AT THE LIBRARY
“I think the health of our
civilization, the depth of our awareness about the underpinnings of our culture
and our concern for the future can all be tested by how well we support our
libraries.”
CARL SAGAN, Cosmos, 1980
“Libraries are brothels for the
mind. Which means that librarians are
the madams, greeting punters, understanding their strange tastes and needs, and
pimping their books. That’s rubbish, of
course, but it does wonders for the image of librarians.”
GUY BROWNING, The Guardian, October 18, 2003
Finding credible information, let
alone an optimal treatment, for diabetes shouldn’t be a terribly difficult
task. The options of said optimal
treatment, however, permutations of direct or indirect influencers of blood
sugar are finite but vast. So how does
one find then categorize the differing options, narrowing the field to such
optimal solution, in spite of credible, though oftentimes divergent
information? Well, there really are only
a few places that house and disseminate such information: a doctor, the internet,
a friend, other health-providers such as a nurse or dietician, a bookstore, a
national library[1]
such as the US Library of Congress, a private library, or a regional, state,
city, university, or local library.
There certainly must be good
information about diabetes somewhere on the internet,[2]
and it does provide the added benefit of being accessible by anyone on the
globe with a connection and an interface.
Trouble is, navigating to all the relevant sites, documenting,
cataloging, then analyzing and drawing conclusions about a best practice from
the internet, unless you have a specific site in mind already, is a near-impossible
task, as we shall see.
Searching the term “diabetes” on five
well-known search engines in early 2009, I found the following number of relevant
pages: 82,000,000 on GOOGLE, 395,000,000 on YAHOO, 49,000,000 on MSN,
12,769,380 on LYCOS, and 11,380,000 on ASK.
Working alone, and assuming that I’m able to successfully navigate to
each site, spending no more than ten minutes total reading through each site, documenting
my findings, and navigating to the next site, for eight hours each day,
including weekends, it would take 4,703 years
to work through the GOOGLE search results, 22,546 years to catalogue YAHOO’s,
2,842 years for MSN, 729 years to get through the results from LYCOS, and 650
for ASK. I’ll leave this problem to a
more ambitious researcher with substantially more resources at hand to solve.
Before I move on, however, it is
important to remember that we have put ourselves in the shoes of a recently
diagnosed person with diabetes, and thus are tying to find the optimal solution
to our disease. But the search results,
if that task is ever completed, from the internet will not be presented to us categorized
as “good” or “bad,” “effective” or “ineffective,” “true” or “not true.” It is up to the searcher to make that
determination. This concept is best
summarized by Hal Abelson, Ken Ledeen, and Harry Lewis, in their book Blown
to Bits: Your Life, Liberty, and
Happiness After the Digital Explosion (2008):
“The web is no longer a library. It is a chaotic marketplace of the billions
of ideas and facts cast up by the bits explosion. Information consumers and information producers
constantly seek out each other and morph into each other’s roles. In this shadowy bits bazaar, with all its
whispers and its couriers running to and fro, search engines are brokers. Their job is not to supply the undisputed
truth, nor even to judge the accuracy of material that others provide. Search engines connect willing producers of
information to willing consumers. They
succeed or fail not on the quality of the information they provide, because
they do not produce content at all. They
only make connections. Search engines
succeed or fail depending on whether we are happy with the connections they
make, and nothing more. In the bazaar,
it is not always the knowledgeable broker who makes the most deals. To stay in business, a broker just has to
give most people what they want, consistently over time.”[3]
Skipping
doctors, friends, family, relatives, other health-care providers, periodicals, and
bookstores as sources of objective information for the moment, let’s take a
look at a national library. My apologies
in advance for being US-centric; take heart, however, as there is most likely a
national library in your country, though, perhaps with a different
classification system.[4]
First visiting
http://www.loc.gov/index.html, the Library of Congress home page, then
navigating to the catalogue page at http://catalog.loc.gov/, one can search by
keyword, title, author, or subject. The
most general search would be by subject, at which one finds 3,359 matches for
the keyword “diabetes.”
On closer
inspection of the search results, eight of our 3,359 books are from the 18th
century, 1762-1798, to be exact, under the subclass RC, internal medicine, and
five of those rare books, all dissertations entitled Dissertatio Medica Inauguralis, De Diabete, are written in
Latin. The authors and their books’
published dates, are, respectively, William Stevenson (1762), George Jessop
(1771), William Boyd, M.D. (1773), Joseph Hart Myers (1779), and James Vernon,
M.D. (1796). Tentamen Medicum Inaugurale, De Diabete, by Alexander Marcet
(1797), is the sixth book, leaving two books by John Rollo to complete the
century. One of his books is simply
entitled Cases of the Diabetes Mellitus
(1797), and the other, also published in 1797, has the enormous title:
An account of two cases of the diabetes mellitus, with remarks, as they
arose during the progress of the cure: to which are added, a general view of
the nature of the disease and its appropriate treatment, including observations
on some diseases depending on stomach affection, and a detail of the
communications received on the subject since the dispersion of the notes on the
first case / by John Rollo; with the results of the trials of various acids and
other substances in the treatment of the lues venerea, and some observations on
the nature of sugar, &c., [etc.] by William Cruickshank.
This book is
particularly important, as Dr. John Rollo (d. 1809), a Scots physician and
Surgeon General of the Royal Artillery, pioneered the systematic treatment of
the disease by a restricted diet. Using a
urine glucose test devised by Dobson, he came up with the
first effective treatment for diabetes: a diet high in what he called “animal
food” (fat and meat) and low in “vegetable matter” (grains and breads). This diet prolonged life for many diabetics, those
with what we now call type 2, and with modifications, was the only treatment
for diabetes until the 1920s.[5]
Moving on to the
19th century, there were 27 books listed in the Library of Congress
search database, with publishing dates in the 1802 to 1897 timeframe.
So let’s now return
to the books from the Library of Congress dating to the 19th
century. There were 27 books listed in
the LOC search database, with publishing dates in the 1802-1897 timeframe. They are listed here. And, yes, some of these can be found and read
online.
Title: An
essay on the disease commonly called diabetes
Author: Washington, William
Year: 1802
Title: Medical
reports of cases and experiments, with observations, chiefly derived from
hospital practice: to which are added, an enquiry into the origin of canine
madness; and thoughts on a plan for its extirpation from the British isles
Author: Bardsley, Samuel Argent
Year: 1807
Title: Cases of diabetes, consumption, &c.,
with observations on the history and treatment of disease in general
Author: Watt, Robert
Year: 1808
Title: English olive-tree, or, A treatise on the
use of oil and the air bath: with miscellaneous remarks on the prevention and
cure of various diseases, gout, rheumatism, diabetes, &c.
Author: Trinder, William
Martin
Year: 1812
Title: De
diabete mellito
Author: Bennewitz, Heinrich Gottlob
Year: 1824
Title: An inquiry into the nature and treatment of
diabetes, calculus, and other affections of the urinary organs: with remarks on
the importance of attending to the state of the urine in organic diseases of
the kidney and bladder: and some practical rules for determining the nature of
the disease from the sensible and chemical properties of that secretion
Author: Prout, William
Year: 1825
Title: An inquiry into the nature and treatment of
diabetes, calculus, and other affections of the urinary organs; with remarks on
the importance of attending to the state of the urine in organic diseases of
the kidney and bladder: and some practical rules for determining the nature of
the disease from the sensible and chemical properties of that secretion. From
the 2d London ed., rev. and much enl.: with notes and additions by S. Colhoun.
Author: Prout, William
Year: 1826
Title: Hospital facts and observations:
illustrative of the efficacy of the new remedies, strychnia, brucia, acetate of
morphia, veratria, iodine, &c. in several morbid conditions of the system:
with a comparative view of the treatment of chorea, and some cases of diabetes:
a report on the efficacy of sulphureous fumigations in diseases of the skin,
chronic rheumatism, &c.
Author: Bardsley, James Lomax
Year: 1830
Title: Du
diabète sucré
Author: Chaloin, Louis Ernest
Year: 1853
Title: Diabetes
mellitus
Author: Clapp, Sylvanus
Year: 1854
Title: Case
of diabetes mellitus
Author: Jones, Joseph
Year: 1858
Title: On
diabetes, and its successful treatment
Author: Camplin, John Mussendine
Year: 1858
Title: On
diabetes, and its successful treatment. From the 2d London ed.
Author: Camplin, John Mussendine
Year: 1861
Title: Zur
lehre vom diabetes mellitus
Author: Engmann, Wilhelm
Year: 1869
Title: On the origin of diabetes, with some new
experiments regarding the glycogenic function of the liver
Author: Lusk, William Thompson
Year: 1870
Title: Ueber
diabetes mellitus
Author: Wünnenberg, Ludwig
Year: 1870
Title: De la glycosurie, ou, Diabète sucré: son
traitement hygiénique: avec notes et documents sur la nature et le traitement
de la goutte, la gravelle urique, sur l'oligurie, le diabète insipide avec
excès d'urée, l'hippurie, la pimélorrhée, etc.
Author: Bouchardat, Apollinaire
Year: 1875
Title: Considerations
sur la pathogénie et sur le traitement du diabète
Author: Dumoulin, Auguste
Year: 1877
Title: A
treatise on Bright's disease and diabetes
Author: Tyson, James
Year: 1881
Title: De
la gymnastique de l'hydrothérapie
Author: Hoffmann, Louis
Year: 1882
Title: Does the present state of knowledge justify
a clinical and pathological correlation of rheumatism, gout, diabetes, and
chronic Bright's disease?
Author: Tyson, James
Year: 1886
Title: Diabetes.
Mellitus and insipidus
Author: Smith, Andrew Heermance
Year: 1889
Title: Diabetes:
its causes, symptoms, and treatment
Author: Purdy, Charles Wesley
Year: 1890
Title: Cookery
for the diabetic
Author: Poole, W.H.
Year: 1891
Title: Ueber
coma diabeticumm im anschluss an die narcose
Author: Müller, Wilhelm
Year: 1894
Title: Die
Zuckerkrankheit und ihre Behandlung
Author: von Noorden, Carl
Year: 1895
Title: Kliniske undersøgelser over
kvælstofudskilningens forhold til den diætetiske behandling ved diabetes
mellitus
Author: Lauritzen, Marius
Year: 1897
One such book, Diabetes: Its Causes, Symptoms, and Treatment, by Charles
Wesley Purdy, is available on the internet.
And it should come as no surprise, that more than a century ago, in 1890,
Charles Purdy wrote:
“Prophylactic [preventive] measures are
advisable for people of diabetic parentage, or for those whose families present
marked tendencies to the disease. In
such cases it is wise to adopt a system of diet which limits the use of starchy
and saccharine foods to the most moderate proportions. Occupations should be selected which entail
the least possible mental pressure and excitement; and, if practicable, a
residence should be chosen as near the sea-level as possible, with a mean
temperature range of about 70 F. The
observance of the above conditions will insure the individual the best chances
of avoiding the disease.
Until future investigation shall have
revealed some agency through which we are able to check the excessive formation
of sugar in the liver, our chief resource against the disease must consist in
withholding from the system that which it is capable of converting into sugar,
and in supplying that which it is capable of assimilating as nourishment. The accomplishment of this object is the
essential aim of the dietetic treatment of diabetes.
Physiological chemistry as well as
experience have shown us that the chief source of sugar-production in the
system is the carbohydrate foods, more especially starches and sugar. In nearly all mild cases of diabetes, and in
most cases of recent origin, the avoidance of these foods arrests the excretion
of sugar, as well as the more prominent symptoms of the disease. The
sugar-forming powers of the organism in diabetes are feeblest in their
operation upon nitrogenous materials, and therefore animal foods are the least
susceptible of conversion into sugar.
Next in order rank the green parts of certain vegetables, which quite
strongly resist sugar transformation.
Finally, the starchy and saccharine members of the carbohydrate group
are the most easily transformed into sugar of all, and are therefore the most
dangerous for use. Practically, then,
the more completely we are able to eliminate the starchy and saccharine foods
from the diet, the more completely we are able to hold the disease under
control. At first sight this might seem
to be a very simple matter; but when we come to furnish a diet-list that
strictly conforms to the above principle, it will be found a most difficult
problem to solve, owing to the very wide diffusion of starch and sugar
throughout the organic world.
Of the other foods derivable from the
vegetable kingdom, the cereals and seme of the tubers are the most
dangerous. Potatoes, beets, parsnips,
carrots, among the latter; and, of the former, rice, sago, oatmeal, cornmeal,
buckwheat, rye, barley, peas, and beans, should be prohibited without
compromise in most, if not in all, cases.
In the strict form of dieting we are obliged to avoid the whole list. In cases of moderate severity we may,
however, draw upon one class of vegetables greens. Green vegetables consist mostly of cellulose,
and contain little, sometimes almost no, starch. They are rendered still less objectionable if
boiled before being eaten, as the hot water dissolves out much of the remaining
starch and sugar. The starch and sugar
contents of vegetables vary considerably, according to the degree of
cultivation and the nature of the soil and climate in which they are
grown. As a rule, a high degree of
domestic cultivation favors an increase of the starch and sugar, while high
temperature and sunny skies have an opposite tendency. Among the least
objectionable vegetables may be mentioned lettuce, cucumbers, olives,
mushrooms, Brussels-sprouts, cabbage, spinach, and water-cresses.
Most nuts except chestnuts may be
permitted, the list including almonds, walnuts, Brazil nuts, filberts,
butternuts, and cocoanuts.
Great differences prevail in practice
with regard to the use of fruits in diabetic conditions, some authorities
allowing them freely, while others curtail them. Some fruits, such as apples and strawberries,
really contain very little sugar, and in the case of apples the sugar is in
such form that it is often well assimilated by diabetics.
The truth is that it is more difficult
to make a rule which will apply universally with regard to the use of fruits
than with any other class of foods in these cases; and therefore it must to
some extent be a matter of experiment in each individual case. It may be stated, however, in a general way,
that mild cases will bear a moderate use of such fruits as apples, tomatoes,
and strawberries; but in severe cases it is best to prohibit their use without
exception.”[6]
Purdy’s treatment
is particularly salient even today, but I will hold off on my comments for the
moment, as surveying books is the primary task at hand.
The interesting
observation to bring up here is that although the Library of Congress holds the
most books in the world, it does not contain every book. While searching for an electronic version of William
Washington’s book An Essay of the Disease
Commonly Called Diabetes online, which I did not find, I fortuitously found
the book entitled Diabetes Mellitus and
Its Treatment, by Richard Thomas Williamson, M.D., M.R.C.P.,
published in 1898. Interestingly, this
book is not in the collection of the Library of Congress, however, it is an
important book.
In the chapter
“General Principles of Treatment,” Dr. Williamson writes:
“Potatoes
should be excluded from the diet first, then bread, and gradually all
carbohydrates should be cut off. In the
place of bread, the aleuronat and cocoa-nut cakes mentioned on p. 357 may be
given.”[7]
He states that
the chief object to be aimed at in the treatment is to diminish the amount of
sugar in the urine and blood, and to diminish the amount of urine, and to
relieve thirst. And that object may be
attained by removal of the carbohydrates from the diet. Reflecting on the work of John Rollo, Dr.
Williamson writes:
“Ever
since Rollo published his book on diabetes in 1797, and pointed out the value
of restriction of the carbohydrates in the food, it has been acknowledged that
of all forms and methods of treatment this dietetic one is the most important.”[8]
He also writes:
“All
authors agree as to the great value of fat in the severe forms of diabetes;
and, in addition to fatty food, cod-liver oil, lipanin [an artificial cod-liver
oil substitute], and other fats may be given.”[9]
“Most
articles of food from the animal kingdom may be taken freely by diabetic
patients. Butchers’ meat and flesh meat
of various kinds, poultry, game, and fish, may be taken in any form. But in the cooking thereof flour or bread
crumbs should not be used, if a very strict diet is indicated; aleuronat may be
used in place of flour, however, and butter and fats may be freely employed.
The
following articles may also be allowed freely: tongue, ham, bacon, potted beef,
and chicken, preserved meats of various kinds, sardines, tinned and preserved
fish, beef extracts, beef-tea, meat juices, broth, soups, and jellies (when
prepared without the addition of any saccharine or starchy materials).
Eggs in
various forms are most useful articles of diet.
An egg weighing about 600 grs. contains about 90 grs. of albumin and 75
grs. of fatty material. When hard boiled
they can be taken with comparatively large quantities of butter. The “buttered” egg or omelet is a useful
form…Honey, of course, ought never to be taken.
Butter, cheese, and cream may be allowed in large quantities.”[10]
“Fats,
both animal and vegetable, are the most valuable articles of diet for diabetic
patients, especially for those who suffer from the severe forms of the disease,
and may be allowed in large quantities.
The more
important articles of diet, containing a large quantity of fat, are butter,
cream, bacon, cheese, eggs, suet.”[11]
“Cocoa-nuts
contain a small quantity of sugar, but this may be removed easily, and
cocoa-nut flour may be used for the preparation of biscuits.”[12]
Dr. Williamson
concludes his discussion on “cocoa-nuts” with recipes consisting of water, “cocoa-nut,”
eggs, and cream for “excellent” cakes, biscuits and buns made without sugar or
carbohydrates that a diabetic can tolerate quite well, prepare inexpensively at
home, and prefer more, i.e., they taste better, than most diabetic cakes
offered at the time.
In the Appendix,
Richard Thomas Williamson presents the following list of articles of diet and
beverages, arranged in tabular form, which ought to be sanctioned or
forbidden, when for diagnostic or therapeutical purposes a very strict diet is
desirable:[13]
Sanctioned
Butchers' meat of all kinds (except liver); potted and preserved meats.
Ham, tongue, bacon.
Poultry, game.
Fish (Fresh, dried, and preserved; sardines, shrimps.
Broths, animal soups, and jellies (prepared without the addition of saccharine or starchy materials).
Eggs, cheese, cream.Butter, suet, oils, and fats.
Custard (without sugar).
Reliable bread substitutes (gluten bread, almond and aleuronat cakes).
Green vegetables--mustard and cress, watercress, endive, lettuce, spinach, turnip-tops, cabbage, broccoli, Brussels sprouts, spring onions.
Nuts (walnuts, almonds, filberts, hazel nuts, Brazil nuts), but not chestnuts.
Water, soda-water, and mineral waters.
Tea, coffee.
Dry Sherry, claret, Burgundy, hock, Moselle, Ahr wines, most Rhine wines, Austrian and Hungarian table wines (all in moderate quantities, however).
Brandy in small quantities.
Forbidden
Sugar, saccharine and farinaceous articles of food.
Pastry and farinaceous puddings.
Rice, sago, arrowroot, tapioca, macaroni, vermicelli, semolina.
Potatoes.
Wheaten bread and biscuits.
Carrots, turnips, parsnips, beetroot, beans, peas, large onions.
Liver.
Oysters, cockles, mussels, the "puddings" of crabs and lobsters.
Honey.
All sweet fruit and dried fruits.
Port, Tokay, champagne, and sweet wines.
Must, fruit juices and syrups.
Sweet lemonade.
Liqueurs.
Beer, ale, porter, and stout.
Rum and sweetened gin.
Cocoa and chocolate.
Milk in large quantities.
Now, let’s conclude our discussion of the
LOC book search.
From the 18th
century’s eight books on diabetes, at least from the perspective of the Library
of Congress, the 19th century’s growth rate of 237.5%—there are now
an additional 27 books on the shelf—pales in comparison with the next century. Between the beginning and end of the 20th
century, there are now an additional 1,930 books published and stocked on the
shelves. That represents a century-to-century
growth rate of slightly more than 7,048%.
Instead of keeping you in suspense, let me mention here that, although
we’re far from the end of the 21st century, the Library of Congress
already holds an additional 1,367 from this century. Add to that the 27 books in the LOC diabetes
search results that are undated, and we have the grand total of 3,359 books
that we originally found in the database.
Books from the 20th century make up a majority 57%, and those
of the 21st century, not a decade old—10% young at the time of this
writing—make up 41% of the collection.
Let me surprise
you, and, perhaps, quell your fears, by noting that I won’t be listing or going
through any of the afore-mentioned 1,930 20th, or 1,367 21st
century books here. True, I am not the
same caliber investigator as a Gary Taubes, Barry Groves, or host of other past-
and present-day saints. But we know what
truly separates these books from those of the prior centuries. Those writers in the 20th century,
to borrow and alter Charles Purdy’s words, were the future investigators that revealed the agency through which we
are able to check the excessive formation of sugar in the liver. Moreover, the identification of beta cells—those
little heaps of cells—within the islets of Langerhans in the pancreas as the
center of insulin production, tied inexorably to the diabetes condition, and leading
to the purification and dissemination of analog insulin for patient
self-management, is the primary driver of the burgeoning—scientific, dietetic,
therapeutic, historical, and otherwise informational—diabetes book growth in
the 20th century.
3,359 sources
are considerably less than the millions found online, but still pose some
practical problems. First, unless you’re
an elected official, you cannot “check-out” any books from the Library of
Congress; that’s a perk reserved for any voracious reader winning office. Yes, you can read any of them—while you’re
there—but, you cannot bring any books out of the library for any period of
time. And, of course, you have to be in
Washington, DC. I’ve toyed with the idea
of taking a sabbatical there, finding a relatively inexpensive hotel, and reading
through the list of 3,359 books. Assuming
three hours per book, which would include documenting my findings, at eight
hours a day, seven days a week, my sabbatical would have to be almost three-and-a-half
years. Sounds more like retirement. Even if I skim each book for an hour, I would
still need more than a year to complete the task. And that wouldn’t include sight-seeing. A two to three year’s sabbatical, however, is
an intriguing thought.
So, like me, the average diabetic
looking for information is relegated to visiting something more local to learn
the totality of the world of diabetes.
And so it is here that we really begin our journey.
What type of information is available
about diabetes at the local library? I
hypothesized that most books contain good information about the disease, i.e.,
etiology, physiology, impact on society, history, A1c tutorials,
nutritional options, etc., and that there would also be some books advocating a
specific diet. So to test that
hypothesis, I decided to visit my local library.
As of 2008, there were 30,022[14]
total United States Libraries, categorized as armed forces, college and
university, electronic, government, community college, law, medical, public and
state, religious, and special, including industry and company libraries as well
as libraries serving associations, clubs, foundations, institutes, and
societies. Add to those 30,022 the 80
total libraries administered by the United Stated in its territories, and the
3,685 total Canadian libraries, and we have a grand total of 33,787 libraries
listed in the American Library Directory.[15]
During the last week of 2008, and
into the first few weeks of 2009, I visited the Santa Clara City Library, 2635
Homestead Road, in Santa Clara, California.
Not an average library as it turns out, but a very good library with
354,579 book titles and 724 periodical subscriptions[xix]
in its collection, giving it a 2008 HAPLR score of 897, putting it in the 99th
percentile of all libraries.[16]
Peering at the shelf of books
contained within the 616.4 classification, I found 75 books published from 1997
to 2008.[xxi] An additional 19 reference books—not
surprisingly in the reference section—published from 1998 to 2008, that
included significant articles on diabetes, were also found. General diet or other health books neither on
the shelf in section 616.4, nor in the reference section, were disregarded. Reading through the books off the shelf, I
was surprised to find that, with but one exception, each and every book
advocated a specific diet. Of the 75
books off the shelf, only 10 advocated a low-carbohydrate diet to treat the
disease. One book, The First Year: Type 2 Diabetes.
An Essential Guide for the Newly Diagnosed (2001), contained only
objective information, and all the rest—64—an astounding 85% of the books off
the shelf, advocated a low-fat, high-carbohydrate diet to treat a disease
manifested by impaired carbohydrate metabolism.
I’ve included the entire list of both “books off the shelf,” which I’ve
simply labeled as “Books on Diabetes,” and “Reference Books” in, respectively,
Appendices A & B, complete with the evidence; that is, the specific
references in those books that determine whether it advocates a low-fat or a
low-carbohydrate diet.
By the way, general agreement about
what it means to have a low-fat, low-carbohydrate, or even a low-protein diet
has never really been attained, so let’s try to bring some clarity. From a purely mathematical standpoint, if you
have three parameters—in our case the three parameters are carbohydrate,
protein, and fat—and, additionally, three levels—low, medium, and high—the
first question to ask is how many combinations are there? The answer is 3x3x3, of course, which is 27
total combinations. But we then have to
define what it means to have a low, medium, or high level. Again, there isn’t any general agreement in the
literature of those distinctions. To
help with our discussion, let’s define “low” as a range of 0%-30%, medium as a
range of 30%-40%, and high as a range of 40%-100% of total calories. With only three variables, 50% of any one
variable would be a plurality, and slightly over 50% would be a majority; therefore
by definition any percentage greater than 50% has to be high. We could consider anything in the 40%-50%
range to be either in the “high-medium” area or the “low-high,” but I’ve chosen
that range to simply be within the “high” amount.
We can now see from Table 1 those 27
total combinations of low, medium, and high for the three different parameters
of carbohydrate, protein and fat. But
notice that there are only 22 total real possibilities given the above
definitions. Note that the ranges given
above (low = 0%-30%, medium = 30%-40%, high = 40%-100%) do not work for any
specific percentage in number 1 (low carbohydrate, low protein, low fat); that
is, since the low range is 0%-30%, even at the far end of that range—30%—if the
three parameters of carbohydrate, protein and fat were each 30%, the total is
only 90%, not 100%, so we are forced to drop that as a valid option. The same holds true for numbers 18 (medium
carbohydrate, high protein, high fat), 24 (high carbohydrate, medium protein,
high fat), 26 (high carbohydrate, high protein, medium fat), and 27 (high
carbohydrate, high protein, high fat). These
numbers, then, the five discounted options, have all been highlighted. Thus the total amount of real possibilities
of combinations of low, medium, and high portions of carbohydrate, protein, and
fat is 22.
| Carbohydrate | Protein | Fat | |
| 1 | Low | Low | Low |
| 2 | Low | Low | Medium |
| 3 | Low | Low | High |
| 4 | Low | Medium | Low |
| 5 | Low | Medium | Medium |
| 6 | Low | Medium | High |
| 7 | Low | High | Low |
| 8 | Low | High | Medium |
| 9 | Low | High | High |
| 10 | Medium | Low | Low |
| 11 | Medium | Low | Medium |
| 12 | Medium | Low | High |
| 13 | Medium | Medium | Low |
| 14 | Medium | Medium | Medium |
| 15 | Medium | Medium | High |
| 16 | Medium | High | Low |
| 17 | Medium | High | Medium |
| 18 | Medium | High | High |
| 19 | High | Low | Low |
| 20 | High | Low | Medium |
| 21 | High | Low | High |
| 22 | High | Medium | Low |
| 23 | High | Medium | Medium |
| 24 | High | Medium | High |
| 25 | High | High | Low |
| 26 | High | High | Medium |
| 27 | High | High | High |
Table 1
The 27 total combinations of low, medium, and high for the three different
parameters of carbohydrate, protein and fat.
The five discounted options, numbers 1, 18, 24, 26, & 27 have been
highlighted gray.
|
|||
Back to our discussion. We found that 64 books—85% of the books off
the shelf, advocated a low-fat, high-carbohydrate diet to treat a disease
manifested by impaired carbohydrate metabolism.
None described high protein intake, so we are safe to conclude that
these books all refer to either medium or low protein, which is not particularly
relevant to our discussion.
And the reference books, those
written and commented on exclusively by doctors, faired much, much worse. With but one tenuous exception—the diabetes
section in Childhood Diseases and
Disorders Sourcebook (2003) didn’t advocate a diet per se, it stated that “…A child or teen needs to follow a meal
plan developed by a physician, diabetes educator, or a registered dietician,”
but, of course, in 2003, a physician, diabetes educator, or a registered
dietician would most likely have advocated a low-fat diet—18 out of the 19 reference
books advocated, not simply informed
about, but advocated a low-fat, and
by definition, a high-carbohydrate diet to best treat a disease characterized
by, at best, impaired, and, at worst, non-existent carbohydrate
metabolism.
Kind of makes me wonder that if there
were a section written devoted to cigarette, alcohol, or drug abuse, would these
same reference books tout cigarettes, alcohol, and drugs as the basis for treatment?
Granted, our results are just from
one library, and not from a random sample of, say, 30 from the population of
30,000+ libraries. Nonetheless, the odds
that I found the one library with a large majority of shelved books, or all
reference books, written advocating a high-carbohydrate diet, out of all the
libraries out there is rather small.
Yes, it would be interesting to survey a random sample of this nation’s
libraries, perhaps even others around the globe, to find the true mean and
variance of the numbers of diabetes books on the shelves that advocate low- or
high-carbohydrate diets, and then the mean and variance of the reference books,
but I have neither the time nor resources necessary to devote to that
task.
The more relevant question anyway is
why do nearly all the reference books, those credible, driving forces behind
replication by also-rans, why is it that they advocate a high-carbohydrate,
low-fat diet?
[1] A national library is a library specifically established
by the government of a nation to serve as the preeminent repository of
information for that country. Unlike
public libraries, these rarely allow citizens to borrow books. Often, they include numerous rare, valuable,
or significant works; such as the Library of Congress’ Gutenberg Bible. National libraries are usually notable for
their size, compared to that of other libraries in the same country. Some national libraries may be thematic or
specialized in some specific domains, beside or in replacement of the 'main'
national library. For a comprehensive list of national libraries and
further resources, see the Wikipedia article “List of National Libraries,”
online at http://en.wikipedia.org/wiki/List_of_national_libraries. Retrieved on 4/5/09.
[2] In “We knew the web was big...” posted by Jesse Alpert
& Nissan Hajaj, Software Engineers, Web Search Infrastructure Team, GOOGLE
(July 25, 2008), on the blog http://googleblog.blogspot.com/2008/07/we-knew-web-was-big.html,
the authors were surprised to find that content hit a milestone: 1 trillion (as
in 1,000,000,000,000) unique URLs on the web at once. Retrieved on 3/31/09.
[3] See Abelson, Hal, Ledeen, Ken, and Lewis, Harry. Blown
to Bits: Your Life, Liberty, and
Happiness After the Digital Explosion.
Upper Saddle River, NJ: Addison-Wesley, 2008, page 112.
[4] A library
classification is a system of coding and organizing library materials
(books, serials, audiovisual materials, computer files, maps, manuscripts,
realia) according to their subject and allocating a call number to that
information resource. Similar to
classification systems used in biology, bibliographic classification systems
group entities that are similar together typically arranged in a hierarchical
tree structure. A different kind of
classification system, called a faceted classification system, is also widely
used which allows the assignment of multiple classifications to an object,
enabling the classifications to be ordered in multiple ways.
Library classification of a piece of work consists of
two steps. Firstly the ‘aboutness’ of
the material is ascertained. Next, a
call number, (essentially a book's address), based on the classification system
in use at the particular library will be assigned to the work using the
notation of the system.
It is important to note that unlike subject heading
or Thesauri where multiple terms can be assigned to the same work, in library
classification systems, each work can only be placed in one class. This is due to shelving purposes: a book can
have only one physical place. However,
in classified catalogs one may have main entries as well as added entries. Most classification systems like DDC and
Library of Congress classification, also add a cutter number to each work which
adds a code for the author of the work.
Classification systems in libraries generally play
two roles. Firstly they facilitate
subject access by allowing the user to find out what works or documents the
library has on a certain subject. Secondly, they provide a known location for
the information source to be located (e.g., where it is shelved).
Until the 20th century, most libraries had closed
stacks, so the library classification only served to organize the subject
catalog. In the 20th century, libraries
opened their stacks to the public and started to shelve the library material
itself according to some library classification to simplify subject browsing.
Some classification systems are more suitable for
aiding subject access, rather than for shelf location. For example, UDC which uses a complicated
notation including plus, colons are more difficult to use for the purpose of
shelf arrangement but are more expressive compared to DDC in terms of showing
relationships between subjects.
Similarly faceted classification schemes are more difficult to use for
shelf arrangement, unless the user has knowledge of the citation order.
Depending on the size of the library collection,
some libraries might use classification systems solely for one purpose or the
other. In extreme cases a public library
with a small collection might just use a classification system for location of
resources but might not use a complicated subject classification system. Instead all resources might just be put into
a couple of wide classes (Travel, Crime, Magazines etc). This is known as a “mark and park”
classification method, more formally called reader interest classification.
There are many standard system of library
classification in use, and many more have been proposed over the years. However in general, classification systems
can be divided into three types depending on how they are used: (1) Universal
schemes covering all subjects. Examples
include Dewey Decimal Classification, Universal Decimal Classification and Library
of Congress Classification. (2) Specific
classification schemes. Examples include
Iconclass, British classification of Music, and Dickinson classification. (3) National schemes specially created for
certain countries. An example is the Swedish library
classification system, SAB (Sveriges Allmänna Biblioteksförening).
In terms of functionality, classification systems
are often described as (1) enumerative: produce an alphabetical list of subject
headings, assign numbers to each heading in alphabetical order, (2)
hierarchical: divides subjects hierarchically, from most general to most
specific, (3) faceted or analytico-synthetic: divides subjects into mutually
exclusive orthogonal facets.
There are few completely enumerative systems or
faceted systems, most systems are a blend but favoring one type or the other.
The most common classification systems, LCC and DDC, are essentially
enumerative, though with some hierarchical and faceted elements (more so for
DDC), especially at the broadest and most general level. The first true faceted
system was the Colon classification of S. R. Ranganathan.
Universal classification
systems used in English-speaking world: Bliss bibliographic classification (BC), Dewey
Decimal Classification (DDC), Library of Congress Classification (LCC),
EnglishHarvard-Yenching Classification - An English classification system for
Chinese language materials.
Universal
classification systems in other languages: A System of Book Classification
for Chinese Libraries (Liu's Classification), Nippon Decimal Classification
(NDC), Chinese Library Classification (CLC), Korean Decimal Classification
(KDC), Library-Bibliographic Classification (BBK) from Russia.
Universal classification
systems that rely on synthesis (faceted systems): Bliss bibliographic
classification, Colon classification, Cutter Expansive Classification,
Universal Decimal Classification, Brinkler classification.
Newer classification systems tend
to use the principle of synthesis (combining codes from different lists to
represent the different attributes of a work) heavily, which is comparatively
lacking in LC or DDC. Abridged from the Wikipedia article “Library Classification,” online
at http://en.wikipedia.org/wiki/Library_classification. Retrieved on 4/5/09.
[5] Not listed in the Library of
Congress search database, Matthew Dobson (1731-1784) wrote Experiments and
Observations on the Urine in Diabetes (Medical Observations and Inquiries), published in London, in 1776. Matthew Dobson from Yorkshire graduated MD at
Edinburgh in 1756. By evaporating the
urine of a diabetic patient, Dobson was the first to prove the presence of
sugar in urine. He also made the crucial
observation of the excess of sugar in blood, and demonstrated that diabetes is
a systemic disorder rather than, as had been previously thought, a primary
disease of the kidneys. See the Royal
College of Physicians of Edinburgh webpage online at http://www.rcpe.ac.uk/library/exhibitions/diabetes/diabetes.php. Retrieved on
4/30/09.
[6 Purdy, Charles Wesley.
Diabetes: Its Causes, Symptoms,
and Treatment. Philadelphia and
London: F.A. Davis Publisher, 1890, pages 80-87. Entire book available online at http://www.archive.org/stream/diabetesitscause00purduoft/diabetesitscause00purduoft_djvu.txt Retrieved on 5/1/09.
[7] Williamson, M.D., M.R.C.P., R.T. Diabetes
Mellitus and Its Treatment.
Edinburgh & London: Young J. Pentland; New York: The Macmillan
Company, 1898, pages 322-323. Available
through GOOGLE Book Search online at http://books.google.com/books?id=QrsnAAAAYAAJ&pg=PR3&lpg=PR3&dq=Williamson,+M.D.,+M.R.C.P.,+R.T.++Diabetes+Mellitus+and+Its+Treatment.&source=bl&ots=0Gr_k5umq7&sig=IN_EaRtR9e0eQCcuLTfqI_fecDc&hl=en&ei=q438SeiiCKP4tAOMg7HoAQ&sa=X&oi=book_result&ct=result&resnum=1
[8] Ibid, page 325.
[9] Ibid, page
330.
[10] Ibid, pages
330-331.
[11] Ibid, page 337.
[12] Ibid, page
343.
[13] “The diabetic dietaries recommended by most authors agree
generally with that just given, but the following are minor points of
difference: Sir William Roberts adds “torrified” bread and celery to the
articles sanctioned.
Pavy sanctions also turnips, French beans,
cauliflower, asparagus, and vegetable marrow, but only in moderate quantity,
and when boiled in a large amount of water; also radishes and celery.
Seegen allows the following in moderate quantities:
Cauliflower, carrots, turnips, white cabbage, green peas, berries (such as
strawberries, raspberries, currants); also oranges and almonds. But he forbids other fruits, such as grapes,
cherries, peaches, apricots, plums, and all kinds of dried fruits.
In addition to the articles mentioned, v. Noorden
sanctions mussels, oysters, lobster, cauliflower, spinach, onions, leeks,
asparagus, sorrel, French beans. He also
allows the following (amongst other articles), but only in very limited
quantities: Celery, green peas, beans, carrots, mushrooms, radishes, two
medium-sized tomatoes, a thin slice of cocoanut, a thin slice of melon, one
small acid apple, one or one and a half peach, one tablespoon of wild
raspberries or strawberries, four spoonfuls of currants, six greengages[xvi], twelve cherries, half a
medium-sized pear.
Cantini prescribes a very rigid diet of nitrogenous
and fatty foods only. He allows:
Bouillon of various kinds. Beef, tongue,
veal, mutton (but liver is forbidden), duck, goose, chicken, pigeon, and game
of all kinds. Fish, crustacea, lobster,
crabs.
In the cooking and preparation of the above he
forbids the use of flour, sugar, wine, butter, vinegar, and lemon juice; but he
sanctions the use of olive oil and fats, and recommends dilute acetic acid in
place of inegar [sic.], and citric acid in place of lemon juice.
Cantini allows 500 to 600 grms. of
nitrogenous food daily. In order to
improve the digestion, and to increase the strength of emaciated patients, he
recommends 60 to 200 grms. of pancreatic fat.
The fresh pancreas of a cow, calf, or lamb is cut into small pieces, and
mixed with pig’s suet. After three hours
it is lightly roasted.” See Ibid,
Appendix, pages 406-408.
[14] This number is significantly lower than the total of
116,393 libraries as stated by The Whole
Library Handbook 4, because it doesn’t include “school library media
centers” which in 2004 totaled 93,861.
See The Whole Library Handbook 4, edited
by George M. Eberhart, American Library Association, 2006, page 3.
[15] American Library
Directory, 61st Edition. Medford,
New Jersey: Information Today, Inc., 2008, page xiii.
[16] Nationwide public library statistics are collected and
disseminated annually through the Federal-State Cooperative System for public
library data (FSCS). Statistics are
collected from nearly 9,000 public libraries. The FSCS web site is at:
http://nces.ed.gov/pubsearch/getpubcats.asp?sid=041#052. The HAPLR Index includes 15 factors. The focus is on circulation, staffing,
materials, reference service, and funding levels. The Index does not include data on audio and
video collections, or interlibrary loan, among other items that could have been
calculated from the FSCS data. Perhaps
most prominently absent from the data are any measures of electronic use or
Internet service. While such measures
would have been desirable, the FSCS data simply are simply not sufficient for
such comparisons at this time. Internet, electronic services and audiovisual
services are excluded because there is simply not enough data reported by
enough libraries to make comparisons meaningful. What remains are fairly traditional data for
print services, book checkouts, reference service, funding and staffing. It is
likely that in the future, additional measures can be added to the FSCS data to
begin to evaluate such other library services as internet use, electronic
services, and non-print services. The
FSCS data have only been collected on a consistent national basis since 1981.
Since then the data have been refined to be more consistent and to include more
information. That trend is likely to accelerate, making the additional
comparisons possible soon. See Hennen's American Public Library Ratings,
available online at http://www.haplr-index.com/index.html. Retrieved on 1/24/09.
Note: When starting a collection, libraries frequently
consult the Public Library Catalog, a
list of recommended reference and nonfiction books for adults, classified by
subject. There are seven books on
diabetes within the 616.4 classification listed for inclusion in any
collection, of which three were on the shelf.
The seven books listed are: (1) American
Diabetes Association Complete Guide to Diabetes; The Ultimate Home Reference
from the Diabetes Experts. 3rd
edition, completely rev. American
Diabetes Assn., 2002, 517 pages, (2) The
Joslin Guide to Diabetes; A Program for Managing Your Treatment; [by]
Richard S. Beaser, with Joan C.V. Hill and the Joslin Education Committee. Simon & Schuster, 1995, 351 pages, (3) Diabetes Sourcebook; edited by Dawn D.
Matthews. 3rd edition. Omnigraphics, 2003, 621 pages, (4) The Thyroid Guide; [by] Beth Ann Ditkoff
and Paul loGerfo. HarperPerennial, 2000,
171 pages, (5) Mayo Clinic on Managing
Diabetes; Maria Collazo-Clavell, editor in chief. Mayo Clinic; [distributed by] Mason Crest,
2002, 194 pages, (6) Women &
Diabetes: Staying healthy in Body, Mind, and Spirit; by Laurinda M. Poirier
and Katharine M. Coburn. 2nd
edition. American diabetes Assn., 2000,
230 pages, and (7) The John Hopkins Guide
to Diabetes: for Today and Tomorrow; [by] Christopher D. Saudek, Richard R.
Rubin, and Cynthia S. Shump. John Hopkins
Univ. Press. 1997, 422 pages. See
Public Library Catalog 12th Edition: Guide to Reference Books and Adult
Nonfiction. Edited by Juliette
Yaakov. The H.W. Wison Company. 2004.
No comments:
Post a Comment