Before groaning about diving into grammatical nuances in medicine, let us remember that how we speak about our patients often mirrors how we treat them.
Language is powerful and intentional. Are you familiar with the American Medical Association (AMA) Manual of Style? It is not about jogger-pant scrubs and stitched, collared white coats. It is a guide to the writing, editing, and citation styles that form the language of medical publications. Perhaps you used the Modern Language Association (MLA) or Chicago Manual of Style (CMOS) format in college, but medical journals tend to follow the AMA Manual of Style. Originally published in 1962, the much anticipated 11th edition was released in 2020, both in print and online.1 Among its hundreds of pages of grammatical rules are guidelines on the use of apostrophes in medical eponyms.
What’s the deal with apostrophes and why should we care? What we are actually referring to are possessive eponyms, such as Bell’s palsy, Down’s syndrome, Alzheimer’s syndrome, Grave’s disease, Crohn’s disease, etc. Both the American Medical Association and the World Health Organization have suggested that we retire this use of possessive eponyms.2,3 The practice suggests, misleadingly, either a sense of ownership or perhaps a personal affliction of the individual named. Additionally, eponyms complicate and misguide literature searches. The use of possessive eponyms is a matter of habit, and change is long overdue.
Eponyms have traditionally been used to indicate the describer, the patient, or the location where an illness or finding was first described. Historically, the possessive form has been used, but the non-possessive form is becoming more accepted. If you want to geek out even further, naming a disease based on a location (e.g., Lyme disease) is actually a toponym, not an eponym (a highly encouraged icebreaker for your next cocktail party). Possessive eponyms suggest that someone owns a disease. The National Down Syndrome Society made a push to shift terminology from Down’s syndrome to Down syndrome, since the syndrome does not belong to anyone.4 If the name of a disease or syndrome should rightfully belong to anyone, it would be the patient, not the discoverer.
Using possessive eponyms makes searching the literature confusing and inefficient. A study that compared PubMed searches for common eponyms with and without the “‘’s” found large discrepancies in search results depending on how the term was searched. Even though the non-possessive eponym is recommended, searches that did not include the possessive form missed hundreds of potentially relevant results.5 Furthermore, when specifically looking at a disease process like Grave’s disease, results were confounded with the adjective “grave.” (And if you are a patient, it does not inspire hope to be told you have a Grave disease).
The recommendation against possessive eponyms has been in place since 1974,6 and yet, we still can’t say “Bell palsy” without raising an eyebrow (Get it? Raising an eyebrow?). Shouldn’t it be Bell’s palsy? Or Bells palsy? Can you really bring yourself to say “Bell palsy”?
Say it with me: Bell Palsy. Alzheimer syndrome. Down syndrome. Crohn disease. We have all said and heard stranger things in our careers. We can do this.
We can take this one step further. Instead of Bell palsy, it should be “idiopathic facial palsy.” Why use the eponym at all? I’m not sure we are fully ready for this diversion from our medical school textbooks that we worked so hard to memorize. But think on this…why should a patient’s pathology be named after anyone?
For CorePendium, we are developing our own style guided by the principles outlined in the AMA Manual of Style, but with adaptations and modifications in some instances to reflect our own editorial perspective (for example, we format our references to include links to the article’s abstract in PubMed). Spirited internal debate about possessive eponyms fills our Slack channels. Should we follow the path of grammatical righteousness? Or should we cave in to the commonly typed words in the Wiki search? The time is now to abandon the possessive eponym.
References
- Christiansen S, Iverson C, Flanagin A, et al. AMA Manual of Style: A Guide for Authors and Editors. 11th ed. Oxford University Press; 2020.
- Christiansen S, Iverson C, Flanagin A, et al. AMA Manual of Style: A Guide for Authors and Editors. 11th ed. Oxford University Press; 2020.
- World Health Organization. Technical Publications Unit. 1993. WHO editorial style manual. Updated and reprinted 1994, 1998. World Health Organization.
- Christiansen S, Iverson C, Flanagin A, et al. AMA Manual of Style: A Guide for Authors and Editors. 11th ed. Oxford University Press; 2020.
- Ayesu K, Nguyen B, Harris S, Carlan, S. The case for consistent use of medical eponyms by eliminating possessive forms. J Med Libr Assoc. 2018 Jan;106(1):127-129.
- Ayesu K, Nguyen B, Harris S, Carlan, S. The case for consistent use of medical eponyms by eliminating possessive forms. J Med Libr Assoc. 2018 Jan;106(1):127-129.