J A Muir Gray

National electronic Library for Health (NeLH)

Modern healthcare professionals have to resolve the information paradox; they are overwhelmed with information but cannot find particular information when and where they need it.1 The internet and its associated technologies, especially the world wide web, have the potential to both exacerbate and reduce these problems. Simply providing access to the world wide web per se may exacerbate the problems of information overload, since every web browser has access to hundreds of millions of pages of information. However, the cost effective provision of access to timely, current, and high quality information is what internet technology potentially offers. Creation of the National electronic Library for Health (NeLH) should be seen as an attempt to harness internet technologies to solve this information paradox. Sir Edward Waine, regius professor of medicine in Glasgow, who invented Waines thyroid index, an early, pre-computer, decision support system, used to teach about “la maladie du petit papier.” This described the patient who, somewhat nervously, took a little bit of paper out of his jacket pocket towards the end of the consultation and used this paper to remind him of the questions that he knew he was bound to forget in the stress of the consultation. Many clinicians have now found that le maladie du petit papier is now but a fond memory as they face daily “la maladie du grand print-out,” an altogether more daunting challenge. The world wide web has blown away the walls and doors of medical libraries, which once shielded medical knowledge from the public gaze. Members of the public can now have access to almost all the information that professionals have. #### Summary points Healthcare professionals face a paradox; they are overwhelmed with information but cannot find a particular piece of information when and where they need it Creation of the National electronic Library for …

Transferring evidence from research into practice: 3. Developing evidence-based clinical policy

In previous editorials in this series (1, 2), we described a path that leads from health care research evidence to evidence-based health care. The steps include getting the evidence straight, developing evidence-based clinical policy, and then applying the policy.

THE FAILURE OF PREVENTIVE MEDICINE

The failure to promote public health may be due, not to political or economic opposition, but to the fact that the arguments used to persuade people to change their behaviour or to agree to the passage of enabling legislation are set in a linguistic framework which has no meaning for them--namely, the concept of the future.

Section 47 and the Community Physician

The use of the powers of compulsory removal delegated to community physicians, who act on behalf of district councils or London boroughs, by Section 47 of the National Assistance Act of 1948 is reviewed. A questionnaire was necessary because the Department of Health no longer collects the relevant data and 90·8% of the responsible community physicians in England replied. The powers are used about 200 times per annum. In 96·8% of cases the people removed were over the age of 65. In 94% of cases the powers of immediate removal of the 1951 National Assistance (Amendment) Act were used. There was very little evidence to suggest that the powers were being abused. It is argued that these powers should not be repealed but that they should be amended and that they would be the subject of a national review as a preliminary to parliamentary action.

Self-medication by Jockeys

are other surveys, not quoted in their paper, of radiologically detected lesions of the proximal part of the alimentary tract which are mainly from the developing countries of East Africa7 and the West Indies8 and also from Scotland3 and South Australia.9 Although these surveys do not cover a population as well defined as that of the North-east of Scotland they were made on unselected patients who presented for barium swallow and meal examination in the main teaching hospital in the area concerned, and, in the case of the East African series, the only local hospital at that time which provided a comprehensive radiological service. Therefore, with some limitations, these series are, at least so far as disease of the oesophagus, stomach, and duodenum are concerned, comparable with the survey from the North-east of Scotland. The importance of the comparison of surveys of this type is related to the geographical aspects of pathology, the study of which may provide useful information on the aetiology of disease.-I am, etc., E. M. BATESON

Science on Trial: The Clash of Medical Evidence and the Law in the Breast Implant Case

M Angell W W Norton, £22 (to be published January 1997), pp 256 ISBN 0 393 03973 0 Atrend in American litigation has important implications not only for those who practise medicine but also for those who purchase and organise it and for those who make equipment that clinicians use. By describing one particular case in the United States courts, this book focuses on the clash between medical and legal definitions of evidence that has received little attention hitherto but which is relevant world wide. The story itself is relatively simple. A few women claimed that health problems, notably connective tissue disease, had resulted from their breast implants. A few “expert” witnesses asserted that this was the case and propounded theories about how such a causal relation might operate. There was not, and never has been, any strong evidence based on good epidemiological research that breast implants actually cause connective tissue disease, using conventional criteria for defining a causal relation. On the basis …