Wüsteria:

A Case Study in Terminology Integration,

Or:

International Standard Bad Philosophy

Barry Smith

CEN/TC 251

Europe-wide acceptance of the need for a comprehensive, communicable and secure pan-European Electronic Health Record as a prerequisite for high-quality healthcare.

A problem for terminology integration

EHRs across Europe need to use equivalent terms for equivalent disorders

standardized clinical terminologies now exist in an abundance of different flavours.

the Unified Medical Language System (UMLS) contains over 100 systems, with in all some 3 million medical “concepts”

we need international standards for terminologies

responsibility of ISO Technical Committee (TC) 37

ISO TC 37

founded in 1952

by Eugen Wüster (1898-1977)

fan of the Vienna Circle unified science movement (and of the philosophy of Immanuel Kant)

devotee of Esperanto

Wüster

chaired TC 37 for the first 20 years of its existence

was principal author of the documents which have served as the basis for work in terminology standardization ever since.

astonishing influence due to normative character of ISO definitions

Wüster’s vulgar-empiricist theory of concept acquisition

All knowledge of concepts starts out from sensory experience:

The new-born infant finds itself “constantly amidst a panoply of diverse sensory impressions”. Soon, it begins to “analyse” this sensory mosaic ...

... and to mentally sub-divide it into individual objects

objects in reality are constructed by human beings with a high degree of arbitrariness and variability

at some point the child notices that there are individual objects which

are “interchangeably alike”

e.g. apples or bricks or cans of paint

– objects which are also given the same name by older speakers of the language.

Here general concepts enter the scene

“The child learns to blend the individual concepts of such objects in its thinking” and thus arrives at general concepts, which are, like individual concepts “thought (=mental) objects”

all concepts “exist only in the heads of people.”

If “a speaker wishes to draw the attention of an interlocutor to a particular individual object, which is visible to both parties or which he carries with him, he only has to point to it”.

Recall: the Academicians of Lagago

who held that since Words are only Names for Things, it would be more convenient for all Men to carry about them such Things as were necessary to express the particular Business they are to discourse on ...

if the object is not present, “the only thing available is the individual

concept of the object

provided that it is readily accessible in the heads of both persons.”

There is a ‘realm’ (Reich) of concepts

Terminology work is designed to provide clear delineations of the concepts in this realm, and only when such delineations have been achieved can terms be assigned.

The sign

The sign “is a concept which can be materialised at any time ... in the form of a phonetic or graphic sign.”

In this way, objects and concepts are confused not only with each other, but also with signs.

More recent ISO documents have sought to resolve such

conflicts

ISO-1087:1990 defines a concept as: A unit of thought constituted through abstraction on the basis of properties common to a set of objects.

Object = Anything perceivable or conceivable (e.g. a unicorn)

The concept-based approach

leaves those involved in the creation of terminologies unsure as to whether their task is the representation of ideas in people’s heads or of types of entities and relations in the world.

SNOMED-CT:

“Disorders are concepts in which there is an explicit or implicit pathological process causing a state of disease”

Wüster’s concept-based approachhas been astonishingly influential in medical terminology

Yet in medicine we often have to deal with families of entities which manifest no characteristics “identifiable in encounters of similars”

A tumour starts out as tiny mutations in a small number of cells

Wüster’s notion of concept

which underlies the terminology standards of TC 37 has nothing to do with medicine at all.

He was concerned primarily with standardization in the domain of artefacts, of manufactured products

Wüster was a businessman

saw-manufacturer

and part-time professor of woodworking machinery in the Vienna Agricultural College

author of The Machine Tool. An Interlingual Dictionary of Basic Concepts

who devoted the bulk of his spare time to international terminology standardization (to support international trade in wood products)

Wood products truly are such as to manifest characteristics identifiable

in encounters of similars– because they have been manufactured as

such.

Vocabulary itself is treated by Wüster and his TC 37 followers “as if it could be standardised in the same way as types of paint and varnish [TC 35] or aircraft and space vehicles [TC 20]” [12, p. 12].

Unfortunately

Wüster’s definitions have been propagated in ever wider circles through all subsequent generations of relevant standards because of ISO’s own rules governing re-use

How to achieve terminology standardization

How to translate one terminology into another?

By some benchmark, some tertium quid (here: medical reality) which is not itself a system of terms or concepts

(Ontology)

ISO“In the course of producing a terminology, philosophical discussions on whether an object actually exists in reality are beyond the scope of this standard and are to be avoided. Objects are assumed to exist and attention is to be focused on how one deals with objects for the purposes of communication.”

Moral

Esperanto is not a model for unification

Efforts at unification designed to overcome the problems created by divergent local cultures are themselves local cultural artifacts, and bring problems of their own