The Kindness of Strangers: Kinds and Politics in Classification Systems - administrative history of large-scale classification systems

Library Trends, Fall, 1998 by Geoffrey C. Bowker

THE INTERNATIONAL CLASSIFICATION OF DISEASES IS A PRAGMATIC CLASSIFICATION

In order to communicate information in the aggregate, it must first be classified. At any time over the past 100 years, one can find complaints about the Tower of Babel that afflicts the storage and communication of medical knowledge.(1) David Rothwell (1985) notes that:

   More than two hundred statistical systems are being used by the United
   States government to monitor health, occupational and environmental
   conditions through the country. Despite the incredible amount of
   information accumulated, there is no method of coordinating these data into
   a single coherent database, a national health information system. (p. 169)

Mark Musen (1992) complains:

   The medical-informatics community suffers from a failure to communicate.
   The terms that WMR uses to describe patient findings generally are not
   recognized by Medline. The manner in which Iliad stores descriptions of
   diseases is different from that of Dxplain. Therapy plans generated by
   ONCOCIN are meaningless to the HELP system.... Each time another developer
   describes yet another formalism for encoding medical knowledge, the number
   of incompatibilities among these different systems increases exponentially.
   (p. 435)

Musen indicates that there is no clear relationship between "the Unified Medical Language System [UMLS] advanced by the National Library of Medicine and the Arden syntax proposed by the American Society for Testing and Materials as a standard for representing medical knowledge" (p. 436). The ICD, he points out, originated as a means for describing causes of death; a trace of its heritage is its continued difficulty with describing chronic, as opposed to acute, forms of disease. This is one basis for the temporal faultlines that emerge in its usage. The UMLS originated as a means of information retrieval (the MeSH scheme) and is not as sensitive to clinical conditions as it might be (p. 440).

The two basic problems for any overarching classification scheme in a rapidly changing and complex field can be described as follows: first, any classificatory decision made now might, by its nature, block valuable future developments. If we decide that all instances of Sudden Infant Death Syndrome are to be placed into a single box (ICD-10, 1992, vol. 1, R 95, p. 890), then we are not recording information that might be used by future researchers to distinguish possible multiple social or environmental causes of the syndrome. We are not making it impossible to carry out such studies, but we are making it difficult to retrieve information. Second, inversely, if every possible relevant piece of information was stored in the scheme it would be entirely unwieldy.

The decision not to collect is the most difficult for any classification on these grounds, whether it be the acquisition department of a library, the curator of an art museum, or the collector of information for vital statistics. There are always practical budget and storage issues. These are balanced against two other factors: (1) the need for a well ordered and, in some sense, parsimonious repository that can be used, and (2) the side bets that are made about what material will be useful in the future. This latter is particularly difficult.