Moving away from Eponyms

The Oxford English Dictionary defines an eponym as “a person after whom a discovery, invention, place, etc., is named or thought to be named”. Medicine is full of diseases and syndromes named after people who described something. You might have heard of: Alzheimer disease (named after Alois Alzheimer), Hodgkin disease (named after Thomas Hodgkin), Parkinson disease (named after James Parkinson) or Down syndrome (named after John Langdon Down).

Eponyms have since long been a way to honour the person who first described a disease. Sociologist Robert K Merton says that “eponymity, not anonymity, is the standard”. Eponyms were an enthusiastic acknowledgement by the scientific community of the person’s contribution to medical science. Besides, the names do reflect the history of the disease.

However, this is no longer the case. There is a growing lobby which believes that this trend ought to be abandoned in favour of more descriptive nomenclature. And they have several arguments to strengthen their case- the first being that very often credit is given to a person who didn’t deserve it.

Professor Stephen Stigler, who teaches statistics at the University of Chicago, has proposed Stigler’s law of eponymy. This law states that no scientific discovery is named after its original discoverer. For example, the Pythagoras theorem was known to Babylonian mathematicians long before Pythagoras. The Fibonacci numbers were known to Indian mathematicians since 200 BC, while Fibonacci gave the series in 1202 AD. Halley’s comet had been observed by astronomers long before Edmond Halley was born, since at least 240 BC.  In medicine, Hulushi Behçet from Turkey recognised Behçet disease in 1937, but Benedictos Adamantiades described a case before him in 1930. As Alfred Whitehead said (hopefully he was the first to say this!): “Everything of importance has been said before by somebody who did not discover it”.

Very often several people arrive at a new idea around the same time, while the one who gets more publicity or is more popular ends up being rewarded. As if to prove his law, Stephen Stigler himself credited Robert Merton for his observation! As Mark Twain said:

“It takes a thousand men to invent a telegraph, or a steam engine, or a phonograph, or a photograph, or a telephone or any other important thing—and the last man gets the credit and we forget the others. He added his little mite — that is all he did.”

Two days ago, I was preparing my lecture on vasculitis, and strangely found that Wegener’s granulomatosis was missing from the new edition of my textbook. I went on to discover that the nomenclature of this condition is now ‘granulomatosis with polyangiitis’. Friedrich Wegener, a German pathologist had first described the condition in two reports. In 2006, Woywodt and Matteson stumbled upon his past and found out that at some point in his career he was a follower of the Nazi regime. He had worked in an office where medical experiments were conducted. Raising concerns about his professional conduct, the name change was recommended.

There is a whole list of medical eponyms with Nazi associations. Reiter’s syndrome is now renamed reactive arthritis. Hans Conrad Reiter was a physician leader of the Nazi party, who authorised medical experiments on prisoners in concentration camp during World War II. A similar story surrounds Hans Asperger who described the autism spectrum disorder.

There will be those that argue that eponyms make learning easy. But then those who have had to memorize the 31 eponyms associated with aortic regurgitation such as Austin-Flint murmur, Duroziez sign, Watson pulse and Lincoln sign will disagree! Do eponyms trivialize scientific knowledge? There is an interesting paper by Waseem et al which showed that only 10% of orthopedic surgeons could correctly identify Finkelstein’s test as described by Finkelstein.

Another issue is with the use of possessives. Should it be Alzheimer disease or is it Alzheimer’s disease? Is Down syndrome correct or is it Down’s syndrome? As the Lancet indignantly says: “The possessive use of an eponym should be discontinued, since the author neither had nor owned the disorder.”

Well, I don’t see eponymophilia abating in the near future. Who doesn’t want to be immortalized for posterity? But then I agree with what Dustin says.