To cherry pick is to choose selectively. It’s supposed to originate from the way cherry pickers select the ripest, unblemished cherries to pick; why cherries rather than apples, oranges, or any other fruit is unclear. It is a modern expression. The Oxford English Dictionary first records it in 1966, from The Times, although it first appears on Ngram in 1954. In science, it is commonly applied to picking evidence to suit theory; in medicine, to choosing uncomplicated patients for treatment.

Some authors don’t seem to realise that cherry picking is a pejorative term: it is not just selecting, but selecting to unfair advantage. We expect football managers to go for the best players available; we don’t accuse them of cherry-picking. We are not happy when private treatment centres take all the easy primary total hip replacements, leaving the NHS with the sicker patients and the revisions, and with trainee surgeons who have never seen a primary. And, to quote an appropriate use in an article about systematic reviews, “Reviewers who ‘cherry pick’ studies to be included may bias findings towards a preconceived hypothesis.” But it is inappropriate to label a technique for selectively excising liver metastases as cherry picking, or to apply the expression to how humans have selected phenotypes when breeding domestic animals.

Low hanging fruit is also about selection and dates from the 1970s. It implies that all the easy stuff has been done. It’s been applied to genotyping, vaccines, and to chasing up test results as an easy way of reducing diagnostic errors. There’s not so much blame attached to picking low hanging fruit as to picking cherries; it’s more disappointment that more effort hasn’t, or can’t, be made. Thus, in discussing the links between pharmacology and nutrition, “…most of the low hanging fruit has been picked;” or in writing of new applications to the Food and Drug Administration (FDA), “the ‘low-hanging fruit’ has been almost entirely harvested.” Cherry picking is a useful metaphor, but, while appropriate, I’m not sure low hanging fruit expresses the sentiment any better than, “…most of the easy links have been made” and “all the easy drugs have been found.”

Another bite at the cherry is getting another chance. It’s easier to understand why cherries are the subject of the metaphor here—the fruit is small enough, unlike an apple or an orange, to miss completely at first attempt, but then to be eaten at one bite. It is a rare metaphor in medical writing, and one of the retrieved articles in PubMed was a non-metaphorical report of a boy who developed a cherry-sized lesion after an octopus bite.

Some authors choose to enclose their metaphor in quotation marks: “cherry pick,” “low-hanging fruit.” There is no need to do so unless there is a risk that the words will be taken literally.

Competing interests: 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.

Neville Goodman is a retired consultant anaesthetist and a writer, and co-author of a book on medical English.