The Australian Rheumatology Association wrote to the MJA recently, advocating that the eponym “Reiter’s syndrome” be expunged from the medical literature. They argued that the distinction of having one’s name immortalised in an eponym should never be accorded to doctors involved in crimes against humanity. They considered that honouring the Nazi physician Reiter with his own eponym was a travesty.

So writes the editor of the MJA. He then discusses the merits of eponym cleansing. Perhaps a good idea but the circle of Willis, the Krebs cycle, the Henderson-Hasselbalch equation in biochemistry, Addisons disease, etc, etc are going to be very difficult to eradicate.

Perhaps we should settle for not creating any new eponyms?

“In many hospitals there are too many consultants for the facilities available and this is extremely wasteful. The other obvious gross excess is the vast number of managerial posts and a system which enables managers to promote each other and proliferate in an almost malignant manner, adding another financial burden to the hospital and also causing ridiculous bureaucratic duplication and unnecessary minor regulations not related to patient care.”

Who said that? It was Sir Roy Calne (Emeritus Professor of Surgery, Cambridge University). Obviously commentating on his view of things in the United Kingdom, however one has heard similar observations closer to home.

The debate continues—are bare metal stents better or worse than drug-eluting stents in terms of mortality and/or stent thrombosis?

Two drug-eluting stents have been approved by the US Food and Drug Administration—a sirolimus-eluting stent and a paclitaxel-eluting stent.

Are these better than bare metal, bearing in mind that they are much more expensive?

And which of these is the best? A paper and editorial comment on this topic concludes that the mortality was similar with both bare-metal and drug-eluting stents. However, sirolimus-eluting stents were associated with the lowest risk of myocardial infarction.

As the technology of sophisticated diagnostic tests improve, we can expect an increase in incidentalomas. And this is happening with brain MRI. To what extent is measured in this study from the Netherlands—2000 subjects from the general population (mean age 63.3 years) had a high resolution, structural brain MRI. 456 (22.8%) of the subjects had an abnormality detected.

Asymptomatic brain infarcts were present in 145 persons (7.2%). Among findings other than infarcts, cerebral aneurysms (1.8%) and benign primary tumours (1.6%) mainly meningiomas, were the most frequent.

In only 2 of the 2000 subjects was intervention necessary—one with a subdural haematoma and the other had an aneurysm treated. Who would like a free brain MRI for Christmas?

The authors of the paper point out that a rare disease is defined as one that affects 200,000 people or fewer. On the other hand there are approximately 7000 such disorders. Furthermore, in the US, patients with rare diseases number ~25 million people—almost 12% of the population.

So, collectively, they are not so rare. The problems arising from their rarity include poor coverage in medical schools, physician’s inexperience with the diseases, and neglect by the pharmaceutical industry because of small market potential.

They suggest that the individual advocacy groups for the rare diseases should be more united and hence become more powerful advocates of their causes.