Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Acronyms
The term “acronym” is widely misused to mean any type of abbreviation, even those that aren’t acronyms.
In this case etymology helps to resolve the confusion and improve understanding. “Acronym” comes from two Greek words: the adjective ἄκρος, highest, topmost, outermost, and the noun ὄνομα, a name. So, an acronym is a pronounceable word formed from the first letters of a set of words. There are various types:
• Acronyms that are the same as words that already existed when the acronym was formed; medical examples include ACE (angiotensin-converting enzyme) and AIDS (acquired immune deficiency syndrome), not to be confused with AID (artificial insemination by donor or auto-immune disease, or a panoply of others: https://www.acronymfinder.com/AID.html).
• Acronyms that form strings that can be regarded as potential words and have therefore been adopted as words; examples include warfarin, which stands for the Wisconsin Alumni Research Foundation plus –arin.
• Acronyms that neither are words nor have become words but that sound as if they might be words; CABG (coronary artery bypass graft, pronounced “cabbage”) is an example.
• Acronyms that can be pronounced as if they were words but aren’t; examples include ZIFT (zygote intra-fallopian transfer).
Some acronyms extend beyond the first letters of the words from which they are derived; examples include ANOVA (analysis of variance) and PREP (pre-exposure prophylaxis).
Yet others borrow letters from inside words rather than using only their initials. This is a particularly common way of creating acronyms by which to name clinical trials, such as the RECOVERY trial, the name of which was created by using some initial letters plus more than one letter from one word plus internal letters from yet another: randomised evaluation of covid-19 therapy. This is a lazy method, albeit one that in this case created a memorable acronym, even if one might not be able to remember what it stood for.
The ideal acronym is self-referential—the word chosen to be the acronym should reflect the nature of the subject that it refers to. For example, when Robin Ferner and I published a review of the benefits and harms of laughter in a Christmas BMJ issue, we called it MIRTH (a methodical investigation of risibility, therapeutic and harmful)—an example of a self-referential acronym.1 Indeed, our mirthful article not only dealt with the clinical effects of laughter, but also elicited it, as reports from readers testified. The RECOVERY trial also turned out to be self-referential,2 although that couldn’t have been predicted, merely hoped for, when the name was coined.
Initialisms
The original meaning of the word acronym in English, first recorded in 1940, was “A group of initial letters used as an abbreviation for a name or expression, each letter or part being pronounced separately.”3 However, that is what is more properly called an initialism, to distinguish it from a true acronym, first identified as such in 1943, as described above. GTN, an initialism for glyceryl trinitrate, and TNT, an initialism for trinitrotoluene, are two explosives that are unlikely to be confused with each other, even though at one time GTN for therapeutic use was also called trinitrin, which was sometimes abbreviated as an initialism, TNT.
Other short forms
Nor should acronyms be confused with other abbreviated forms, such as shortenings, contractions, and back-formations. A shortening is simply a shortened form of a longer term, such as the name of any syndrome, disease, or test turned into slang simply by omitting the words “syndrome,” “disease,” or “test”; examples include “Cushing’s [syndrome],” “Parkinson’s [disease],” and “a Wassermann [test].” Single words can also be shortened—for example, any kind of instrument used to look into the body, such as a colonoscope, cystoscope, laryngoscope, or otoscope, can be called a scope.
In a contraction selected letters are taken from within a single word; for example, “Dr” for doctor” or “Mr” and “Mrs” for Mister and Mistress.
A back-formation is a word formed by clipping off the end of another. In America the action of a burglar is to burglarise, but in the UK we use the much simpler back-formation, to burgle. Medical examples include “gynae” for gynaecology and “paeds” for paediatrics.
I have given other examples of all of these types of abbreviations elsewhere.45
Acronymic sleuths
The word “sleuth” has occasionally been appropriated for acronymic purposes, as the following examples show:
• Second Life Educational Undertakings in Theatre History6;
• System for Locating Eruptive Underwater Turbidity and Hydrography;
• Slope, Land use map, Excluded area, Urban area, Transportation map, Hillside area.
I have found the second of these only in websites devoted to listing acronyms. The third is a commonly used acronym in the world of urban planning and climate change.
There is also an acronym that reflects both medical and investigative sleuthing. In an abstract published in the journal BJU International in 2020, a group of surgeons, members of the Urological Society of Australia and New Zealand, at its 73rd annual scientific meeting, reported a study that they had carried out, in which they searched male and female surgeons’ locker rooms for unguarded items, “medical paraphernalia” as they put it, that might be of interest to a thief. They found 185 scalpels, seven pairs of scissors, and 88 types of needles, mostly hypodermic needles, both short and long (n=58), but also 12 intravenous cannulae, seven suture needles, and a few other types. There were 25 tourniquets, 14 alcohol skin swabs, and nine syringes. In addition, they found, among 73 other items, 16 pens, 11 endotracheal tubes, 11 scrub hats, six urinary catheters, five pairs of sterile gloves, a surgical drape, a surgical gown, and a kidney dish. They also found a few medications: three 5 mL vials of 1% lidocaine, one vial of lidocaine plus adrenaline, a ketorolac suppository, and a 5 mL vial of fentanyl.
These surgical sleuths called their study “Surgeon’s Locker-room Environment—Understanding the Hazards.”7
Finally, an acronymic puzzle
The acronym CHOP stands for the combination of four chemotherapeutic medicines, cyclophosphamide, doxorubicin, vincristine, and prednisolone, given here in their rINNs (recommended international non-proprietary names), If you don’t already know where the acronym comes from, try to work it out before consulting a recent paper on the subject.8
