{"id":34309,"date":"2015-05-27T15:22:57","date_gmt":"2015-05-27T14:22:57","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=34309"},"modified":"2015-05-27T15:23:55","modified_gmt":"2015-05-27T14:23:55","slug":"neville-goodmans-metaphor-watch-im-in-the-army-now","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2015\/05\/27\/neville-goodmans-metaphor-watch-im-in-the-army-now\/","title":{"rendered":"Neville Goodman’s metaphor watch: I\u2019m in the army now"},"content":{"rendered":"

\"neville_goodman\"<\/a>Many metaphors are helpful; many metaphors are irritating; a few are harmful. It\u2019s not surprising that military metaphors abound in medical writing: disease is the enemy; drugs are the weapons with which to fight. Then we can write about, \u201cThe armed truce between the intestinal microflora and host mucosal immunity,\u201d or about how our victory over tuberculosis is more realistically a truce, or about a truce between factions arguing that crystalloids are better than colloids. In truth, the last of these is a literal truce, in that it is an agreement between people to stop arguing; the intestinal microflora and M. tuberculosis<\/em> have no thoughts in the matter.<\/p>\n

It is easy to lapse into military metaphor. However appealing to journalists<\/a>, writing of patients\u2019 battling cancer or of being brave to do so is thoughtless. Describing the general drive to improve cancer treatments as a battle is less personal but still inappropriate<\/a>. It\u2019s not just cancer: there are battles against infectious diseases, battles in the treatment of stroke, the battle against human trafficking\u2014although that really is a battle. In which people die. Extending the metaphor livens it up (for a while): battle of the bulge<\/em> applied to obesity or to aortic aneurysms. But what we\u2019re really writing about with our battles, our fights and our wars, are efforts, arguments, problems and difficulties: less sensational, more truthful, and better description.<\/p>\n

Some military metaphors work. In auto-immune diseases, antibodies don\u2019t really attack<\/em> body cells, but destroy<\/em> isn\u2019t correct because it is the antibodies\u2019 binding to receptors, thus initiating a response, that does the damage. Please don\u2019t ask me for any more detail. My medical student career ended before immunology really began: my immunological knowledge is something shaped vaguely like a capital Y and “Fab,” and I\u2019ve just had to look up what that stands for.<\/p>\n

Bailey and Love (pale, bulky and offensive) strikingly described cancer of the stomach as “one of the captains of the men of death.” Its 26th edition is blue, and I don\u2019t know if the metaphor is still in its pages, but it didn\u2019t originate there. In 1918, William Osler referred to the Pneumococcus<\/em> as the “captain of the men of death,” citing John Bunyan as its originator (The life and death of Mr Badman<\/em>, 1680). Bunyan meant consumption, itself a metaphorical name for tuberculosis. No: thinking about it, consumption is a literal name, because that is what happened, just as diabetes mellitus is “sweet urine.”<\/p>\n

Time bombs, often ticking, are used to warn us of the same apocalyptic horsemen\u2014a biblical metaphor\u2014that cause rising tides (q.v.): obesity, diabetes, Alzheimer\u2019s, hypertension, antibiotic resistance. Efforts to defuse the bombs start with launching campaigns. But in all this metaphorical blether it is easy to forget\u2014while the doctor is busy slaying the disease\u2014that the battleground is the patient. While one of the combatants might emerge victorious and more or less unscathed, the battleground rarely fares well. I am far from<\/a> the first to ask<\/a> for special thought before lobbing another shell over the trenches in pursuit of a disease-free world.<\/p>\n

Competing interests:<\/strong> I have read and understood BMJ policy on declaration of interests and declare that my only competing interest is my co-authorship of a book about medical English.
\n<\/em>
\nNeville Goodman<\/strong> is a retired consultant anaesthetist and a writer, and co-author of a book on medical English.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Many metaphors are helpful; many metaphors are irritating; a few are harmful. It\u2019s not surprising that military metaphors abound in medical writing: disease is the enemy; drugs are the weapons with which to fight. Then we can write about, \u201cThe armed truce between the intestinal microflora and host mucosal immunity,\u201d or about how our victory […]<\/p>\n

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