Should Medicine Still Bother With Eponyms?

Edith Sheffer’s young son always disliked labels such Asperger’s syndrome. But in 2016, a psychiatrist told him that he should be proud: His condition was named after Dr. Hans Asperger, an Austrian scientist in the 1930s who used his position to help save children like him. By devising a diagnosis that emphasized the children’s intellectual abilities, the psychiatrist said, Dr. Asperger tried to spare them from the Nazi campaign to “euthanize” youths with cognitive disabilities.

Dr. Sheffer, sitting next to her 12-year-old son, knew this wasn’t entirely true. Now a historian of 20th-century Europe at the University of California, Berkeley, she had spent years researching Dr. Asperger for her 2018 book, “Asperger’s Children.” Before he became known as a benevolent savior — “a psychiatric Oskar Schindler,” as Dr. Sheffer put it — Dr. Asperger marched in line with the Nazis’ medical framework.

His diagnosis, which he later called autistic psychopathy, was part of the larger Nazi medical effort to divide lives into two categories: worthy or unworthy of living. And, Dr. Sheffer learned with horror, he had personally condemned dozens of children to the killing centers. “I don’t want my son to be named after someone who sent children like him to their deaths,” she told Vox in 2018.

By the time her book was published, Asperger’s syndrome was no longer listed in the Diagnostic and Statistical Manual of Mental Disorders. In 2013 it was folded into autism spectrum disorder, in part because there was not solid evidence that it warranted its own diagnosis. But shortened versions of the term are still used widely in the autism community, many of whom refer to themselves with terms, such as “Aspie,” derived from the name Asperger’s.

Dr. Sheffer has since been gratified to see that other medical organizations, including the American Psychiatry Association and the World Health Organization, which put out the 11th revision of the International Classification of Diseases, or ICD-11, have largely phased it out. “I think the message has reached the medical community,” she said.

Asperger’s is (or was) a medical eponym, part of a hallowed tradition of naming body parts, diseases, disorders and tools after great medical figures. Its demise illustrates the risk inherent in idolizing anyone from another era, and adds support to a growing movement to end this tradition altogether. But some scholars contend that even “canceled” eponyms have a place, as stark reminders of the ethical breaches medicine should never repeat.

An eponym was once considered medicine’s highest honor. Like monuments to great generals, they paid tribute to medicine’s most brilliant minds, ensuring their names would live on in perpetuity. The best-known example is the fallopian tubes, named after Gabriele Falloppio, an Italian priest and anatomist who is credited as being the first to describe them. Others include Alzheimer’s, Parkinson’s and Hodgkin’s diseases, all named for European medical men.

So it was a shock when, in the early 2000s, dozens of eponyms were discovered to be linked to National Socialist doctors who had violated every value of medical consent and human dignity. These offenders could be found lingering in the lungs, attached to common diseases like arthritis and even on craters of the moon. There seemed to be only one possible response: purge the Nazis. These names were “not only a travesty but an affront to the profession,” two doctors wrote in 2007 in The Israel Medical Association Journal.

“We owe it to our patients, we owe it to their loved ones, we owe it to the victims of these atrocities,” said Dr. Eric Matteson, a retired rheumatologist who helped rename a disease of inflamed blood vessels formerly known as Wegener’s granulomatosis. “You are doing them an injustice.”

Beginning in 2000, after hearing a rumor that Dr. Friedrich Wegener had ties to National Socialism, Dr. Matteson and a colleague spent years combing through World War II archives around the world. They eventually learned that Dr. Wegener was a Nazi supporter who had worked three blocks from the ghetto in Lodz, Poland, and might have dissected victims of medical experimentation. In 2011, several major medical organizations moved to replace Wegener’s syndrome with “granulomatosis with polyangiitis” — a mouthful, admittedly. (“Wegener’s” can still be found in the ICD-11.)

The hunt for Nazi names was on. Clara cells, a type of cell that lines the lungs and secretes mucus, were found to be named for a Nazi doctor who experimented on soon-to-be-executed prisoners. The cells were renamed club cells, reflecting their bulbous shape. Reiter’s syndrome, a form of arthritis caused by a bacterial infection, was renamed “reactive arthritis” after it was found to have been named for a doctor who performed deadly typhus experiments on prisoners of the Buchenwald concentration camp.

In most cases, the name change fit with medicine’s growing preference for descriptive terms over honorific ones. “Many of us just don’t use eponyms because they’re not anatomically informative,” said Jason Organ, an anatomist at Indiana University. Rather than a fallopian tube, he said, “uterine tube just makes more sense — it tells you what it is.” In some cases, the inconsistent use of eponyms can even lead to medical errors, Dr. Organ added.

Not all anatomists agree with this slash-and-burn approach. Dr. Sabine Hildebrandt, an anatomical educator at Harvard Medical School, trained in Germany a few years before the legacy of Nazi medicine began coming to light. To her, eponyms provide an opportunity to remind future doctors of the path medicine must never go down again. “I would like to see them not as badges of honor, necessarily, but as historical markers — as teaching moments,” she said.

In the classroom, Dr. Hildebrandt highlights Frey’s syndrome, one of the rare medical eponyms that celebrates both a female researcher and a victim of the Holocaust. The syndrome, a neurological condition that can cause heavy facial sweating while eating, is named for Lucja Frey-Gottesman, a Polish neurologist who was murdered by the Nazis after being sent to the Lvov ghetto.

Dr. Hildebrandt also draws attention to Dr. Charlotte Pommer, a name that her students probably have not encountered. In 1942 Dr. Pommer, a young German anatomist, walked into the laboratory of her department’s director, Dr. Hermann Stieve, only to be confronted with the executed bodies of five people she recognized, members of the resistance group Rote Kapelle. Horrified, she abandoned the field.

Dr. Pommer gave up her bid for immortality. No part of the body is named after her; no papers list her as an author. Dr. Stieve gained renown for his contributions to medicine, including disputing the “rhythm method” of birth control and studying the effects of stress on the menstrual cycles of doomed female prisoners. By contrast, Dr. Pommer led a life of obscurity, treating victims of war in a nearby hospital.

Dr. Hildebrandt uses this story to show that complicity was not the only choice available to doctors of that era, and that there are other ways to be remembered than by having something named after you. Her 2016 book, “The Anatomy of Murder: Ethical Transgressions and Anatomical Science during the Third Reich,” is dedicated to Dr. Pommer. “It really is about correcting history,” she said.

Seen this way, eponyms might be compared to the modern German tradition of Stolpersteine, or “stumbling stones”— brass plaques, embedded in cobblestone streets across Europe, that commemorate Holocaust victims by listing their names and the date they were seized from their homes. They are meant to arrest passers-by, prompting them to contemplate past atrocities and the lives of those who were lost.

Similarly, many scholars argue that medicine should discard Nazi eponyms but retain those related to victims and resisters, to honor their stories. But the “right” side of history doesn’t stay put; as norms and standards change, and as scholars like Dr. Sheffer and Dr. Matteson uncover damning new evidence, many more are sure to fall from grace.

“If you pull enough of the threads here, a lot of this stuff’s going to come unraveled,” Dr. Organ said.

Dr. Sheffer notes another strike against eponyms: They often don’t even honor the right person. The term Asperger’s first emerged in the 1980s, at the suggestion of a British psychiatrist named Dr. Lorna Wing. Yet Dr. Wing conducted far more extensive research into the condition that would bear Dr. Asperger’s name. “He doesn’t deserve the credit,” Dr. Sheffer said. “If anything, we should use the name Wing’s syndrome because we’re going by her definition, not his.”

There is also a more fundamental reason to get rid of eponyms. Highlighting an individual obscures the reality that medicine moves forward through collaboration, debate and gradual consensus. But that’s a lesson that even doctors are still learning.

“Trying to keep an eponym and strip it of its honorific meaning is probably really, really challenging,” said Jason Wasserman, a bioethicist at the Oakland University School of Medicine who writes about medical ethics in the Nazi era. “Built into medical culture is the glory of the discovery.”

Source: Read Full Article