Fighting new diseases by giving them blander labels

Something new and bad is always blowing through — winds roar and cities flood, or people cough and die.

Whether it is a hurricane or a dire new epidemic, each iteration will be similar enough to previous ones that we recognise it, but different enough that it needs a new name. And here meteorology and medicine have formally parted ways. The split became official a few months ago, when the World Health Organization (WHO) issued strict new “best practice” guidelines for naming human infections.

As anyone named Katrina or Sandy knows well, the weather people find it useful to tag catastrophe with a human name. The health people now advocate just the opposite. Old habits of identifying diseases should be forsworn, the health organisation urges. No longer should disease names refer to specific doctors (as in Hansen’s disease, Whipple’s disease, Bell’s palsy) or specific patients (like the members of the American Legion who fell victim to that first giant outbreak of Legionnaire’s disease in 1976). Names should not cite specific places (like Lyme, Connecticut, or the Ebola River in Congo) or specific animals (rat-bite fever, tick-borne encephalitis, mad-cow disease). They should not contain scary words like “fatal” or “unknown.”

Rather, “to minimise impact of disease names on trade, travel, tourism and animal welfare,” to deflect panic and avoid all appearance of praise or blame, disease names should be purely descriptive. They should reflect symptoms, seasonality, age group at risk and causative agent, if known, in a short, snappy phrase, or at least one amenable to abbreviation.

And so, among recent epidemics, thumbs-down to swine flu, bird flu and MERS (Middle East respiratory syndrome), and a tepid nod of approval to SARS (severe acute respiratory syndrome) — although even the bland SARS was said to unfairly single out the residents of the Hong Kong Special Administrative Region, one of the 2003 centres of that disease.

Our habits for naming illnesses are nowhere near so scientific or amenable to change, forming instead a long, colourful, inconsistent parade of blame and acclaim. At one extreme, we have the targeted venom unleashed on the innocent as syphilis exploded across 16th-century Europe. The Italians called it “the French sickness”; the French called it “the Neapolitan sickness”;  the Russians called it “the Polish sickness”; and a few decades later, the Japanese knew it as “the Portuguese sickness”.

At the other extreme is the example of the post-infectious arthritis known for half a century as Reiter’s syndrome. The German physician Hans Reiter was first to identify this inflammation of the joints, eyes and urinary tract, and it was formally named after him in the 1940s. Subsequently, though, Reiter’s complicity with Nazi atrocities was uncovered, leading to a formal proposal to substitute “reactive arthritis” for a name felt to confer undue glory on a miserable human being.

We see human names attached to so many aspects of health care now. Hospitals are losing those pleasant old generic labels like General, City and County, and now are as likely to be known by the name of a major donor. More recently, medical schools have also begun to reward cash infusions with a grateful change of name.

A few of these donors will inevitably turn out to be somewhat less virtuous than they were magnanimous, but so far no one has suggested unnaming an institution to preserve our profession’s moral integrity. It will presumably happen someday, just as it did to Reiter. In the interim, we are left with health care names that honour the dishonourable and those that disparage the blameless, and the great majority that simply remember the unsung, doctors and patients alike. It does seem a shame to slam down this window on history.

Perhaps rather than WHO’s suggestion, we might consider the method of Lance Armstrong — stricken with testicular cancer, he named his disease “the bastard.” Unfortunately, we are likely to run out of obscenities long before we run out of
diseases.