Mobile devices change the way medicine is taught, learned and practiced: that’s a great challenge for libraries

Interactive map of mobile technology projects at medical libraries & medical schools all around Europe

Recently, I was invited to sum up all incentives on mobile technology in our subject area for the summer issue of the Journal of EAHIL. The resulting monographic section was published as Use of mobile devices in medical libraries and medical schools. Alltogether 14 projects were listed throughout Europe.

Actually, the title for the introduction was a two sentences sum-up: „Mobile devices change the way medicine is taught, learned and practiced. That’s a great challenge for libraries“. (PDF) The papers in this special issue on mobile technologies have one thing in common. They all agree that “smartphones and tablet computers have become the new cultural ‘norm’ within personal and professional lives”. Especially tablets are used to enhance teaching, learning and practice of medicine. As you learn in this issue, some European medical schools have already recognized the value of tablet computers in learning and loan them or present them as a gift to students. Six from eight contributions regard tablets, which reflects pretty much the use we all recognize in lectures, libraries, on the ward, on the go. As students use tablets for learning and looking up information, it is clear that this will affect libraries too.

What may the future hold for medical librarians in the age of mobile devices as the new cultural norm?

Some reacted or pro-acted by lending tablet computers, recommending apps, licensing content, or training students in order to make the best of these devices. Some medical libraries have even developed their own apps or written designated iBooks, some – with the help of engaged faculty – are embedding tablets and contents into the curriculum. The projects in this issue present a wide range of interventions in terms of embedding mobile devices and technologies in medical libraries and schools for the sake of the medical education process.

Featured Original Article

  • Enhancement or replacement? Understanding how legitimised use of mobile learning resources is shaping how healthcare students are learning Fuller R Joynes V, p 7
  • Mobile technologies and medical education at Heidelberg University Library Gehrlein S, p 11
  • Design, development and implementation of a mobile learning strategy for undergraduate medical education Toro-Troconis M, Morton C, Bennie T, Leppington C, Hemani A, Lupton M, p 14
  • The Branch Library of Medicine Münster created a tablet toolbox for embedding mobile digital learning resources into the curriculum Obst O, p 21-22
  • Re-inventing the e-book: how tablets increased e-book take-up at Bern University Bissels G, p 23
  • From pilot to practice: iPads at the University of Helsinki Faculty of Medicine Masalin T, p 27
  • What are the attitudes of F1 doctors in Prince Philip Hospital towards their use of the iDoc app? Bruch S, Paget T, p 32
  • Abandoning native apps to become future friendly, Jergefelt M, p 36

These articles were published in JEAHIL, Issue 2, 2015

Watch Repairer, Taxi Driver, Librarian: How threatened are our jobs in the digital age?


For 702 different jobs, the Oxford researchers Frey and Osborne examined the degree of susceptibility to computerisation. With a probability of 65%, the occupation “librarian” was calculated as quite good computerisable (1). How does this translates into the reality of our daily work? Do we now all have to be anxious for our jobs? Fearing that our jobs will get lost? That libraries get extinct?

Yes and No. Let’s take a closer look at the evidence: 1. The Oxford study was published in September 2013. Since then, 11 libraries were closed in Germany. That’s less than 0,1% of the 14.300 German libraries. And the number of employed librarians isn’t shrinking either. 2. The usage of libraries are steady or even increasing as well as 3. the budgets. These three observations are a good indication of the lasting attractiveness of libraries. But what about the attractiveness of librarians? For sophisticated library tasks we are desperately looking for candidates, but simple library jobs may definitely be threatened.

To understand this more clearly, let’s take a look at some other occupations examined by the Oxford researchers: The Watch Repairers and the Taxi Drivers will both be replaced with a probability of 99% and 98% resp., but the Recreational Therapists and the Computer Systems Analysts are totally safe jobs (p<1%). And this is the key message of the report: Watch Repairers and Taxi Drivers do routinely, simple work, which could be easily replaced by automation (watch building/repairing robots) or smart algorithms/services (Google cars, UBER service). On the other hand, the Recreational Therapist and the Computer Systems Analyst are so highly individual and innovative tasks, that nobody can think of a computer algorithm or robot to replace them. We as librarians are somewhere in between these two work groups. Some of us already perform highly ambitious tasks, and some of us do routinely simple tasks. The hypothesis of a two-class system in librarianship is supported by the higher susceptibility to computerisation of “Library Assistants” (95%) and “Library Technicians” (99%) in contrary to the normal “Librarian” (65%). (1)

Is your fate predestined then? One way to success, the other to extinction? Yes and No. There is no such thing as Kharma in librarianship. You can switch to other, more future-ready tasks by your capabilities, training or both. Each and any boss would be happy for such a staff member especially in the present days of rapid change. But: If you work in the acquisition or circulation department it could be somewhat harder. Then you are definitely on the wrong track. Acquisition and cataloguing will be the first tasks to become centralised on a regional or national level; circulation and stacking will be automated by robots resp. replaced by digital content. So my advice would be: If you are in one of these dead ends, ask for transfer to the reference or teaching department or apply for project management for centralisation and automation (remember: be the hammer not the nail).

If you change to the more specialised things such as rare books, that would be really smart. Be sure to collaborate with G.L.A.M. (galleries, libraries, archives, and museums). And if you do old books, mix this up with the latest technology, such as the Bavarian State Library did, which gives away the Gutenberg Bible for free on an iPad.(2) And if you are in reference, become specialised. Don’t do the routine questions, which could easily be automated (Google) or centralised (nation-wide reference), but the ones which are local, customized, cunning, and of high priority. You will find a list of specialisations in the references (3).

Be open-minded in everything (especially the needs of your users) and get trained, trained, trained. Not only by the usual library instructors, but by the very experts in the field, world-wide, which are often no librarians (any more). And do not forget research. For academic libraries, it’s the core of success. For instance, researchers do not have a clue of data management and if they had, they would love a librarian to do it for them, as the computer scientist Daniel Lemire said: “So I think that librarians should move on to more difficult tasks. For example, we badly need help with what I would call “meta-science”. For example, we have collections of papers that refer back to data sets. These data sets are typically poorly hosted, partially replicated, and so on. We badly need to clean up this mess. We need data object identifiers. We need help tracking data sets, their transformation and so on. In effect, I would push librarians into data science. That’s the next frontier.” (4)

To sum-up, let’s quote Marc Andreessen, the famous internet entrepreneur: „The spread of computers and the Internet will put jobs in two categories: People who tell computers what to do, and people who are told by computers what to do.“ (5)


  1. 1. Frey CB, Osborne MA. The Future Of Employment: How Susceptible Are Jobs To Computerisation? [Internet]. 2013 Sep 17 [cited 2015 Aug 30] Available from:
  2. Bayerische Staatsbibliothek. Famous Books – Treasures of the Bavarian State Library [Internet]. 2012 Jun 25 [cited 2015 Aug 30] Available from:
  3. Obst O. The Librarian of the Future. Journal of the European Association for Health Information and Libraries 10(4):24-25 (2014)
  4. Lemire D. Commentary to John Duouis: An Open Access thought experiment. [Internet] Confessions of a Science Librarian 2012 Aug 29 [cited 2015 Aug 30] Available from
  5. Mims C. How the internet is making us poor. Quartz 2013 Mar 3 [Cited 2015 Aug 30] Available from:

Foto: (c) Shrimpgraphic at

Published in Journal of EAHIL 2015; Vol. 11 (2): 51-56

The Librarian of the Future


Who do you think “Librarians of the Future” are? How would they behave and what would they look like? In my imagination they are like a space hero, a Flash Gordon-like figure with almost magical cyber librarian skills nobody ever had heard of. But hold on – many of us practice such skills already. Every time I listen to some of my colleagues from abroad I’m deeply astonished about the diversity of tasks they perform, the services they have invented, and the kind of non genuine library task they manage. (Maybe that’s the reason why every year I’m more content to be a librarian, and I cannot imagine a more powerful and amazing work.) Let me demonstrate some of the tasks and skills that I have come across:

  • Authority for tablet computers, e-book readers, and respective apps (medical as well as productive). Handles mass sync and restore of hundreds devices as well as volume purchases of apps with casualness;
  • Budgetary expert and fund raiser. The library budget is not set in stone; if you want to develop interesting projects, you have to look for money, write proposals, and know how to take money out of the pockets of your boss;
  • Embedded librarian. Show up at the point of care, support doctors and nurses, looking for clinical outreach, being liaisons, and acting at roadshows;
  • Impact firefighter. Performing scientometric analyses on the spot. An expert in every kind and database of measuring impact. Know your h-index in sleep;
  • Lawyer with a profound knowledge in copyright, plagiarism, and detection tools. Negotiates publication rights with publishers;
  • Lecturer for group and personal training to create a positive climate that encourages team building and openness for change;
  • Lobbyist and networker at task forces, Faculty Boards, Deans, committees, advisory boards, both inside and outside the organization;
  • Marketing manager for user needs assessment, performing SWOT analyses, doing surveys, interviews, focus groups, public and customer relation, stakeholder reporting, and exploring the return of each Euro invested in the library for the organization;
  • Master of Medical Education, multimedia, and e-learning. Web sites, magazines and leaflets are an important part of library marketing, so librarians could be journalists, editors, designers. They could be lectures, presenters, and motivators as well. For example, the Cushing Library at Yale has an instructional design librarian employed, who helps faculty with their video lectures (see picture above);
  • Program manager of Open Access, technical manager of Open Access repositories, press person for publishing on demand, expert in megajournals and APCs; (1)
  • Teaching librarian. Deeply embedded into the curriculum, he teachs each and every customer at each and every occasion; he masters lecturing and is the gate keeper for information literacy at his organization;
  • The Visionary develops enthusiastically strategies for the library of the future and experiments like crazy(2).

The demand for such sophisticated tasks is extremely high and often faculty members regard librarians as skillful experts for many of these tasks, as the computer scientist Daniel Lemire noticed:

So I think that librarians should move on to more difficult tasks. For example, we badly need help with what I would call “meta-science”. We need help tracking data sets, their transformation and so on. In effect, I would push librarians into data science. That’s the next frontier. In science, we badly need help from people whose main goal is not to contribute new quanta, but rather keep track of what is happening. Students are awful at managing documents, citing them, finding relevant work, and so on. I think that a lot of librarians already help, but we might need what I would call “teaching librarians”. I have yet to see a librarian on a Ph.D. committee in science, but I think it could be a good idea. (3)

It is my sincere hope that librarians will always be open for such honorable expectations and never fail.


  1. Frank Norman: Megajournals [ accessed] Nov, 11th 2014
  2. T. Scott Plutchak: Breaking the barriers of time and space: the dawning of the great age of librarians. J Med Libr Assoc. Jan 2012; 100(1): 10–19. [] accessed Dec, 11th 2014
  3. Daniel Lemire: Let us be clear. August 29, 2012 [] accessed Nov, 11th 2014
  4. Brandon A.N. Academic status for medical school librarians. Bull Med Lib Assoc. 1970 Jan;58(1):1–6
  5. []

Foto: myfuturedotcom 6052488441 at

This article will be published in JEAHIL, Issue 4, 2014

I recently came across a citation from Alfred Brandon (4) describing (purely coincidentally of course) exactly the same things I had discovered:

Today the typical medical librarian must be an administrator, educator, researcher, collector, public servant, fund raiser, accountant, architect, psychologist and public relations expert. With this enlightened viewpoint in mind, I object to being classified as the stereotyped librarian of twenty-five years ago. I object to following outmoded policies and procedures. I object to the status quo attitude and lack of experimentation and desire on the part of some for improved methodology for librarianship.

Your library: a successful service center for a successful faculty

How to implement research support

Yesterday there was disastrous storm in my hometown. Many cellars and garages were flooded including some ofthe library’s storerooms. But thankfully many people helped out of nowhere. There’s a saying in Germany: manyhands make light work and so the storm passed over quite easily. In a rapid changing environment you need to adaptand develop unexpected strengths and skills. That holds very much true for the library itself. The thunder storm inour book world is that there are no books left. That is good news for disasters but bad news for our profession. Justto change to digital media or gadgets will not work in all cases. Our principal financing comes from the faculty andthe scientists are both specifically demanding and library denying. So we had the idea to develop a strategy forresearch support in order to serve our scientists even better. We came up with the following ideas, measures and stepsto rebuild the library to a successful service center for a successful faculty. To accomplish our tasks we tried to thinkfrom a strict researcher perspective.

Challenges for research

At first we thought about what the real challenges for a researcher were. Of course, they are more interested in theircareers and publishing in Nature than in obtaining articles via interlibrary loan. The visibility of research output –local and international – is of crucial importance for the individualscientist as well as for the Dean. We discovered that at the moment,there was no portal for the scientific publications of the faculty, letalone a repository that highlighted the best papers and researchachievements of the faculty. We also found that the informationlandscape has become increasingly complex. There are sophisticateddatabases, research portals but access to information and researchpapers is complex and time consuming. Information literacy is valuedhighly and together with the usually strong fluctuation this equals forstrong training needs.There is also now a growing commitment by research funders (DFG, ERC and Horizon 2020) to publish in OpenAccess journals but there is a lack of knowledge among researchers for publication and funding opportunities. Thelibrary must support the publication of research results in high-ranking journals as much as possible. In addition thereare the progressive needs of students and teachers through new curricula (Science). Current e-learning styles andsystems (Flipped Classroom/Blended Learning) overwhelm teachers. Support for multimedia, mobile working,learning and teaching methods in the faculty is necessary.

Finally the library must promote the quality of doctoral work and the integrity and freedom from plagiarism of research and doctoral theses as there is a decrease in the number of doctorates awarded recently on account of insecurity and resignation of doctoral students.

Challenges for the Library

  1. The increasing use of library resources over the Internet has led to an alienation between the researcher and library. As a consequence identifying new developments in research and delivering appropriate services is becoming very difficult for the library. And even if there are services which match the needs of the researcher, they do not know about them.
  2. The newly to be developed services require specialized skills and competencies that must be acquired by the employees. Therefore, dedicated staff development is necessary.
  3. The centralization of traditional library tasks such as cataloging and media processing has led to a restructuring of the tasks in the library, resulting in staff cuts and reduce freedom to decide things on our own.

Worldwide trends in research support

  • Archiving and long term storage of primary research data;
  • Visibility of institutional research output by Current Research Information Systems, University bibliography and publication of scientific articles in professional and university repositories;
  • Integrity of research and PhD theses;
  • Simplifying and supporting access to quality information, 24/7, mobile and personalized services;
  • Support in publications, especially from Open Access;
  • Development of research and publication skills of PhD students and young researchers.

Proposals to implement

  1. The quantitative and qualitative study of the information needs of researchers;
  2. market analysis of „good practice“ examples such as in other libraries;
  3. develop a strategy to support research in collaboration with the Dean’s Office, scientists and other stakeholders. This strategy involves the joint establishment of priorities and objectives, key achievements and outcomes, a structure for quality and risk management, and professional development;
  4. development of a product and service portfolio;
  5. a program of continuous staff development of library staff.

This article was published at JEAHIL, Issue 3, 2014.

No student has to come to the library anymore


Returning home from a road trip through several US american medical libraries, I am even more convinced that just now, just today, we have the unique opportunity (or nightmare, depending on your point of view) to participate in the transition from the printed to the digital age. Brown University / Alpert Medical School’s Library consist of working places and computers only – no textbooks, and (almost) no librarian – it is well managed by a single person, halftime. The pride of Harvard’s Countway Library of Medicine is the „Center for Biomedical Informatics„, where the associate director of the library, Dr. Alexa T. McCray resides. And Yale’s Cushing Whitney Medical Library is very much into the iPad, both as a learning tool for freshmen and (with the iPad mini) as a patient tool for residents. Yale wants to create “Leaders of Medicine” and they imagine the iPad may well be a means for that purpose.

Transitioning from printed to digital age, the transition from printed to digital libraries is just a little facet for a society, that is shaken up by computer glasses, driverless cars, wearable technologies, and quantified selves. As part of this little facet, the transition from printed to the textbooks seems to be just a tiny yigsaw piece. But nevertheless, textbooks do represent a highly successful business model for both libraries and publishers, and therefore it is literally vital to know, when and how the transition process is starting if at all.

As a successor of the iPad lending project [1], since this year the Medical Library of the University of Münster is providing students with an iPad toolbox, serving as a modern, mobile and sustainable learning infrastructure. The toolbox is a pre-configured tablet computer with all the learning materials needed to pass the preclinical exams: electronic textbooks, anatomy apps, tools for exam preparations, and of course PDF annotating and note taking programs.

The project is a partnership between library, faculty, and major scientific publishers. Our goal is to gain a better understanding, how tablets and mobile learning applications affect the education of present and future students. After evaluating the study results, the logical next step would be to provide all freshmen students with such a device, giving them a tool as one single point of access to learning resources, study organization, e-learning, learning simulations as well as patient care.

There were two claims associated with the project called „easyphysikum„:

  1. The exam should be passed more easily
  2. No student has to come to the library anymore

At the moment 130 students are enrolled into the project, 70 having their own tablet computer and 60 loaning an iPad Air from the library for 5 months. Including the content provided by the publisher and staff resources, the project budget amounts to a quarter of a million Euro.

For such transition projects, investment and risk-taking are necessary. But this is quite worthwhile. As the example of the Brown’s Medical Library demonstrates, medical schools may well do without a pivotal medical library as we know it. To experiment with future-oriented learning environments may open up new ways to fulfill our very mission: providing (information) services to our users supporting them achieving their goals. Therefore we quite enthusiastic about the strong interest of universities, faculties, and libraries in this project even at this early stage.

(1) iPad lending project: First Results

This article was published in the June issue 2014, page 18.

Foto: (c) ZB Medizin

Students are a source of inspiration for the library


deutsche Version

Not only since I became a grandfather have I appreciated being with young people. Not only in the private sphere, even and especially in the library. It gives me great joy to be with young people, to work together, to discuss together, to serve them. Grandfather encounters young – which is of course a cliché. An elderly with a wealth of experience, young people sitting at his feet and listening attentively to his advice. But that is not so with us. Rather the opposite. The elderly is listening to the young: We ask students for their opinion on our ideas. We work with them on our projects. We even write reports together.

What impressed me most is her fresh, unspoiled point of view. They are always asking: „Why is this so and so in the library?“ And with many things, I can only reply : „Well, I do not know.“. „Why users are not allowed to bring in their food and coat?“. “ Well, I do not know. That has always been the rule.“ If you are curious, such a “Why?” can be very rewarding. Each “Why?” can be a door to the future and a source of inspiration.

If you were to ask me, „What is the greatest danger for the library?”, I would refer to Donald T. Hawkins, who said: „What will kill our profession is a lack of imagination.“. Lack of imagination and clinging to old answers will result in a stubborn, narrow angle of view and as a consequence poor, useless services. Life will pass over us dinosaurs – but wait: Presumably, life has already passed over us – we just have not noticed. Because libraries are still visited quite well, we seriously believe our plan is accurate.

How can you make an agile mammal out of a lazy dinosaur? For example one could try to integrate students in the planning of future services, in the daily business of the library, whether in the form of task forces that come together only for specific tasks, or in the form of an advisory board, which advises the library permanently.

Coming together with students, talk to them, ask them about their wishes, and not only in anonymous surveys, but live, face-to-face, brings each individual and the library immense benefit. It’s some work, but it is worthwhile and the advantages are obvious: better networking, more influence on campus, higehr reputation, services are optimized and sustainable, we know our market, we know our user, we define common goals, and pull together with them. Since the last five years we have very good experiences with a student advisory board, we make use of two task forces regarding the use of tablets in education, and the unique experiences of the 14 student assistants employed by the library.

What I like most about these encounters is the great enthusiasm of the students, their boundless optimism, and their strong imagination, which they are happily willing to share with the library. To devote themselves entirely to a single end, to better services. Certainly, some students are plain stupid and cannot put themselves in the shoes of librarians (but then librarians would damn fail too for put themselves in student’s shoes), but the majority of them, especially in medicine, is simply brilliant, extremely smart people, very creative. It would be a shame and waste of resources, not to unleash their potential.

This article was published in the March issue 2014.

Foto: UKM Münster

Studierende sind ein Quelle der Inspiration für die Bibliothek


englische Version

Nicht erst seitdem ich Grossvater geworden bin schätze ich das Zusammensein mit jungen Menschen ausserordentlich. Nicht nur im privaten Umfeld. Auch und gerade in der Bibliothek macht es mir große Freude mit jungen Menschen zusammen zu sein, zusammen zu arbeiten, zusammen zu diskutieren. Großvater trifft auf Jugend – das ist natürlich auch ein Klischee. Alter Mensch mit reichem Erfahrungsschatz, jungen Menschen sitzen zu seinen Füßen und lauschen andächtig seinen weisen Ratschlägen. Bei uns ist das aber nicht so. Eher das Gegenteil. Der alte Mann hört den Jungen zu: Wir fragen Studierende nach ihrer Meinung zu unseren Ideen. Wir beziehen sie in unsere Projekte mit ein, wir fordern ihr Feedback heraus.

Was mich am meisten dabei begeistert, ist ihre frische, unverbrauchte Sichtweise. Sie fragen immer „Warum ist das so?“. Und bei vielen Dingen kann ich nur antworten: „Weiß ich auch nicht.“ „Warum dürfen Benutzer nicht mit Mantel in die Bibliothek?“ „Weiß ich auch nicht, das war schon immer so.“ Wenn man neugierig ist, kann ein solches Warum? sehr bereichernd sein. Jedes Warum kann eine Türe in die Zukunft sein und eine Quelle der Inspiration.

Wenn man mich fragen würde: „Was ist die größte Gefahr für die Bibliothek, würde ich mit Donald T. Hawkins antworten: „What will kill our profession is a lack of imagination.“ Lack of imagination und Verhaftet sein an alten Antworten bewirken einen starren, engen Blickwinkel und als Konsequenz schlechte, nicht passende Services. Die Evolution wird über uns Dinosaurier hinweg gehen – aber halt: Vermutlich ist die Evolution bereits über uns hinweg gegangen – nur wir haben es noch nicht gemerkt. Wir glauben weil die Bibliotheken voll sind, würde unser Dienstleistungskonzept noch stimmen.

Wie kann man aus einem behäbigem Dinosaurier ein flinkes Säugetier machen? Man könnte z.B. versuchen, Studierende in die strategische Planung, in das Alltagsgeschäft der Bibliothek einzubinden, sei es in Form von Taskforces, die nur für spezielle Aufgaben zusammenkommen, sei es in Form einen ständigen Advisory Boards, der die Bibliothek berät.

Mit Studierenden oft in Kontakt zu sein, mit ihnen häufig zu reden, sie nach ihren Wünschen zu fragen, und das nicht nur in anonymen Umfragen, sondern live, face-to-face, bringt jedem einzelnen und der Bibliothek immense Vorteile. Es macht einige Arbeit, aber es lohnt sich, die Vorteile liegen auf der Hand: Vernetzung, politische Einflussmöglichkeiten, wirklich nützliche, zielgerichtete Services, Zukunftsfähigkeit, Wissen um den Nutzer, den Markt, gemeinsame Ziele definieren, an einem Strang ziehen. Wir machen seit fünf Jahren sehr gute Erfahrungen mit einem Studierendenbeirat und haben kürzlich zwei Taskforces zum Einsatz von Tablets in der Ausbildung installiert.

Was ich am meisten an diesen Begegnungen schätze ist die große Begeisterungsfähigkeit, ihr grenzenloser Optimismus, ihr ausgeprägtes Vorstellungsvermögen, das sie nur allzu gerne bereit sind, mit der Bibliothek zu teilen. In den Dienst der Bibliothek, nein: In den Dienst der gemeinsamen Sache zu stellen, wenn sie merken, dass es der Bibliothek ernst ist (mit den Veränderungen) und es den anderen Studierenden zugute kommt. Wenn Sie merken, das am anderen Ende des Tisches ein genauso engagierter Mensch sitzt. Viele Studierende – die Mehrheit, gerade in der Medizin – sind einfach brilliant, äußerst kluge Köpfe, super kreativ. Es wäre eine Schande und Ressourcenvergeudung, dieses grosse Potenzial nicht zu nutzen.

English version

Foto (c): UKM Münster

Wenn du in der Wahrheit Halt findest, kehrt alles andere zu dir zurück

Mein Leitspruch seit ein paar Tagen.

Krisen, so schmerzhaft sie für unmittelbar Betroffene sind, haben auch ihr Gutes: Sie führen zu größerer Klarheit im Denken und zwingen dazu, der Wirklichkeit ins Auge zu sehen und sie nicht länger zu verklären. In Krisen werden Mythen überprüft – und, jedenfalls nicht leichten Herzens, gegebenenfalls entsorgt. Klaus-Dieter Frankenberger, FAZ 26.3.2014

„GEHORCHE KEINEM“ bleibt vorerst dunkel


Die ULB Münster sandte am 08.01.2014 folgende Nachricht über den Äther:

Vielleicht haben Sie es ja schon bemerkt: Die Leuchtbuchstaben des Kunstwerks „GEHORCHE KEINEM“ bleiben auch nach Einbruch der Dämmerung dunkel. Dieser Zustand wird voraussichtlich bis zum kommenden Frühjahr andauern.

Bereits seit einiger Zeit gab es Probleme mit dem Ausfall einzelner Buchstaben. Die bisherigen Bemühungen, den Defekt zu beheben, blieben aber letztlich ohne nachhaltigen Erfolg. Nun ist klar: Erst ein recht aufwändiger Tausch der innenliegenden Elektronik wird das Problem dauerhaft lösen.

Aufgrund der winterlichen Witterung sind die notwendigen Arbeiten erst für das Frühjahr 2014 geplant. Der Grund: Die Buchstaben sind sehr groß und aus einem anfälligen Material gefertigt. Ein möglicher Materialbruch beim Entfernen der Buchstabenfronten soll nicht riskiert werden.

Da defekte Leuchtbuchstaben die künstlerische Wirkung des Werks beschädigt, hat die ULB entschieden, die Beleuchtung bis zur endgültigen Behebung des Defekts komplett abzustellen.

Mein Kommentar: Gute Reaktion! Jeder einzelne Buchstabe hat seine eigene Bedeutung, die der Künstler gegebenenfalls zu erklären und zu verteidigen wüßte. Nicht auszudenken wäre z.B. ein Ausfall des Buchstaben „K“ gewesen.

Foto: Pressestelle der ULB Münster

Trust no guideline that you did not fake yourself

Foto: Peter J Dean at

It is not surprising to anyone, that in the billion Euro health care market, pharmaceutical companies exert influence wherever possible (1). Clinical trials with negative outcomes will not be reported or published as those in favor of a new pharmaceutical. When looking up “all” studies on a clinical intervention you obviously will not find the retained ones. Librarians know that and will make their users aware of the so called publishing bias. Instead we usually promote information to our users such as clinical guidelines as a source of high evidence, which is accumulated and easy to practice. However, in the light of some new findings, this practice has to be considered quite strictly.

In August, the major German newspaper Frankfurter Allgemeine Zeitung alerted their readers to several cases of faked practice guidelines. Their headline was straight forward: “What the guidelines conceal – millions with heart failure follow the advice of an impostor” (2).

They claimed that thousands of deaths in Europe are accountable to the – currently valid – guidelines of the European Society of Cardiology. The reason is a favorable evaluation of beta-blockers based on scientific misconduct. Many more examples can be found in a disturbing report by Jeanne Lenzer in the British Medical Journal titled “Why we cannot trust clinical guidelines” (3). On the basis of well-known fraud and newly discovered suspected cases (also in the prestigious Cochrane Library), Lenzer showed that guidelines are not above suspicion: “Guidelines are usually issued by large panels of authors representing specialty and other professional organisations. While it might seem difficult to bias a guideline with so many experts participating under the sponsorship of large professional bodies, a worrying number of cases suggests that it may be common. A recent survey found that 71% of Chairs of Clinical Policy Committees and 90.5% of Co-chairs had financial conflicts.”

An analysis of Gisela Schott in the renowned journal Deutsches Ärzteblatt arrived at the same conclusion. On the basis of two examples from Germany she proved that there is a significant influence of pharmaceutical companies on guidelines (4). For example, Schott identified several ludicrous shortcomings of the German S3 guideline for the treatment of psoriasis vulgaris by efalizumab:

  • The producer of efalizumab promoted the responsible medical society financially;
  • numerous guidelines authors received financial support from the producing pharmaceutical company or exercised consultant activities for them;
  • conflicting interests were not documented in the guideline

Schott summarizes that you should maintain a healthy scepticism towards German guidelines: “Of the 15 voting participants in the consensus process of the S3 guideline, 10 declared partially numerous financial connections with up to eleven different pharmaceutical companies.”

With this information at hand, doctors fall in a serious dilemma: when I apply the guideline, it can harm my patients. If I do not apply the guideline faithfully, it can damage my career. As a first consequence, the Working Group of the German Medical Societies (AWMF) has issued a strict paper on Recommendations for dealing with conflicts of interest at professional societies ( From now on, the 70 societies and 2500 experts who are responsible for the several hundred guidelines of the AWMF must now declare detailed conflicts of interest that might impair their professional judgment.

It will take some years if this action will lead to clean guidelines if ever. The fight will continue, because obviously the pharmaceutical companies are not going to let somebody put one over them. We librarians should be aware that whatever the result of this fight may be, we have to keep our users informed about these imponderables. Do not trust information just like that – not even guidelines – and always be aware of the many obstacles in the knowledge transmission process.

This article will be published in the December issue 2013 of JEAHIL.

1. Goldacre B. Bad Pharma: how drug companies mislead doctors and harm patients. Harpercollins 2012
2. Frankfurter Allgemeine Zeitung, 28.08.2013, Nr. 199, S. N1 (Abstract: