Metaphor Watch kicked off (a metaphor for started) with epidemic, used ubiquitously and inappropriately for the non-communicable diseases of industrialized nations. I rounded off (a metaphor for finished) with a quote that wins a prize for tautologous exaggeration, that “the world is heading for a vascular tsunami of pandemic proportions.”

From this, I want to return to the word tsunami. The point about a tsunami is that it is overwhelming. Not just big, not just sudden, but overwhelming. There is no escaping a tsunami if you are in its path; the only hope is to get out of its path. There are plenty of medical articles about real tsunamis, with the two expected peaks: one after the Boxing Day tsunami of 2004 and the other after the Fukushima disaster in March 2011.

I found no evidence that these events prompted any increase in the metaphorical use of the term. The first in PubMed®, in 1997, warned of a tsunami of managed care, moving eastwards from the west coast of America, threatening the way physicians, but especially radiologists, work. The abstract ended with another metaphor: “Evolution will demonstrate once again the survival of the fittest.” I don’t know how the last 20 years have treated US radiologists, but I doubt any real resemblance to a tsunami. And I would say that there is no medical condition for which tsunami is appropriate, but you can find examples on PubMed® or Google Scholar, and they are the usual suspects: diabetes, cardiovascular disease, Alzheimer’s, and so on.

The number of articles is swelled because the word tsunami has been used for patents. The Terumo® Corporation of Japan manufactures a range of Tsunami™ stents, and Ecolab® produces an oxidizing sanitizer called Tsunami 100™. It is also the name for a computer program, “immodestly dubbed TSUNAMI” as the authors amusingly put it, used to compare protein subfamilies.

Tsunami also describes calcium waves, but this is a descriptive rather than a metaphorical use.

I think the metaphor is appropriate—although overused—applied to data or information, and there are plenty of examples. But do not, as with explosions (qv Metaphor Watch 22 Dec 2016), over egg the pudding. A veritable tsunami of guidelines on hypertension management, a veritable tsunami of publications, preparing for what could be a veritable tsunami of requests for gastroenterology services, a veritable tsunami of electronic information and electronic chores: these and many more are wasted words.

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

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.