Searching the Medical Literature Using the Commodore Amiga

The Setting

Sooner or later you'll be faced with having to "look it up." Try to imagine: You need some specific information in order to treat a patient with an unusual medical condition. So you pick up a standard medical textbook such as Harrison's which does refresh your memory but does not contain the latest information you require. Because you seem to recall reading something about this unusual medical condition recently, you now go through your collection of medical journals and reprints. You find that you probably threw out the issue that discussed this problem because you never imagined that one day you would have to treat it. You call your colleague who tells you that he hasn't seen a patient like yours in years. You have a key to the hospital library which is closed for a long holiday weekend. The librarian who usually does your literature searches is on vacation. What are you going to do?

The "Old-Fashioned" Way

You could drive over to the hospital and begin a manual literature search, a process which could easily take an afternoon or an evening if not more.

There are thousands of medical journals published worldwide each year and it would be impossible to thumb through the index of each in the hope of finding specific information. A more efficient way would be to consult an reference (such as Current Contents or Index Medicus) which indexes by key word every article published in the many medical journals that it reviews. Searching the literature is an art and choosing good key words is critical. However, once you know the author and title, you could look it up provided that your library carries that journal and that the volume you need hasn't been lost, misplaced, or is out at the bindery.

Enter the Age of the Computer

In this day and age, there are extensive databases of information for practically every sphere of human knowledge and medicine is no exception. Often these databases are stored on CD ROM but their lease or purchase, at present, usually makes more sense for libraries than for individuals. Most of us (at present!) might find it more cost-effective to use someone else's database collection and pay them for access time. This approach allows many choices.

Probably the the easiest is to request the librarian at your facility to access the Elhill computer at the National Library of Medicine (NLM) and conduct a MEDLINE search. MEDLINE is an electronic database of abstracts from some 3600 medical journals of the 20 - 25,000 medical publications that the NLM receives. If your librarian is friendly and helpful, you will describe the information you would like to obtain and together you will develop a search strategy based on appropriate key words. It is important to be present during the MEDLINE search because you may find that you need to change your key words, thus expanding or narrowing your search.

Not every hospital library has the required computer facilities and those that do may not allow you to be present during the search which, in turn, could result in a set of references which are of limited use. Also, when the regular librarian goes on vacation, the remaining personnel may not know how to use the computer system. Also, to do a MEDLINE search directly, you need to know a special command language. Although it is certainly possible to learn this language on your own or take a course sponsored by the National Library of Medicine, many of us would not want to if the frequency of our literature searches didn't justify it. Fortunately, there are other ways of approaching the problem.

On-line Telecommunications Services

Some major telecommunications services, such as CompuServe, will allow the user to access various professional databases. On CompuServe, one can access MEDLINE by typing GO PAPERCHASE at the main menu and following the instructions. In addition to hourly CompuServe charges, there is a PaperChase surcharge of $24.00 per connect hour prime time and $18.00 non- prime time. Photocopies of references can be ordered on-line at $10.00 per copy first class delivery or $25.00 for express mail or fax. Additional fees may apply, e.g. for manuscripts longer than 25 pages, etc.

Interestingly, with CompuServe, MEDLINE searches are not carried out at the Elhill computer at the National Library of Medicine , but rather on the computer system at PaperChase which is affiliated with Beth Israel Hospital in Boston, Massachusetts and which leases medical databases from the National Library.

Getting medical information via a national telecommunications service is incredibly convenient and easy although you still need to think of key words and your thinking and typing time is charged accordingly! If your literature searches are relatively infrequent and you already are a member of CompuServe -- and many Amegans are -- you may find this route to immediate information to be just what the doctor ordered. Check the network that you use to see if a similar service is provided.

Becoming more Direct

Having the most current information at your fingertips can be an addicting experience and you may easily find yourself consulting databases more and more frequently. You may soon decide to avoid paying the middle man and subscribe to PaperChase directly. The user interface and accessible medical databases (MEDLINE and HEALTH) are the same as for CompuServe users, so that knowledge of commands and search strategy, etc. are immediately applicable.

When you contact PaperChase (1-800-722-2075), they will send you a packet filled with useful information about their databases, how to perform a search, and the charges you can expect to pay. You can use CrossPC (Consultron) on your Amiga to run their complimentary 720K IBM diskette which contains a demonstration of a typical search.

The charge per connect hour is a uniform $23.00 regardless of the time of day. Although photocopy charges are the same, there are an additional series of charges not applied to CompuServe users, e.g. 10¢ per reference or abstract displayed or printed. I could easily envision these charges mounting up depending on the specific search. However, there are no "start-up" or monthly fees. The support person at PaperChase felt that the various charges balanced each other and that there was no substantial difference in overall cost between accessing PaperChase directly and indirect access through Compuserve. Special plans are available to academic centers. PaperChase plans to include other databases such as CANCERLIT and AIDSLINE in the near future which will be available to all users.

Commercial Alternatives

Users of PaperChase are basically limited to the MEDLINE and HEALTH databases because these are the ones that PaperChase leases from the National Library of Medicine. Commercial alternatives such as BRS Information Technologies can be quite competitive by offering access to a very large number of databases in medicine, science, finance, business, education and the humanities to name a few. Entire textbooks and journals are available on line. If you like to keep up with a certain area or topic, BRS offers a service whereby you can store your search strategy. Then each time the database is updated, the computer will automatically run your search and mail you the new references it finds!

None of this comes cheaply. Individuals pay a one-time $95.00 registration fee and there is a $20.00 monthly minimum applied against usage. There are a variety of additional charges such as for on-line SORT- ing ($1.00) and SAVE-ing ($2.25). Connect time charges vary according to database and range from $22.00/hr non-prime time for MEDLINE to $100.00/hr. prime time for CURRENT CONTENTS: CLINICAL MEDICINE. There is a substantial reduction in cost for schools of the health sciences (Colleague Student Program) with students assessed a flat rate of $17.00/hr.

A telephone call to BRS marketing (1-800-955-0906) will bring you some informative brochures, a sign-up form, and a program demo on a 5¼" 360K IBM floppy diskette that you can copy onto a 720K 3½" IBM floppy disk and run on an Amiga using CrossPc (Consultron). You may also want to contact Dialog Information Services (1-800-334-2564) to see how their services compare with those of BRS.

Becoming REALLY Direct

As you see the impact of knowing the latest information, you may want to access the National Library of Medicine (NLM) and its many databases directly. The problem, as I mentioned, is that you will need to learn the search routine and the associated commands for MEDLINE which, in reality, really isn't that much of a problem. However, the NLM makes searching easier by providing (at $29.95) an interfacing software package called -- amusingly enough -- Grateful Med. What is not so amusing is that this software is available only on IBM and MacIntosh formats.

Using Grateful Med on the Amiga (MacIntosh Emulation)

Grateful Med will run on an Amiga equipped with AMAXII+ (ReadySoft), which consists of AMAX 2.5 software and an internal board which when fitted with MacIntosh 128K ROMs will allow an Amiga to emulate a Mac Plus. The board has an external serial port connector to which a 2400 baud Supra modem with a standard Mac serial cable can be attached.

With Grateful Med, you compose your search (keywords, medical sub- headings, etc.) off-line so that when the software rings up the NLM you will only be charged for the search itself. If you want to order a reprint you have to run a separate program called -- are you ready? --Loansome Doc which requires a separate (automatic) phone call -- a procedure which you may find inconvenient.

Learning to use Grateful Med is facilitated by the complimentary demo disk provided by the NLM. The easy-to-follow manual included with the software is an excellent long-term reference. Finally, the program itself contains a certain amount of on-line help. The NLM support staff are excellent and they will be delighted to answer any questions that still remain (1-800-638-8480).

The bottom line is that Grateful Med 1.5 and the AMAX+ system work spectacularly together and I have now run several successful searches, one of which, I am told, provided information that may have saved a patient's life. There are several additional points regarding both AMAX and Grateful Med that some readers may find helpful.

1. My hardware set-up involved installation of the AMAX board in an Amiga 2000 having a GVP 68030 combo card and a total of 4 MB regular (auto-config) and 6 MB expansion memory. Even with this unusual set- up, I had no problems with the AMAX internal card/software combination!

2. If you are using a GVP accelerator/memory expansion combo card you will need the latest GVP AMAX driver which regrettably is not supplied on the AMAX disk but can be obtained from the GVP bulletin board or, I presume, by calling GVP.

3. All Mac software (which I ran under System 6.05) resided on a partition of a Syquest 88 MB removable disk which it shared with a normal Amiga partition. The GVP FaastPrep program was used to format and partition the disk.

4. Installing Grateful Med 1.5 on the Mac simply involves dragging icons into a drawer. To access the databases at the NLM, you will have to apply for a user I.D. and a password which basically involves telling the NLM how you intend to pay for their services. You will also need a local Tymenet or Sprintnet telephone number but this you can look up in the booklet supplied by the the NLM with your software.

5. Grateful Med does insist on initializing your modem and this can cause difficulty. If you are having problems with your modem not re- setting or with total gibberish coming through after you connect to the Elhill (NLM) computer, the problem may be with the default initialization sequence. If you do need to alter the initialization string, you can use the Mac TeachText program to modify the BLOGIN file which contains the Hayes commands. The excellent support staff at the National Library will help you.

6. Using the latest AMAX 2.5 software with the 128K ROMS on an external cartridge rather than on an internal board, does NOT work for Grateful Med or any other telecommunications program that tries to address the Amiga serial port as a Mac serial port. I have verified this on both my Amiga 2000 (workbench 2.0) and my 3000 systems.

   Interestingly, I was able to get Grateful Med (as well as other telecommunications programs) to work with the external cartridge on an old Amiga 2000 (workbench 1.3) using the old AMAX 2.0 software. Therefore, I would recommend to workbench 1.3 users who have problems getting Grateful Med to work with the AMAX external cartridge to try using the old AMAX software.

7. I do not own the Emplant Board (Utilities Unlimited) so that I cannot comment about it's suitability for running Grateful Med.

8. I had a problem connecting with -- ready? -- PDQ, which is a database containing cancer related information. Grateful Med is able to connect to PDQ but then waits endlessly until you are finally logged off the system Fortunately, the PDQ interface is extra- ordinarily friendly so that, unlike MEDLINE, no special interface software is required to use it! I have used both Mac and Amiga telecommunications software to dial my local Sprintnet access number (the same as used for Grateful Med) and log on to the National Library of Medicine and then connect to PDQ. The NLM provides specific written information on what to do. If all else fails, the NLM support line is available. You can get your PDQ password from them at the same time. Also, be prepared to wait a minute or two before the computer realizes that you are there, especially when you log on to PDQ for the first time.

Using Grateful Med on the Amiga (IBM Emulation)

The Grateful Med IBM version (6.0) is currently an upgrade ahead of the Mac version. I was able to run the IBM Grateful Med version on an old Amiga 2000 with 1.3 system software, an XT bridgeboard (Commodore 2088), and the 1.0 version of the Janus software. I have an AST Six Pack multi- function board in this computer which increases the IBM memory from 512K to 640K RAM and provides both a clock and a serial port. To the latter, I connected my old 2400 baud Supra modem.

Installing the the IBM Grateful Med software was a breeze. The program will create for you a (default) directory called GM6 which will now contain everything you need. When you change directory (CD) to GM6, you can run Grateful Med by typing SEARCH (RETURN). You can easily navigate your way around the program by the up and down arrows on the Amiga keypad. The AST serial port works flawlessly and there was no difficulty at all dialing the NLM computer system and running a search. Naturally, you still need a local access telephone number from Sprintnet or Tymenet in addition to your I.D. and Password. Searching the literature is the same as for the Mac version of the program but the software gives you more information about what is happening.

I did hope that it would be possible to run Grateful Med using CrossPc (Consultron). Unfortunately, Grateful Med was unable to use the Amiga serial port and the modem connected to it. Other P.C. telecommunications programs were able to use the Amiga serial port and the modem so that I feel confident that the problem is not with CrossPc.

Conclusion

The are a variety of choices available for literature searching on the Amiga, some of these made possible only by the IBM and Mac hardware emulations that are available. I don't think you can go far wrong whatever choice you make.

The most cost-effective approach is probably to have the librarian do the search and have your organization cover the cost. If you can be physically present during the search, you can be reasonably sure of getting some useful references. Realistically, the librarian may be too busy to run your search at a moments notice and you may not be available when he or she actually does.

If you are a member of CompuServe -- and there are many advantages of becoming a member -- you can carry out a literature search at your own convenience without having to rely on anyone else. You can use an Amiga without needing to emulate some other computer and you can use the pleasant PaperChase interface. Searching MEDLINE through PaperChase via CompuServe is an excellent choice for CompuServe users.

If you are not a member of CompuServe and have no desire to join, you could sign with PaperChase directly. The interface is PaperChase's own and there is the claim of more effective searches of medical literature published prior to 1985. An unenhanced Amiga works fine. You only pay for what you use and there is no monthly fee or minimum. Special pricing options are available for institutions.

Once you get "hooked" on electronic databases and experience the impact the information in them can have on patient care, you may very well decide to explore a commercial service such as Dialog or BRS. In view of the large number of databases and services open to you with this option, the cost may be very reasonable indeed. Special plans for institutions and individuals may be available and should obviously be explored prior to signing on. For example, if you find that you are consulting MEDLINE frequently and you already have a CD ROM drive connected to your Amiga, you might want to consider Dialog's offer of a CD ROM subscription, with monthly updates, for $1895.00 a year.

Finally, there really is no substitute for getting right to the source. And for medical databases, this means connecting to the Elhill computer at the National Library of Medicine. MEDLINE, which contains abstracts of 3600 journals, annuals, etc. is only one of approximately 40 databases on the MEDLARS system. Performing a MEDLINE search via the National Library of Medicine is the least costly alternative and, unsurprisingly, the NLM computers are updated first before any other leased copies are made available.

To search MEDLINE you either have to learn the command language or use one of the Grateful Med interface programs. To use the Mac version, you can attach a modem to the external serial connector of an AMAXII+ internal card and then install and use the software just as you would for a Mac Plus. I have no experience with Grateful Med and the Emplant board. To use the IBM version on your Amiga, you'll need one of the bridgeboard cards as well as a serial card or a multi-function card with a serial port.

Final Thoughts

Please do not think that if you are not in a medically related area that this article is irrelevant to you. Nothing could be further from the truth. Whether you are a high school student needing information for a term paper or a business person seeking financial data, it is all out there on databases. To enter this world of knowledge, all you need is an Amiga, a modem and some telecommunication software.

The second point to be made is that although there is a wide variety of excellent software available for the Amiga, there are occasionally times when you will have critical need for a program that does not have an Amiga version. With other computers, you may have no alternative other than to purchase a whole new system. With the Amiga and its high quality, reasonably priced emulation hardware, you have a very reasonable chance of being able to run the program. Why purchase a different computer system just to run a few programs if you can add a card to the Amiga and keep right on working?

Having the very latest knowledge is important and the power and versatility of the Amiga can help you get it.

Slide show of Grateful Med interfaces.

June, 1993

List of Publications -->

Return To Home -->