DOI: 10.1111/j.1471-1842.2009.00844.

x
Using
evidence
in practice
Blackwell
Publishing
Ltd
Using evidence in practice

Using evidence in practice

Fahrenheit 451?: a burning question on the

evidence for book withdrawal
Andrew Booth

Introduction
With space at a premium in most libraries,
particularly those located in a health service
context, the health librarian frequently encounters
pressures to withdraw outdated items from their
library book stock. Should this be left to the
experience and expertise of the librarian on the
spot? Or is there, perhaps, a body of evidence to
inform this processmaking it more systematic
and rigorous? This question came to my mind
recently. Indeed, it reawakened distant memories
of a Regional Stock Withdrawal Initiative which I
coordinated in South East Thames.1 As 20 years
might be construed a decent enough interval
between uses of a terrible punning title (although
some readers will disagree!) I have allowed this
book-burning analogy to rise phoenix-like within
the collective health librarian consciousness.
Before formally considering the evidence base,
we should at least acknowledge that books are
different. First, given the variety of topics covered
by your average health library, it is not desirable to
implement some standard cut-off date regardless
of discipline. Books do not have a sell-by date to
be implemented across every shelf. Nevertheless,
particularly within a health context, information
within books is consistently volatile. As Antman
and colleagues demonstrated,2 textbooks are
particularly inefficient in capturing current knowledge. It is not exaggerating to say that outdated
health information can kill, although fortunately
the frequency with which such instances are
reported (note, I do not say occur!) is low enough
not to require our taking out indemnity insurance.
We should also appreciate that updating of editions

of popular textbooks is almost exclusively determined by commercial considerations and not by a

philanthropic desire to refresh prevalent medical
knowledge at appropriate intervals.
A second factor relates to recognition, to
misquote John Donne, that no book is an island
entire of itself. Each item in a book collection
must be considered in relation to the collection as
a whole. A library with many alternatives to a
particular book considered for withdrawal may be
less forgiving than one where no such alternatives
exist. Collection development policies also imbue
an individual book with greater collective significance when it is designated to an area of the
collection labelled as core. The existence of such
policies provide an important antidote to unwelcome
connotations of weeding that evoke vacuuming
up Cochranes classic Effectiveness and Efficiency3
and replacing it with a pocket guide to evidencebased medicine!
Finally, we must acknowledge factors in favour
of book withdrawal. Some suggest that weeding
of a book stock has a positive effect on the use
of the collection that remains, although this
phenomenon remains contested. Furthermore a
do nothing option is not cost neutrallibrarians
rarely consider that an item lying unused on a shelf
is costing space, light, heat and cleaning, not to
mention opportunity costs.4 Of course, this must
be weighed against the time and effort required to
remove it from the shelves and, sometimes, the
equal time and effort it takes to remove it from the
catalogue. Deferring a decision to a later date may
betray a lack of professional courage rather than
reflecting prudent management. In my first professional post, I relegated old volumes to the plentiful
shelves of our postgraduate centres breakout
rooms, only to discover later that I had removed
any possibility that these items would be used,
although they still figured on the catalogue. I had
also perpetuated an ongoing waste of space

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Using evidence in practice

and added a supernumerary interim stage to the

process of throwing the volumes out for good!

Context for the question

Recently, I re-encountered a posting to the lis-medical
Jiscmail discussion list dating back about a year
and a half: Hello all, I am looking at formalizing
my collection management policy in the light of
both a monster weed we are undertaking and work
to shift various aspects of our collecting into a
more electronic world.5
Putting aside the B-movie connotations of the
monster weed, I was reminded that one of the
exemplar burning questions identified by Eldredge6
was: When weeding a hospital library collection,
how does one determine the publication year
before which materials can be weeded from the
collection?. I therefore formulated the following
hypothetical scenario.
Scenario
A health librarian working in a multidisciplinary
education centre library built 15 years ago is
concerned at the lack of bookshelf space
remaining for new acquisitions. The librarian
decides to examine the evidence base for book
withdrawal, specifically within a health library
context. To initiate the search, he or she formulates
the following SPICE question:7
Setting:

Looking at a multidisciplinary
health library ...
Perspective: ... from the perspective of the professional members of staff ...
Intervention: ... are research-based methods of
book withdrawal ...
Comparison: ... superior to professional
judgement ...
Evaluation: ... with regard to both efficiency of
process and subsequent use of the
bookstock.

The evidence base?

A search of Library and Information Science
Abstracts ( lisa) using withdrawals, of
cinahl using weeding and withdrawals and

the Library, Information Science and Technology

Abstracts (lista) database using Weeding and
DISCARDING of books, periodicals, etc. complemented by a simple targeted Google Scholar
search (e.g. weeding and health and libraries)
reveals only six relevant items published in the
decade between 2000 and 2009 (Table 1). Such a
disappointing yield attests that book withdrawal
in health libraries, arguably more critical given the
volatility of health information, has received less
attention than in the more politicized domains of
public and school libraries.
This Using Evidence in Practice feature is not
intended to offer mini-reviews of the evidence
base, so the interested reader is referred to individual
items in Table 1 and the reference list. Instead, we
will illustrate more generalizable observations
about the quantity and quality of the evidence
base. Including the specific setting of a health
library, considered an important feature of a
focused question,7 was particularly detrimental
for the number of items retrieved. Clearly, there is
a significant trade-off between relevance and
availability of the evidence. If we broaden our
question to other contexts, which do we include or
exclude on the basis of relevance? While excluding
public and school libraries may be justified, how
do we allow for possibly confounding disciplinary
differences if we admit small academic libraries?
More significant is the mismatch between the
type of material that I was seeking to address my
question and that retrieved from my quick and
dirty search. I was looking for a methodology by
which I might implement a weeding policy. Overall
items I retrieved were rich on know-how but poor
on evidence. They also tended to focus on macrolevel considerations for the process as a whole
rather than on the micro-level operational detail of
conducting the weeding. Interestingly, one item
draws parallels with a physicians diagnosis and
treatment, making it easier to argue that weeding
is legitimately viewed as a facet of evidence-based
practice.8
Several items were retrieved through multiple
database routes (lisa/lista/cinahl). However,
two of the most useful items, a report in a regional
newsletter of an MSc Project11 and possibly the
professions most unobtrusive randomized
controlled trial in a research section newsletter,9

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Using evidence in practice

Table 1 Articles on stock withdrawal in a health library context (20002009)
Identifier
(date)

Geographical
area

Study design/
article type

Main conclusions

Indiana
University
(USA)

Process
description

Staff used appropriate bibliometric strategies,

measures and resources to effectively facilitate process

University
University of
Eldredge
et al. (2002)9 Health Sciences New Mexico
Library
(USA)

Randomized
controlled trial
(RCT)/reported
from poster

First reported use of RCT in this setting. It appears

adaptable to weeding and other collection resources
applications. Rejects hypothesis that weeding
increases usage. Adjusted data involving removal of
popular titles does not confirm hypothesis either

Gushrowski
(2007)10

University
Dental Library

Indiana
University
(USA)

Process
description

Follow 6-step process: develop plan and be prepared to

deviate from it; keep project manageable by working on
reasonable size portions of collection and involving as many
staff members as possible; determine which data to collect;
determine objective criteria; keep expectations reasonable;
have disposal plan for de-accessioned items and be aware
of any restrictions library is under

Scott
(2004)11

Primary care
National
Health Service
Library

Scotland (UK) Brief literature

review and
case study

Weeding criteria included amount of use item received,

relevancy, value (both financial and intellectual), age and
condition. A method was devised to carry out task. Excel,
Endnote and Heritage Library Management System
manipulated to yield relevant information

Shisler
(2007)12

Nursing library

Ursuline
College,
Ohio (USA)

Overview
illustrated by
case study

Proposes basic criteria for historical materials and for

purchase. Presents checklist of eleven questions used in
weeding older materials. Provides reference resources and
discusses benefits of lean but varied collection

Tobia
(2002)13

Academic
health sciences
library

University of
Texas at
San Antonio
(UTHSCSA)
(USA)

Descriptive
case study

Weeding project reclaimed shelf space, removed

out-of-date and duplicate materials and identified books
needing repair or replacement

Cox &
Gushrowski
(2008)8

Setting
University
Dental Library

were more difficult to identify. The former was

located through a Google search and not covered
by any of the formal databases. The latter was
located not through library-specific databases but
through cinahl. This account from a poster has
not subsequently been published in the peerreviewed library literature. As this is a randomized
controlled trial, I subsequently conducted a
known item search to see if it was included in the
Cochrane Librarywith no success. A search on
weeding on the Cochrane Library yields only a
single recordon seasonal allergic rhinitis!
Regarding the contexts of the included articles,
two were multiple accounts of a single dental
library initiative,8,10 one related to a nursing
library12 and two were academic health sciences
libraries.9,13 The single most relevant item, the

MSc project account,11 was conducted in the UK

National Health Service so scored best on immediate relevance. However, how do we handle the
signal-to-noise balance, given that the newsletter is
unlikely to have been peer reviewed? On the positive side, four of the six articles (from Interim,11
Hypothesis9 and two from Journal of the Medical
Library Association12,13) were easily accessed in
full-text format without charge. However, the item
most likely to hold the potential to resolve my
scenario, the Masters dissertation itself,14 would
likely prove more challenging to obtain.
Despite the unsatisfactory nature of my evidence
quest, unexpected benefits were derived during the
course of the search. For example, I am reminded
that book withdrawal should not be tackled in
isolation, but should be fully integrated within the

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wider context of collection management.15 This

includes more strategic issues such as identifying
core collection areas in the first place, as well as
preventive strategies, such as including a policy
for gifts and donations. Such features make the
subsequent process of weeding much easier in the
long run. More importantly, a key theme I had not
expected, emerged relating to the importance of
communication with readers about what you are
doing and why you are doing it.16 Arguably, this
aspect of public relations17 is far more critical to
the success of the weeding process than technicalities
regarding cut-off dates and areas for exemption.
Indeed, we might go further to suggest that involving
users in the decision-making process, including
eliciting suggestions for new acquisitions, could
turn around perceptions of the weeding event
from a negative purge to a much more positive
collection refreshment. Certainly, we would not
expect users simply to anticipate plumes of black,
or white, smoke at the library windows to signal
the professional staffs collegial activity!18

Conclusion
This brief case study of a burning question from a
realistic health library setting vividly illustrates
limitations of the existing evidence base. Not that
the evidence base is unhelpful. Arguably, if we
were to consider a wider range of generic
articles,19,20 and even the classic textbook on the
topic (assuming it has not been thrown away!),21
we might obtain the necessary ingredients for a
successful stock withdrawal policy, together with a
significant fund of practical wisdom and know-how.
In fact, the most interesting item of research, as
opposed to more discursive evidence, demonstrates
that adding multiple entry points to a catalogue
record did not translate into an increase in
circulation.22 No doubt, too, a wider search would
yield more systematic methodologies for stock
withdrawal, such as the CREW method used in
public libraries.23 Such methodologies may well
translate to a health library context. It is clear too
that, if our decision making incorporates
consideration and review of even a small body of
the available evidence, we will achieve a more
holistic, considered and justifiable outcome than
reliance alone upon librarian expertise, experience

and intuition. This is illustrated in our recognition

of the user perspective, even where this is only
acknowledged as requiring better communication
concerning what is going on. What is apparently
missing is what is most desireda rigorous, contextsensitive methodology that is easy to implement
and that can simply be taken ... off the shelf!

References
1 Booth, A. Fahrenheit 451a regional stock withdrawal
policy. Medical Library Bulletin of the Thames Regions
1990, 84, 35.
2 Antman, E. M., Lau, J., Kupelnick, B., Mosteller, F.
& Chalmers, T. C. A comparison of results of
meta-analyses of randomized control trials and
recommendations of clinical experts. Treatments for
myocardial infarction. Journal of the American Medical
Association 1992, 268, 2408.
3 Cochrane, A. L. Effectiveness and Efficiency Random
Reflections on Health Services. London: Nuffield Provincial
Hospitals Trust, 1972.
4 Steele, K. Budgeting for libraries: Space equals
money. Bottom Line: Managing Library Finances
2008, 21, 1223.
5 Fricker, A. Collection Management/Development Policies.
Posting to lis-medical discussion list. Item no. 18274,
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13 Tobia, R. C. Comprehensive weeding of an academic
health sciences collection: the Briscoe Library experience.

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19 Handis, M. W. Practical advice for weeding in small

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