Your Voice

December 1, 2003

A call to root out "pejorativism" in the medical lexicon

My pulse quickened as I read the headline on page 33 of the July 2003 issue: "Diagnosis: Michelin tire baby syndrome" (Pediatric dermatology: What's your Dx?). I sadly envisioned the reaction of the anxious parents when they were informed that their blessed child and the most important being in their life had "Michelin tire baby syndrome." They most likely experienced the same reaction that parents of yore (when I was a resident) endured when they were told that their precious baby was a "FLK" ("funny looking kid") or a "bird headed dwarf."

In 1993, I wrote: "Using the name 'Michelin tire baby syndrome' does not bring forth the feelings of compassion, concern, and sensitivity that are the essential emotional prerequisites for physicians and other professionals who provide care for these children and their families" (Amer J Med Genet 1993;46:613). Writing about the same subject in 1999, I stated that such inappropriate and pejorative terms "should be driven out of the medical lexicon on the same Michelin tires that are transporting the 'Michelin tire baby' syndrome to nomenclature oblivion" (Genet Med 1999;1:170).

Unfortunately, the journey to nomenclature oblivion was detoured to the pages of Contemporary Pediatrics. Please make certain there are no return trips.

Murray Feingold, MD
Waltham, Mass.

Reply:Although I agree that names such as Michelin tire baby syndrome may be misconstrued as pejorative, they should conjure an image of an innocent self-limited process, not the fear that might be associated with, say, "disseminated nevus lipomatosis superficialis."

The Dermatology Lexicon Project (DLP), a federally funded project (of which I am a member) based at the University of Rochester, has a mandate to come up with uniform descriptors for dermatologic lesions and to develop a nomenclature system for thousands of dermatologic disorders. We hope to establish reasonable terminology that will reflect the pathophysiology of these disorders. This should contribute to the demystification of dermatologic names and guide professionals and patients to the appropriate literature.

Although "Michelin tire baby syndrome" may be displaced by the new lexicon rubric shortly, for now it is the best descriptive term we have. A rose is still a rose by any other name!

Bernard A. Cohen, MD
Section editor, Pediatric dermatology

The problem with "problem" behavior

Thank you for Dr. Stanley Turecki's article on handling behavioral complaints ("The behavioral complaint: Symptom of a psychiatric disorder or a matter of temperament?" August 2003). His levelheaded approach is an excellent counter to the current emphasis on viewing variations of normal as pathologic. Far too often, parents bring children in to be treated for a presumed disorder because the school or relatives and neighbors have suggested doing so. The approach I take with them is, "It's a problem if it's a problem," by which I mean that behavior does not need to be addressed (certainly not with medication) unless it is causing dysfunction; otherwise, it is merely a finding. I will be giving Dr. Turecki's article—which is clear enough to be understood by nonprofessionals—to parents to help them grasp this important concept.

Jon Matthew Farber, MD
Alexandria, Va.