Eponyms in science: A proposal to minimize their use

An eponym is a real or fictitious name of a person or a place that is used to refer to a particular thing. Across all scientific fields, there are many natural laws, equations, and natural or biological phenomena named after their presumed discoverers, but the medical sciences stand out with approximately 8000 eponyms. ¹⁸ In human and veterinary medicine, many physiologic and pathologic processes, anatomic structures, symptoms, and diseases carry the name of the medical professionals who first studied or published those findings in the literature, while others are named for the location (eg, Lyme disease) or first/most famous patient (eg, Lou Gehrig disease) in which the disease was described.

Eponyms have been used to recognize the contributions of a person or a group of people in their respective fields. Eponyms are also used as a form of medical shorthand, conveying a complex concept or disease syndrome in one name, such as Cushing and Addison diseases. Because eponyms provide professional recognition and a form of immortality, their use can also help inspire others to make new discoveries and contribute to the medical sciences. Their widespread use is therefore understandable. However, although eponyms can be seen as a positive concept that strengthens the links between science and history, some believe their use should be abandoned due to technical and ethical reasons.^11,22

Eponyms lack descriptive power. For instance, Horner syndrome is a neurological disorder of many animal species characterized by miosis (constriction of the pupil), enophthalmos (sinking of the eye into the orbit), ptosis (drooping of the upper eyelid), protrusion of the third eyelid, and anhidrosis (absence of facial sweating). ¹⁹ The term Horner syndrome provides no direct information about the disease itself. On the other hand, the scientific term for Horner syndrome, that is, oculosympathetic paresis, is informative and briefly descriptive, indicating that the disease affects the nerves in the sympathetic trunk and results in partial paralysis. Similarly, Vogt-Koyanagi-Harada-like syndrome (a rare disease of dogs that is similar but not identical to its human counterpart, Vogt-Koyanagi-Harada syndrome) causes granulomatous uveitis and symmetrical granulomatous dermatitis with depigmentation predominantly on the dorsal muzzle, nasal planum, lips, and periocular area. ⁷ While the widely used eponym lacks the descriptive ability to outline the main aspects of the disease, the term uveodermatologic syndrome promptly informs the reader that the disease affects the eyes and the skin. Similar issues arise when using eponyms for morphologic features found in particular diseases. Homer Wright and Flexner-Wintersteiner rosettes occur in many neuroepithelial neoplasms in human and veterinary medicine. ²¹ The former is characterized by neuronal differentiation and the latter by photoreceptor/retinal differentiation, features that would be better described by the use of the terms neuroblastic and retinal rosettes, respectively.

Different eponyms can be used regionally for the same disease/phenomenon. For example, sideropenic dysphagia, a human disease characterized by dysphagia, iron deficiency anemia, and esophageal webs, is referred to as Plummer-Vinson syndrome in the USA and Australia, Paterson-Kelly syndrome in the UK, and Waldenstrom-Kjellberg syndrome in Scandinavia. ¹⁷ Another problem with eponyms is that they are often not defined consistently from reference to reference, ⁸ which can lead to decreased accuracy, poor communication, and misunderstandings. Finally, there is inconsistency in the spelling of the names (Bechterew vs Bekhterew disease) ²² and the use of possessive versus non-possessive forms (Down vs Down’s syndrome) of eponyms, complicating literature searches. ⁹ The US National Institutes of Health have recommended the non-possessive form since 1974. ²

While the “immortalization” of the discoverer is an argument in favor of eponyms, discoveries have been assigned to people that popularize or call attention to ideas rather than to the individuals that actually conceived the ideas. This phenomenon is so common that it has been referred to as Stigler’s law of eponymy. ¹⁴ Yes, another eponym. It states that no scientific discovery is named after its original discoverer. This observation was attributed to Robert Merton by Stephan Stigler to provide an ironic example of the law. In addition, ideas can arise in the minds of different people in different places and are often based on the work of many predecessors, so why should only one person get the credit? Darwinism is used to refer to evolution by natural selection, when the theory was independently formulated by Charles Darwin and Alfred Russel Wallace in the 1800s. ¹³ Another example of an inappropriate attribution is the so-called Arnold-Chiari malformation, a congenital malformation of the skull and nervous system that was originally described by Chiari in the late 1800s. Arnold only published a single case report, but his name was added to the eponym by two of his former students. ⁴ While Arnold has recently been removed from the eponym, most scientific publications still refer to both forms interchangeably, as most scientists are familiar with the term Arnold-Chiari malformation. The distinct clusters of neoplastic lymphocytes within the epidermis or follicular and apocrine gland epithelium in epitheliotropic lymphoma in humans and other animals are historically referred to as Pautrier microabscesses. Apart from the fact that these clusters of neoplastic lymphocytes are not microabscesses, French dermatologist Dr. Lucien M. Pautrier (1876–1959) did not originally describe these findings but was nonetheless given credit for the discovery. ⁶

Another issue with eponyms is that they reflect disparity in opportunities for women and minorities, resulting in the vast majority being named for white men. Historically, many universities did not allow women to enroll, and consequently, women could not obtain academic degrees. The few women who were able to break into the scientific community were often subjugated to positions that offered little opportunity for discovery. Rosalind Franklin was a pioneer and contributed substantially to the understanding of the molecular configuration of DNA using X-ray crystallography. ¹⁰ The data she generated was the first to confirm the DNA model that Watson and Crick theorized. While Franklin published her results in the same 1953 issue of Nature as Watson and Crick’s article on the structure of DNA,^5,16 the double helix was dubbed the Watson and Crick model of DNA. It took decades for Franklin’s contribution to be exposed and become part of the popular scientific knowledge. ³

The Blalock-Taussig shunt is an example of an eponym that includes a woman’s name (Helen Taussig), but leaves out a key partner in the development of the procedure used to correct the tetralogy of Fallot, another eponym that is admittedly useful shorthand for a congenital anomaly characterized by pulmonary or infundibular stenosis, ventricular septal defect, overriding aorta (biventricular aortal origin), and right ventricular hypertrophy. ¹² Working in Alfred Blalock’s laboratory, Vivien Thomas, the grandson of a slave, developed a canine model of the disease and then demonstrated that the corrective surgical procedure was non-lethal in dogs. Standing on a step stool behind Blalock, Thomas coached him through the first procedure on a human. Thomas’ contributions were not acknowledged in Blalock’s writings, and he was not included in the eponym. ¹

Eponyms can also make people, who should not be famous, famous, as some are named for individuals with ethical issues that are inconsistent with an honorary eponym. Max Clara, who described Clara cells, Hans Reiter of Reiter syndrome (a form of reactive arthritis), and Friedrich Wegener, known for Wegener’s granulomatosis (characterized by necrotizing vasculitis, granulomatous lesions of the respiratory tract, and glomerulonephritis), were all Nazi supporters. ²⁰ Carl Clauberg, who developed the Clauberg method (a progesterone assay), conducted sterilization experiments on women and girls in Auschwitz-Birkenau during World War II and was a convicted war criminal. ¹⁵ While as Whitworth wrote “history is what happened, not what we or the revisionists wish had happened,” ¹⁷ do we really want to pay homage to these men by continuing to use these eponyms?

The use of eponyms can also affect objectivity. By associating a concept with an individual, when the idea is questioned or challenged by colleagues, it can appear to be a personal attack. Eponyms can lead to adherence to a concept/system due to institutional or personal loyalty, which can override objective evaluation of potential challenges or modifications, one of the pillars of the scientific method.

The debate over the use of eponyms has been going on for decades, ⁸ and the current widespread use of eponyms in science may render their replacement a cumbersome, if not impossible task. There are compelling arguments in favor and against their use. The great number of eponyms makes it easy to select specific examples to support either view, but eponyms give historical perspective, and the advantage of eponyms as medical shorthand is difficult to overcome. Thus, their use will likely continue; however, given the drawbacks listed above, minimizing their use is strongly encouraged. When possible, the use of scientific nomenclature or acronyms, that specifically and accurately convey the concept, is recommended. Acknowledging that any meaningful change in the use of eponyms will have to start in veterinary schools, we encourage veterinary school instructors to carefully consider all the ramifications of eponyms before using them and when teaching them.