{"id":37057,"date":"2016-07-15T12:04:49","date_gmt":"2016-07-15T11:04:49","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=37057"},"modified":"2016-07-22T12:46:15","modified_gmt":"2016-07-22T11:46:15","slug":"neville-goodmans-metaphor-watch-no-we-arent-nearly-there","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/07\/15\/neville-goodmans-metaphor-watch-no-we-arent-nearly-there\/","title":{"rendered":"Neville Goodman&#8217;s Metaphor Watch: No, we aren\u2019t nearly there"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/02\/neville_goodman.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-thumbnail wp-image-33270\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2015\/02\/neville_goodman-150x150.jpg\" alt=\"neville_goodman\" width=\"150\" height=\"150\" \/><\/a><\/p>\n<p>It must be one of the most annoying and predictable child behaviours. Perhaps even more predictable than asking if orange juice has got bits in. Any journey of any length will be punctuated by the repeated question, \u201cAre we nearly there?\u201d Put \u201cchildren car journeys nearly there\u201d into Google and you\u2019ll get lots of advice. It\u2019s a really tedious question, to which the answer is always, \u201cBe patient!\u201d, so why (as a former colleague complained to me) do editorialists feel so keen to ask it? Children are asking a literal question, the \u201cthere\u201d being grandma\u2019s, the zoo, or the seaside. In medicine the question is metaphorical; the destination is not a place but a result: a better diagnosis or a better treatment.<!--more--><\/p>\n<p>It\u2019s not easy to measure the phrase\u2019s prevalence because all the words are stopwords on PubMed, which makes the phrase unsearchable in any way. Google Scholar has no such restrictions: for example, you can enter the search &lt;\u201cand so\u201d AND medicine&gt; and get nearly three million results. Doing the same for \u201care we there yet\u201d gets 30000. That doesn\u2019t mean there are 30000 articles containing the phrase, because some of the results will be duplicates, but nonetheless that is an awful lot of wasted words.<\/p>\n<p>I looked at the first ten results: were any of them nearly there? A pathway of hyaluronan catabolism? It\u2019s enormously complicated, with many hyaladherens and inhibitors associated with the various hyaluronidases. So, we have a long way to go to devising the pathway.<\/p>\n<p>Will we be able to show specific genetic causes in complex diseases? \u201cWe believe that definitive proof of causation will remain elusive, owing, in part, to our inability to randomly assign people to genotypes.\u201d So that\u2019s a loser, then.<\/p>\n<p>How about pharmacogenetics and designer drugs, a topic that gets regular airing in the national press suggesting we will all be buying cures off the shelf by next year? Well, it is \u201cnot on the immediate horizon, more a distant goal.\u201d<\/p>\n<p>Another topic that has made the nationals is human-mouse models, but pessimism\u2014realism?\u2014rules: \u201cthe clinical translational capacity of even the most optimized models may be restricted by limited diversity in the human major and minor histocompatibility alleles that can be expressed in a mouse\u201d.<\/p>\n<p>Two showed a bit more promise. Applying gene therapy for severe combined immunodeficiency has made a promising start, but it is only a start, so, no: we aren\u2019t there yet. And genetic screening prevents hypersensitivity reactions to abacavir \u201cin some patients, but with provisos.\u201d<\/p>\n<p>The other four articles were pay-for-access, but there seems little doubt that we aren\u2019t there, and that any article asking if we are will conclude that we aren\u2019t.<\/p>\n<p><em><strong>Neville Goodman<\/strong> is a retired consultant anaesthetist and a writer. He is co-author of a book on medical English.<\/em><\/p>\n<p><em><strong>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.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>It must be one of the most annoying and predictable child behaviours. Perhaps even more predictable than asking if orange juice has got bits in. Any journey of any length [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/07\/15\/neville-goodmans-metaphor-watch-no-we-arent-nearly-there\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5763],"tags":[],"class_list":["post-37057","post","type-post","status-publish","format-standard","hentry","category-metaphor-watch"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Neville Goodman&#039;s Metaphor Watch: No, we aren\u2019t nearly there - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/07\/15\/neville-goodmans-metaphor-watch-no-we-arent-nearly-there\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Neville Goodman&#039;s Metaphor Watch: No, we aren\u2019t nearly there - The BMJ\" \/>\n<meta property=\"og:description\" content=\"It must be one of the most annoying and predictable child behaviours. 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