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Derogatory nomenclature is still being used: The example of split hand/foot

Nearly 10 years after JohnCarey, theEditor-in-Chief of this Journal, stated that the time has come to eliminate pejorative terms in medical genetics [Carey, 2006], it is dismaying to find in the literature the continued use of offensive terms to describe human malformations. Lobster-claw is a case in point. While we read with interest the recent publication of Argawal and colleagues, describing a patient with split hand/foot, we were disappointed in the authors’ choice for its title: “Lobster claw deformity” [Agrawal et al., 2014]. The use of this outdated and offensive term prompted us to do a literature search to determine whether other authors continue to utilize this nomenclature. Within the last 10 years (2004–2014), we identified eight manuscripts with titles that include “lobster claw” to describe patients with split hand/foot malformation [Nayak et al., 2005; Cyriac and Lashpa, 2006; León-Mateos et al., 2008; Mumoli, 2012; Rios et al., 2012; Gulia and Marwah 2013; Gupta et al., 2013; Agrawal et al., 2014], and several others that use this term in the abstract. The history of the nomenclature surrounding split hand/foot has been summarized [Elliott et al., 2005]. Biesecker et al. [2009] in his manuscript addressing standard terminology for the hands and feet proposed split hand/foot replace ectrodactyly and lobster claw deformity. Both publications stress that this latter term is both offensive and inaccurate. Feingold, in his elegant correspondence highlighting the use of inappropriate, demeaning and pejorative terminology to describe syndromes, discussed his personal goal of eradicating the use of such terms [Feingold, 2006].As agroup, clinical/medical geneticists strive to utilize current and sensitive terminology to describe disorders and dysmorphic findings [Moeschler and Nisbeft, 2011]. Sowhy has the terminology surrounding split hand/foot escaped this trend?Onepossible explanation is that themost recent ICD-10CM version (2015) continues to use the term “Lobster claw hand” (Q71.6) to describe split hand. Interestingly, the lower extremity equivalent is classified more appropriately as “split foot”— (Q72.7). In, fact we seem to be going backwards as ICD-9-CM uses “cleft hand” (755.58), an acceptable alternative. The literature suggests that clinicians external to genetics use lobster clawmore commonly; however, it is surely the responsibility of all of us to educate and promote awareness regarding the use of sensitive language with respect to malformations. Ludman, in a