Guest Editorial: Conducting (Paperless) Research

    I think that I shall never see   
    A poem lovely as a tree. — Joyce Kilmer (1886–1918)

    Baby boomers may celebrate or regret those bygone days when research was conducted in silent, dusty, dimly lit library stacks. Thin, yellowed pages felt important beneath our fingers as we leafed through heavy volumes— the important ones had to stay in the Reference Section — in search of the information we would carefully copy onto index cards to take home and sort and organize. Those were the days of typewriters and carbon paper and (bless it!) erasable bond. Those were the days when even budding conservationists could never know how many trees they were killing in the name of Thesis Papers.

    Now, research can be conducted with ease and without fear of admonishment from John Muir. Data once only available in massive texts can be accessed online. Journal articles can be downloaded instead of Xeroxed. The evolution of paperless scholarly exploration is giving even the faint at research heart the incentive to see what’s out there on a variety of topics and, when data are lacking, conduct their own studies. We salute their efforts and present some intriguing details about how we came to be a paper-based society and how we can alleviate some of the burden on trees.

    Paper (whose name is derived from papyrus,¹ the ancient Egyptian reed made into scrolls and paper-like parchment) has not always been made from trees. Writing/printing surfaces also can be made from hemp. By the early 20th century, markets for hemp byproducts were well established and advancements in harvesting technology promised to increase cultivation levels. Yet despite the fact that hemp is a far more economical and environmentally friendly plant, its use was thwarted by a series of events.

    Two men were at the heart of hemp’s prohibition: Lamont DuPont, whose company had patented the chemical processes that turned trees into paper, and William Randolph Hearst, who owned 800,000 acres of forest and sought to use DuPont’s process to make newsprint of his trees. By playing on the public ballyhoo regarding hemp’s drug association, Hearst used his extensive media influence to perpetuate the “Reefer Madness” campaign — he was instrumental in persuading the US Congress to pass the Marihuana Tax Act, which prohibited hemp production. By double-teaming society, Hearst and DuPont saved themselves billions of dollars that would have been lost had hemp come into broad use.² Apparently, it was more acceptable to kill trees than to kill profits.  

    Fast forward to the 21st century and concern about global warming, which even the White House agrees may be a real threat to life as we know it.³ How might we reverse some of the devastating effects of global warming? One solution is to avoid killing the trees that can help protect our environment and to use some less environmentally toxic method to accumulate and disseminate information.

    Although certainly the impetus for creating the World Wide Web and all of its ramifications is not completely altruistic and green-minded, the online research revolution it has spawned has saved (one would think) or redirected the use of a fair number of forests. The list of electronic resources expands daily. For example, this journal is available online at https://www.o-wm.com and its sister publication, WOUNDS, is also a click away (https://www.woundsresearch.com). Take a look at just a few other sites — they can become an everyday part of your practice, no matter what your professional activities entail, and provide the literary resources you need. You will not only save paper, but you also will save another precious resource — oil — by not hopping in your car in pursuit of information.  

    Drug references can be downloaded to your Palm Pilot® or pocket PC from ePocrates at https://www2.epocrates.com/index.html. The basic free version is a gold mine of drug dosing and interaction data while the subscription versions offer a great variety of additional resources.  For alternative but similar products, you can find the good old Physician’s Desk Reference (PDR) at https://www.pdr.net/mobilepdr/mobilepdr.aspx and learn about the free MobilePDR or visit Tarascon at https://www.tarascon.com/ to learn about a similar offering.

    If textbooks are your forte, a visit to eMedicine at https://www.emedicine.com/ will give you access to comprehensive, regularly updated tomes on: dermatology; emergency medicine; biochemical warfare; a variety of surgical specialties including orthopedics, ENT, plastic surgery, general surgery, neurosurgery, OB/GYN, thoracic surgery, trauma, urology, and vascular surgery; internal medicine and most subspecialties; neurology; ophthalmology; pediatrics; physical medicine and rehabilitation; psychiatry; radiology; and sports medicine. Most are downloadable for free if you are an author of a chapter or part of one of the many institutions that sponsor the project; otherwise, the cost is nominal.

    The Merck Manual is available at no charge online at https://www.merck.com/mrkshared/mmanual/home.jsp along with other Merck publications on linked pages.  

    Martindale’s The Reference Desk, available at https://www.martindalecenter.com/ lets you drill down through most fields of human endeavor; access the “Virtual” Medical Center at https://www.martindalecenter.com/HSGuide.html. This site allows you to explore every medical specialty under the sun, including specialized topics such as wounds, at https://www.martindalecenter.com/MedicalSurgery_3_ST.html#WOUND, which includes text and pictorial materials.  

    The granddaddy of biomedical online information sites is Entrez, available at https://www.ncbi.nlm.nih.gov/gquery/gquery.fcgi? itool=toolbar. From there, you can link to Medline searches at Pubmed (accessible directly at https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed). Or, conduct genetic research at Online Mendelian Inheritance in Man (OMIM) at https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM&itool=toolbar.

    The serious medical trivia lovers among us who want to be the life of the party might even download the entire OMIM (a mere 45-megabyte file) at https://www.ncbi.nlm.nih.gov/Omim/omimfaq.html#download, which can be loaded onto personal portable devices. Many but not all full-text articles are available at: https://www.ncbi.nlm.nih.gov/entrez/query.fcgi? db=pmc. If you want free online journals, visit the Public Library of Science at https://www.plos.org/ to have a look at a new paradigm in publishing.

    As thoughtful wound ostomy continence practitioners, we often want to know if what we are doing is evidence-based. The Cochrane Collaboration at https://www.cochrane.org/index0.htm is the fountainhead of evidence-based medicine and includes current and extensive reviews of wounds and ulcers. Those interested in holistic approaches to care will enjoy a visit to the Dietary and Herbal Supplements section of the National Center for Complementary and Alternative Medicine at the National Institutes of Health (https://nccam.nih.gov/health/supplements.htm), which provides access to the International Bibliographic Information on Dietary Supplements (IBIDS) Database at https://grande.nal.usda.gov/ibids/index.php, a searchable source for both consumer and peer-reviewed information on food supplements. A complementary resource is the Computer Access to Research on Dietary Supplements (CARDS) Database, available at https://dietary-supplements.info.nih.gov/Research/CARDS_Database.aspx. Between these two resources, no patient query should go unanswered.  

    Consumer online resources also can be useful to professionals. For instance, a visit to https://www.google.com, followed by a search under the “images” tab for the word “ulcer” and a click on “search” reveals a few dozen dazzling educational images on the first page alone, with another 13,000 or so available for your viewing pleasure.

    Hopefully, you are finding these paperless research ideas fascinating, more convenient, and less cumbersome than library research. You already may have tried some of these sites and downloaded files from some of the resources. Now, how do you keep it all organized? Simply go to https://desktop.google.com, download Google Desktop, and index your entire computer.

    Israel recently observed the Hebrew holiday Tu B’Shvat, the annual celebration of the “New Year of the Trees.”4 This cheerful, minor holiday is often acknowledged by planting trees. Like Arbor Day in the US (the date of which varies from state to state, depending on climate), it serves as a reminder of the importance of trees to life on earth.  Although you are most likely reading this on paper, we hope that reminding you of the importance of this vital resource will lead you to explore and utilize online resources, saving trees as you expand your educational horizons.

    For the poetic among us, here is the rest of Kilmer’s tribute.
Trees
I think that I shall never see   
A poem lovely as a tree.
A tree whose hungry mouth is prest   
Against the sweet earth's flowing breast;   
A tree that looks at God all day,
And lifts her leafy arms to pray;   
A tree that may in summer wear   
A nest of robins in her hair;   
Upon whose bosom snow has lain;   
Who intimately lives with rain.
Poems are made by fools like me,   
But only God can make a tree.

1. Merriam-Webster Online Dictionary definition of paper. Available at:  http://www.m-w.com/dictionary/paper. Accessed January 27, 2006.

2. Hemp: history and facts. Available at: http://www.ylana.com/hempartc.htm. Accessed January 27, 2006.

3. Climate change fact sheet: the Bush Administration’s actions on global climate change. Available at: http://www.whitehouse.gov/news/releases/2005/05/print/20050518-4.html. Accessed January 27, 2006.

4. Katz L. All about Tu B’Shvat. Available at; http://judaism.about.com/od/tubshvat/a/all_tubshvat.htm. Accessed January 27, 2006.