It's Acronymania All Over Again: Title and subTitle BreakWith Due Reference to YB Yogi Berra FREE

The chief merit of language is clearness and we know that nothing detracts so much from this as do unfamiliar terms.—Galen on the Natural Faculties

The beginning of wisdom is to call things by their right names.—Chinese proverb

Does everything have to be reduced to an acronym? Is it to save space or is it just a cute way to develop an expression? Whether you call it acronymia, as the late William Beck¹ did, or acronymitis, as Bernard Jaffe² did, it is the same.

When I read a scientific article, I look for the definitions of the acronyms at the beginning. All respectable journals will insist on ICAM (intracellular adhesion molecule) being defined the first time it is used and also all other acronyms. Failure to do so leaves readers hanging. The purpose of writing is education. Tell us what you are acronyming about. In a recent issue of Critical Care Medicine, I found 52 acronyms, many of which were never defined. Some of them are familiar. They are listed in Table 1. Check how many you know. There are many that I did not know.

The US government is the leader in generation of acronyms beginning with radar, AWOL, and SNAFU and now HCFA, NIH, FDA, HHS, and NLRB. Greenberg and Stern³ suggest that a beginner level of acronyms includes an understanding of such terms as DNA, HIV, MRI, and NIH. Intermediates will understand CAD, MI, NSAID, CDC, and AHA. For advanced standing, you must deal with HCFA, TPA, ADH, ODC, ARA, MIS, and APSAG.

Ransom⁴ writes, "In the beginning was the word and only much later the acronym." He lists CADUCEUS (Committee Advocating Development and Use of Chymopapain to Eliminate Unnecessary Back Surgery). I think this is the grand champion. It takes the symbol of medicine and converts it to a committee on a drug use. How can you do better than that? Ransom also says that a blood acronym level of 0.15% would be presumptive of impaired comprehension in California. Surgery requires precise language—words that are understood—so that techniques, procedures, diagnoses, and care of patients can be described clearly, unambiguously, and definitively. There is no room for shortcuts that could be misinterpreted. We can't accept a statement such as, "You forgot to tell me that you did it that way." Now we are faced with a world of abbreviations, acronyms, aphorisms, euphemisms, and trite expressions that can be confusing and imprecise.

The use of acronyms is increasing exponentially. (Doesn't everything increase exponentially?) Perhaps acronyms save space so that CVVHD (continuous venovenous hemodialysis) does not have to be spelled out every time, but is PICU (pediatric intensive care unit) needed? William Safire in his column in The New York Times says that mathematicians deplore the misuse of the word exponential for increasing rapidly. Exponential may not be rapid. Acronyms in science include TOE (a theory of everything) and GUT (a grand unified theory).

Is there an answer to acronymitis? Jaffe² reviews several explanations for this. One is the progression of language from sentences to words to letters, just as we have gone from molecular to chromosome to nucleotide base pairs. A second is communication by computer. The third he thinks most likely is sheer sloppiness and lack of caring. He urges a return to words and says, "Let's end the epidemic of acronymitis." Beck¹ cites 23 dictionaries of acronyms, initialisms, and abbreviations. He suggests the only solution is to insist on a list of the acronyms used and their meanings at the beginning of every scientific article.

Now we have wars of the acronyms. Focused assessment with sonography for trauma (FAST) is an established method of assessment of injured patients. An international conference in Baltimore, Md, by the FAST Conference Committee decided, according to Boulanger,⁵ that this was the most appropriate acronym for this examination. Then Biffl et al⁶ wrote, "Post-injury torso ultrasound: FAST should be SLOH," where SLOH stood for systematic look for occult hemorrhage. In a recent exchange of letters in the Journal of Trauma, these authors debate (argue) the proper acronym. Who cares? Who gets the credit? As Emerson once wrote, "Tho old the thought and oft expressed tis his at last who says it best."

An HTR (hybrid tea rose) by another name would smell as sweet.—DFWS (Derived from William Shakespeare)

RACE now stands for repetitive alveolar collapse and expansion. Previously, this was called breathing. The surgical infection people have ginned up new terms for old problems. Now FSC is failed source control, which we would call persistent infection (PI) or persistent peritonitis (PP). Of course, PI would also be present illness. A wound infection is now called a surgical site infection (SSI). What will they think up next?

Clinical trials of drugs bring out great ingenuity in acronym development. Perhaps there is an acronym central to develop and coordinate them. PROWESS is the recent trial of recombinant human activated protein C for severe sepsis.⁷ The actual trial is the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis, which is RHAPCWESS but that isn't nearly as classy as PROWESS. What does it mean? There is GUSTO for global use of strategies to open occluded coronary arteries in acute coronary syndromes. The International Study of Infarct Survival is ISIS.

There have been 3 clinical trials of platelet glycoprotein IIb/IIIa integrin blockade, the ESPRIT trial (the enhanced suppression of the platelet IIb/IIIa receptor with integrin therapy), the EPIC trial (evaluation of C7E3 Fab in the prevention of ischemic complications), and IMPACT II (eptifibatide) (integrilin to minimize platelet aggregation and coronary thrombosis II trial). They are all about the same drug.^{8 - 10} Take your pick. What turns you on? Then there is RAMSES, Intersept, NORA, and SEP III. Even those who observe studies have gotten in on it. There is MOOSE for meta-analysis of observational studies in epidemiology, QUDROM for quality of reporting of meta-analysis, CONSORT for consolidated standards of reporting trials, and STARD for studies assessing and reporting diagnostic tests.¹¹

The message seems to be to design a descriptive phrase for what you are doing and change the words and order so that there is a catchy acronym that you will be proud of. There are many more.

There are other problems with the inclusion of aphorisms, euphemisms, neologisms, eponyms, and trite expressions in our scientific literature and language. Can we live without them? It would be good if we could. No one just dies, they pass on, pass over, depart this vale of tears, depart this life, expire, go to their heavenly home, or just pass. We go to health centers when we are sick rather than a German Krankenhaus (sick house).

Organ^{12 - 13} has written about our problems and lack of precision with eponyms and suggests a cure for the Vater, Bochdalek, Treitz, and Oddi disease. His cure is to eliminate eponyms and use the correct term, particularly for anatomic structures. Organ cites McDermott who wrote that Morton, Jenner, Harvey, and Vesalius were never honored with an eponym, so why honor Santorini, Alcock, or Camper. Who were they anyway? Does anyone really know these origins? It is unlikely. Organ¹³ is concerned that the trend toward lack of clear scientific communication cannot be reversed.

Acronymania is confusing and distorts language, but at least it is funny. Dusseau¹⁴ summarized the problem well when he wrote,

Imprecise expression cannot be easily corrected, for this process of writing is identical with the process of thought. This is why first-rate physicians and scientists are unfailingly good writers. But both disregard the euphony and cadence of fine style and the convenience of readers in the overuse of elaborate acronyms and abbreviations. Even the most knowledgeable reader may have forgotten that DIMOAD means "diabetes insipidus, diabetes mellitus, optic atrophy and deafness," and that AWUID is not a ten-armed cephalopod but a "super-conducting quantum-interference device." The reader will resent having to backtrack to find out or resorting to a reference volume in which the obscure "initialism" (as it is now sometimes called) fails to appear, for technical writers often invent temporary abbreviations for terms too awkward to repeat.

Fortunately, RVEDVI for right ventricular end-diastolic volume index is defined at the beginning of the abstract.¹⁵

Neologisms are everywhere. Ransom⁴ cites Lewis Carroll, who described "portmanteau words" such as smog and motel. We bombard each other with trite expressions, such as "pet peeve," "sounding a clarion call" (of course), "finding that the literature is replete," "finding daunting challenges," "balances that must be struck," "things on the horizon," and "things that offer of a ray of hope." We also beg the question. A quantum jump is suddenly not huge. There is public outrage. If it were private no one would know of it. Things are always deeply discouraging if not profoundly so if not vividly exposed to navigate the waters to a topic that is always hot. This provides the ability to deal constructively with a majority that is always overwhelming, except in Florida. Aspects are always relevant. There is always a beacon of hope that is on the horizon, if not the light at the end of the tunnel, and a tower of strength.

We must call on editors to limit acronyms or clearly define them when used and to eliminate the other problems of language that confuse our work in the care of patients.^{16 - 17} Can we ask authors to do likewise? Hope springs eternal, to end tritely.

Corresponding author and reprints: Arthur E. Baue, MD, Box 396, Fishers Island, NY 06390.