They say you are what you eat. A couch potato. A meathead. A breadwinner. Just as our vernacular has embraced the language of food to describe people, so too has the medical community used such language to describe disease. A long tradition of examining human bodies has spurred an extensive list of food-named pathologies — the peau d’orange of inflammatory breast cancer, the “blueberry muffin” rash of a baby with congenital cytomegalovirus, the “cauliflower ear” of a varsity wrestler with repetitive head trauma. Food eponymophilia is a curious phenomenon in medicine, particularly in medical education.
In a recent review article on the subject, Drs. Mourouguessine Vimal and Anandabaskar Nishanthi list almost 100 distinct food eponyms within pathology. Some are based on microscopic appearance, such as the “coffee bean nuclei” of papillary thyroid cancer or the “oat cell carcinoma” of the lung. Others are related to gross appearance, such as the “chocolate” ovarian cyst or the “honeycomb” lung of pulmonary fibrosis. Why is it that pathologists gravitate toward these culinary metaphors? Drs. Vimal and Nishanthi note that “pathologists often hunt for clues … to make this tedious task more acceptable and more convenient, pathological findings are usually compared with food.”
Food names in pathology are particularly useful for undergraduate medical education because medical students often struggle with pathology at first. I spoke to Dr. Vania Zayat, Assistant Professor of Pathology at the University of Central Florida College of Medicine, who particularly likes the “fried egg” cells of a seminoma. She writes, “The histology of it really looks exactly like a fried egg. When I describe it to students as such, it makes it so much easier to visualize … especially if it is someone with no histology background that just sees everything blue and pink.” Dr. Zayat recognizes that first- and second-year medical students often have no prior experience in pathology and may find it daunting. Even those familiar with pathology may be burdened with the bulk of new information that accompanies the preclinical years of medical school.
In an article from The American Journal of Medicine entitled “Diagnostic Utility of Food Terminology: Culinary Clues for the Astute Diagnostician,” Dr. Nicholas Mark and others concur that “analogies add flavor, provide a lingua franca for description, and offer a mnemonic. Presenting medicine in food descriptors makes a boundless field easier to digest.” In other words, medicine is difficult enough as it is, with cumbersome words like “hepatobiliary tree,” “gastrocnemius” and “telangiectasia.”
Dr. Zayat believes that adding humor makes the field more enjoyable, which is especially true for students who are new to the world of medicine. Naming pathology items after foods makes concepts “easily accessible, familiar and relatable.” “When you tell someone it looks like a cauliflower or a coffee bean, for example,” Dr. Zayat writes in an email, “then they start relating to it more… It makes a powerful memory aid and assists in making a rapid diagnosis.”
I also spoke to Dr. Stephen Geller, Chairman Emeritus of Pathology at Cedars-Sinai in Los Angeles, California, who suggests that the tradition of using food to name pathology highlights how ancient the field really is. “In the pre-science years of medicine,” he writes, “when photography did not exist, authors needed something dramatic to help them portray findings.” Before the internet and electronic medical records, descriptive language was necessary to communicate pathology to surgeons and other clinicians successfully. These descriptions were crucial for educating the next generation of doctors and have remained a staple long after the advancement of technology.
Dr. Geller, who is also Professor of Pathology at University of California, Los Angeles and Weill Cornell, recognizes the limitations of food eponyms in modern medical education. What may be a familiar food to one student may be foreign and therefore unrecognizable to a student from a different cultural and culinary background. For example, many students have not seen or consumed the grains used to describe “millet seed” tuberculosis or “sago spleen.”
Dr. Geller also stresses that “even if [students] know the foods, they may not visualize the change unless it is explained.” For example, “bread-and-butter” pericarditis is not named simply for a piece of buttered bread; it is actually named for the way bread appears after both sides are buttered, placed together and pulled apart, which is significantly more complicated to visualize. Dr Geller goes on to note that teachers who use obscure eponyms, such as caseous necrosis, should explain the origins for the terms. “Unless you alert the student,” he warns, “he or she may think of Brie or Velveeta instead of cottage cheese or pot cheese.”
However, food does remain a universal language. Dr. Mark and others argue, “Although many have never seen a nutmeg, the description of nutmeg liver remains apt and, importantly, memorable.” The food eponym as a mnemonic is powerful in its descriptive capability, even if the food itself is unfamiliar.
Physicians and physicians-in-training experience the human body in a grossly tangible way. I distinctly remember a cold, gray morning in the anatomy lab when I was gently flaying the skin off of a cadaver in order to expose the sinewy tendons of the upper extremities. “This is how I pull the fat off a piece of chicken,” one of my classmates said, a statement that reinforced the deeply wondrous recognition that we are all organic, all mortal. After all, is the fat under our skin much different than the fat under the skin of a chicken?
Food indeed is the one of the only things that we experience with all of our senses — we appreciate texture, smell, aesthetic in our food just as we appreciate these elements in the human body. What else besides food can we truly experience as viscerally as we experience the inner workings of the human body and the diseases that ravage us? It is no surprise, therefore, that food is the natural metaphor — the obvious comparison — for any physician examining the human condition.