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Objectivity: Terms should be objective and avoid subjective interpretations or value judgments about the
disease.

Granularity: The name should allow for different levels of detail depending on the specific needs. For
example, a general classification might be sufficient for some purposes, while a more detailed sub-
classification will be needed for others.

Comprehensiveness: The nomenclature should encompass a wide range of diseases and conditions.

Adaptability: As human understanding progresses, the system must remain flexible to incorporate new
knowledge, discoveries, and evolving perspectives on diseases. Equally crucial is its ability to adjust to
changes in an ever-changing socio-political landscape.

Accessibility: The terminology should be clear and understandable for both healthcare professionals and the
public, whenever possible.

International applicability: Ideally, the nomenclature should be usable across different continents, countries
and languages, facilitating global health communication.

IS SCIENCE A DEMOCRATIC PROCESS?
In science, can we decide what is right by voting? Are experts always right? How can a consensus be
manipulated? Does making a democratic decision make it more appropriate? Can participants in a survey
be influenced by a caucus of people with vested interests as it happens in national or international politics?
Perhaps we all know the answers.

Fortunately, the scientific process does not care for human consensus. We cannot decide whether the earth
is flat or not through a democratic consensus, but only through scientific observations and their validation.
Instead, “democracy in science” refers to the idea that scientific processes should be transparent and open to
scrutiny. While scientific principles are based on evidence, peer review, and replication, the process itself is
not inherently democratic. Scientific research involves a mix of individual expertise, rigorous testing, and
peer-reviewed replication rather than democratic voting.

The beauty of scientific exploration lies in the freedom to use terminology that best reflects current
understanding. Enforcing a single term for everyone is not exactly democratic, is it? As recently pointed out,
“When the evidence is not sufficient to support a unanimous vision, consensus becomes nothing more than
[2]
the convergence of opinions of many researchers on a particular topic” . However, the question remains:
Was there a real need for this? Was it driven by the stigma surrounding alcoholism and obesity? As further
commented, “Whether unanimous or not, the scientific consensus is the pillar of the relationship between
[2]
science and society as it avoids confusion and misinformation” . Has the renaming initiative resolved
confusion or exacerbated it? If the former were true, we would not have witnessed a plethora of responses
including the above comments. Alternatively, could the name change represent another facet of the crisis
outlined: “In the last years, the integrity, quality, and reliability of scientific research have been the subject of
criticism both from within and outside the scientific community.” The term metabolic associated fatty liver
disease (MAFLD) was proposed principally because of the need for an affirmative diagnosis unrelated to the
presence or absence of other concomitant liver diseases, while also reflecting its underlying pathogenesis.
On these grounds, there has not been any argument. Removing the word “Non-Alcoholic” has also not been
contested and is of particular value in parts of the world where alcohol consumption is frowned upon due to