Medical libraries are essential. So why are we imposing cuts on them?

In a recent blow to evidence-based medicine, the Canadian Agency for Drugs and Technologies in Health (CADTH) is quietly eliminating half its staff at its Research Information Services team while the College of Physicians and Surgeons of British Columbia (CPSBC) is closing its medical library.

In no small amount of irony, the CPSBC directed its members to the services of CADTH, apparently unaware of the job losses and cuts made just the week before.

Family physicians and specialists in smaller, rural hospitals are left with no access to library services and must now purchase costly information resources on their own. Meanwhile, members of the CPSBC Board, many of whom are adjunct faculty at the University of British Columbia or the University of Northern British Columbia, will continue to enjoy unchanged access to library services at university libraries.

If you still envision libraries as rooms filled with books, it’s time to embrace the 21st century.  We’ve been here awhile. Today, most medical information health-care providers rely on is available online, but most high-quality information is usually at a cost. Most importantly, not all health-care professionals have equal access to reliable internet connections or the financial resources to purchase individual subscriptions to medical literature. This leaves them at risk of using lower quality information that is easier (e.g., free) to access.

Curating and managing easy access to these resources still requires humans with specialized training and knowledge. As the firehose of information produced during the COVID-19 pandemic demonstrates, the skills of information professionals are needed more than ever. In just four years, we’ve seen a quarter of a million articles published on the disease. That’s 10 times as many articles as on syphilis, a disease that is on the rise and has been with us for centuries.

For already exhausted and overworked family physicians or nurse practitioners, spending time searching for information on their patient’s rare disease or complication isn’t good use of their limited time. Even confirming a drug will not harm a developing fetus relies on tools managed by medical libraries. These libraries – and the librarians and library technicians who staff them – play a critical role in providing access to such tools and conducting searches on behalf of frontline health-care workers.

Unlike the United States and England, Canada has not been successful in creating a national library of health. Given the ample research both these countries have done into the effectiveness of medical libraries in reducing costs, improving patient safety and more, it’s clearly a sound investment. Instead, Canada’s fragmented system means that some health-care professionals, primarily those affiliated with medical schools, enjoy comprehensive access to resources while others, including those in rural and remote areas, are left to fend for themselves.

These cuts have repercussions for all Canadians, whether they work in health care or not.

As cost-cutting measures are pursued without impacting frontline staff, libraries become an easy target but Canada continues to provide less and less coordinated and equitable access to health information for health-care professionals and the public alike.

These cuts have repercussions for all Canadians, whether they work in health care or not. CADTH’s decision to stop producing in-house systematic reviews to support its drug reimbursement recommendations in favour of industry-sponsored research introduces a new layer of bias into the evaluation process. Relying on drug companies to provide research raises concerns about the integrity of the clinical and economic analyses used to make decisions about what drugs get paid for by taxpayers in Canada. As we move toward a national pharmacare program, ensuring unbiased evaluations becomes paramount to safeguarding the health and wellness of Canadians.

Call us cynical, but we’re more comfortable having in‐house expertise generate unbiased clinical and economic analyses than drug companies providing us with the research themselves. With the coming of pharmacare, it seems like a particularly sound investment to ensure these evaluations are done with as little bias as possible as the incentive for pharma companies to pad their bottom lines with government dollars is growing.

The revolutionary concept of evidence-based medicine, once championed by pioneers like David Sackett at McMaster University, is now being disregarded. How can you make decisions on the best available evidence, when so much of the evidence isn’t available to you? How can you partner with patients to understand risks when misinformation and disinformation are everywhere on social media and there is little incentive to provide unbiased information?

Health-care providers should be spending their time treating patients, not hunting for resources. Medical libraries and their staff are essential for supporting this work.