Problematic key medical_system:western

I have started a discussion on the, in my view, problematic tag medical_system:western: discussion. I think the term and the definition are Eurocentric and use words that have questionable meaning. I would be happy if people who are more experts on the topic and also people from other global communities could comment on the critique so we can enhance the tag to keep OSM a global and inclusive project.

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I’m not quite sure I understand what is perceived problem? Trying to tag such (somewhat ambiguous) differences at all, or use of specific wording?


If the issue was only specific wording, I would not find it as problem. Definitions might be non-obvious, but I would not think their naming is a problem in itself.

For example Spanish flu illness neither originated in Spain, nor was most prominent there. But it got its name for whatever reasons (historically because Spain was brave enough to be first to publicly admit the health issue IIRC), and the name stuck. Nowdays if you speak of “Spanish flu”, people will know what you are talking about, even if without knowing the etymology of the word the the term would be misleading.

Same thing applies to “western medicine” (now even more commonly known by perhaps equally problematic term “modern medicine”). The fact is that east and west are ridiculous terms to use on a sphere (nowdays when we mostly don’t believe the Earth to be flat plane), but they have defined meaning. Most everybody would understand what is meant by “western world” or where is “far east”, even if the terms would be ridiculous on themselves if one tried to understand them just parsing word-by-word without taking their etymology into consideration.

So it is that the common medical practices at the the time got their names for whatever historical reasons, and people nowdays (mostly) understand what they mean. And so such terms as “western medicine” are still wildly used today.


The bigger problem is that the terms are somewhat ambiguous (and becoming more so every day – for example, using leaches were common “western medicine” at the time, but nowdays is predominantly not considered to be one).

To me it seems, wiki pages about medical_system:* should be expanded with better explanation, and link to wikipedia articles for details and explain in more details things they refer to that are commonly understood to be unambiguous. (And mention those that are ambiguous!).

They should also more highly recommend to use more precise multi-tag health_specialty:*=yes in addition (or instead) of more ambiguous medical_system:*=*

E.g. using health_specialty:clinical_pathology=yes is both more precise (less ambiguous), more detailed, and less controversial than medical_system:western=yes (as is health_specialty:acupuncture=yes better than medical_system:chinese=yes). And you can use multiple of them to mark all available medical services.

The only advantage of using medical_system:*=yes is if mappers can’t be bothered to find all fill in all that details, but would like to provide at least some (very) rough expectations of what type of medical facility is about. (of course, it is mostly useful for mapping exceptions - i.e. “chinese” medical facilities in countries employing predominantly “western” facilities, or vice versa).

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Yes, please! There’s also two major “western” medical systems in place: conventional/evidence-based medicine (EBM), sometimes also referred to as “allopathic medicine”, and homeopathy as the predominant alternative medicine in “the western world”. People seeking one system usually don’t want to end up at a practitioner of the over system :grin:

Maybe it would also make sense to have some “rough” medical systems and them further divide them, if people know details. Sometimes, it can be hard to figure out what type of medicine is actually practiced at a place and just having a rough “alternative medicine or” “traditional medicine” might be better than just “unknown”.

Yes, that is to the point. Especially because the description says

Western medical system used globally, now based on science

Evidence-based medicine didn’t originate in what we’d like to call the “western world” and it doesn’t make any sense to call it like that. Thank you!

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For what it’s worth, East Asian languages call it “Western medicine” (Chinese: 西醫, Vietnamese: thuốc tây or Tây y) to contrast it with traditional Chinese medicine and the like. But you have a point that these terms can be problematic. Indigenous peoples further to the west, in the Americas, have their own medicinal traditions that are quite distinct from what’s generally called Western medicine.

I could imagine similar concerns about ambiguity and cultural sensitivity extending to our existing cuisine classification system, if you can call it a system.

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A fairly large +1 to the sentiment that “western” and “eastern” are somewhat-outdated / outmoded ways to describe medicine. Yes, there are long-standing traditions about this (as Minh has stated) which likely won’t go away soon, but OSM can “do better” here while remaining familiar with the existing frameworks and traditions.

I mean… I don’t really think we should call homoeopathy, or other quack practices, a “medical system”

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thank you, I was thinking the same yesterday. I don’t think “homoeopathy” qualifies as “alternative medicine”, rather it could be seen as an alternative to medicine.

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I fully agree, but there is still the need to tag doctors (yes, a lot of the pracitioners are doctors over here) that practice this … “thing”, even if it’s just medical_system=placebo. Or are you suggesting not to?

I think we should map them, but that we should not call them “doctors”. That’s a legally protected title in many places. How about “practitioner”?

How about wellness_practice_system for things like homoeopathy? It’s neutral enough…

I’ve tagged pharmacies that have this specific extra ‘skill’ as shown on the facade big neon text display healthcare:speciality=homeopathy

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I’d rather thread carefully here…

On one hand Placebo effect is often accepted (even by “western medicine”, i.e. scientific method) as real thing that can improve on health, even if actual mechanisms by which it accomplishes that are still not fully known.

On the other hand, many “western medicine” practices (I’ve already mentioned older leaches there, but more current is still used “food pyramid” for example and many others) have been proven over time to be actually detrimental to health, as were many of “just ingest/inject yourself with this chemical and you’ll be fine” “western logic” drugs (e.g. Avandia, Darvon etc.) found to be.

I’m playing a devil’s advocate here a little, but if we start threading on the path “I think those and those medical practices are quack”, I forsee it won’t be long before antivaxer lobby start demanding that anything related to vaccines be removed from healthcare namespace too.

So I would rather just document what healthcare:specialty it is and let users choose whether it is acceptable to them or not, instead of trying to force my opinions and regulate whether e.g. “traditional chinese” is “medicine” or not.

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I think this is a common-sense approach. It’s already pretty common to specify healthcare:speciality in combination with healthcare=alternative.

The latter tag, which has an iD preset, relies on the idea that there’s a mainstream healthcare system in a given region, which is often true but maybe not universal. It technically conflicts with classifying the kind of healthcare infrastructure. For example, this Chakra healing and meditation center is tagged as a Chakra alternative-medicine something. But maybe a key other than healthcare would provide more flexibility.

Alternative to what? We should use terms that describe the conceptual underpinnings of each medical system. These terms should be the same as those used by the systems own practitioners.

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healthcare=alternative was approved for “alternative medicine” as the term is widely understood: anything other than “mainstream medicine”. I think precisely defining terms such as these would quickly fall outside of OSM’s core area of competency. Instead, the tag should either imply that the practitioner self-identifies as practicing alternative medicine (which does happen), or perhaps that the practitioner is understood by the surrounding community to practice alternative medicine.

At least in the cases where I’ve tagged healthcare=alternative, the practitioner made a point of distinguishing themselves from conventional medical practices. They wouldn’t want the consumer complaints and regulatory scrutiny that surely would accompany any listing as amenity=doctors healthcare=doctor on a mainstream map.

As for me, as a mapper, all I’m looking for is a primary feature tag. If neither healthcare=alternative nor amenity=doctor healthcare=doctor is appropriate, then I guess I’m left with healthcare=centre, which the wiki tries desperately to steer me away from.

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| Minh_Nguyen Minh Nguyễn
April 20 |

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healthcare=alternative was approved for “alternative medicine” as the term is widely understood: anything other than “mainstream medicine”.

there is also religion=*

We have to draw somewhere a line, or what about healthcare=greengrocer (an apple a day keeps the doctor away)?

I think precisely defining terms such as these would quickly fall outside of OSM’s core area of competency. Instead, the tag should either imply that the practitioner self-identifies as practicing alternative medicine (which does happen), or perhaps that the practitioner is understood by the surrounding community to practice alternative medicine.

so we’ll tag healers and the like as “medicine” because they claim it is?

Hang on, I was talking about the circumstances in which one might apply healthcare=alternative for “alternative medicine”. In particular, I was focused on cases where the practitioner affirmatively identifies as alternative medicine and doesn’t claim to be practicing mainstream medicine (because they don’t want to be arrested). I didn’t assert that “alternative medicine” is “medicine”, unqualified; that’s not how these terms are normally used in English.

I think tags like healthcare=alternative should have a definition (as they do now), but not necessarily a precise one. We don’t need to litigate the precise contours of alternative versus mainstream medicine, which would be really distracting in all of its real-world nuance and controversy.

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Or “we can cure you of your transsexuality”/“we can cure you of your sexuality”. :wink: (Although people like me often need to be “diagnosed with a disorder” :roll_eyes:). Some in the 1850s said that enslaved people trying to escape slavery were suffering from “drapetomania”.

(I don’t know anything about “Traditional Chinese Medicine”. But there’s a long history of “western medicine” being totally unscientific)

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Like it or not, but “alternative medicine” is a commonly used term in the English-speaking world.

But we’re allowed do something differnet from commonly used terms (just look at “highway”)

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To be fair, it only seems to steer you away from it unless you further qualify it. If you add healthcare:speciality=psychiatry or healthcare:speciality=shiatsu then it is further qualified and thus acceptable according to wiki.

And then it is up to the users to determine for themselves if either (or both) of those are quackery.

on the subject of mainstream/normality (digression)

Or “we can cure you of your transsexuality”/“we can cure you of your sexuality”. :wink: (Although people like me often need to be “diagnosed with a disorder” :roll_eyes:). Some in the 1850s said that enslaved people trying to escape slavery were suffering from “drapetomania”.

And “what is considered mainstream” definitely changes with time. Bloodletting by leeches are no longer mainstream western medical practice, yet it were most definitely normal and mainstream not so long ago.
Nowadays schizophrenia is too considered a mental illness that needs to be cured so one can become “normal” member of society. Yet I guess in several decades (when we all start uploading our minds to global consciousness) society may well reverse that position by 180 degrees, and those who do not yet hear other voices in their heads would be the poor souls that need to be cured :wink:

But I do find it curious when people think that “normal” somehow means “desirable”. Nothing could be further from the truth. In fact, if one want to accomplish something extraordinary, by the very definition one has to be not normal. I find it the failure of educational system. To put it layman terms, “normal” mostly simply means “mainstream”, or more precisely defined that some sample lays in the belly of the normal distribution / bell / gaussian curve in some defined set.

So, all OSM mappers (and any volunteer of any kind) is definitely not normal is the set of global mostly-capitalism-driven set of humans on this planet with “why would I lift my finger if I won’t get paid for it in hard cold cash” mentality. But at the very same time and by same token they are totally normal in this forum!

True. But note that some things that are pushed under alternative medicine umbrella just because they are not mainstream might be more than that:

Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials.

i.e. one may well be not mainstream medicine at the same time as not alternative medicine (in fact, all medical breakthroughs are by definition neither mainstrean nor alternative medicine. Gene splicing is most definitely scientific, repeatable, testable etc., yet it is not (yet) mainstream (or at least wasn’t few years back)).

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I agree with your conclusion that this isn’t an either-or proposition, partly because of the negative connotations that come with both terms, depending on who uses them. However, just the fact that a technique isn’t mainstream doesn’t necessarily distinguish its facilities from the practice of mainstream medicine and (in the countries where this applies) the mainstream healthcare system.

Wikipedia’s article on alternative medicine has an unusually long lede section, not because it needs copyediting but because the term is so controversial, nuanced, and difficult to define. Taking the first sentence out of context isn’t a good strategy for understanding the term. I’m glad our wiki isn’t in the business of reinventing the encyclopedia.