Acronyms

Medical research must be a wonderfully rewarding career. Imagine the satisfaction of coming home and saying "Honey, I found a cure for cancer today!" Unfortunately, cancer treatments are measured by the 10-year survival rate, so you can't count on getting that sort of satisfaction more than once a decade. Even telemarketers deserve a good day more often than that. Of course, getting the Nobel Prize for medicine must give you a nice warm tingle, but the prize committee also likes to wait a few years before giving an award. On a day-to-day basis, the real satisfaction in medical research comes from creating acronyms.

Arguably, anybody can create an acronym. Politicians do it all the time, with characterless results: FDA, FTC, USPS. Granted, NIMH (National Institutes of Mental Health) is pronounced the same way as NIM, a game, but that's random chance. And NIAID (National Institutes of Allergy and Infectious Diseases) is pronounced as if it were spelled NAIAD (a water nymph) but close doesn't count. The government did give us Volunteers in Service to America (VISTA) but that was in 1965, and government has never achieved the same level since. The Nixon Administration gave us the Committee to Re-Elect the President (CREEP), but they never used the acronym themselves.

Medical acronyms are usually no better than the governmental variety, but now and then a couple of DRS (Diltiazem Reinfarction Study) are really BRILLIANT (Blood Pressure, Renal Effects, Insulin Control, Lipids, Lisinopril and Nifedipine Study), come up with a real gem – an OPAL (Ontario Prehospital Advanced Life Support), an EMERALD (European and Australian Multicenter Evaluation Research on Atrial Dofetilide), or a DIAMOND (Danish Investigation of Arrhythmia and Mortality on Dofetilide).

Many acronyms just seem to have been thrown together for fun, without any intentional meaning. EARS (European Atherosclerosis Research Study) doesn't include a study of the auditory system. And HOOP (Health Online Outreach Program) doesn't include a study of basketball. Names like that seem to be hardly more than WHIMS (Women's Health Initiative Memory Study). Others go a step further, and have names that commemorate the past: SOCRATES (Study of Coronary Revascularization and Therapeutic Evaluations), OSLER (Sir William Osler, a great physician, was memorialized with the Objective Structured Long Examination Record), and CAESAR (Computer Assisted Evaluation of Stenosis and Restenosis System). There's also a study called ICARUS (Islet Cell Antibody User Registry, which doesn't quite fit the acronym). In Greek mythology, Icarus, while flying on a pair of wings made of feathers and wax, went too near the sun. His wings melted, and he fell to Earth and died. This was the first report of tragic results during a scientific experiment and may have been a poor choice for a medical acronym.

Other names are more upbeat. There's ASPIRE (Action on Secondary Prevention by Intervention to Reduce Events), COURAGE (Clinical Outcomes Utilization Revascularization and Aggressive Drug Evaluation), and DEFIANT (Doppler Flow and Echocardiography in Functional Cardiac Insufficiency: Assessment of Nisoldipine Therapy). The "How Effective are Revascularization Options in Cardiogenic Shock?" trial is an example both of medical and acronym building HEROICS. According to Dr. Tsung Cheng's wonderful report "Acronyms of clinical trials in cardiology – 1998," the GUSTO study (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Ocluded Coronary Arteries) was followed by another study developed by researchers who disagreed with the conclusions of the GUSTO trial. The name of the follow-up? DISGUSTO.

Sometimes acronyms can be too good. In the June 2002 issue of the journal Chest, there's a warning that an attractive acronym may lead people to agree to participate in a trial they might otherwise avoid. According to this report, "A research study with an acronym of AWESOME, BEST, BRILLIANT, FAMOUS, FANTASTIC, GREAT, GUARANTEE, HAPI (sic), MUST, NEAT, OPTIMAAL (sic), PROGRESS, PROVED, SMART, SOLVD (sic), TOPS, or VALID is probably promising more than it will deliver." They also mention the Beaumont Interventional Group – Mevacor, ACE Inhibitor, Colchicine Restenosis Trial: BIG-MAC.

Some acronyms are so popular that they're used over and over – and that can be a problem, too. The April 1999 American Heart Journal carried a report of acronyms that had been used for at least four different clinical studies. These included BEST, CARE, EPIC, MUST, and PRIME. Since Dr. Cheng lists six studies, all with the acronym BEST, and all in the field of cardiology, it's only reasonable to wonder which BEST is the best BEST.

There's no question that cardiologists are the most avid acronym makers. A review of cancer acronyms turned up CONQUEST (Computerized Needs-Oriented Quality Measurement Evaluation System) and PIVOT (Prostate Cancer Intervention Versus Observation Trial), but the rest of their acronyms were alphabet soup. In nursing, the Association of Perioperative Registered Nurses is AORN, when, with a minor effort, they could have been the American Council of? SAMBA is the Society of Ambulatory Anesthesiologists. But in this group, the prize goes to the International Academy of Nursing Editors. Their acronym? INANE.

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