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Vol. 49. Num. 3.March 2013
Pages 89-130
Vol. 49. Num. 3.March 2013
Pages 89-130
Letter to the Editor
DOI: 10.1016/j.arbr.2012.07.013
Wegener's Disease and Clara Cells: Eponyms and Dignity in Respiratory Medicine
Enfermedad de Wegener y células Clara: la eponimia y la dignidad médicas en medicina del aparato respiratorio
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Joaquim Geaa,b,c,??
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Jgea@parcdesalutmar.cat

Corresponding author.
, Mauricio Orozco-Levib,c,d, Rafel Aguilóa
a Servicios de Neumología y Cirugía Torácica, Hospital del Mar, Instituto de Investigación del Hospital del Mar (IMIM), Barcelona, Spain
b Departamento de Ciencias Experimentales y de la Salud, Universidad Pompeu Fabra, Barcelona, Spain
c Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Bunyola, Mallorca, Spain
d Servicio de Medicina Respiratoria, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
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Dear Editor,
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We would like to comment on a situation that, in recent years, has led to the adoption of a series of agreements between the most important respiratory medicine journals (American Journal of Respiratory and Critical Care Medicine, Chest, European Respiratory Journal and Thorax) and the Forum of International Respiratory Societies (FIRS).

It has been proposed to refrain from using in our professional practice, and especially in all medical publications, the names of professionals who actively collaborated in activities that are considered crimes against humanity. We cannot ever forget the programmed genocide of Jews and Romani gypsies, and the execution of homosexuals and the physically and mentally disabled, as well as an important number of Spanish citizens (about 5000) in Nazi death camps. Among the doctors who actively collaborated with Nazism was Dr. Friedrich Wegener, who described the disease that, until now, has borne his name.1 Starting in 1932, Wegener became an active member of the German National-Socialist party,2 as well as a high official in the Sturmabteilung (the paramilitary Storm Detachment or Assault Division),3,4 sadly famous for its ominous participation during the Kristallnacht (Night of Broken Glass). By 1939, he was working as a pathologist in Lotz, participating in the necropsies of prisoners who had been executed nearby. The Polish government declared Wegener a war criminal at the end of the war, and his case was transferred to the United Nations War Crimes Commission, but Wegener was never prosecuted before he died in 1990. When these facts surfaced decades later, the American College of Chest Physicians (ACCP) withdrew the Clinical Award that he had been awarded in 1989, while at the same time proposing to modify the term “Wegener's granulomatosis”5 to ANCA-associated vasculitides,3 granulomatosis with polyangiitis (GPA) or even respiratory granulomatosis.6

Similarly, Dr. Max Clara, who described the cells that bear his name, was also an active member of the Nazi party.7 Clara himself admitted in 1937 that his finding of non-ciliated secretory cells of the bronchiolar epithelium was based on samples obtained from prisoners executed by the Regime. According to the methodology reported in his articles, these samples were “preserved by vascular injection immediately after death”.8 It has also been demonstrated that the Clara's scientific research during this time period was directly linked with the abundance of “anatomical material” available at the time.9,10 Finally, it seems that both he as well as his collaborators directly participated in experimentation with prisoners who were later executed.10,11 In the aftermath of the war, Clara was arrested and imprisoned for a short time, after which he was no longer accepted in any German academic institutions but continued to practice in Turkey. In this case, it has been proposed that the term “Clara cells” should be changed to “club cells” or “bronchiolar exocrine cells”.10 Also, the expression “Clara cell protein” should be substituted with “protein secreted by club cells”.

The academic quality of the two aforementioned clinicians cannot be refuted. Nevertheless, their careers were founded on acts of questionable ethical behavior, the promotion and political backing of known criminals9 and their direct involvement in racist doctrine.12 Therefore, it seems improper to acknowledge them with eponyms in the medical nomenclature, as this represents a high distinction for those of our profession. Our main objective in medicine is to help those who suffer from disease, and ethical behavior is a fundamental guideline. In this direction, the ACCP considers that “academic life cannot be separated from moral life,” and the medical community should condemn such behavior. Patient associations have also made several requests for eponyms that they consider offensive to be substituted.9 Furthermore, the FIRS and the editors-in-chief of the aforementioned journals also consider terms without eponyms to be better because they also describe diseases and other biological phenomena more precisely.13,14

In May 2012, in a joint meeting of the FIRS and the head editors of the aforementioned journals, it was decided that the terms (a) Wegener's disease, and (b) Clara cells (associated with Clara cell protein) would start to be replaced by their alternative denominations as of January 2013, while maintaining the term Clara in parentheses for one year afterwards. This same month, the different journals will publish this resolution in editorial pieces stating that as of January 2014 both expressions should disappear definitively. At the same time, the World Health Organization (WHO) will be urged to modify their diagnostic codes ICD10 and ICD11. We believe that Archivos de Bronconeumología, the journal of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Latin American Thoracic Society (ALAT) and the Ibero-American Association of Thoracic Surgery (AIATC), should join other prestigious respiratory medicine journals and proceed towards changing to the denomination of granulomatosis as well as bronchial exocrine cells in their publications. In addition, this would subscribe to the growing tendency towards abandoning eponyms in medicine.13,14

References
[1]
J.C. Jennette,R.J. Falk,K. Andrassy,P.A. Bacon,J. Churg,W.L. Gross
Nomenclature of systemic vasculitides: proposal of an international consensus conference
Arthritis Rheum, 37 (1994), pp. 187-192
[2]
M.J. Rosen
Dr. Friedrich Wegener, the ACCP and history
Chest, 132 (2007), pp. 739-741 http://dx.doi.org/10.1378/chest.07-0769
[3]
A. Woywodt,M. Haubitz,H. Haller,E.L. Matteson
Wegener's granulomatosis
[4]
A. Woywodt,E.L. Matteson
Wegener's granulomatosis—probing the untold past of the man behind the eponym
Rheumatology (Oxford), 45 (2006), pp. 1303-1306
[5]
M.J. Rosen,R. Irwin
Dr. Friedrich Wegener and the ACCP, Revisited
Chest, 132 (2007), pp. 1723-1724 http://dx.doi.org/10.1378/chest.07-2640
[6]
R.J. Falk,C. Jennette
ANCA disease: where is this field heading?
J Am Soc Nephrol, 21 (2010), pp. 745-752 http://dx.doi.org/10.1681/ASN.2009121238
[7]
NSDAP membership card of Dr. Max Clara, 1935. Archive: Bundesarchiv, Berlin. Signature: BArch (former BDC), NSDAP-Zentralkartei.
[8]
M. Clara
Zur Histobiologie des Bronchalepithels
Z mikrosk anat Forsch, 41 (1937), pp. 321-347
[9]
A. Woywodt,S. Lefrak,E. Matteson
Tainted eponyms in medicine: the “Clara” cell joins the list
Eur Respir J, 36 (2010), pp. 706-708 http://dx.doi.org/10.1183/09031936.00046110
[10]
Y. Winkelmann,T. Noack
The Clara cell: a “Third Reich eponym”?
Eur Respir J, 36 (2010), pp. 722-727 http://dx.doi.org/10.1183/09031936.00146609
[11]
R. Müller
Untersuchungen über das Vorkommen von Vitamin C im Hoden des Menschen
Z mikr anat Forsch, 52 (1942), pp. 440-454
[12]
S. Hildebrandt
Anatomy in the Third Reich: an outline. Part 1. National socialist politics, anatomical institutions, and anatomists
Clin Anat, 22 (2009), pp. 883-893 http://dx.doi.org/10.1002/ca.20872
[13]
I. Rosner
Reiter's syndrome versus reactive arthritis: Nazi-phobia or professional concerns?
Isr Med Assoc J, 10 (2008), pp. 296-297
[14]
A. Woywodt,E. Matteson
Should eponyms be abandoned? Yes

Please cite this article as: Gea J, et al. Enfermedad de Wegener y células Clara: la eponimia y la dignidad médicas en medicina del aparato respiratorio. Arch Bronconeumol. 2013;49:126-7.

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