Clinical Anatomy 27:1137–1140 (2014)

POINT-COUNTERPOINT

The Debate Over Eponyms KYLE M. FARGEN*

AND

BRIAN L. HOH

Department of Neurosurgery, University of Florida, Gainesville, Florida

Traditionally, important clinical or anatomic discoveries were labeled with the discoverer’s name, to serve as both a means to recognize and reward the discoverer’s contribution to the field but also because scientific names were often harder to remember and more difficult to communicate. Eponyms have been pervasive throughout anatomy and medicine over the last few centuries. Recently, some experts have argued that eponyms harbor significant limitations and have become antiquated. For instance, some eponyms fail to convey the characteristic findings associated with the disease or structure for which they are associated and eponyms are often times variable based on country and journal and in the grammatical form that is used. In fact, some individuals are going so far as to call for the removal of eponyms from published medical literature and medical textbooks going forward. In this article, we explore the arguments for and against the continued use of eponyms within medical education and practice, so that readers may understand both sides of the debate. Clin. Anat. 27:1137–1140, 2014. VC 2014 Wiley Periodicals, Inc. Key words: eponyms; anatomy; medicine

INTRODUCTION A major function of organized medicine is its endless pursuit toward improving the quality and safety of care provided to its patients. Fully engrained in this function is the commitment toward optimizing the education and training of tomorrow’s physicians and scientists. As part of this ongoing educational reappraisal, there has been increasing debate within the medical community recently regarding the merits and limitations of eponyms within medical education (Jeffcoate, 2006; Rashid and Rashid, 2007; Whitworth, 2007; Woywodt and Matteson, 2007; Matteson, 2008; Mora and Bosch, 2010; Ma and Chung, 2012; Fargen and Hoh, 2014). Traditionally, important clinical or anatomic discoveries were labeled with the discoverer’s name, to serve as both a means to recognize and reward the discoverer’s contribution to the field but also because scientific names were often harder to remember and more difficult to communicate. For these reasons, eponyms have been pervasive throughout anatomy and medicine over the last few centuries. Recently, some experts have argued that eponyms harbor significant limitations and have become antiquated. For instance, some eponyms fail to convey the characteristic findings associated with the disease or structure for which they are associated, and some eponyms are undeserved. In fact, some individuals

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2014 Wiley Periodicals, Inc.

are going so far as to call for the removal of eponyms from published medical literature and medical textbooks going forward. The purpose of this article is to explore the pros and cons of the continued use of medical eponyms by evaluating both sides of the argument.

IN SUPPORT OF EPONYMS Tradition and History Arguably the strongest argument in support of the continued use of eponyms in medical education is the pervasive use of eponyms throughout history. All physicians in training have been inundated with numerous eponyms throughout both medical school and residency training. Most of us have sentimental attachments to the way we learned disorders, structures, and techniques through eponyms. Many physicians fondly

*Correspondence to: Kyle M. Fargen, MD, MPH, Box 100265, Gainesville, FL 32610, USA. E-mail: [email protected] ufl.edu Received 1 April 2014; Accepted 5 April 2014 Published online 23 April 2014 in Wiley Online (wileyonlinelibrary.com). DOI: 10.1002/ca.22409

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1138 Fargen and Hoh recall being questioned by their educators regarding obscure eponyms, only to feel a sense of accomplishment when they were able to correctly recall a rare and long-forgotten name associated with a particular disorder. The field of medicine has a vast and distinguished history, and the traditions that are carried down from one generation to the next have meaning and historical significance (i.e., the Hippocratic oath). For many of us, eponyms were an integral part of the language of medicine that we learned and practiced. Replacing these famous names with descriptive terms may almost seem like heresy. Furthermore, eponyms may engender medical diagnoses or discoveries with a unique personality and help place the discovery into its historical context (Ma and Chung, 2012). Consider amyotrophic lateral sclerosis, which fails to convey the same history and emotion as Lou Gehrig disease. Similarly, secondary hypercortisolism doesn’t quite invoke the same sentiment among neuroscientists as Cushing’s disease, named after the father of modern neurosurgery who described this entity in detail in the 1920s. In addition, students who are learning these entities for the first time often learn about the historical context at the same time they learn the eponym for the disorder, which may allow for a more rounded educational experience. Part of learning the way we practice medicine currently comes from learning how medicine evolved through history. In this regard, eponyms provide additional meaning to the diagnoses or structures that are learned by students.

Ease of Communication Often times, disorders have long or difficult scientific names. Eponyms, on the other hand, usually involve only one or two linked family names and may be easier to communicate. One example is the “tetralogy of Fallot,” which is much easier spoken than “congenital cyanotic heart disease due to ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and aortic dextroposition” (Woywodt and Matteson, 2007). Although some eponyms certainly make communicating of disorders more tedious with long hyphenated names, in many cases eponyms may serve as effective shorthand for more difficult scientific names.

students, great thinkers of the future who sacrifice for the greater good may also have the chance to be immortalized in medical textbooks with an eponym.

Sometimes Indispensable There are certain eponyms that have become so entrenched in medical language that they have become indispensable. For instance, the “circle of Willis” is now so engrained in anatomical language that few of us even know the generic name for the structure. While the “circle of Willis” does not help to explain the role of the structure within the cerebrovascular system, every medical student or physician knows exactly what is being communicated when they hear the term. In fact, the vast majority of practicing physicians would be clueless if they heard the term “circulus arteriosus cerebri.” An additional example is that of the Heimlich maneuver, which every physician, student, and lay person is familiar. How would one communicate this maneuver of repeated abdominal thrusts effectively without using the name “Heimlich”?

They Remain Pervasive in Modern Medical Education A final argument in the support of eponyms is the current widespread use of these names in textbooks, medical school curricula, and in modern medical practice. Attempting to remove all eponyms from medical teaching and language would require that generations of physicians abandon these entities. Removing eponyms from medical school curricula may damage graduating students’ ability to communicate effectively with those physicians who learned with eponyms, as the younger generation may not be familiar with the common names used by the older generation. Conversely, the older generation may not be familiar with the modern scientific names taught to the younger physicians. In addition, as most experts producing manuscripts, authoring textbooks, and teaching medical school curricula tend to be senior physicians and scientists, it seems like a nearly insurmountable task to mandate these individuals abandon the terms that they learned and replace them with scientific nomenclature which they may be unfamiliar.

ARGUMENTS AGAINST EPONYMS Celebrates Discoveries and the Discoverer

Nondescript

Many brilliant researchers and clinicians have been immortalized through eponyms. While some of these are undeserved, the vast majority of individuals celebrated by an eponym deserved accolade through the result of personal sacrifice, intelligence, or creativity. In some cases, these individuals were initially ostracized by the medical community as their discoveries appeared to oppose accepted practice standards or norms. It would seem fair that those who have made significant discoveries in medicine should be rewarded with an eponym for that discovery. Similarly, if we continue to teach and use medical eponyms to our

Perhaps the strongest argument against the continued use of eponyms is that eponyms are inherently inaccurate and non-scientific. Medicine requires accurate and standardized description of disease processes to ensure adequate comprehension and communication. The vast majority of eponyms include few or no hints as to the scientific criteria that form the basis of the disorder or structure for which the eponym is named. Using the previous example of Lou Gehrig disease, the name conjures up images of baseball greatness but fails to adequately describe the essential components of the disease, as does the term

Medical Eponyms 1139 “amyotrophic lateral sclerosis.” At least acronyms, such as VATER syndrome or “PML,” summarize long, difficult names into abbreviations describing the entity’s criteria and provide useful information both for recall and communication (Mora and Bosch, 2010). Scientific names, on the other hand, are named based on definitions, attributes, or clinical findings. Therefore, most eponyms fail to provide useful clinical information and do not assist with recalling or communicating important characteristics of the entity. Using scientific names in the place of eponyms may help improve ambiguity associated with these entities.

Eponyms May Be Undeserved While many eponyms are named after important discoverers, some eponyms have been rewarded to individuals that did not deserve the honor. Consider Dr. Takayasu, who failed to recognize many of the essential attributes of Takayasu arteritis yet still was awarded the eponym (Woywodt and Matteson, 2007). Another example is Lister’s tubercle, a bony prominence on the radius. Interestingly, Dr. Lister hardly even made mention of the prominence in his few publications regarding the wrist. Furthermore, a close colleague stated that Lister had never even made reference to the structure in their discussions (Bett, 1952; Ma and Chung, 2012). A third example is that of the Arnold–Chiari malformation. Unlike Chiari, who had published thorough anatomic and pathologic descriptions of these congenital malformations in the late 1800s, Arnold published a single case report of an infant with a sacral teratoma and a small encephalocele. The term Arnold–Chiari malformation was coined by two former students of Arnold just a decade later, and this name became common verbage (Solt, 2011). Only recently has Arnold been justifiably removed from the eponym in published medical literature. In addition to eponyms that have been awarded to underserving individuals, some eponyms are named for individuals who arguably should not be celebrated for their achievements. Two interesting, frequentlycited examples are those of Reiter syndrome and Wegener granulomatosis. The use of both of these eponyms have come into serious question after it was discovered that both Reiter and Wegener were Nazi physicians that may have been involved in the mistreatment of Jewish patients or prisoners (Mora and Bosch, 2010; Wallace and Weisman, 2000; Woywodt and Matteson, 2006). A more clear but less widely known example is that of Dr. Clauberg and his progesterone bioassay. Dr. Clauberg was a Nazi obstetrician convicted of crimes against humanity for the work that led to the discovery of the Clauberg bioassay for which it is named: his experimentation on and sterilization of Jewish women (Sweet and Csapo-Sweet, 2012).

Winner-Takes All Another shortcoming of eponyms is that they fail to recognize the complex achievements of all of the individuals who committed time and effort to make

the discovery, but unfortunately were not awarded the eponym by history. Consider the excellent article by Lo and Ellis detailing the development of our understanding of the “circle of Willis” (Lo and Ellis, 2010). Years of anatomic dissections and research from multiple, committed physician–scientists were instrumental in driving understanding of this critical neurovascular network. Instead of “circle of Herophilus-Galen-da Carpi-Vesalius-Fallopio-Casserio-Wepfer-Willis,” time has granted the eponym to Willis alone. While there are certainly eponyms named for single individuals who are responsible for the lion’s share of the discovery, many eponymous entities had important collaborators who have been left out of the name. It seems unfair that those who may have made significant sacrifices, and in the process made significant scientific strides, not be awarded by an eponym just because they were overshadowed by a more popular collaborator. Perhaps the best way to avoid this injustice is to eliminate the use of eponyms altogether, which would solve the problem of unfair naming of discoverers.

Lack of Consensus on Possessive Form Additionally, the grammar surrounding eponyms is frequently inaccurate. In fact, the form of the eponyms used is highly variable based on country, time, and publication (Macaskill and Anderson, 2013). Over the last four decades, the possessive form has fallen out of favor and now most authorities agree that eponyms should be used only in the non-possessive form without apostrophes, as the namesake person does not have proprietary claim on the entity (McKusick, 1998; Cheng, 2010). Therefore, many eponyms are commonly communicated in an inaccurate grammatical form and a highly variable manner. While seemingly benign at first, this variability may actually have important implications on future research and online learning. The use of both possessive and nonpossessive forms of the entity may significantly affect the results of online database and resource searches, such as PubMed, based on which form of the eponym is used in publications and which form is searched (Amarnani et al., 2013).

Confusion with Eponyms Finally, it is not uncommon for medical and graduate students to be confused regarding the origin of eponymous names. For instance, Charcot-Marie-Tooth disease can be confused for a dental disorder. The Wada test is often misinterpreted to be an acronym by students when it is in fact an eponym referring to Juhn Atsushi Wada, a Japanese Canadian neurologist (Wada, 1949). Foster Kennedy syndrome is a syndrome named after Dr. Robert Foster Kennedy, but is frequently mistaken for two individuals named Dr. Foster and Dr. Kennedy. Given that there a vast number of eponyms, some with strange and long hyphenated names, it is no wonder that many students have been confused while learning this nomenclature.

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CONCLUSION Eponyms are deeply rooted in medical history, education, and language. While eponyms allow us to celebrate the efforts of tireless researchers in their critical discoveries and add personality to the terms we communicate, they are inherently inaccurate and variable. While the debate over the use of eponyms in medicine continues, the pros and cons of each side of the debate are readily apparent. However, it is undeniable that eponyms are deeply engrained in the art and practice of medicine. It appears as though those wishing to see the extinction of eponyms from medical curricula have a large uphill battle going forward.

REFERENCES Amarnani A, Brodell RT, Mostow EN. 2013. Finding the evidence with eponyms. JAMA Dermatol 149:664–665. Bett WR. 1952. Sir William Watson Cheyne, (1852–1932). Ann R Coll Surg Engl 11:364–366. Cheng TO. 2010. No apostrophe s after an eponym. Int J Cardiol 140:259. Fargen KM, Hoh BL. 2014. A rose by any other name: Eponyms and neurosurgery. World Neurosurg 81:77–79. Jeffcoate WJ. 2006. Should eponyms be actively detached from diseases? Lancet 367:1296–1297. Lo WB, Ellis H. 2010. The circle before willis: A historical account of the intracranial anastomosis. Neurosurgery 66:7–18; discussion 17–18.

Ma L, Chung KC. 2012. In defense of eponyms. Plast Reconstr Surg 129:896e–898e. Macaskill MR, Anderson TJ. 2013. Whose name is it anyway? Varying patterns of possessive usage in eponymous neurodegenerative diseases. PeerJ 1:e67. Matteson EL. 2008. All medical eponyms should be abandoned. Presse Med 37:250–251. McKusick VA. 1998. On the naming of clinical disorders, with particular reference to eponyms. Medicine (Baltimore) 77:1–2. Mora B, Bosch X. 2010. Medical eponyms: time for a name change. Arch Intern Med 170:1499–1500. Rashid RM, Rashid RM. 2007. Medical eponyms: our past, present, and future. Int J Dermatol 46:996. Solt I. 2011. Chiari malformation eponym- time for historical justice. Ultrasound Obstet Gynecol 37:250–251. Sweet F, Csapo-Sweet RM. 2012. Clauberg’s eponym and crimes against humanity. Isr Med Assoc J 14:719–723. Wada J. 1949. A new method for the determination of the side of cerebral speech dominance. A preliminary report of the intracarotid injection of sodium amytal in man. Igaku Seibutsugaki 14:221–222. Wallace DJ, Weisman M. 2000. Should a war criminal be rewarded with eponymous distinction? The double life of Hans Reiter (1881–1969). J Clin Rheumatol 6:49–54. Whitworth JA. 2007. Should eponyms be abandoned? No. BMJ 335: 425. Woywodt A, Matteson EL. 2006. Wegener’s granulomatosis—Probing the untold past of the man behind the eponym. Rheumatology (Oxford) 45:1303–1306. Woywodt A, Matteson E. 2007. Should eponyms be abandoned? Yes. BMJ 335:424.

The debate over eponyms.

Traditionally, important clinical or anatomic discoveries were labeled with the discoverer's name, to serve as both a means to recognize and reward th...
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