Open Letter to NLM Regarding MeSH Term Changes

As many members have read and responded to the call on various listservs, we would like to share with the wider MLA member audience about the origins of this letter.

The letter to NLM NIH about MeSH began in response to a tweet by a PubMed user and former medical librarian, Christian Minter, who brought to the attention of medical library workers a few of the recent changes to MeSH terms in 2022 that are offensive and outdated – the current term “Blacks” and “Health Disparity, Minority and Vulnerable Populations.” 

Later, Aidy Weeks, Immediate Past Chair, Latinx Caucus, tweeted a thread detailing the experience that herself and other members of the Latinx Caucus who were involved in the inclusive MeSH term suggestions project (for Hispanic/Latinx folks) went through while trying to communicate those suggestions to the MeSH team at NLM.

Additionally, there was also this thread by a cataloguer named Alissa, based in Australia, about the current term “Native Hawaiian or Other Pacific Islander.”

A group of PubMed users, including current and former MLA members and medical library workers, led by Kelleen Maluski, worked on an open letter and gathered signatures up until May 31st before the group will send it to NLM/NIH. Other writers of this letter included: Misquith, Chelsea, Christian Minter, Jamia Williams, Aidy Weeks, Stephanie Roth, Ursula Ellis, Katie Lobner, and Violet Fox.

A copy of the letter that has collected hundreds of signatures is provided below:

Dear MeSH Committee,

We, a group of medical library workers, are reaching out to request changes be made to the process in which medical subject headings (MeSH) terms relating to marginalized groups (based on but not limited to race, dis/ability status, ethnicity, sexual orientation) are decided upon in order to make them reflective of practices that use person-first language, recognize the problematic nature of outdated and offensive terms, and take into account the identifiers used by the communities themselves, while also making them inclusive and respectful of the groups being described in order to not cause harm.

Specifically, we are asking that this process be transparent and open to feedback from information professionals, researchers, scholars, and the communities whose lived experiences are most impacted by these terms, as we are all stakeholders who use PubMed and benefit from the research and scholarship made available through this resource.

We request that you address the MeSH vocabulary, which is outdated, discriminatory, and includes offensive terminology making up its controlled vocabulary and scope notes. We and other medical library workers have experienced consistent roadblocks and a lack of information in response to concerns brought forth related to the MeSH vocabulary, we now provide you the opportunity to address the following concerns:

MeSH Record: “Blacks”

A more recent incident is the introduction of the MeSH term “Blacks” that was previously noted as the “African Continental Ancestry Group.” The use of this terminology is not only concerning for information professionals but creates great harm for our users as well as those in the profession. “Black” as a term used to denote racial identity is a proper adjective; not a noun. Here’s guidance that the Journal of the American Medical Association (JAMA) (Flanagin et al., 2021) has published and a New York Times article that gives further context.

As in the past, when library workers reached out through emails and submission forms to the MeSH Committee to ask that this terminology be changed, they were met with a lack of any thoughtful response or indication that the committee understood the trauma of such terminology would inflict. The responses, when they were not just an acknowledgment that the request was received, most times felt scripted and did not answer the concerns being addressed.

In addition, the scope note needs revision as well. Recommending that the outdated term “Negro” be used is not acceptable, especially not in 2022, and this was a missed opportunity to write a respectful definition in the scope note as opposed to simply listing discoverable terms lacking necessary context. Utilizing cultural humility in the creation of scope notes would assist in making these both discoverable and respectful. Please take a look at Cultural Humility as a Framework for Anti-Oppressive Archival Description (Tai 2021) and Queering the Catalog: Queer Theory and the Politics of Correction (Drabinksi 2013) for recommendations on how to accomplish this.

We are asking that this committee reverses the unnecessary harm that they have already caused and minimizes further unnecessary harm or trauma by taking the following actionable steps:

• Immediately update the MeSH “Blacks” to an appropriate and correct term (e.g. “Black people”) and include a definition in the scoping note that accurately represents the identities of those being attached to the subject heading. It is also important to recognize that selecting terminology to describe a racial group is a very nuanced issue, as there is no one global term for individuals of the African Diaspora. Individuals may identify as Black, African American, or by their country of origin.
• Update scope notes of race-specific terms to inform PubMed users that race is socially constructed and is not considered a biological concept, but rather as a proxy to investigate social and health disparities. Consider adding this language to the following MeSH records: Racial Groups and branch terms

MeSH Review and Decision-Making Process

Below are recommendations to make further improvements to the MeSH creation, review, and decision-making process.

Build-in more transparency

Creating transparency in the process of editing/updating/creating MeSH by:

• Documenting the review process, who is involved in the creation of MeSH and what makes them subject experts able to address such topics, how decisions about MeSH changes are made, and supplying open access to these documents
• Providing transparency and assessing for bias of any algorithmic-based decision making in adding new terms or indexing them to PubMed records

Bring in experts and pay for their labor

Bringing in appropriate experts at early stages of the review process to discuss improvements to identity-based MeSH terms and pay them for their labor and expertise – whether this be through hiring consultants or engaging with information professionals, researchers/scholars, and community leaders who have expertise in addition to lived experience

Create avenues for feedback 

Creating processes when reviewing and updating MeSH that include the public and information professionals at early stages of the review process. This could include town halls, national calls, public forums, and more.

Provide training opportunities 

Implementing training for all members of this committee that are conducted by outside entities and pay experts for their labor, time, and knowledge.

When searching within MeSH, users should not have to be confronted with derogatory and trauma-inflicting language in order to find articles that can assist with their needs (see Tai 2021 and Drabinski 2013 articles listed above for more information). As the largest freely available biomedical database, PubMed should hold itself to the highest standards of inclusion and interdisciplinary connections on both a national and a global scale as a leader on these issues. Terms like “Blacks” and others that have been identified should not be allowed in such a space and calls for changes from the information professionals utilizing these resources should not go ignored. In addition, maintaining historical records in order to improve discoverability should not come at the cost of creating a hostile environment for users. As current and former medical library workers, it is difficult for us to continue to explain or support NLM’s MeSH vocabulary and term changes that are harmful to the students and other researchers that we work with.

Organizing and categorizing information has always been a key responsibility of libraries. The NLM can and should take a leading role in updating terminology in a way that increases access to information without harming others. Other government agencies and departments like the OMB and HHS may also benefit from this important work.

For our part, we intend to work with the Medical Library Association, information professionals, our networks, and other organizations to bring awareness to this issue. We want to ensure that our goal is to bring stakeholders together and advocate for a more inclusive controlled vocabulary benefiting the health of the communities we support.

As key stakeholders and users of NLM’s information resources, we ask that you will take our requests seriously and we look forward to hearing your response.

The authors are accepting additional signators until June 10. Please reach out to us if you would like to be included and were unable to sign the originally circulated Google document.