First-in-Man

I have long been intrigued by the fashion for attributing originality by naming a procedure, complex, or clinical sign after the first person to describe it, and by the perseverance with which such eponyms persist. Blalock-Taussig, Norwood, Glenn, Fontan—marks of honor bestowed by the community in a frontier culture—remain prevalent monikers of operations performed for congenital heart disease, decades after introduction, despite the rationalizing simplifications they represent, and in defiance of the many departures that have transformed their original iterations. That historical field brings to mind a surgeon I encountered many years ago who cataloged his personal, if not eponymous, procedural innovations; notches in a belt, akin to a compendium of patents received or invited lectures given. As I began to explore the literature in that field, aiming to develop a better understanding of how technical progress is chronicled in the medical record, it became clear that, just as the fidelity of certain procedural eponyms may be suspect, the novelty and provenance of purported innovations can be ambiguous, and that, more generally, claims of primacy are inherently fraught. Years later, I came to appreciate the implications of that list, similar to but more acquisitive than the historical stream of eponymous procedures in its insinuation that technical innovations are uniquely forged by a single person, that procedural primacy is the embodiment of innovation in interventional medicine.Innovation, however, is much more complex, almost inevitably occurring within and evolving from an array of inputs and influences, both successes and failures, emanating from the individual him- or herself, as well as countless predecessors and contemporaries. This observation should go without saying, but it is worth a reminder in the current era, in which innovation has become uniquely esteemed. Accounting for all the influences contributing to the execution of any new procedure, to acknowledge …