Summary

  • On 26 June 1997, National Library of Medicine made MEDLINE searching free through PubMed and Internet Grateful Med. Older access methods still carried charges.
  • Patients and families joined the searching audience. NLM expanded coverage for lay readers, published training materials and improved tools with librarians' help.

By 1998, patients and their families were searching MEDLINE for useful health information. NLM's account of the year after free web access puts them in the story alongside doctors and librarians. The institution responded by expanding its coverage of publications written for the lay public. The readers had changed; the catalogue was changing with them.

That is a more revealing sequel to a free search launch than a traffic total. A person could now approach the literature through a browser without a search charge or a PubMed user ID. They still needed to find terms that worked, understand the result and obtain the document. The library had removed a fee and acquired a broader teaching assignment.

National Library of Medicine (NLM) had announced free web access on 26 June at a press conference in the Dirksen Senate Office Building. Senators Tom Harkin and Arlen Specter hosted; Albert Gore demonstrated PubMed. The original NLM bulletin, on its first page, supplied the practical details behind the occasion.

PubMed needed no user ID. Internet Grateful Med still required an ID and password, but searching stopped being billed that day; a version dispensing with the ID was planned for July. Ordering documents through Loansome Doc continued to require an account. A reader could therefore search first and deal with registration when ordering a document.

NLM attributed the free service to savings in telecommunications and software costs. Its archived web notice also named the routes that would keep charging: the ELHILL command system and the DOS, Macintosh and Windows versions of Grateful Med among them, even when accessed over the Internet. There was a price incentive to change the way one searched.

PubMed offered a small search box with substantial machinery behind it. Advanced searching supported Medical Subject Headings, or MeSH, Boolean operators and restrictions to particular fields. Related-article links offered another route through the literature. Initial links to publishers' full text covered 24 journals, some requiring subscriptions. Finding a citation and obtaining the paper involved distinct arrangements, each spelled out in the notice.

The work beneath the interface appears in Sheldon Kotzin's 1998 remarks to MEDLARS users, the source of that account of patients and families. The chief of NLM's Bibliographic Services Division described entering records, assigning MeSH terms and publication types, and checking quality. The preceding year had brought 512,000 new citations. Expanding coverage for lay readers meant making editorial choices about what this machinery would process.

People were putting it to use. Kotzin reported 320,000 searches a day from 46,000 distinct IP addresses each weekday. He also described training needs among both newcomers and experienced searchers. Familiarity with an old system had a shelf life. NLM put course workbooks online and invited others to use and modify them, giving librarians material they could adapt to their own readers.

Those librarians helped alter the software too. A group met NLM staff on 16 April 1998 to discuss search features and telecommunications difficulties. Kotzin listed suggestions already acted on, including attached subheadings in MeSH expansion and a rise from 100 to 150 variants in truncated searches, with a warning when the limit was exceeded. This was the sort of progress that could make a search better without earning a Senate demonstration.

Meanwhile, the old disk business had become a poor advertisement for maintaining everything forever. Distribution of the DOS, Macintosh and Windows Grateful Med disks ended in April 1998, after twelve years. Keeping all three current with vocabularies and features had become impossible, NLM said. Recent sales amounted to fewer than five new disks a month of each version. Most users of an association flat-rate programme, which was also ending, had already moved to the web.

The search charge had gone, the software cupboard was getting tidier, and the librarians were still busy. Patients and families were among the people using the new route. Their presence helped change what NLM indexed, while teaching and user feedback changed how people could search it. The search box was small enough for a home screen; accommodating its audience was a much larger job.