Annabel Bentley: Information overload…are you waving or drowning?

Information is out of control. Whether it’s a bulging email inbox of journal alerts or an unread pile of medical journals, we’re all drowning in unread and out-of-date information. But at last, I may have found the secret to effortless continuing professional development (CPD): just read 75 trials and 11 systematic reviews a day. What a relief. Now I can get on with the rest of my life, safe in the knowledge that I’m up to date. But only once I’ve diligently worked my way down that towering pile of journals.

I don’t know whether to feel depressed, overwhelmed, or inspired. There’s more medical research to help me stay up to date than I can possibly read in a lifetime, let alone in a few snatched moments on a quiet Thursday night in. Recently I tried to read (and then re-read whilst feeling increasingly bemused or enthused depending on my wavering motivation) a PLoS paper titled: 75 trials and 11 systematic reviews a day: How Will We Ever Keep Up? This includes some neat graphs showing the unstoppable growth of controlled trials and systematic reviews since the end of the twentieth century. I was alarmed when I realised that this pales into insignificance compared to the explosion of narrative reviews and case reports over the same time period. As I imagined my growing daily reading list I had to conclude: medical information has become unmanageable. And what’s more, it’s getting worse. We are drowning in evidence. 
The question is how do we make sense of the information deluge? Some have tried, and the Cochrane Library is a very successful example. But the trouble is that the problem is not simply information overload. Underlying issues are incomplete publication of trial data and incomplete synthesis of available evidence, with less than half of all Cochrane reviews being up to date. I wonder if a potential solution is to develop a wiki-style production system for systematic reviews? Harnessing the power of mass collaboration, sometimes described as wikinomics, might help speed up the publication and dissemination of systematic reviews globally. The online identity of authors, reviewers and editors would need to be managed securely for this to work.

Another information problem is “filter failure,” a term coined by Clay Shirky, a New York University associate. His assessment is that information is not really the problem, but that we need better ways of filtering it. I wonder if using Twitter, a social filter, may help. I’ve been challenged by some clinicians that Twitter is pointless, simply adding to the information overload problem. I disagree. I joined as @doctorblogs in 2008 simply because I love new technology and all things geeky. But I soon discovered the benefits, such as hearing about breaking news faster than from conventional news sources such as newspapers and printed medical journals, which simply can’t compete with Twitter’s realtime updates. It can also help you to keep up with medical conferences, without having to be there. For example, if you want to hear live updates from the Evidence 2010 conference just follow the Twitter hash tag #ev2010 on 1st -2nd November 2010.

My conclusion is the information problem is now so big, that we need to do things radically differently, instead of doing more of the same. So perhaps in the future we’ll see wiki-Cochrane reviews or clinical trials on YouTube. Otherwise, the only remaining solution may be for doctors and researchers to set up an Information-Users Anonymous support group. We could start each meeting by solemnly declaring the first of the twelve steps: “We are powerless over information – and our lives have become unmanageable”. I hope it doesn’t come to this.

Annabel Bentley is interested in evidence that matters to patients and health risk communication. Originally trained as a surgeon, she is currently medical director at Bupa Health & Wellbeing. The views in this blog are her own and not of any organisation she works for.