Today’s Interim Associate Director for Data Science and a 19th century Surgeon General: They served in different eras under different conditions, but the similarities between the challenges they faced are striking.
A Modern Leader
Last summer Francis Collins, MD, Director of the National Institutes of Health (NIH), selected Patricia Flatley Brennan, RN, PhD, as the new Director of the National Library of Medicine (NLM). In January of this year Dr. Brennan also assumed the role of NIH Interim Associate Director for Data Science (ADDS).
Dr. Brennan faces a daunting task in these dual roles. Data and information are being generated on a scale never seen before, especially in the health sciences. Moreover, it is being generated in new ways, with new technologies, and often only captured in ephemeral media like web-based discussion forums, databases, and even blogs like this one. Gathering, organizing, preserving, and providing access to the salient aspects of this new knowledge is just as difficult as it is important. An unprecedented challenge, to be sure… but not one without historical parallels.
Lessons from History
The historian James A. Huston, discussing the value of history, wrote that "History provides perspective for the judgment of ideas, policies, and procedures… a much more important contribution of history than its direct lessons is the pool of vicarious experience which it provides—experience which is the raw material of imagination.” Huston elaborated: “It is a function of history to provide rich experience out of which imaginative leaders will create new methods to meet new situations."
While the challenges of today’s data-driven world are thoroughly modern and unique, there are historical analogies that can provide helpful perspectives. One hundred and fifty-five years ago, the Surgeon General, who in some ways was Dr. Brennan's NLM predecessor, faced a similar challenge.
A Time for Bold Leadership
William A. Hammond was the newly-appointed Surgeon General of the US Army as the country entered its second year of civil war in 1862. His office included a tiny library of just a few hundred volumes—a library which would eventually grow into today's National Library of Medicine. Hammond represented a significant change in the leadership of his organization. The fourth man to hold the title "Surgeon General" in the medical department that had been reorganized six decades earlier, Hammond was the first to be selected based purely on merit rather than simple seniority. The Secretary of War could easily have continued the tradition of appointing the highest-ranking and longest-serving officer in the medical department as Surgeon General, but he was looking for something different. The country was at war, the challenges ahead were immense, and he needed someone who could bring fresh vision, audacious ideas, and bold leadership to the position. He saw those traits in the young William Hammond.
A New Age
In 2016, NIH Director Francis Collins was looking for a new NLM Director. As with Hammond’s appointment, this would be the fourth person to hold the Director title, 60 years after the Library had been reorganized as a civilian institution with its current name. Collins needed someone who could lead the National Library of Medicine into the age of data science, someone who could address a new kind of challenge. Dr. Collins selected Dr. Brennan to meet this challenge. Like Hammond, she was an unorthodox choice—the first nurse and the first non-MD to serve as the NLM Director. There are substantial parallels between Brennan and Hammond and the challenges their organizations faced. The challenges and opportunities we see at NLM today make it worthwhile to examine these parallels.
Examining the Parallels
In 1862, Hammond recognized that the world of medical knowledge was changing. This change had been emerging for decades, as the scientific revolution prompted ingenious and resourceful innovators like Edward Jenner, René Laennec, and William Beaumont to develop new medical techniques and procedures. Hammond could see that such breakthroughs and advances would no longer be rare, isolated incidents. Doctors and surgeons would be seeing new types of injuries on a vast scale, and they would inevitably, necessarily devise new techniques and develop new knowledge from these experiences.
Abundant New Information
Hammond also recognized that, while there was value in the individual experiences and knowledge gained by busy physicians in the field, if he could harness and share this abundant new information he could make it exponentially more effective across the Army Medical Department and beyond. Nothing like this had been done before. Not only was the scope of knowledge to be captured unprecedented, but the effort to proactively acquire and preserve it, to have systems in place before the information had been generated, was prescient and novel.
A Focal Point for Medical Knowledge
Hammond approached this challenge the way he approached everything: with methodical, deliberate action, foresight, and strategy. He found the best people to help him—imaginative, enterprising medical officers like George A. Otis, Joseph J. Woodward, and John H. Brinton—and he gave them the necessary resources to develop their expertise and fulfil his vision. Most importantly, he firmly established a vision for the future of the Surgeon General's library as a focal point for the accumulation and distribution of medical knowledge.
Hammond directed surgeons to send in specimens, much as today's researchers have been encouraged to share their findings through a range of health services research and public health information programs. John Brinton and George Otis received barrels of surgical specimens from the field; Dr. Brennan's team is receiving "barrels" of digital data in much the same way. Hammond collected physical objects, like new medical instruments and improvised surgical devices, for the information they could convey. Today the Internet of Things—ubiquitous interconnected devices and sensors—allows objects to generate their own data, conveying information in new ways.
A new information medium—photography—also provided exciting new possibilities for Hammond and his field officers in 1862, but it required new ways of analyzing and sharing information. Photographs and photographic plates could yield new insights and the obvious advantages of a visual record, but they were fragile, easily corrupted, and hard to reproduce and disseminate. Today we have access to data sets full of potential insights and opportunities for discovery, but they can be just as hard to preserve and share as those early photos.
Deriving the Greatest Benefit
As we look out over the information landscape in 2017 we see the emerging changes, just as Hammond did in 1862. Powerful computers are inexpensive and widely available. Cloud-based networks enable global collaboration. As in the Civil War, the walls of the laboratory are disappearing and knowledge generation is now possible for any creative and enterprising researcher. And, as in the Civil War, this unprecedented flow of information needs to be captured and preserved to derive the greatest benefit. This is the challenge facing Dr. Brennan and the NLM, and it is every bit as daunting as the challenge Hammond faced. Fortunately, Dr. Brennan and her team appreciate that history can provide the vicarious experience, the "raw material of imagination," necessary to succeed.
About the Author:
Kenneth M. Koyle is the Deputy Chief of the History of Medicine Division at the National Library of Medicine, whose mission is to collect, preserve, interpret, and provide access to one of the world’s richest collections of historical material related to human health and disease. Ken’s primary area of historical expertise is 19th century military medicine.
 James A. Huston, PhD; Sinews of War, p. ix