BEYOND THE PAST: IF THE HISTORY OF MEDICINE CAN BE ALTERED, WHAT DOES IT MEAN FOR PHARMACOVIGILANCE?
Recently in discussion with a client and in subsequent communication, I happened to use the term Parkinson's disease and was told that in their company they had stopped referring to diseases as if possessed by their eponymous describer, but now as Parkinson disease, as he hadn't personally suffered from it. I was transported back to my early years of learning (and subsequently teaching) anatomy when it was fashionable to revise the standard anatomical nomenclature to remove the names of those who had first described a particular structure. Thus, the Eustachian tube became simply the auditory tube: whilst this is possibly a more accurate locatory name, to me, it swept aside a whole raft of medical history. Poor old Bartholomeo Eustachio, the man who in the 16th century published a series of ground-breaking anatomical studies, later collected as his Opscula Anatomica, was ruthlessly airbrushed from the history of medicine. Needless to say, there was a considerable resistance to the changes from the more romantically inclined in the profession and people will still refer to the auditory tube by the name of he who described it. It certainly led me to many hours in the University Library reading the history of medicine at the expense of my more pressing academic subjects, with the inevitable reverses in my confrontations with the examiners!
Why I mention this is that, following the conversation on the subject of Parkinson(s) disease, I spent some time looking at the life and works of someone who was one of our most remarkable polymaths, Dr James Parkinson. He was respectively a revolutionary, a social reformer, a geologist, paleontologist and of course a physician. He wrote an early compendium of chemistry in 1799, published several volumes on Public Health over the next three years and a paper on the design of trusses! He also at this time started his great work on geology and paleontology, Organic Remains of a Former World. An Examination of the Mineralized Remains of the Vegetables and Animals of the Antediluvian World Generally Termed Extraneous Fossils. This was published as three volumes, the last appearing in 1811. During this period he also found time to write papers on gout and several more public health works. Together with his son he also produced “A Case of diseased appendix vermiformis.” In the Medico-Chirurgical Transactions, London, a first description of a case of appendicitis in England, recognising rupture of the appendix as the cause of death.
However, the pinnacle of this remarkable man's career was undoubtedly his detailed description of the neurological condition that still carries his name. His essay “on the shaking palsy” of 1817 was a masterpiece of clinical observation and emphasised that the movement aspects of the disease were of greater clinical significance that the more familiar tremor.
It is interesting that other disciplines seem to be more than happy with eponyms: physicists use a Geiger counter, chemists have their Bunsen burners and mathematicians are happy to use a theorem of Pythagoras. So I trust that we will echo Newton when he acknowledged his debt to the past in his letter to Robert Hooke: “If I have seen further it is by standing on the shoulders of Giants”*. I'd like to think that all courses included a history of our distinguished predecessors. I'll continue to champion James Parkinson as on of the greatest of them all and recommend that we all look up our eponymous benefactors - it's a fascinating study.
But, why is this relevant? It got me thinking; Pharmacovigilance education often begins with a glance at the history of medicine and its unfortunate outcomes, but if, in the world of medicine we are altering the context of the past, what could that mean for the future of PV?
*Of course I accept that Newton was probably insulting scoliotic and short statured Hooke here but the sentiment holds true.