I think Stephen Francoeur nails exactly what is lacking about it:.

“I’m with you on the need to be more expansive in what we teach and how we teach in our information literacy efforts, but I’m not sure this merits a new term for the effort. It seems like transliteracy so narrowly focused in your blog post that it can be defined simply as ‘doing information literacy instruction really well.’⁹

Wilkinson admits that this is a fair summary for his definition of ‘transliteracy’ but defends the use of the term as a ‘placeholder’.

Why use a ‘placeholder’ when we could say ‘do information literacy instruction really well’?

Check out this response post from John Jackson in which he takes seven paragraphs (625 words!) to say pretty much what I said in my first two paragraphs (60 words) – albeit in a much more ’scholarly’ manner.

I’ve often wondered why so many self-described academics use language seemingly intended to make the ideas harder to access through an obtuse vocabulary or tortured phrasing. I was kvetching about this once to a friend who offered a theory. “Perhaps,” said my friend, “the value that academics offer in a market economy is the value of their ideas…and by making it harder to access their ideas, the market value of what they’re selling is driven up.”

That’s as good an explanation as any I’ve ever seen.

I encourage people (especially information professionals) to avoid this sort of writing at all times. It doesn’t matter if academics in other disciplines embrace the practice. *Our* profession is about removing obstacles between the user and the information that user seeks. I’m going to repeat that in a larger font now. Feel free to imagine me yelling this:

Our profession is about removing obstacles between the user and the information that user seeks.

This includes obstacles like obtuse, redundant, or vague language.

No arguments

Among all the response posts is not a whiff of an actual response.

Bobbi Newman writes:

“Transliteracy is a new concept in general and we are working to apply it and I’m ok with it being a work in progress (the blog is less than a year old). I understand that many people aren’t. They want clear rules, definitions guidelines, and measures and pie charts, but I’m not sure I am able to help them at this point. I’m ok with that too. Not in a mean way but in a I-can’t-do-everything-at-once sort of way.”

Here’s how I read that:

Transliteracy is a newish scholarly buzzword and we are working on milking it for publication purposes in the LIS world (we’ve been working on it for a year so far). I understand that many people want to know what the word means. They think that librarians should probably avoid using words they can’t define. I can’t help them there because I’m too busy. I did have time to create a blog based on the concept, but I don’t have time to define it.

Really, Bobbi. That’s how it reads to me.

The nonsense continues

I have no illusions that my comments will stop anyone from using terms foolishly, but I can hope that it may spare a few individuals from the anxieties associated with fears that they’re not on top of this ‘new thing.’

Meanwhile, the nonsense continues unabated. Check out Buffy Hamilton’s presentation “Participatory Librarianship: Creating Possibilities Through Transliteracy, Learning, and Linchpins”

Here’s the text of slide #51- try reading it aloud.

“transliteracy provides us a way of theorizing how these literacies transact with each other for meaning making”

Here’s the text of slide #52. Again, try reading it aloud.

“transliteracy is the conceptualization of how we use these literacies than the tools or containers although certainly the ways we access information, share, and create it have taken on new forms”

Text of slide #54 (you know what to do).

“as sponsors of transliteracy, libraries can close the participation gap.”

Try to get past the syntactical problems with these statements and tell me what they mean. Tell me that ‘transliteracy’ is used here in a meaningful way. I’d enjoy being proven wrong.

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Literacy

Very briefly, the term literacy¹ refers to either:

1. The ability to read and write

or

2. Knowledge of, skill in, or competence in an specific area or subject.

The former is a very real concern if the university professors and academic librarians I know are to be believed.²

Still, I think we’re mostly concerned with the latter.

Sorts of Literacies:

My wife and I frequently talk about our aspirations for the cultural literacy of our children. We think that they need to hear stories from Mother Goose, the Brothers Grimm, Aesop’s Fables, and (to the surprise of some who know us) both the Hebrew and Christian bibles. We’re atheists, but we know that stories from the bible(s) are frequently referenced in literature and in life- and that knowledge of these stories will enhance their understanding of the world around them.

Plenty of people tell me that they need help with something because they are not computer literate. I don’t know that I much like this term (I think that lack of confidence is a more frequent problem than actual incapability), but the popularity of its use can’t be denied. People know that to be “computer illiterate” is to be unskilled in the use of computers.

Then there’s the literacy that librarians, of course, care a whole lot about, Information literacy³

Information Literacy

I like the 1989 ALA definition:

“To be information literate, a person must be able to recognize when information is needed and have the ability to locate, evaluate, and use effectively the needed information”

I also like this one from the Association of College and Research Libraries:

“Information Literacy is the set of skills needed to find, retrieve, analyze, and use information.”

These are simple, clear definitions that are broad enough to incorporate any tools. Some years ago, information literacy included the ability to thumb through an index of periodicals- I remember doing this in elementary school. Today, the elementary school student might search a database of indices. Regardless of the changes in technology, the above definitions of information literacy continue to be good and useful.

Technologies change and tools change, but the definition of information literacy doesn’t need to.

Here’s where I start to get a bit confused. What’s the point of terms like “digital literacy“?

The Wikipedia definition of digital literacy is as follows:

“Digital literacy is the ability to locate, organize, understand, evaluate, and analyze information using digital technology. It involves a working knowledge of current high-technology, and an understanding of how it can be used. Digitally literate people can communicate and work more efficiently, especially with those who possess the same knowledge and skills.”

So…it’s information literacy with computers. In our world, don’t you have to be “digitally literate” (and “computer literate”) if you’re going to claim information literacy? If so, “digital literacy” is just an aspect (a huge and important aspect) of information literacy.

Isn’t health literacy just a specialized kind of information literacy? How hard is it to take the above definitions of information literacy and make a couple of small edits to make them good for health literacy?

Information Health literacy is the set of skills needed to find, retrieve, analyze, and use Health information.

To be information health literate, a person must be able to recognize when health information is needed and have the ability to locate, evaluate, and use effectively the needed health information.

So, not hard.

Now we’ll remove the “health” from a definition of health literacy from the U.S. Department of Health and Human Services and make it about information literacy generally.

HealthInformation literacy includes the ability to understand instructions on prescription drug bottles, appointment slips, medical education brochures, doctor’s directions and consent forms, and the ability to negotiate complex health care systems. HealthInformation literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health important situations.”

You could do the same thing with “media literacy,” or “financial literacy.” Sure, they’re specialized subsets, but it’s all information literacy. Are terms like electracy really useful in any way? I don’t think so.⁴

Okay. So what’s “transliteracy”?

Wikipedia uses a definition from PART (Production and Research in Transliteracy):

Transliteracy is the ability to read, write and interact across a range of platforms, tools and media from signing and orality through handwriting, print, TV, radio and film, to digital social networks.

Of course, PART’s own site calls this a “working definition.” So…the group providing the definition notes that it isn’t really thoroughly defined yet.

Has there been another time that a bunch of librarians were excited about another buzzword that was, at best, vaguely defined? I keep thinking back to T. Scott’s take on “Library 2.0″:

“My problem with the term is the same as ever — it is simply incoherent. People who use the term refer continually to the “Library 2.0 concept” but I’ll be damned if I can figure out what that “concept” is. Everyone who uses it has their own intention for it, and one knows that it has something to do with social networking software and with making libraries better, but is there really any more to it than that? It’s a very sloppy use of language, and I’m a firm believer in the concept that a sloppy use of language betrays sloppy thinking.”

Anyone else see the parallel?

Libraries and Transliteracy

In my seeking to understand what transliteracy is and why it should matter to libraries, I came across a number of references to this presentation by Bobbi Newman.

Bolded lines below are the text from her slides.

Slide #12: Soon people will need to be transliterate in order to be involved in and contribute to society.
Slide #13: It is already happening.

People who aren’t transliterate can’t participate in society? That sounds important. Where are they being prevented by the absence of their transliteracy from being a part of society?

Slide #14: Facebook privacy settings are complex and change frequently.

I don’t think a thorough understanding of Facebook privacy settings (or Facebook generally) is required to be involved in and to contribute to society, do you? Even if they were, knowing how to use social networks and other online tools could just as easily be defined as digital literacy or information literacy. Where’s the need for the new term “transliteracy”?

Slide #15: It is not just on the fun sites.

But you’re limiting the discussion here to computers and Web sites.

Slide #16: Government agencies are no longer issuing print forms.

Aside from the fact that this statement is patently untrue⁵, it seems again to point to the use of internet tools.

Slide #17: Banks are sending alerts and account balance information via text messages.

For those who want them, yes. Is texting now required to be a part of society?

Slide #18: Your health insurance plan has a website and you have an account.
Slide #19: The price of computers is dropping allowing more people to own one.
Slide #20: Free WiFi access points are increasing, allowing more people internet access.

More and more people are using computers and the internet, yes. What does this have to do with “transliteracy”?

Slide #21: For many people these are new experiences.
Slide #22: Experiences they can have with no training, no supervision and no support.

(How DARE people have new experiences without supervison!)

Yes, they CAN have them that way if they want. They can also check Consumer Reports or do other research to help them decide what computer to buy. They can ask at the library/McDonald’s/coffee shop how to connect to their WiFi. They can call the insurance company and be walked through how to use the Web site.

Again, what does this have to do with “transliteracy”?

Slide #22: If we only focus on literacy we are failing our patrons.

If libraries only supported readin’ and writin’ on slips of thin, dead tree, they WOULD be failing their patrons- but that’s not the case. Libraries have been working hard for years at providing computers, connectivity, and instruction. Libraries care quite a lot about information literacy and expend a great deal of effort helping patrons build information literacy skills.

So, given that libraries are NOT just focusing on words that are printed on dead-tree paper and given that they ARE providing instruction in information literacy…what here is new and different, meriting a new term?

Slide #23: In order to best serve our patrons we need to move from literacy to transliteracy.

It seems from these slides that Bobbi is saying she thinks “transliteracy” means “inclusion of online stuff and other newish technologies.” If that’s the case, libraries have already made this transition.

Slide #24: How do we shift our focus to transliteracy?
Slide #25: Talk with your coworkers and colleagues about it.
Slide #26: Talk with your patrons about it.
Slide #27: Add it to your strategic plan, mission statement and goals.

So, what would these conversations sound like?

Librarian 1: Hey, I read that we should be talking about transliteracy.
Librarian 2: Okay. What’s transliteracy?
Librarian 1: I don’t know, but if we don’t mention it in our strategic plan, we’ll seem unhip. If we suggest it to our director, though, she might think we’re really on top of new trends.
Librarian 2: I’m game. What part of the strategic plan should this transliteracy stuff be added to?

[pause]

Librarian 1: Um…Do a find-and-replace for “library 2.0?”

Librarian 2: Nice.

That’s not the end of the unappealing similarities between the libraries-and-transliteracy-stuff and the library-2.0-stuff.

One of the worst things about “Library 2.0″ was the way its advocates (who now don’t talk about it at all) seemed to talk mostly only to each other in language which (usually unintentionally) excluded and alienated others from participating in the conversation. Still, I never saw a post about Library 2.0 that was as bad in this regard as Transliteracy and Incommensurability, posted by Lane Wilkinson at Libraries and Transliteracy.⁶

At first, I was convinced this post was pseudo-intellectual gobbledygook. After several aborted attempts, I finally read it in the right frame of mind and discovered that it made a few good points. These points have repeatedly been made much more clearly elsewhere, but Wilkinson is definitely not a charlatan. It’s not gobbledygook.

My complaint is that his dense use of jargon and needlessly specialized language makes his post almost totally inaccessible.

What would happen if people discussed his post the same way he wrote it?

Seriously.

Rothman, what’s your problem? Why are you picking on those nice transliteracy people?

I’m not. I’m picking on their ideas and their writing. Their writing because it is awful and their ideas because…well…I think they have no new ideas.

The world changes as technology changes. Education and libraries adapt (well or poorly, but they adapt). There’s nothing new here. There’s no need for a new movement, a new term, or so much discussion about nothing.

Look at this post by Tom Ipri:

“One thing which excites me about Transliteracy is, because of its newness, the skills involved are not well-defined.”

I’d like to ask Tom: Aside from the term, what exactly is new about transliteracy? Like “Library 2.0,” the term is being used without really being defined. That makes it awfully convenient to write about, because it can mean anything you want it to.

“Of course, Transliteracy involves a whole swath of cognitive skills that transcend navigating new technology.”

Skills which, of course, Tom doesn’t describe.

“To a certain extent, trust is a teachable skill and librarians invest a great deal of effort in instilling notions of trust. How do we trust that a web site is reliable? But beyond that, individuals need to learn how and when other individuals are trustworthy.”

Oooookay. I’ll agree that the ability to identify who is trustworthy is a good ability to have. What is your point in bringing up this bit of common sense? What is new here? Where is the need for the term “transliteracy” and why should libraryfolk care?

I don’t think critical theory is as important to libraries right now as practical matters. That said, critical theory has things to offer libraries and librarians- but this isn’t critical theory. This is nonsense. Further, it is a kind of nonsense we’ve seen before in the “library 2.0″ silliness- so it really is Commensurable Nonsense.

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Craig Stoltz (previously mentioned) dropped me an email to point out a post I’d missed from The Health Care Blog by Alicia White of Bazian (the company which evaluates stories for the NHS’s Behind the Headlines service).

Says Ms. White:

…we’ve developed the following questions to help you figure out which articles you’re going to believe, and which you’re not.

Questions include:

• Does the article support its claims with scientific research?
• Is the article based on a conference abstract?
• Was the research in humans?
• How many people did the research study include?
• Did the study have a control group?
• Who paid for and conducted the study?
• Did the study actually assess what’s in the headline?
• How can I find out more?

Good stuff. Go read it.

Thanks again for the pointers, Francesca and Craig!

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“Trying to Measure the Quality of Health Information on the Internet: Is It Time to Move On?” [html] | [PDF]

Short answer:

Hell, no.

Longer answer:

Says the article:

“The natural assumption is to believe that there exists a link between the quality of information on the Internet and harm. However, a systematic review attempting to evaluate the number and characteristics of reported cases of harm in the peer-review literature determined that for a variety of reasons, there was little evidence to support this notion.”

It is impossible to quantify why people make bad decisions. For instance, say someone makes foolish financial decisions and loses everything they own: can it be determined if these bad decisions were made based on information they found online?

On the other hand, ask anyone you know who works in an Emergency Room if they’ve seen people who have done harm to themselves with a self-diagnosis or self-treatment based on something they read online. Every one of them will confirm they have. This isn’t necessarily the fault of the information found online, but knowing as we do that people increasingly make decisions about their health that are informed by information they find online, we don’t need evidence to assume, a priori and with confidence, that bad information can lead to harm. It is common sense for everyone in the health community to promote/produce good online information resources and discourage the existence/use of bad online information resources. Most importantly, we must help both health professionals and patients gain the information and health literacy skills to tell the good from the bad.

Authors Deshpande and Jadad argue that the evaluation tools for Web sites suffer…

“…from several limitations, which, in addition to those mentioned by the authors, include uncertain levels of usability, reliability, and validity.”

I won’t argue with that. I don’t think any single evaluation tool can let someone without information literacy skills determine the quality of information found online. I don’t think that even a vast arsenal of such evaluation tools will do the trick.

The authors have questions I’ll answer (I don’t care that the questions were intended to be rhetorical- they need to be answered):

“Will we ever develop an ideal tool that allows individuals to assess the quality of health information?”

Nope. We’ll also never invent a diagnostic tool that can replace a good physician’s experience and judgement- but that doesn’t mean we shouldn’t create tools that help new doctors build these skills or help more experienced doctors flesh out their differential.

What are the determinants of this quality?

That’s a pretty broad question, but the MLA has a good basic guide of where to start.

“Is it possible to assess or measure quality?”

Medical librarians assess the quality of information every single day. So…yeah, it is.

“Even if possible, is the formal assessment of quality even necessary?”

Necessity depends on who the user is and what his/her particular information needs are.

“Does it even matter?”

Kind, encouraging teachers throughout the world often say that there’s no such thing as a stupid question. These extraordinarily compassionate educators are lying. Yes, it matters.

I’m a Web enthusiast who sees a lot of value in lots of online collaborative efforts. There are absolutely places and uses for the wisdom of the crowd- but to hear some people talk about apomediation, you’d think the wisdom of the crowd could replace the judgement of experts.

“For example, Internet users could provide ratings or recommendations based on their own experiences to judge the quality and relevance of health information.”

Huh. So if we’re just gonna’ go with what a crowd of self-selecting amateurs agree upon, I guess we don’t need double blind trials any more, either? We’ll just ask a crowd their opinion. Who needs empiricism? Science, schmience. Why should we take this article more seriously because the authors have two MDs and dotorate between them? I’m not Andrew Keen¹, but neither am I an irrational technotopian.

“Analogous to the peer-review process, aggregation of ratings from many individuals (a form of crowdsourcing) allows “good” information to be highlighted prominently, while “not so good” information gets pushed to the bottom.”

That’s a terrible analogy. In the peer-review process, both the author(s) and the reviewer(s) are credentialed experts in their field. I would not ask a room full of neurologists for advice on my house’s plumbing and I would not ask a room full of plumbers about the treatment of peripheral neuropathy. For the “Digg” model to work at all for health information, the crowd should be very large and very knowledgeable. On the other hand, even widely agreed-upon practices have later been proven wrong by empirical testing and evidence…so shouldn’t we rely on evidence?

The problem with relying only on the wisdom of crowds is that, sometimes, the crowd shows an alarming lack of wisdom regarding health information. Huckster snake-oil salesman Kevin Trudeau’s Natural Cures ‘They’ Don’t Want You to Know About was a New York Times self-help Best Seller! (For more on why this is a great example of an unwise crowd, see this video.)

Let me illustrate with a real life example: When our infant son developed what appeared to be a tremor, we didn’t waste time asking a crowd. We first asked a local pediatric neurologist for his opinion. When he was unable to make a diagnosis, we asked Dr. Marc Patterson, a pediatric neurologist at the Mayo Clinic. Dr. Patterson’s unusual experience and education enabled him to make a diagnosis very quickly.²

I wonder: If Drs. Deshpande and Jadad have family members with worrying illnesses, do they consult the best available clinical expert, or go to the wisdom of the crowd?

But I’m getting off-track. Back to the article.

As seems to be typical for malinformed physician technotopians, these authors point at Wikipedia to support their perspective.

“The interplay of users to collaborate and deal with information overload has already been proven successful in other areas outside the health space. For example, Wikipedia not only allows users to submit content on various topics, but also provides the capability for users to edit the content of others. Although there is the potential for misuse, Wikipedia, which relies on anonymous, unpaid volunteers, seems to be as accurate in covering scientific information as the Encyclopedia Britannica.”

Well, yeah. And I’d trust Wikipedia as a source for health information about as much as I’d trust Britannica….which is to say not very much.³

“Since its inception in 1990 until the present day, the health system has grappled with how to manage potential harm associated with information available on the Internet. Research in this area, for the most part, continues to assume that techniques used to evaluate paper-based information can automatically be applied to online resources, ignoring the added complexity created by the multiple media formats, players, and channels that are brought together by the Internet.”

Someone please explain to me why peer review is less effective with texts distributed online than texts distributed on artifacts of dead trees. Text is text. Someone please explain to me why peer review would be less effective if this text is read aloud and recorded/played online as video or audio (downloadable or streamed in any format). The “added complexity” the authors mention impacts peer review in no way. Perhaps this is why they make such an assertion while providing utterly no support for it.

I like Web technology and have made a nice niche for myself by writing and talking about how it can be useful to health information professionals. I am sick to death, however, of people attempting to make names for themselves with inane prognostication and unsupported technotopianism. When these authors write that “…as the Web continues to evolve, we will likely gain new insights as to how this happens along with a better understanding of how to handle health information from any source…”, I want to beat my head against a wall. To me, this is no different from saying we should go ahead and build lots more nuclear reactors because we have faith that technology will work out a way to dispose of nuclear waste in a safe manner before we are harmed by our inability to dispose of it properly. Such things are too important to take on faith in the future.

“The time has likely come to end our Byzantine discussions about whether and how to measure the quality of online health information. The public has moved on. It is time to join them in what promises to be an exciting voyage of human fellowship, with new discoveries and exciting ways to achieve optimal levels of health.”

Such a perspective would have us ally ourselves with the Jenny McCarthys of the world. Jenny McCarthy believes and popularizes the idea that immunizations cause autism spectrum disorders, despite the fact that there is no scientific evidence correlating immunizations and ASDs.

Laypeople, even brilliant laypeople, do not generally have the information or health literacy skills to know where to find quality information and to know what to trust. My brother is an experienced Web programmer. He has topped out every IQ test he has ever taken. He is a brilliant man and as talented an autodidact as anyone I know. Still, when he needed a medical procedure, he was able to find more information and trust its authority by conferring with me- because I spend my days finding and evaluating health information.

Reliance on science and expertise is not Byzantine. Rationalism is not Byzantine. Empiricism is not Byzantine. Politicians should not make public policy decisions based on polls and clinicians should not make decisions based on the misinformed preferences of their patients. Clinicians have a duty to educate patients and help point them towards good information because the volume of shoddy information is growing at an alarming rate.

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I have believed in the value of the dialectical process since long before I knew there was a term for it and have always believed that honest criticism serves the criticized, the critic, and those witnessing the process.

So I LOVE that Dean decided to specifically address one of my criticisms.

I questioned Dean’s assertion that “Google’s search results are emblematic of an approaching crisis with information overload”.

Dean writes:

Google most certainly is emblematic (a visible symbol) of information overload, and in fact is the information specialist’s laboratory for it.

I see honest disagreement here.

I think Google is emblematic of the way that the clever application of technology overcomes “information overload.” The Web is huge, filled with an insane amount of information that is varyingly good, bad, ugly or [fill in your favorite adjective here]. But if one uses Google to search for Google Scholar Dean, the first four results are about Dean Giustini, the author of the UBC Google Scholar Blog. It took typing three words and I found EXACTLY what I was looking for in about 0.51 seconds. To me, this doesn’t paint an image of Google as a symbol of information overload.

Dean continues:

“It’s well-documented throughout the blogosphere that web 2.0 has resulted in too many RSS feeds, too much data and information from disparate sources with little connection to each other.”

First, there are many popular positions (technical, political, philosophical…) expressed in the blogosphere (and elsewhere) that I believe to be wrong-headed, foolish, unwise or silly. I also believe that decisions based on evidence and direct experience tend to get better results than those built on blogosphere buzz and hearsay.

Second, I’m sincerely flabbergasted to hear a librarian (or any information professional) complain that there is “too much data” or “too many RSS feeds”.

“Web 2.0″ doesn’t cause an information glut. What causes an information glut is being an information glutton, taking on more than anyone can reasonably manage. There aren’t too many RSS feeds. Rather, there are users who subscribe to too many RSS feeds. The solution isn’t for less data to exist, the solution is smarter, more selective use of the data. The tools that help us filter and manage the information that we care most about are continuing to improve in power and sophistication.

The feeds I subscribe to are so carefully chosen and filtered that I started to worry about missing out on serendipitous discovery of information I didn’t know I needed. I remedied this by using feeds from the social bookmarking of medical librarians (and other beloved medical/technology information nerds) to keep an eye on what they find interesting. In this way, the tools that Dean sees as contributing to the “information glut” open me up to new ideas, thoughts, and resources that I would otherwise not have found. With the smart use of my aggregator, I can browse these quickly and easily, discarding what doesn’t suit my interests.

Dean also writes:

“99% of the information that we are finding in Google is irrelevant to medicine.”

Sure, but I’ve never heard a single physician claim Google is irrelevant to Medicine. On the contrary, many talk about how frequently they use it. Meanwhile, 99.99% of what’s findable via PubMed is irrelevant to a particular healthcare information need. So what?

Meanwhile, turnabout is absolutely fair play, and Dean reciprocates by sharing some criticism of my own writing. Because I’m really enjoying the direct discussion and believe in the dialectical process, I’m going to address each of his criticisms.

Dean writes:

“If you have some different ideas on where the web is, why don’t you write your own piece?”

I will absolutely be pleased to write an Op-Ed on the Web and health information at the invitation of the first prestigious medical journal which invites me to do so.

I’d might use the opportunity to demystify buzzwords, clear up popular misconceptions and/or call for a new sort of rigor in the way that writers in medicine and libraries use technology buzzwords in order to better empower each other and those whose needs they serve.

I could alternately suggest practical ways in which existing technologies could be leveraged to expand or improve information services for clinical patrons.

Dean writes:

“One thing about David’s blogging is that he doesn’t explore the social or cultural context for all the tools he introduces.”

That’s usually true. After all, I’m neither a sociologist nor a cultural anthropologist.

I usually talk about how Web tools might be applied in the setting of a medical library. That’s sort of what this blog is for- and I’ve said that from the very first post.

I run a hospital library and I solve problems that hospital-based users experience while using technology. I write about the things that interest me and that I think will interest others who do similar work and face similar problems. That’s what defines the general scope of this blog- and I’m happy with it.

Dean writes:

“It’s much harder to place information technologies in some context than it is to merely announce that you’ve found a new tool worth exploring.”

Although I really do think it is important and useful just to share the existence of tools that I think may be of interest or use to other medical libraryfolk, I often provide context. Some examples:

• The Future of the Hospital Librarian (Pure Op-Ed on the future of hospital librarianship)
• Misdiagnosed Cyberchondriasis (Taking apart a very stupid term that is increasingly popular in mainstream media)
• Veropedia: Like Wikipedia, Except Totally Lame (A review and critique)
• PogoFrog vs. the Dyson Vacuum Cleaner (A review and critique)
• Elsevier’s WiserWiki (A review and critique)
• Rating Medical Blogs (A review and critique)
• Social Search for Health Librarians (A review and critique)
• Disliking “Web 2.0″ and Hating “Web 3.0″¹

Both Dean and Dr. Ves Dimov (at Clinical Cases and Images) seem to think that I want to replace “Web 2.0″ with some other term.

Dr. Dimov writes:

David seems to suggest the alternative term “Web Geekery” which does not sound much better than “Web 2.0.”

I have at no time suggested that my complaints with the (mis)use of “Web 2.0″ would be solved by replacing it with ANY other term. “Web Geekery” is just the phrase I use to describe the stuff that interests me.²

I will point out, though, that not a single person has ever needed me to explain what I mean by “Web geekery.”

For the record, Ves- I don’t think there was anything wrong with your description of “Web 2.0 and Medicine” in 2005. You were talking about applying the trends O’Reilly described with “Web 2.0″ to the needs of medicine. Still, I dearly hope that many of the current uses of “2.0″, “3.0″ and (yes, really!) “Web 4.0″ will go away. The metaphor threatens to outgrow and eat what it was supposed to represent.

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MedlinePlus has a new page on Health Literacy with links to lots of good stuff.

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Testimonials from real patients and physicians on how the Internet has helped them with their health care treatment and delivery.

Above: Embedded video. If you are reading this via your feed aggregator, you may need to visit the site itself to view.

What bothers me about this video is that “the internet” isn’t the best tool for ANY of the purposes mentioned in this video. There are better tools for finding quality health information than Google and “the internet.”

Also: What is “Health Think”? (See opening and closing titles)

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More about McKean here and here.

Also be sure to check out McKean’s blog, Dictionary Evangelist.

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On 7/21/2007, a Harris Poll was released which stated that in the last two years, the percentage of people who “have used the Internet to search for health-related information” has gone from 53% to 71%. This was based on a telephone poll of 1,010 adults between 7/10/07 and 7/16/07. The Harris report refers to these people as “cyberchondriacs.”

The media seems to love this story. BusinessWeek, ars technica and a ton of others have offered articles on it.

I think the study matters and merits coverage, but I object to the term “cyberchondriac.”

Managed care has resulted in physicians not being able to spend as much time educating patients at the same time patients are taking more responsibility for their healthcare decisions. The healthcare consumer who decides to do some research using the most powerful research tool the world has ever seen isn’t a hypochondriac. That consumer is taking responsibility for her healthcare and becoming informed.

Let us say that a patient is told that she had a kind of hypothyroidism. That patient goes to the bookstore and buys a book published under the name of Mayo (or Johns Hopkins or some other very reputable authority) on thyroid disorders. The patient reads the book and makes notes on questions she wants to ask her doctor when she goes in for her next office visit. This isn’t hypochondriasis. This is the sort of patient clinicians should treasure. A patient who self-educates and asks informed questions saves the time of clinicians.

Now let’s imagine that the same patient skips the book and instead searches Medline Plus for information about hypothyroidism, printing some pages out and making notes on questions she wants to ask her doctor when she goes in for her next office visit. This isn’t hypochondria either. This is the exact same behavior in a patient that clinicians should celebrate and encourage.

Hypochondriasis is a very real disorder. The hypochondriac doesn’t need an Internet connection to experience its awful symptoms.

If clinicians want to complain about patients who look up health information online with no regard to the authority of the information or the information provider, that’s fine. Those clinicians would do well to volunteer and donate to help improve outreach and information literacy programs in medical libraries. When the clinician encounters a patient who habitually looks for health information from poor sources, the clinician should refer the patient to the nearest medical library or at least point the patient towards Medline Plus.

I won’t be using the word “cyberchondriac” to describe people who seek health information online.

I won’t use it to describe hypochondriacs who look for health information online, either. It has a glib feel to it that doesn’t sit well with me when describing someone dealing with a disorder as awful as hypochondriasis.

[/soapbox]

The Newest Vital Sign is based on a nutrition label from an ice cream container. Patients are given the label and then asked 6 questions about how they would interpret and act on the information contained on the label.

Specifically, the patient is handed a copy of the nutrition label and then asked a series of 6 questions about it. Patients can and should retain the label so they can refer to it while answering questions. It is not necessary to give the patient time to review the label before asking the questions. Rather, they will review the label as they are asked and answer the questions.

The questions are asked orally and the responses recorded by a clinical staff member on a special score sheet, which contains the correct answers. Based on the number of correct responses, the health care provider can assess the patient’s health literacy level.

You can order yours here.

Yes, it is created by Pfizer- but they’ll send you a copy of the peer-review study of the Newest Vital Sign (or you can snag it yourself here).

More about NVS:

• MedScape article: Newest Vital Sign May Be an Effective Quick Screen for Health Literacy
• Pfizer’s promotional materials

[via BHIC]