Alliteration in medicine: a puzzling profusion of p's

PROBLEM: Puzzling, progressive profusion of alliterative “p's” in published papers. PURPOSE: To depict this particular “p” predominance with pinpoint precision. PLAN: Periodic, painstaking perusal of periodicals by a professor of paediatrics. PROPOSAL: The “p” plethora is positively perplexing and potentially perturbing. Alliteration is a literary device consisting of repetition of the same starting sound in several words in a sentence.1 Consider, for example, Shakespeare's playful parody of alliteration in Peter Quince's prologue in A Midsummer Night's Dream: “Whereat with blade, with bloody blameful blade, He bravely broach'd his boiling bloody breast.” Alliteration has appeared frequently in the medical literature—for example: “Respiratory syncytial virus—from chimps with colds to conundrums and cures;”2 “The choreas: of faints, fevers, and families;”3 “Coronary artery stents—gauging, gorging, and gouging;”4 “Moschcowitz, multimers, and metalloprotease;”5 “Alagille syndrome: a nutritional niche for Notch;”6 “Theodor Billroth: success with sutures and strings.”7 Perusing the medical literature with alliteration in mind, I have become perplexed by a peculiar propensity for the letter “p” to be placed in prominent positions. Consider for a moment the alliterative content of the BMJ, a prestigious periodical also published in Pakistani, Polish, and Portuguese. Perhaps the prime example is a piece entitled “A potpourri of parasites in poetry and proverb,”8 but the journal has presented articles addressing such topics as paracetamol poisoning,9 practitioners' pressure to prescribe,10 physicians' partnerships with patients,11 partnerships for prevention in public playgrounds,12 and pregnancy outcomes which have been persistently poor.13 Other topics have included patients' priorities,14 the political process of puzzling out private versus public priorities,15 and the ponderous problem of whether the priorities in apportioning resources should be primarily pragmatic or principally principled.16 In pursuing this plethora of “p” further, it becomes apparent that this predominance extends past paper titles to many other aspects of medicine. The purpose of this paper is to point this puzzling phenomenon of “p” profusion to the attention of practising physicians.