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HALT: Help acronyms leave (medical) trials

THERE'S A cardiology clinic in Minneapolis that specializes in patients with difficult-to-treat heart disease, known by doctors as ``no option" disease because neither surgery nor placing a stent is likely to be helpful. When a cardiologist started the clinic several years ago, he thought about naming it the No Option Clinic. But it quickly dawned on him that such an appellation would probably backfire. At worst, the clinic would seem to be a useless place to go. At best, it would seem like the kind of place that would have copies of ``Final Exit" in the waiting room instead of People.

So he scrambled to find another -- and settled on Options in Myocardial Ischemia Syndrome Treatment, conveniently abbreviated as OPTIMIST. The ``no option" clinic had become the OPTIMIST clinic, by dint of forceful and creative abbreviation .

Minneapolis is not the only place where evocative acronyms have sprung up in medicine. One place they're easy to find is the medical literature's catalog of clinical trials. Who wouldn't want to sign up for trials with names like CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Events), HELP, HOPE, IMPROVED, LIFE, RESCUE, or SAVED ? The National Spelling Bee set might object to MIRACL and MIRRACLE, but if it suggests a cure, most would overlook the error.

There are others: AWESOME, BRILLIANT, CADILLAC, CASH, COURAGE, EXCITE, FANTASTIC, GUARANTEE, PROMISE, PROSPER, PROTECT, and VIGOR. If you're hungry, there's BIGMAC, HERO, and one of my favorites, CABG PATCH. That's short for Coronary Artery Bypass Graft Surgery with/without Simultaneous Epicardial Patch for Automatic Implantable Cardioverter Defibrillator. At least it makes a case for acronyms saving space.

The rules for creating acronyms are bent so far by many of these names that they might as well have been made up before anyone knew what a trial was about. Take ALIVE, for Azimilide Post-Infarct Survival Evaluation, which chooses letters from the middle of a word and ignores the first letter of others. Or SURVIVE -- that, somehow, is short for Survival Of Patients With Acute Heart Failure In Need Of Intravenous Inotropic Support.

At a time when researchers complain that not enough patients, especially among minority groups, are signing up for clinical trials, you might be tempted to nod at these names as just another way to entice people to sign on -- as in ENTICES, for ENoxaparin and TIClopidine after Elective Stenting. And according to a small study that appeared last month in the New England Journal of Medicine, the fact that a trial has an acronym -- convoluted, life-affirming, or just space-saving -- increases the rate at which researchers cite the study, which is a commonly used way of measuring the influence of a given study. (The University of Toronto researchers who authored the NEJM study coyly gave their work an acronym: ART, for Acronym-Named Randomized Trials in Medicine Study.)

So why not use the tools of successful marketing to benefit the collective health? People like acronyms, and they make things easier to remember.

Well, for one thing, medicine shouldn't mix with salesmanship , however subtle the pitches might be.

And if you doubt that these naming schemes are having some effect, consider this: Trials with acronyms enrolled five times as many people on average as those without, the NEJM study reported .

The upbeat acronyms are just another bit of evidence that marketing is taking over medical decision-making. Drug companies often spend lots of money naming new drugs, and the crowding around inspirational names is so great that the Food and Drug Administration often has to reject names that sound similar to existing drugs.

Since it approves clinical trials, the FDA could very well apply the same scrutiny to trial names as it does to drug names. No, researchers don't need to be off-putting. We shouldn't go as far as two trials affiliated with the New Hampshire End of Life Project: Dying Experience at the Hitchcock and Dying Experience at Dartmouth, better known as DEATH and DEAD.

But such brutal honesty is an exception in a world of clinical trials with sunny acronyms, and this ought to worry us. Doctors and patients should make decisions about who enters a trial based on the best data, not the snazziest name.

Dr. Ivan Oransky is deputy editor of The Scientist.

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