CURRICULUM-BASED CLASSIFICATION

ACase Study at SouthwestCollege of Naturopathic Medicine Library

By Daniela Solomon

Abstract

This paper presents classification systems changes that Southwest College of Naturopathic Medicine (SCNM) Library considered necessary in order to organizeits collections in ways more readily comprehensible to its users. Because the main purpose of classification is to arrange the materials in ways that facilitate access to information, the classification of the SCNM collections was changed to match more closely the curriculum structure at the College, and thus, to be closer to its users understanding. These changes have been made within areas where the differences between naturopathic and conventional medicine are most obvious, more precisely: diet therapy, acupuncture, homeopathy, physical medicine, botanical medicine, and environmental medicine. Naturopathic medicine uses a natural approach to health and healing. However, many consider naturopathic medicine pseudoscientific. One of the implications of this general attitude towards naturopathy is that within both the Library of Congress and the National Library of Medicine classification systems the naturopathic medicine presence seems to bea minimal afterthought. Although a steadily increasing interest in alternative health use by the general public is observable, both in general and in academic settings, the Library of Congress and the National Library of Medicine have been slow in making any changes in their subject headings and classification systems. The article focuses on changes made within three areas: botanical medicine, homeopathy, and nutrition and diet therapy. The spirit of this process is reflected by the Library’s logo: ”A Customized Information Service that Fits Your Natural Health Research Needs.”

Introduction

The purpose of any library classification system is to “bring related items together in a helpful sequence from the general to the specific” (Taylor, 2004), and thus, to facilitate access to information. Classification systems are not perceived as ends-in-themselves but for their socially useful endof intermediatingknowledge communication to library’s clientele. However, the communication between individuals and the information systems is influenced by theorganizational structure of the information system, the representation of resources, the ability of the information system to create meaningful contexts, and the relevance of the organizational structure of the information to the individuals’ knowledge(Jacob,2004).The intermediary position between an information system and individuals makes classificationsboth important and powerful.

The history of information organization starts as the same time with the history of written documents. Many classification schemes were developed based on different methodologies or scopes. Although there is no recognized “best classification system,”the classification based on subjects prevails within libraries because librarians consider this arrangement the best way to arrange and point out the resources that their libraries have on different subjects. Classification schemes create collections of related resources in a hierarchical structure and thus, are different from other subject indexing systems. A hierarchical classification scheme enables users to look for related items that have not previously been identified as relevant and facilitates browsing. However, Kelley (1937) has identified thirteen factors that affect the usefulness of the classification systems based on subjects. These factors include the evolution of knowledge, the inadequacy of linear representation, the nature of systematic classification that separates parts from the whole, and the public that the collections address. The same factors of influence were identified by Bowker (1999) and Olson (2004). In addition, two other factorswere identified: classification structure, the vocabulary used in naming different subjects,the biases introduced by this vocabulary (Olson, 2001), and the political aspects of promoting professional groups (Bowker, 1999).

A classification system cannot be all-inclusive, and what is excluded is decided through the authority system that uses an accepted universal language. Olson (2004) discusses about the importance of subject headings or classification number assignment as “a means of interpersonal communication via language,” since this will control subject representation, and, therefore, access to information. She argues that this process introduces biases that lead to marginalization of specific categories and topics. Therefore, classification is seen as a mean to manipulate the informational environment. Largely used classification systems are produced or maintainedby recognized institutions likethe Library of Congress and the National Library of Medicine.However, these classification systems regularly have been criticized as being slow to make changes that would correspond to new information requirements (de Groat, 1997; Richmond, 1972; Olson, 2001). In order to fulfill its social value, classification systems need to bring the right information to the usersas they need it. Following this perspective, information professionals need to acknowledge the informational needs of the users they serve and understand the structural organization of the knowledge within the subjects of their collections. This could result in locally developed classification systems adapted to the specific informational needs.The locally created classification systems are advantageous because of the customized scheme, adapted to its specific content and user groups, and because of the flexibility, as they are easier to change and/or include new areas of interest. At the same time, the locally developed classification systems have some disadvantages: they are time consuming - and therefore expensive, requires extensive specialist subject knowledge, it is a very subjective process and it is relatively easy to overlook something and this can lead directly to a lack of consistency. To be cost effective, these alternative classifications need to be very carefully developed and documented, and also need to be continuously maintained. The alternative classification systems existence greatly depends on the librarians’ commitment and devotion to the public they serve.

Literature Review

Although the literature includes many critiques of classification and subject indexing systems, as Olson (2001) comments, it is difficult to find these articles because of the way that library and information science (LIS) indexes functions.

Most of the articles critique the biases in vocabulary used for subject headings and classification classes relative to gender, sexuality, race, age, ability, ethnicity, language, and religion (Olson, 2001; Morgan, 1996). Olson (2001 and 2004) makes a complete analysis of these articles to find the effects of these biases on access to categories of information by specific categories of users. Olson also mentions the impact ofmainstream vocabulary usage on the marginalized topics. Othercategories of articles critique different classification systems for their slowness in adapting to knowledge evolution and change in language usage (de Groat, 1997, and Richmond, 1972), or the inadequacy of all linear classification systems (Bensman).

Another category of articles present different alternative classification systems, locally developed, usually for better access to information of a specific category of users. Thus, Ferrari (1999) presents the case of art libraries locally devised classification system that respond to the art libraries public’s requirements. Bowker (1999) presents the case of Nursing Intervention Project at the University of Iowa that has created a new classification system to correspond the information needs of the medical nurses. The new developed classification also supports the professional legitimization. He also discusses another alternative classification system, specifically the International Classification of Disease. The Brian Deer Classification’s website at Union of British Columbia Indian Chiefs (UBCIC) Library and ResourceCenterintroduce another alternative classification system that cannot be of largely use anymore because of lack of documentation and maintenance. In contrast to Brian Deer Classification, the North Carolina State Publications’ classification scheme is well documented and further developed (North Carolina State Publications).

The Debate

One of the marginalized and misrepresented topics within LLC and NLM is the naturopathic medicine. Naturopathic medicine, as an organized profession also known, more informally, as alternative and complimentary medicine, has a natural approach to health and healing “emphasizing the treatment of disease through the stimulation, enhancement, and support of the inherent healing capacity of the person” (Naturopathic Medicine Network). Naturopathic medicine is based on six principles: the healing power of nature, identify and treat the cause, first do no harm, treat the whole person, the physician as teacher, prevention. The result of applying these principles is that the naturopathic physicians attempt to maximize the patient’s wellness, to prevent health problems, to treat the whole person and not just the immediately presenting symptoms but rather find the underlying causes of a condition. They apply treatments that incorporate a variety of noninvasive, natural methods based on the individual patient’s individual needs. In contrast, M.D.’s and other allopathic practitionerstend to treat symptoms and to combat diseases by using more formulaic,faster acting remedies, such as drugs and surgery. (Lindlahr, 1975).

The practice of naturopathic medicine includes clinical nutrition, botanical medicine, homeopathic medicine, physical medicine, acupuncture, etc, but the training in a graduate naturopathic medicine school includes the “basic medical sciences” as well, such as anatomy, physiology, pathology, etc. Manyconsidernaturopathic medicine as being pseudoscientific and its theories are considered “simplistic and/or clash with science-based knowledge of body physiology and pathology”(Barrett).Although naturopathic medicine theories and methods are not entirely new approaches to health and disease, they have not yet been fully accepted by the mainstream medicine. However, partially due to the rising and excessive costs of American health care, people have an increasing interest in using alternative and complementary medicine.

Although the contrast between these two fields comes from the profound differences between the bases of knowledge upon which they are built the generally accepted indexing vocabulary for naturopathic medicinelargely follow the mainstream medicine perspective, and as a result it is often less than helpful in building anaccurate overall image of this domain. Also, the structural organization of the knowledge within the above-mentioned classification systems follows the allopathic medicine points of view and sometimes those orders and arrangements make no sense to naturopathic medicine students and practitioners.

See Appendices A.

Presentation

The primary mission of SCNM is to prepare students to become effective naturopathic physicians, educated and trained in the principles and the practice of naturopathic medicine. The College’s philosophy is reflected through its departmental structure and its curriculum. Within the College, SCNM Library is a small but dynamic library, specialized in alternative and complementary medicine and related materials. SCNM Library collections include books, proceedings of different conferences, journals, video cassettes, audio cassettes, and CD-ROMs. SCNM Library’s main users are the students, alumni, and faculty members of the College. Other categories of users are students from other schools with comparable or similar specialization, naturopathic physicians, and the nearby general public, which has a growing interest in alternative and complementary medicine.

Since the beginning of the College, the Library hasundergone some changes in its organization before deciding on its present structure. One of the changes towards the beginningof the Library was to use mostlythe National Library of Medicine Classification because the Library serves a medical school. Apparently this decision was made by a medical librarian, with previous medical library experience. The Library of Congress Classification was added, to supplement for subjects that were not biomedical, such as psychology and religion. The coming of a new librarian brought in the use of Library of Congress subject headings mainly, combined with some National Library of Medicine subject headings and originallydevised subject headings. The originally developed subject headings were created to overcome the complete or partial lack of suitable subject headingsin either the LC or NLM classification systems,and to fit the needs of scholarly naturopathic medicine researchers.Even more, the classification itself has been adapted and customized in many places in order to accommodatethe College curriculum and users’ understanding.

The major changes that SCNM Library has made are in the areas where the differences between naturopathic and conventional medicine are most obvious, more precisely: pharmacology, nutrition and diet therapy, acupuncture, homeopathy, physical medicine, and environmental medicine. This paperinsistson the changesdone within the areas of pharmacology, homeopathy, and nutrition and diet therapy.

Herbal Medicine vs. Pharmacology

The use of plants and plant products in treating different diseases has a long history. Although it is recognized that herbal medicine in combination with the preventive principles “could be among the most cost-effective, practical ways to shift the focus of modern health care from disease treatment to prevention,” the U.S. Food and Drug Administration (FDA) considers herbal remedies to be “worthless or potentially dangerous,” and as a result, herbal products can be marketed in the U.S. only as food supplements (Office of Alternative Medicine, 2002).

The Pharmacology class of the NLM classification includes “works on pharmacology in general or on the pharmacology of individual drugs or types of drugs grouped according to their specific action.” One of subclasses specifies Drug Standardization. Pharmacognosy. Medicinal Plants. A similar structure may be found in the Subclass RS of the LC classification. See Appendices B.

The study of pharmacology at the College focuses on “the principles and mechanisms of drug action and the purpose of pharmaceutical interventions,” while the Department of Botanical Medicine studies “plants as medicine” including the historical use of plants as medicine, research, pharmacognosy, clinical applications, and case analysis. Therefore, for theSCNM students, medicinal plants and their use in medicine are part of the practice of naturopathic medicine,whereas for them “pharmacology” refers only to synthetic prescription drugs. As a result, from a naturopathic point of view, the most appropriate place for the medicinal plants would be close to theherbal medicine -the “approach to healing which uses plant or plant-derived preparations to treat, prevent, or cure various health conditions and ailments,” subclass WB 925 in NLM classification, and subclass RS1-431 in LC classification. As a result, the whole group QV760 to QV770 was moved to the newly created classification numbers WB 910 to WB 914. See Appendices B.

Homeopathy

Although the homeopathyhas a long tradition, its philosophy is not accepted in the same way by both allopathic and naturopathic medicine.The differences come from the different importance that each branch of medicine confers upon it. Homeopathy considers that disease is the body’s way to show an imbalance of some kind within the body, and the treatment is used rather to restore the natural balance and help the body to cure itself rather than fight off thesupposed disease, and each patient is treated individuallywith a particular cure. Whereas this philosophy works in perfect harmony with the naturopathic philosophy, M.D.’s and other allopathic practitioners generally are skeptical about homeopathy’s beneficial results (Fraser).

The skeptical attitude towardshomeopathy easily is observable in NLM classification, which has assigned only a few subject headings for this whole field. On the other hand, strangely, LC classification has a much better representation of the plethora of knowledge within homeopathy. The LC classification structure for homeopathy is much more suitable for the scope of homeopathy as taught at the SCNM. Therefore, an arrangement very similar to LC’s RX classification for homeopathy was decided upon, but it was inserted into the NLM scheme at and immediately around the one base number designated for homeopathy, at WB 930. The new arrangement extends from WB 929 through WB 934.6., with hundreds of items there, in accordance with SCNM Library’s user’s needs. See Appendices C.

Nutrition and Diet Therapy vs. Biochemistry

Diet and nutrition--the knowledge of how to prevent illness and maintain health through nutrition–is studied in almost every medical school. The topic began to be studied in order to find ways to eliminate nutritional deficiencies resulting from undernutrition, but lately it has shifted to dealing with chronic diseases caused by nutritional excesses, and the federal dietary guidelines follow that same line. However, the federal government's approach does not recommend supplementing the typical diet with vitamins or nutritional supplements, nor does it categorize certain foods for their propensity to cause diseases. Opposing this perspective, the naturopathic approach to diet recommends the use of vitamins and nutritional supplements in order to promote optimal health and to prevent illnesses ( Natural Health Line).

NLM classification includes diet therapy in its WB section, which is for the practice of medicine, but vitamins and general nutritional requirements are included in QU, the Biochemistry class, and items on diet are classified in QT, which is for Physiology. The same separations may be observed in the LC classification, with some being classified in the RC class – the Internal Medicine section, and some in RM class – the Therapeutics section. See Appendices D.

This separation cannot be understood by the naturopathic medicine students or practitioners since--as the description of the Department of Nutrition courses offered by SCNM specifies--the dietary supplements, vitamins, diet therapies, and nutrition are all part of Therapeutics and contributeto disease cures and optimal health. This perspective led SCNM Library to change all the items between QU 145 and QU 220 - General Nutrition,to a newly created interval, WB 371 through WB 402.5, right next to the NLM Classification’s Nutrition class. See Appendices D.

Conclusion

The currently-in-use classification systems’ limitations and the changes in the informational needs for particularly categories of users impose on highly specialized libraries the imperative to look for new approaches to index the content of their collections and innovative ways of rearranging it. Furthermore, the burden of building useful collection to support research and teaching while staying within budgetary limitsrequires a deep understanding of the users’ specific information needs. SCNM Library has acknowledged the need for changes within itsin-practice-classification and acted accordingly to meet students and faculty information needs. Many changes have been finalized recently, and although no study has yet been done to verify whether an improved access to information was or was not obtained, as first-hand observations, the Library staff now getsfewer questions about discrepancies between the previous arrangements on the shelves and students’ understanding and usage continues steadily to increase, especially within the modified classifications. The spirit of this process is reflected by the Library’s own marketing slogan: ”A Customized Information Service that Fits Your Natural Health Research Needs.”