4
15. Brautigam M. Terbinafine versus itraconazole: a controlled clinical comparison in onychomycosis of the toenails. J Am Acad Dermatol 1998;38(Suppl):S53-6. 16. Havu V, Brandt H, Heikkeila H, Hollmen A, Oksman R, Rantanen T, et al. A double-blind, randomized study comparing itraconazole pulse therapy with continuous dosing for the treatment of toenail onychomycosis. Br J Dermatol 1997;136:230-4. 17. Elewski BE. Diagnostic techniques for confirming onychomy- cosis. J Am Acad Dermatol 1996;35(Suppl):S6-9. Declining use of the eponym ‘‘Reiter’s syndrome’’ in the medical literature, 1998e2003 Dave W. Lu, BA, a and Kenneth A. Katz, MD, MSc b Philadelphia, Pennsylvania The German physician Hans Reiter (1881e1969) is associated eponymously with the syndrome of arthritis, urethritis, and conjunctivitis occurring during or after episodes of diarrhea or urethritis. During World War II, Reiter, a physician leader of the Nazi party, authorized medical experiments on concentration camp prisoners. Because of this, some physicians have argued against further use of the Reiter eponym. We investigated trends in use of the Reiter eponym from 1998 to 2003. We searched MEDLINE to identify English-language articles published between 1998 and 2003. Articles were classified by whether the eponym was used without qualification (ie, without mentioning its disfavored use) or not. Five hundred thirty-nine articles were identified. Use of the eponym without qualification was less common in articles published later (34.0% in 2003 vs 57.0% in 1998; adjusted relative risk [RR], 0.49, 95% confidence interval [CI], 0.27-0.71; P = .001) and in articles published in higher impact journals (36.8% vs 56.8% in journals without calculated impact factors; adjusted RR, 0.51; 95% CI, 0.29-0.73; P = .002). Use without qualification was more common in articles written by US-based authors (60.6% vs 31.1% for European-based authors; adjusted RR, 2.28; 95% CI, 1.58-2.97; P \ .001). We concluded that use of the Reiter eponym without qualification decreased from 1998 to 2003. ( J Am Acad Dermatol 2005;53:720-3.) T he German physician Hans Reiter (1881e1969) is associated eponymously with the syndrome of arthritis, urethritis, and conjunctivitis occurring during or after enteric or genitourinary infections. 1,2 Cutaneous manifesta- tions may include keratoderma blenorrhagicum and circinate balanitis. 1 Recently, 3 arguments have been advanced against further use of the eponym ‘‘Reiter’s syndrome.’’ The first is nosologic; it claims that the syndrome properly falls under the heading of other disease entities, such as ‘‘reactive arthritis,’’ in light of its specific bacterial triggers (eg, the presence of Shigella and Salmonella in the gastrointestinal tract and Chlamydia in the genitourinary tract) and its higher prevalence among HLA-B27epositive persons. 1,3,4 The second argument is historical. The syndrome Reiter reported in 1916 had been described previ- ously, dating back to the 1500s 5 ; moreover, Reiter incorrectly attributed it to a spirochetal infection. 2 The third argument is ethical. A leading Nazi, Reiter ultimately became president of the Reich Health Office. 5 During World War II, Reiter autho- rized experiments on concentration camp inmates, 5-7 including one in which 250 Buchenwald prisoners died of typhus inoculations. 5 The ethical case against continued use of the eponym was first voiced by Shafer, 7 who argued that Reiter’s Nazi past ‘‘...does From the University of Pennsylvania School of Medicine, a and the Department of Dermatology, University of Pennsylvania. b Funding source: Funded by a Kirchstein National Research Service Award from the National Institute of Arthritis, Musculoskeletal, and Skin Diseases (Dr Katz). Presented previously (abstract and oral presentation) at the summer meeting of the American Academy of Dermatology, ACADEMY 2004, New York, New York, July 31, 2004. Reprint requests: Kenneth A. Katz, MD, MSc, Department of Dermatology, University of Pennsylvania School of Medicine, 3600 Spruce St, 2 Maloney, Philadelphia, PA 19104. E-mail: [email protected]. 0190-9622/$30.00 ª 2005 by the American Academy of Dermatology, Inc. doi:10.1016/j.jaad.2005.06.048 JAM ACAD DERMATOL OCTOBER 2005 720 Brief reports

Declining use of the eponym “Reiter's syndrome” in the medical literature, 1998–2003

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Page 1: Declining use of the eponym “Reiter's syndrome” in the medical literature, 1998–2003

15. Brautigam M. Terbinafine versus itraconazole: a controlled

clinical comparison in onychomycosis of the toenails. J Am

Acad Dermatol 1998;38(Suppl):S53-6.

16. Havu V, Brandt H, Heikkeila H, Hollmen A, Oksman R,

Rantanen T, et al. A double-blind, randomized study

comparing itraconazole pulse therapy with continuous dosing

for the treatment of toenail onychomycosis. Br J Dermatol

1997;136:230-4.

17. Elewski BE. Diagnostic techniques for confirming onychomy-

cosis. J Am Acad Dermatol 1996;35(Suppl):S6-9.

J AM ACAD DERMATOL

OCTOBER 2005

720 Brief reports

Declining use of the eponym ‘‘Reiter’s syndrome’’in the medical literature, 1998e2003

Dave W. Lu, BA,a and Kenneth A. Katz, MD, MScb

Philadelphia, Pennsylvania

The German physician Hans Reiter (1881e1969) is associated eponymously with the syndrome of arthritis,urethritis, and conjunctivitis occurring during or after episodes of diarrhea or urethritis. During World WarII, Reiter, a physician leader of the Nazi party, authorized medical experiments on concentration campprisoners. Because of this, some physicians have argued against further use of the Reiter eponym. Weinvestigated trends in use of the Reiter eponym from 1998 to 2003. We searched MEDLINE to identifyEnglish-language articles published between 1998 and 2003. Articles were classified by whether theeponym was used without qualification (ie, without mentioning its disfavored use) or not. Five hundredthirty-nine articles were identified. Use of the eponym without qualification was less common in articlespublished later (34.0% in 2003 vs 57.0% in 1998; adjusted relative risk [RR], 0.49, 95% confidence interval[CI], 0.27-0.71; P = .001) and in articles published in higher impact journals (36.8% vs 56.8% in journalswithout calculated impact factors; adjusted RR, 0.51; 95% CI, 0.29-0.73; P = .002). Use without qualificationwas more common in articles written by US-based authors (60.6% vs 31.1% for European-based authors;adjusted RR, 2.28; 95% CI, 1.58-2.97; P \ .001). We concluded that use of the Reiter eponym withoutqualification decreased from 1998 to 2003. ( J Am Acad Dermatol 2005;53:720-3.)

The German physician Hans Reiter(1881e1969) is associated eponymouslywith the syndrome of arthritis, urethritis,

and conjunctivitis occurring during or after entericor genitourinary infections.1,2 Cutaneous manifesta-tions may include keratoderma blenorrhagicum andcircinate balanitis.1

From the University of Pennsylvania School of Medicine,a and the

Department of Dermatology, University of Pennsylvania.b

Funding source: Funded by a Kirchstein National Research Service

Award from the National Institute of Arthritis, Musculoskeletal,

and Skin Diseases (Dr Katz).

Presented previously (abstract and oral presentation) at the

summer meeting of the American Academy of Dermatology,

ACADEMY 2004, New York, New York, July 31, 2004.

Reprint requests: Kenneth A. Katz, MD, MSc, Department of

Dermatology, University of Pennsylvania School of Medicine,

3600 Spruce St, 2 Maloney, Philadelphia, PA 19104. E-mail:

[email protected].

0190-9622/$30.00

ª 2005 by the American Academy of Dermatology, Inc.

doi:10.1016/j.jaad.2005.06.048

Recently, 3 arguments have been advanced againstfurther use of the eponym ‘‘Reiter’s syndrome.’’ Thefirst is nosologic; it claims that the syndrome properlyfalls under the heading of other disease entities, suchas ‘‘reactive arthritis,’’ in light of its specific bacterialtriggers (eg, the presence of Shigella and Salmonellain the gastrointestinal tract and Chlamydia in thegenitourinary tract) and its higher prevalence amongHLA-B27epositive persons.1,3,4

The second argument is historical. The syndromeReiter reported in 1916 had been described previ-ously, dating back to the 1500s5; moreover, Reiterincorrectly attributed it to a spirochetal infection.2

The third argument is ethical. A leading Nazi,Reiter ultimately became president of the ReichHealth Office.5 During World War II, Reiter autho-rized experiments on concentration camp inmates,5-7

including one in which 250 Buchenwald prisonersdied of typhus inoculations.5 The ethical case againstcontinued use of the eponym was first voiced byShafer,7 who argued that Reiter’s Nazi past ‘‘. . .does

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Table I. Percentages of articles using Reiter eponym without qualification, according to year of publication,area of origin of corresponding author, journal specialty, and journal impact factor, and relative risks for use ofReiter eponym without qualification from unvariable and multivariable analyses

Univariable analysis Multivariable analysis

Characteristic

No. of

articles

% Using Reiter

eponym without

qualification*

RR of using

eponym without

qualification 95% CI P value

RR of using

eponym without

qualification 95% CI P value

Year of publication1998 114 57.0 1 \.001 1y .0011999 104 42.3 0.91 0.87-0.96 0.88 0.82-0.942000 89 40.5 0.83 0.74-0.91 0.77 0.65-0.882001 86 37.2 0.74 0.62-0.87 0.66 0.50-0.832002 96 35.4 0.66 0.50-0.82 0.57 0.38-0.772003 50 34.0 0.59 0.40-0.77 0.49 0.27-0.71

Area of origin ofcorresponding author

Europe 312 31.1 1 \.001 1z \.001USA 127 60.6 1.95 1.53-2.37 2.28 1.58-2.97Asia 49 55.1 1.77 0.24-2.31 1.83 1.02-1.64Other 51 52.9 1.70 1.18-2.23 2.00 1.19-2.81

Type of journal in whichthe article was published

Rheumatology 311 40.5 1 .003 1§ .25Immunology 73 30.1 0.74 0.47-1.02 0.83 0.43-1.23Medicine 54 51.9 1.28 0.91-1.65 0.94 0.45-1.42Dermatology 13 84.6 2.09 1.53-2.65 3.00 0.93-5.08Radiology 10 60.0 1.48 0.71-2.26 1.57 0.08-3.06Other 78 44.9 1.11 0.80-1.42 0.92 0.50-1.33

Impact factor of journal inwhich the article waspublished, by quintile

No JCR-calculatedimpact factor{

102 58.8 1 \.001 1k .002

1# 96 51.0 0.91 0.87-0.94 0.88 0.82-0.952** 80 36.3 0.81 0.74-0.88 0.78 0.66-0.893yy 91 34.1 0.72 0.61-0.83 0.68 0.52-0.844zz 83 32.5 0.63 0.49-0.77 0.59 0.40-0.785§§ 87 36.8 0.55 0.38-0.71 0.51 0.29-0.73

CI, Confidence interval; JCR, journal citation reports; RR, relative risk.

*Articles that use the eponym without qualification are those that use the eponym without mention of its disfavored use (compared with

articles that either use the eponym along with mention of its disfavored use or do not use the eponym at all).yComparisons assume European origin of corresponding author, rheumatology journal, and third impact factor quintile.zComparisons assume year = 2001, rheumatology journal, and third impact factor quintile.§Comparisons assume year = 2001, European origin of corresponding author, and third impact factor quintile.kComparisons assume year = 2001, European origin of corresponding author, and rheumatology journal.{Journals that did not have JCR-calculated impact factor.#Median impact factor in first quintile 0.976, range 0.301-1.284.

**Median impact factor in second quintile 2.000, range 1.326-2.729.yyMedian impact factor in third quintile 2.987, range 2.761-3.251.zzMedian impact factor in fourth quintile 3.593, range 3.345-4.829.§§Median impact factor in fifth quintile 7.379, range 4.832-31.736.

not make his a nameworthy of any further honor.’’ In2001 Wallace andWeisman5 echoed this argument inan article entitled ‘‘Should a War Criminal Be Re-warded with Eponymous Distinction? The DoubleLife of Hans Reiter (1881e1969).’’ Since then, numer-ous articles in the rheumatology literature8-14 haveaddressed this controversy; the New York Times also

ran an article on the controversy.15 Furthermore, inOctober 2003 an international group of rheumatol-ogy journal editors decided against further use of theeponym in their journals.8

We investigated recent trends in use of the epo-nym in the medical literature, focusing on articlespublished between 1998 and 2003.

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METHODSSelection and categorization of articles

We identified articles via MEDLINE searchesfor English-language articles published from 1998through 2003 with the keywords or autoexplodedmedical subject heading terms ‘‘Reiter’s syndrome,’’‘‘Reiter disease,’’ or ‘‘reactive arthritis.’’ We excludedarticles that did not specifically mention the Reitereponym or reactive arthritis or that focused specif-ically on the controversy surrounding the Reitereponym.

We dichotomized all articles as follows: (1) articlesthat used the eponymwithout qualification (ie, with-out mention of its disfavored use) and (2) articlesthat used the eponym with qualification (ie, withmention of its disfavored use) or that did not use theeponym at all (instead using terms such as ‘‘reactivearthritis.’’)

We categorized each article by year of publication,corresponding author’s geographic location (basedon mailing address, with geographical groupingsaccording to United Nations definitions16), andjournal impact factor and specialty. Classificationsfor these last two were taken from Thomson ISIJournal Citation Reports (JCR) (Thomson ISI,Philadelphia, Pa).17 Journalswere groupedby impactfactor into fifths, with an additional (lowest) level forjournals not having ISI-assigned impact factors.

Statistical analysisWe used chi-square analyses to examine associa-

tions between authors’ area of origin and year ofpublication, journal specialty, and impact factor. Weused logistic regression to perform univariable andmultivariable analyses of factors related to qualifiedor unqualified use of the eponym. Calendar year wasfitted as a linear variable. Impact factor was also fittedas a linear variable, with the baseline group consist-ing of journals that did not have a JCR-calculatedimpact factor. Because our outcome of interest—unqualified eponym use—was relatively common([10%), the odds ratios from logistic regressionanalyses do not approximate relative risks (RRs).18

Therefore we converted odds ratios to RRs using the‘‘nlcom’’ command in Stata 8.2 (Stata Corp, CollegeStation, Tex; used for all analyses), which generatesRRs and confidence intervals using coefficients fromlogistic regression analyses.

RESULTSThe MEDLINE search identified 730 articles, of

which 617 (84.5%) were in English. Sixty-five ofthese articles (10.5%) did not mention the Reitereponym or reactive arthritis, and 13 articles (1.8%)focused specifically on the Reiter-eponym

controversy. Characteristics of the remaining 539articles included in the analysis, as well as results oflogistic regression analyses, are shown in Table I. Inchi-square analyses, impact factor was significantlyassociated with year of publication (P = .013),corresponding author’s area of origin (P \ .001),and journal specialty type (P \ .001); year of pub-lication and journal specialty type were also signif-icantly associated (P\ .001).

DISCUSSIONThis study demonstrates a clear trend away from

unqualified use of the Reiter eponym in the medicalliterature between 1998 (57.0%) and 2003 (34.0%).Our findings dovetail with those of a previous study,which documented use of the Reiter eponym in38.6% of MEDLINE-indexed articles published from1988 to 1996 compared with 61.4% of those pub-lished from 1980 to 1987.4

US-based authors were more likely to use theReiter eponym than their European counterparts.This likely reflects the eponym’s historically strongerfoothold in Americanmedicine. Despite Reiter’s ownGerman nationality, in fact, it was two Americanjournal articles, published in 1942 and 1945, and aninfluential American arthritis textbook, published in1960, that popularized the eponym.6 French physi-cians, meanwhile, have tended to associate thesyndrome with Fiessinger and Leroy, French physi-cians who published reports of the syndrome in 4postdysenteric soldiers one week before Reiter’s1916 publication.19

Journals with higher impact factors were lesslikely to publish articles that used the eponym with-out qualification. This may reflect increased aware-ness of the eponym controversy among authors whopublish in, and editors who oversee, more presti-gious journals.

Although univariable analyses suggested that useof the Reiter eponym differed by journal specialty,these differenceswere not significant inmultivariableanalysis because of confounding by year of publica-tion and journal impact factor. In addition, fordermatology journals, statistical power was limitedby the small number of articles in dermatologyjournals that used the eponym. Heightened ethicalconcerns over the Reiter eponym parallel those over‘‘Hallervorden-Spatz disease,’’ a neurodegenerativesyndrome first described by the German physiciansJulius Hallervorden and Hugo Spatz in 1922.20

During the Nazi era, Hallervorden, a neuropatholo-gist, actively participated in the regime’s adult-eutha-nasia program20,21 and conducted research on brainstaken from euthanized children from Poland.21 Inlight of these activities—called those of ‘‘an accessory

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to mass murder’’ by one physician21—some physi-cians have advocated discarding this eponym.20,21

In summary, use of the Reiter eponym withoutqualification in the English-language, MEDLINE-indexed medical literature decreased significantlybetween 1998 and 2003. Nosologic, historical, and/orethical concerns with the eponym may continue tolead physicians toward making Reiter’s associationwith the syndrome one solely ‘‘of historical interest.’’1

REFERENCES

1. Taurog JD. The spondyloarthritides. In: Kasper DL, Braunwald

E, Fauci AS, Hauser SL, Longo DL, Jameson JL, et al, editors.

Harrison’s Online. New York: McGraw-Hill; 2004-5. Available at:

http://www.accessmedicine.com. Accessed August 16, 2005.

2. Reiter H. Uber eine bisher unerkannte Spirochaeteninfektion

(Spirochaetosos arthritica). Dtsch Med Wochenschr 1916;

42:1535-6.

3. Inman RD. Classification criteria for reactive arthritis. J Rheu-

matol 1999;26:1219-21.

4. Pacheco-Tena C, Burgos-Vargas R, Vazquez-Mellado J, Cazarin J,

Perez-Diaz JA. A proposal for the classification of patients

for clinical and experimental studies on reactive arthritis.

J Rheumatol 1999;26:1338-46.

5. Wallace DJ, Weisman M. Should a war criminal be rewarded

with eponymous distinction? The double life of Hans Reiter

(1991-1969). J Clin Rheumatol 2000;6:49-54.

6. Weyers W. Death of medicine in Nazi Germany. Lanham (MD):

Madison Books; 1998.

7. Shafer N. Why Reiter’s disease? N Y State J Med 1977;77:1913-8.

8. Dendi P, Desai S, Jacobs FM, Rokosz GJ, Bulan JH, Panush RS,

et al. Ethics and rheumatology. Bull Rheum Dis [serial on the

Internet] 2003-4;52(10):[about 7 p]. Available at: http://www.

arthritis.org/research/bulletin/archives.asp. Accessed July 29,

2004.

9. Ernst E. Dr Reiter: the ‘‘Third’’ and ‘‘Fourth’’ Reich. Semin

Arthritis Rheum 2003;32:244-5.

10. Gottlieb NL, Altman RD. An ethical dilemma in rheumatology:

should the eponym Reiter’s syndrome be discarded? Semin

Arthritis Rheum 2003;32:207.

11. Gross HS. Changing the name of Reiter’s syndrome: a psychi-

atric perspective. Semin Arthritis Rheum 2003;32:242-3.

12. Panush RS, Paraschiv D, Dorff RE. The tainted legacy of Hans

Reiter. Semin Arthritis Rheum 2003;32:231-6.

13. Wallace DJ, WeismanMH. The physician Hans Reiter as prisoner

of war in Nuremberg: a contextual review of his interroga-

tions (1945-1947). Semin Arthritis Rheum 2003;32:208-30.

14. Zaller R. Hans Reiter and the politics of remembrance. Semin

Arthritis Rheum 2003;32:237-41.

15. Altman LK. Experts re-examine Dr. Reiter, his syndrome and his

Nazi past. The New York Times 2000 Mar 7:Sect. F:7.

16. United Nations [homepage on the Internet]. New York: United

Nations. c2000-2004. Documentation, Maps. Available at:

http://www.un.org/Depts/Cartographic/english/htmain.htm.

Accessed July 29, 2004.

17. ISI journal citation reports on the Web: 2003 JCR science

edition [database on the Internet]. Philadelphia: Thomson ISI.

2004 [cited 2004 Jul 29]. Journal summary list: rheumatology;

immunology; dermatology; radiology, nuclear medicine and

medical imaging; medicine, general and internal. Available at:

http://www.thomsonisi.com/.

18. Altman DG, Deeks JJ, Sackett DL. Odds ratios should be

avoided when events are common. BMJ 1998;317:1318.

19. Fiessinger M, Leroy E. Contribution a l’etude d’une epidemie

de dysenterie dans la Somme. Bull Soc Med Hop Paris

1916;40:2030-69.

20. Harper PS. Naming of syndromes and unethical activities: the

case of Hallervorden and Spatz. Lancet 1996;348:1224-5.

21. Shevell M. Hallervorden and history. N Engl J Med 2003;348:3-4.