Willebrand's Disease or an Inherited Clotting Factor

PRESTON, England, Aug. 31 -- Rosenbach's syndrome by any other name would still be a form of paroxysmal tachycardia. So what's in a name?

From Addision's disease to Zollinger-Ellison syndrome, medical eponyms remain ubiquitous in the literature in favor of more scientific descriptions of disease. Now comes a proposal to do away with Down's and its ilk.

Eponyms -- words coined from the name of a person credited with a discovery, insight or action -- are the focus of a point-counterpoint debate published in the Sept. 1 issue of BMJ.

"Eponyms lack accuracy, lead to confusion, and hamper scientific discussion in a globalized world," wrote Alexander Woywodt, M.D., of the Lancashire Teaching Hospitals NHS Trust here, and Eric Matteson, M.D., of the Mayo Clinic College of Medicine in Rochester, Minn.

"Instead of using eponyms, we should use our interest in medical history to provide fair and truthful accounts of scientific discoveries and to dissect individual contributions. We call on the editors of medical journals and textbooks to abandon the use of eponyms," the authors wrote.

But eponyms "are so widely used and recognized that their eradication, even if it were desirable, would take a purge of monumental proportion and effort." countered Judith A. Whitworth, M.D., of the Australian National University in Canberra. "Why bother?"

"Eponyms bring color to medicine, they provide a convenient short hand for the profession and the community alike, and they embed medical traditions and culture in our history," Dr. Whitworth wrote for the defense.

Although eponyms often honor achievements, such as the identification of a unique form of lymphoma by Thomas Hodgkins, or a devastating form of dementia by Alois Alzheimer, they can also enshrine in infamy the people whose names they take.

In their condemnation of eponyms, Dr. Woywodt and Dr. Matteson argued that some medical eponyms honor those who deserve only scorn, such as Friedrich Wegener, the pathologist for whom Wegener's granulomatosis is named.

"We discovered that Wegener had been an early member of the Nazi brown shirts and that he had been the pupil of a prolific expert on 'racial hygiene.,," they wrote. "Wegener was also wanted as a war criminal, although the reasons remain unclear."

Furthermore, eponyms often honor those who first make a discovery public rather than the actual scientist who did the discovering, they argued.

"Behet's disease serves as an example," they wrote. "Hulushi Behet recognized the disease in 1937, but Benedictos Adamantiades described a case of the disease in 1930. And what about all the other people who contributed? To acknowledge everyone who discovered facets of the disorder, we would have to name it Hippocrates-Janin-Neumann-Reis-Bluthe-Gilbert-Planner-Remenovsky-Weve-Shigeta-Pils-Grtz-Carol-Ruys-Samek-Fischer-Walter-Roman-Kumer-Adamantiades-Dascalopoulos-Matras-Whitwell-Nishimura-Blobner-Weekers-Reginster-Knapp-Behet's disease."

Finally, eponyms fail the test of scientific accuracy, they argued, with some diseases going by different eponyms (or none at all) in different countries. In addition, clinicians are often confused about the actual clinical features of a disease known primarily by its eponym, and in some cases an eponym can represent two different diseases (the authors cite the case of de Quervain's disease, an eponym that can describe tendovaginitis of the hand or a rare thyroid disorder).

But love them or hate them, eponyms, like outdated golfing magazines in urology waiting rooms "are here to stay" Dr. Whitworth argued.

"The use of eponyms in medicine, as in other areas, is often random, inconsistent, idiosyncratic, confused, and heavily influenced by local geography and culture. This is part of their beauty," she wrote.

"For example, Plummer-Vinson syndrome in the United States (and Australia), Paterson-Kelly's syndrome in the United Kingdom, and Waldenstrom-Kjellberg syndrome in Scandinavia all describe sideropenic dysphagia."

But eponyms, like abbreviations, are often practical, she added.

"Do we really want to speak of congenital cyanotic heart disease due to ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and aortic dextroposition rather than Fallot's tetralogy? Or hereditary disorder of renal tubular function with vitamin D resistant renal rickets, glycosuria, aminoaciduria, and hyperphosphaturia for Fanconi's syndrome? Or violent muscular jerks of the face, shoulders, and extremities with spasmodic grunting, explosive noises, or coprolalia instead of Tourette's syndrome?"

She also argued that like their original inspirations, eponyms come and go, and when a better term comes along, the older, outmoded term will fade quietly away.

Neither the yeas nor the nay mentioned Lou Gehrig's disease, a rare case of a medical eponym for a patient. But in the world outside the land of baseball, it remains amyotrophic lateral sclerosis.