The Sieve of Asclepius: A History of Navigating the Medical Literature, From Index to Algorithm

For centuries, physicians have lamented the proliferating medical literature. This article traces the evolving strategies by which physicians have attempted to render this literature navigable for the purposes of research, teaching, and patient care. Beginning with John Shaw Billings' foundational indexing work at the Library of the Surgeon General's Office, the article examines successive (and overlapping) search regimes-including personal curation practices, abstract journals, pharmaceutical industry information services, citation indexing, and computerized retrieval systems-analyzing how each embedded value judgments about what counted as important or useful medical knowledge. Even as systems of search have evolved over time in conjunction with new technologic capabilities, business models, and search-related behavioral patterns, they have also grappled with enduring tensions between selectivity and comprehensiveness, between commercialism and scientific merit, and among the very boundaries of the conditions to be categorized and navigated. This history underscores how systems of search are not external maps of the knowledge ecosystem but are constitutive of it, influencing everything from journal rankings to research priorities to clinical practice. As literature search becomes integrated with artificial intelligence capabilities, a historical perspective helps physicians appreciate how such technologies condition what they know.