What’s in a medical name?

The naming of diseases can sometimes bring up unexpected ethical issues

There is a long tradition of naming diseases after the doctor or researcher who discovered them. The use of eponymous titles is a somewhat hallowed tradition in medicine, serving as a shorthand way of referring to complex syndromes. Quite often, the name associated with the disease is not that of the first person involved in its description, yet for pragmatic reasons the original eponym continues to be used.

In my experience patients love eponyms. Let’s be honest, it is far easier to hold the attention of your average dinner party audience with the breathless announcement that you have just been discharged from hospital with Mallory-Weiss syndrome, rather than admit to having torn your gullet. Especially when the damage may have been induced by excessive vomiting brought on by an ill-advised drinking binge. Doctors generally like eponyms. For those engaged in medical research, there is the slim, but ever-present chance that your name will be immortalised when you make a significant breakthrough in your area of expertise.

And for those of us who are happy to earn our crust closer to the clinical coalface, eponyms tax our medical school memory banks, but inevitably lead to memorable malapropisms of the type that rarely emerge from a more functional explanation of disease. Some eponyms have a great ring to them. Who would not want to boast of having an Argyll Robertson pupil, at least until they discovered it resulted from a syphilitic infection of the nervous system? (Dr Argyll Robertson, an Edinburgh physician, first described the small, irregular and unequal pupils that do not react to light in 1869).

There is, however, a noticeable movement away from medical eponyms. Some doctors argue that eponyms do not reflect scientific discoveries: In their view eponyms usually refer to one person whereas scientific discoveries often reflect a group effort over time. Others disagree, pointing out that eponyms bring colour to medicine; that they provide a convenient shorthand for the profession and public alike; and they embed medical traditions and culture in our history. Bodies such as the World Health Organisation (WHO) do not encourage the use of eponyms, especially those that refer to place names (toponyms).

The current coronavirus pandemic has been named ‘Covid-19’ by the WHO, a term derived as ‘CO’ from corona, ‘VI’ from virus and ‘D’ from disease. But it was never referred to as ‘Wuhan Severe Acute Respiratory Syndrome’, even when it was globally recognised that the Chinese city of Wuhan was the first Covid-19 epicentre. And the WHO has recently moved against the practice of referring to variants of concern as a UK variant, a Brazilian variant or an Indian variant. Instead they have been renamed as Alpha, Gamma, and Delta variants. WHO is hyper conscious of inadvertently ‘bad mouthing’ a country or region in its nomenclature of new diseases.

Perhaps one of the strongest arguments against eponyms is their association with criminal behaviour. Nazi doctors and their involvement with humanitarian and racial atrocities are a particular concern. A recent series of incriminating studies on Nazi doctors’ biographies has sparked this movement, proposing the use of eponyms, such as ‘ANCA-associated granulomatous vasculitis’ or ‘granulomatosis with polyangiitis’ instead of ‘Wegener’s granulomatosis’, ‘congenital cutaneous candidiasis’ instead of ‘Beck-Ibrahim disease’, and ‘spider naevus’ instead of ‘Eppinger’s spider’, among others.

Friedrich Wegener was a German pathologist who had been detained as a suspected war criminal by the Allies in 1945. But he was released without facing trial. However, there is now evidence to suggest that Wegener, who died in 1990, was involved in the selection of Jews in the Lodz ghetto for genocide and also that he probably carried out postmortems on the victims. Writing in a recent edition of the Postgraduate Medical Journal, Dr Yandy Marx Castillo Aleman suggests the convening of an international committee of physicians and ethicists to propose alternative names for the eponyms of doctors who displayed complicity during the Nazi era. Such a committee could also honour the eponyms and stories of doctors who were victims of Nazi genocide.

Perhaps the most powerful argument in favour of eponyms is that they support the balance between art and science in medicine, something that is recognised as increasingly important in the modern education of doctors. But maybe the real reason I am in favour of retaining their use is that Houston’s valve is the only eponym I could even remotely lay claim to. However, as it refers to the folds that encircle the inside of the rectum, I am secretly hoping that a namesake will soon make a breakthrough involving a more prosaic part of the human anatomy.