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Eponym debate: The case for biologically-descriptive names

Should diseases be named after people? This conclusion of a two-part series looks at the arguments for using biologically-descriptive names, not eponyms.

Naming a disease after the scientist who discovered it, like Hashimoto's thyroiditis or Diamond-Blackfan anemia, just doesn't work anymore, some physicians say.

A main argument against eponyms is that plain-language names -- which describe the disease symptoms or underlying biological mechanisms --  are more helpful for patients and medical trainees. For example, you can probably figure out a bit about acquired immunodeficiency syndrome (AIDS), whooping cough or pink eye just from their names.

"The more obscure and opaque the name -- whether due to our profession's Greek and Latin fetish or our predecessors' narcissism -- the more we separate ourselves from our patients," says Caitlin Contag, MD, a resident physician at Stanford.

Stanford endocrinologist Danit Ariel, MD, agrees that patients are often confused by eponyms.

"I see this weekly in the clinic with autoimmune thyroid disease. Patients are often confusing Graves' disease with Hashimoto's thyroiditis because the names mean nothing to them," says Ariel. "So when I'm educating them about their diagnosis, I try to use the simplest of terms so they understand what is going on with their body."

Ariel says she explains to her patients that the thyroid is overactive in Graves' disease and underactive in Hashimoto's.

Ariel says she believes using biological names also helps medical students better understand the underlying mechanisms of diseases, whereas using eponyms relies on rote memorization that can hinder learning. "When using biologically-descriptive terms, it makes inherent sense and students are able to build on the concepts and embed the information more effectively," Ariel says.

Medical eponyms are particularly confusing when more than one disease is named after the same person, Contag argues. For example, neurosurgeon Harvey Williams Cushing, MD, has 12 listings in the medical eponym dictionary.  

Stanford resident physician Angela Primbas, MD, agrees that having multiple syndromes named after the same person is confusing. She says it's also confusing to have diseases named differently in different countries. In fact, the World Health Organization has tried to address this, along with other issues, by providing best-practice guidelines for naming infectious diseases. (Genetic disorders, however, lack a standard convention for naming).

In addition, Primbas said she thinks naming a disease after a single person is an oversimplification of a complex story. "Often many people contribute to the discovery of a disease process or clinical finding, and naming it after one person is unfair to the other people who contributed," she says. "Plus, it's often disputed who first discovered a disease."

Also, few disease names recognize the contributions (or suffering) of women and non-Europeans. And some eponyms are decidedly problematic, like those named after Nazi doctors. A famous example is Reiter's syndrome named for Hans Reiter, MD, who was convicted of war crimes for his medical experiments performed at a concentration camp.

"Reiter's syndrome is now called reactive arthritis for the simple reason that Reiter committed atrocities on other human beings to conduct his 'science.' Such people should not have their name tied to a profession that espouses the principles of beneficence and nonmaleficence," says Vishesh Khanna, MD, a resident physician at Stanford. He says medicine is swinging away from using these controversial eponyms to describe them on the basis of their biology instead.

Personally, Khanna also admits that naming a disease after himself wouldn't sit well.

"Receiving credit for discovering something can certainly be a wonderful feather in a physician's career cap, but the thought of actually naming a disease after myself makes me cringe," says Khanna. "Patients and doctors would utter my name every time they had to bring up a disease."

Such sentiments may be why Contag's example of a good disease name -- cyclic vomiting syndrome -- is in plain English. Was no one eager to lend his or her name to it?

While the debate over medical eponyms continues, Khanna suggests a potential solution. "Perhaps a reasonable approach to naming going forward is to allow the use of already established eponyms without dubious histories, while only naming newly discovered diseases based on pathophysiology," he says.

Everyone I spoke with agrees that changing medical eponyms will only happen slowly, if at all, since it is difficult to change language. However, it can be done, according to Dina Wang-Kraus, MD, a Stanford resident in psychiatry and behavioral sciences.

"I looked through our diagnostic manual and we do not have diseases named after people in psychiatry. This shift happened quite some time ago so as to avoid confusion and to allow clinicians from all over the world to have a unified language," says Wang-Kraus. "In psych, we often say that we wish other specialties would adopt a universal nomenclature too."

This is the conclusion of a series on disease name eponyms. The beginning is available here.

Photo by 4772818

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