There ought to be a word

Dermatologists love to invent words.

My interest in etymology, (not to be confused with entomology) has grown along with the importance of precise and efficient EMR documentation. Along the way, I learned some great words and acronyms and made up a few of my own.

Our mentors coined some of the best neologisms in medicine: acne necrotica milaris, confluent and reticulated papillomatosis, pityriasis lichenoides et varioliformis acquisita, erythema ab igne, acne keloidalis nuchae, chondrodermatitis nodularis helicis, acanthosis nigricans, pseudofolliculitis barbae.  

These days, it’s relatively easy to identify the existence and meaning of a word with search engines, websites and apps.  There are even words for those of us obsessed with seeking this information. Dr. Ivan Goldberg satirically proposed the term “problematic internet use” (PIU) in 1995. But the condition, also known as compulsive internet use (CIU) or internet addiction disorder (IAD), is now being considered for DSM inclusion. I prefer my term, “browsomania” and confess to meeting one of my proposed browsomaniac diagnostic criteria:

• >10 personal use internet searches per day;

• prolonged searching potentiated by prior search results;

• feeling anxious or isolated when brower access in unavailable;

• making lifestyle changes in order to retain Internet access; and

• spending significant resources in order to gain paraphernalia for ready web access.

That led me to other words and phrases created to describe phenomena arising from our everyday web interactions:

• premature etextulation is the act of inadvertently clicking “send” before a text has been completed

• emalfeasance is  the act of mistakenly sending an email to the wrong recipient, to the senders’ detriment

• social notworker is someone who spends their workday on social media

• connectile dysfunction is a sudden and expected loss of internet access

I also occasionally invent words to help communicate with my staff. “Nomophilia” refers to positive feelings generated by a familiar name on the schedule, or a phone call. This sensation often occurs in the absence of related information, but is usually triggered by the name of a pleasant patient who is able to understand and adhere to recommendations. 

On the other hand, “nomophobia” is caused by a name that evokes vague discomfort. This sensation usually marks difficult personalities or problems. Anyone using this word should be aware that is an alternate cyberspace definition (less user-friendly, in my opinion): a fear of being outside the range of mobile phone contact. Additional useful clinical terms created by others are:

• Alexithymia, which is a personality trait characterized by difficulty in describing or recognizing emotions. A high prevalence of this condition has been reported among psoriatics.

• Orthorexia nervosa, which is an excessive preoccupation with avoiding foods perceived to be unhealthful;  orthorexia nervosa by proxy is common in my pediatric patient population.

• Cyberchondria, which is the unfounded escalation of concerns about common symptoms based on review of online information.

Product naming

Inventing names for products is big business. The infant demographic has been recognized as a high profit margin target, so I should not be bewildered by the many of these product names: Butt Paste, Bum Genius, Baby Don't Be Bald, Say Yes to Carrots, Babyganics.

Nomenclature for medications is more complicated. Every drug has at least three names, the chemical name, the generic name, and one or more brand names. Generic names are governed by evolving rules. For example, “imod” is a suffix used for an immunomodulator drug while “imus” marks an immunosupressent.  Suffixes that subdivide biologics include “mab” for monoclonal antibody, “umab” for humanized monoclonal antibody, and “cept” for receptor molecules.

The process of procuring a brand name is less scientific, but more intricate, and can cost hundreds of thousands of dollars. Pharmaceutical companies hire branding consultants to design an appealing name years before their drug is ready to market. Basic rules are related to the sound of a name. T, G and K are considered more appealing to men and S, M,V, L and R to women. Many newer brand names include Q, X and Z to suggest cutting edge science. Unfortunately, the increasing popularity of these letters has led to similar-sounding names that generate confusion and possible dispensing errors.

Dermatologists that remember efalizumab, one of the first biologics developed for psoriasis, will probably remember the brand name Raptiva^TM.  But they may not remember Xanelim, Genentech’s original name for Raptiva^TM. After spending an undisclosed sum on Xanelim (including branded labelled promotional merchandise) the name had to be changed in order to limit potential confusion with the almost homophone drug, Zevalin^TM.  A different confounding factor prompted a minor name change to  Hemangeol^TM  from the original Hemangiol^TM, now restricted to use outside of the United States. The U.S. FDA reportedly required modification for the U.S. product name, because an -iol suffix could be confused with non-ionic radiographic contrast agents.

Most people are familiar with the term “dog year” (1=7 human years). There ought to be a phrase for a similar concept applied to cellular equipment. Mine is “cellular year”.nI estimate that one of these is equivalent to about three months, but it is shrinking rapidly.

The telephone was invented 140 years ago, and rotary phones became available 40 years later. These telephones of my childhood were sturdy and the design was current for several decades. Rotary phones gradually yielded to touchtone technology in the 1960s, contributing to the invention of cellphones less than 15 years later. The first handheld, touchtone cellphone could be purchased in 1984.  Within a decade the first text message was sent. By the year 2000, the first commercial camera phone was available for early adopters. And in 2007, the iPhone hit the market. Less than 10 short years later, sixth generation smart phones have cameras that produce high quality images, processors as good as laptops, and as a forethought, wireless carrier contracts allowing for a new phone every year (or every four cellular years). 

Readers with interest in cosmetic dermatology may be familiar with poetic words that describe an increasingly popular look: balayage (balāˈyäZH) is a hair dye technique that yields graded color change; ombré and sombré are the results.

Acronyms

Acronyms are also great opportunities for creative naming. Dermatology has several: PHACE, LEOPARD and PUPPP.  We invented a catchy one to refer to the inflammation that often complicates molluscum. The BOTE sign (for Beginning Of The End; http://pediatrics.aappublications.org/content/131/5/e1650) was intended as an optimistic moniker that heralds spontaneous resolution and helps alleviate unnecessary concern for bacterial infection. 

LEAP is another emerging acronym in the dermatology world, related to the 2015 New England Journal of Medicine report on the Learning Early About Peanut database. This landmark study revealed the importance of early peanut exposure on enabling food tolerance. So  I was initially thrilled when a patient’s mother identified herself as a LEAP-certified dietician, imagining that I had found a professional colleague to help introduce foods to my many patients with orthorexia nervosa by proxy.  Within a few clicks, I located the $195 at-home LEAP course, and appreciated the acronym irony.  LEAP-certified dieticians are apparently experts in Lifestyle, Eating and Performance, trained to help people with multiple food sensitivities (like arthritis, irritable bowel and migraine) adhere to a proper elimination diet.

This brings me to some special words to consider as we practice medicine. Agnotology is the study of why ignorance exists, especially as it relates to inaccurate or misleading scientific data. Three types of ignorance have been defined: lack of knowledge, unintentional misinformation, and intentional misinformation.

The Dunning-Kruger effect is related, a condition manifest in people who don't know what they don't know. Dunning and Kruger described this phenomenon in 1999, and recognized it in people with low ability who misperceive their intelligence as higher, as well as to high ability people who erroneously assume that others have similar intelligence. Wise men throughout history have had similar musings, without the need for neologism:

• Real knowledge is to know the extent of one's ignorance (Confucius)

• Ignorance more frequently begets confidence than does knowledge (Charles Darwin)

• The fool doth think he is wise, but the wise man knows himself to be a fool (Shakespeare)