A New Major Medical DictionaryJoe Segen2019-03-24T20:07:08+00:00
A New Major Medical Dictionary
Part 2 An Evolving Solution
There are 2 ways to do anything:
The right way and the wrong way.
We usually don’t realize it’s the wrong way until we’re elbows deep in the muck…by which time it’s too late, we’re galloping off in the wrong direction, hired the wrong people, bought the wrong supplies, leased the wrong space in the wrong place, committed to an ill-conceived plan, overspent the budget and torpedoed any chance of success.
I write medical dictionaries.
Don’t laugh…like telephone books, somebody has to write them. The person who single-handedly shoulders such a daunting task is either insane…naive…or both.
I began compiling material for this project in 1984. The word Modern figured so prominently in the title of the then-nascent work (The Dictionary of Modern Medicine), that I started with a blank sheet of paper.
I deliberately ignored material that one would expect to find in standard medical dictionaries–each had decades of experience, consultants aplenty in every field of expertise and a support team of secretaries and sundry Hey You’s.
Without a niche–in my case, modern–it would take years to build a viable product. I was–and still am–one guy. In retrospect–despite having a niche–I wasn’t naive…I was insane.
But, I reasoned (as madmen are wont to do), I wasn’t doing all of medicine…just the new stuff. I confined the rapidly growing pool to terms that I came across in journals of recent vintage. That way, I knew a particular term was in active use (i.e., “modern”)–unlike the thousands of obsolete or senescing terms which are carried forward from one edition of venerated medical lexicons to the next.
It turns out that I’d accidentally stumbled on the right way–assuming continued interest are a benchmark thereof–to write a new medical dictionary. New medical dictionaries don’t come along too often; ones that stand the test of time, less so.
Sometime in the mid-1970s–and I’ll freely admit I’m piecing parts of this story together–somebody at John Wiley & Sons in New York decided they should put their corporate muscle behind developing the mother of all medical dictionaries. Big name professors were recruited from both sides of the pond and both sides of the Channel. The busy bees began with a core of aging medical products, including the 4-volume Dictionnaire Français de Médicine et de Biologie which–quelle surprise–needed translating.
It was the first new medical dictionary to be compiled since the Taber’s was published in the 1940s. It turned out–with the benefit of 20:20 hindsight–Wiley had figured out the wrong way to write a new medical dictionary.
After 10 years of compiling, Wiley et al had nearly 200,000 terms, a fair few of which hadn’t been used for decades, making it big, but not particularly useful. They christened it The International Dictionary of Medicine and Biology(IDMB) and called it a wrap. It was a 3-volume behemoth with an eye-watering price of $300, at a time when the Dorland’s had 110,000 entries and cost about $40. I doubt Wiley sold anywhere near the 10,000 copies they needed to move just to break even, assuming (and I believe I’m being conservative) the project only cost $3 million–based on my highly speculative estimate.
The IDMB never made it to a second edition. I’m pretty sure they lost their shirts.
Wiley subsequently sold its medical division to Churchill, which pared the IDMB into a one-volume affair. It, too, lasted one edition.
In 1984, I began compiling The Dictionary of Modern Medicine (DMM).
My project was Wiley’s diametric opposite. I had no budget, no staff, no equipment, no core dictionary from which to start, and fortunately, no one to tell me what to include or not…or tell me how daft undertaking such a monumental project really was.
I started with a blank piece of paper, and settled on 3 rules:
• Current Use Rule To be included as an entry, the term must have appeared in a recent published work (including the then-nascent internet), journal* or textbook. Many terms get stuck in lexical limbo and have been carried forward in the above-mentioned major medical dictionaries as if they’re still in active use, which is avoided by sticking to this rule.
*I included “throwaway” journals, adverts for drugs, biomedical news appearing in the mass media.
• All-Inclusive RuleAny term that impacts–even obliquely–on medicine has been included: no one can criticise the DMM for unbalanced coverage.
Are serial killers fair game? Yes, via Forensic psychiatry
Waste management? Yes, via Public health
Automatic weapons? Yes, via Emergency medicine
Genocide? Yes, via Humanitarian aid
• Source Rule All terms come from somewhere; the source should be acknowledged. Any single-author work in medicine raises serious questions of credibility. The only way to address this issue is to do what the major medical dictionaries have never done…quote the source. At last count (March 2019), the DMM had 56,478 references…which is far more than one finds in other medical dictionaries.
Quoting references results in a far more authoritative product than could a board of so-called experts who don’t quote any sources for definitions. But how does the DMM–a one-man show–stack up against DSTMs? The DMM still differs substantially from the DSTMs, as I’ve maintained the focus on modern terminology, so the comparison is misplaced…for the moment.
For the first 20 years of growing the DMM, I shouldered the additional task of preparing the material for the printer by doing the DTP (desktop publishing) work. This resulted in 3 medical lexicons: the first with the Parthenon Group (1992, with 12,000 entries), the second with Simon and Schuster (1996, with 18,000 entries) and the last paper dictionary with McGraw-Hill (2005, with 23,000 entries). It became increasingly apparent that the volume of information was reaching the limits of manageability—think, a 35,000 page MS Word file. I was spending too much time making the product look pretty and not enough time growing it.
So in 2005, I began porting the whole megillah into a database. The DMM is now growing at a rate of 1,000 to 2,000 definitions per month, a rate that is impossible with text-based (DTP) software. The transition to a database has markedly improved information access. The DMM now has over 400,000 searchable terms, making it, as far as aliases and synonyms are concerned, 3-fold larger than Dorland’s Medical Dictionary. Yet, despite it being significantly larger, searches of the DMM take milliseconds and never miss. In contrast, searches of the text-based Kindle version of Dorland’s are slow, and typically come up dry.
Based on my experience, text-based medical dictionaries are anachronisms. If there is to be a continued place in medicine for the information product known as a dictionary, the only platform on which it can be delivered is a database. Databases have no size limit and are designed for keyword and boolean searching, neither of which are possible with text-based material.
The current public version (version 5) of the Dictionary of Modern Medicine database has over 55,000 biomedical terms of interest to med students, physicians, scientists and advanced health professionals. The 55,000 terms are from 8 data sets in the DMM:
• Medical Abbreviations and Acronyms
• Alternative and Complementary Medicine
• British medicine
• Hereditary Syndromes
• Obsolete/Retired Terminology
Version 5 was available for Apple users (Mac and iOS devices—which required users to download Filemaker Go https://itunes.apple.com/us/app/filemaker-go-17/id1274628191?mt=8 from the App store). I just delivered the 6th edition (v.6) to Kent Hummel, our database expert. It has 58,260 entries and includes an additional data set, Evidence-Based Medicine. It should be available by early April (2019) and accessible to Windows users as well. Filemaker does not support Android devices.