The End of the Term Debate

Submitted by Robert Felt on December 7, 2007 - 2:17pm.


I originally planned this post as review of the A.A.A.O.M. Portland Conference term meetings and seminars with a concentration on the announcement of "Acupedia," a wikipedia-style web site that will present different term lists for comparison. I labeled the post "The End of the Term Debate" to emphasize that the presence of such a tool meant the end of two ideas that have long retarded the development of CM in the English-speaking world; that is, the notion that translation standards would lead to some never-defined but supposedly horrid outcome and the idea that terminology was about the selection of words rather than the preservation of ideas.

The acupedia prototype shown at the A.A.A.O.M. meeting will allow for multiple term choices to be displayed, along with descriptions of why the choice was made. This is nothing if not an open standard. However, I've not been able to obtain a confirming source for the information I have gathered on the acupdedia project and A.A.A.O.M.'s on-going participation with the W.H.O. and W.F.C.M.S. standards groups. These processes are underway but not finalized. Any further detail is thus best left to A.A.A.O.M. to announce. However, this blog post was announced to those who get the site update emails something like a month ago so I am thus publishing this "as is," and will prepare another blog entry when I am certain that I am reporting the names, dates and details accurately.

Please -- I am not claiming that A.A.A.O.M.'s decision to send a representative to Asian term standards meetings, or the naming of a committee to participate with the W.H.O and the W.F.C.M.S. term standards groups, is an official endorsement of any particular term standard, or even standards themselves. However, what it is absolutely not is an endorsement of continuing term chaos. I think the fairest characterization is that the A.A.A.O.M. has recognized that the long absence of the English-speaking profession from a process the rest of the Chinese medical world sees as necessary has poorly represented our needs and interests. All you need to do is to look at these lists to understand that the Asian bias in favor of biomedicalization is very powerful. Perhaps the most telling measure of the W.H.O. bias is their rejection of a "Western Medical Correspondences" approach whereby biomedical correspondences would have been listed in addition to direct translations. This approach is analytically superior, not only because it provides more information, but also because it eliminates the difficult-to-prove assertion of a one-to-one equivalence. For the most part, there is very little research establishing these equivalences, most of which are really just clinical observations. While that does not mean the observations are not useful, it does mean that they are an easy target for skeptics. They are, in short, an invitation to discredit Chinese medicine.

I suspect that part of the decision to reject a correspondences approach that could have increased the biomedical information available by providing disease and symptom correspondences for any concept, was rooted in the conviction that direct translations would be poorly received in the West. Happily, Eric Brand, Nigel Wiseman and Paul Unschuld (among others) did engage these processes from the very beginnings and did speak strongly against the wholesale biomedicalization of CM, often with considerable success. I think it is fair to say that without their efforts traditional concepts would have been preserved to a far lesser extent. However, regardless of what credit anyone may wish to give Eric, Paul and Nigel for their effort, it is clear that A.A.A.O.M. has decided to engage the pan-Asian consensus that English CM needs a consistent professional language.

Does this mean that I think the W.H.O.or W.C.F.M.S. term lists are the "last word?" No. Some of the selections are borderline, some are worse. Frankly, I think these Asian-generated English standards are flawed by a misperception of what is driving the acculturation of CM in the English-speaking world. Yet, they are a point of departure from which something useful can happen. What might be the most important feature of these lists is the fact of their genesis in Asia, particularly "official China." This could be one case when "not invented here" is an advantage because the engagement of Asian organizations with official standings who have no ownership of the debate among English-speaking writers helps remove the theme of personal motivation from the discourse.

Clearly, the Asian representatives that comprise the majority of these standards groups believe that it will be biomedically-trained physicians that will drive the acculturation of CM in the west. Personally, I do not believe this will be the case. It is, and will continue to be, people who are interested in traditional medicine who will lead. Will these lists lead English-speaking writers to biomedicalize Chinese medical concepts? Possibly not with their former enthusiasm, as the traditional names for diseases and symptoms are increasingly recognized as containing clues to therapy. Nonetheless, an evaluation of the Asian standards is not the main point. The main point is that West has met East and a dialog has begun, and that the West, at least the American portion of it, is represented by its central practitioner association.

In that regard, I would like to make a few, careful suggestions about acupedia.

First, I strongly suggest that the unique and primary key for acupedia entires be the Chinese characters Not only is this the main analystic fact - Chinese medicine is Chinese - it permanently resolves the search and term set decsions. What belongs in the term set is what exists in Chinese and any subset initially chosen can be expanded as required. With the measurable polysemy in Chinese medical terms at around 14%, there will be entries that must support multiple definitions but this is typical of any collection of ideas in any natural language. From the programming viewpoint, providing for one is providing for all so there is no inherent increase of cost or complexity. I also suggest that the pinyin associated with the characters be searchable both with and without tones. While this does require the development of a cross-reference table where untoned pinyin searches can be further refined via the user's selection of the more specific toned entry, it will permit search access for everyone, regardless of their computing environment.

Next, by starting with the Asian standards, perhaps a combination of the W.H.O. and W.C.F.M.S. lists, the people who reference acupedia will be able to see who recognizes what Chinese concepts as valid, relative to these Asian lists. This is not to say that "I don't recognize this as a term" is not a valid entry, only that it is impossible to judge the utility of a term list for any purpose without understanding its extent. This is also true of term selection, without knowing the extent of the terms required, it is impossible to know whether each preferred term has been associated with the most appropriate Chinese idea. If the entries are based on Chinese, and if a basic term set represented by the W.H.O./W.C.F.M.S. lists is taken as a foundation, people will be able to judge the value of inclusions and exclusions for themselves.

Finally, I suggest that participation in acupedia be staged. By constraining the first additions to full lists, rather than single term offerings, acupedia can provide a broader view, entirely rooted in Chinese. Also, since this can be accomplished with less sophisticated data entry procedures (loaders rather than user-ready systems), acupedia can be up an running quicker, at less expense, and yet provide a valuable reference. Entries based on explicit definitions could be compared, not only for their facility in English, but for their faithfulness to definition. If, likewise, the second round were limited to commentary based on research in the Chinese language, that is, the work of Chinese literate writers, any arguments about concept inclusion or definition would contribute to the knowledge base. With this as a base, much of the ground would be covered. I'd suggest further that references be strongly encouraged, particularly as wiki software makes hyperlinking very easy. Thus, when acupedia is finally opened to commentary by all, much less editing will be required because there will be a foundation of definition. Editing is the bain of wiki projects because the qualification of material occurs after it is entered thus demanding constant editorial effort.

I think the 1007 A.A.A.O.M. meeting in Portland was something of a watershed for the field, I look forward to reporting more when I have more information.