Who owns an idea?

The concept of attaching one's name to a discovery or a technique is not new. Various parts of the brain and the body have been named after people. As a result, neuroanatomy students have studied the aqueduct of Sylvius (now known as the cerebral aqueduct) and the Sylvian fissure (now known as the lateral fissure), two distinct structures named after two distinct people named Sylvius. Anatomists, thankfully, have abandoned the practice because they came to realize that eponymy--the use of a person's name to identify a place or structure--provides no meaningful descriptions and leads to confusion.

The eponym, unfortunately, is alive and well in physical therapy. We have a litany of eponymous approaches in almost all aspects of physical therapy practice, and we can even buy belts, lumbar supports, traction devices, and other therapeutic tools with people's names attached to them. Eponyms seem part of a "star" system.

One could argue that the use of eponyms is indefensible because eponyms do not provide meaningful descriptions. There is, however, a much better reason to stop the practice. Eponyms increase the temptation of people to claim proprietary rights to ideas and concepts. Because of the manner in which ideas and treatment approaches are often introduced in physical therapy, the control of ideas is an especially grave problem for us.

In professions with long-standing traditions of scientific inquiry, the custom is to communicate through peer-reviewed journals. If you have a treatment approach, you are expected to report on its use on real patients in a paper published in a reputable journal. Other people are then free to critically analyze what you say and to try your methods. They, too, can then contribute to a growing published dialogue that leads to refinement and enhancement. The interaction is collegial and results in improved care--and often in the process of getting the paper published-and the person originating the ideas is compelled to clarify, expound, define, and reexamine. What can then be shared via other approaches-via continuing education, for example has benefited from peer interaction.

Too often in physical therapy new treatments are extolled in continuing education courses and "throwaway" publications. Sometimes books are also promotional tools. The drumbeat of public support is sought before there is any clear and careful review of terms, concepts, and descriptions--let alone any test of efficacy. If the drum beats a popular rhythm, then acceptance is almost ubiquitous. True believers come to provide testimony, and pretty soon you may be considered professionally inept and socially questionable if you have not jumped on the bandwagon. Ironically, all this often happens even as terms central to the concepts remain undefined and a general vagueness pervades underlying theories.

In the face of rather widespread acceptance of unproven concepts, clinical researchers are like salmon desperately swimming against the flow. Their task is difficult enough, because in a haste to market rather than to share ideas, the itinerants of the continuing education circuit often fail to leave any meaningful written record of what they do, let alone any evidence that their treatments have an effect. Nonetheless, responsible clinicians and researchers are obligated to conduct research for the benefit of our profession's credibility and our patients' needs and for the development of new treatments.

For a long time, members of our profession decried the behavior of Doman-Delacato advocates because, among other reasons, proponents of that technique remained so secretive that only they were in a position to conduct research on theft treatments. We were right to condemn this behavior, but we are failing to see it repeated all around us. In physical therapy, many courses now receive the official blessing of people for whom techniques are named, and in some cases when others try to teach the same concepts, litigation is threatened. In cases like these, science and responsibility are lost in a bid for control and personal gain. In the world of the biomedical sciences, the best protection for an idea is to publish it in a clear fashion so that the world knows it is yours.

The time has come for those who choose to sell us their ideas to understand that they do not, in perpetuity, own all notions derived from those ideas. The time has also come for people in our profession to develop ideas in the public forum where those ideas can be critically assessed, debated, and refined. Certainly those who have developed teaching methods, course materials, or unique aids should fed free to retain proprietary rights over these products and services and to gain appropriate credit and remuneration. But those who reserve the right to veto all use of ideas are out of place in a community of caring health professionals.

Perhaps we can learn something from the anatomists. When I consider the jealous ownership of ideas so prevalent in our profession, I am reminded of Camillo Golgi, who believed that the nervous system consists of one continuous network of tissue, and Santiago Ramon y Cajal, who argued for the neuron doctrine--that the nervous system consists of discrete cells. Golgi developed the very techniques that Cajal used to prove Golgi wrong. It was Cajal's use of the "Golgi stain" that provided much of the evidence for his argument. Golgi never came to accept the refutation of his ideas by Cajal, even when the two shared the 1906 Nobel prize, but Golgi provides us with a lesson.

There are those who honor themselves by attaching their names to ideas and then attempt to possess those ideas. But we should pay homage to those who freely offer their ideas and methods to the world, for it is only then that the ideas and methods take on lives of their own. We need more people who, though they may fear refutation, are willing to place their ideas in the light. Ideas worthy of survival thrive in the light and flourish in the face of critical analysis.

Jules M Rothstein, PhD, PT

Editor