{"id":37262,"date":"2016-08-19T11:14:01","date_gmt":"2016-08-19T10:14:01","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=37262"},"modified":"2016-08-19T11:14:23","modified_gmt":"2016-08-19T10:14:23","slug":"neville-goodmans-metaphor-watch-cast-iron","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/08\/19\/neville-goodmans-metaphor-watch-cast-iron\/","title":{"rendered":"Neville Goodman&#8217;s Metaphor Watch: Cast iron"},"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><em>The BMJ<\/em>\u2019s columnist, Margaret McCartney, wrote that we need, \u201c<a href=\"http:\/\/www.bmj.com\/content\/354\/bmj.i3692\">cast iron divisions between healthcare and industry<\/a>\u201d because their priorities are different. (Being <em>The<\/em> <em>BMJ<\/em>, there was no hyphen; but dictionaries give the substance cast iron as two words and the adjective cast-iron as hyphenated.) Margaret used the metaphorical <em>cast iron<\/em> instead of the literal <em>clear<\/em>, or <em>distinct<\/em>, because (I presume) she wanted to stress that these divisions should be immutable. The Royal College of Nursing asked for a \u201ccast iron guarantee\u201d that nurses will sit on the executive boards of NHS foundation trusts, presumably a guarantee that wouldn\u2019t be broken. Not that guarantees or promises should be seen as sacrosanct: David Cameron gave a cast-iron guarantee that there would be a referendum on EU membership if he became Prime Minister, and look where that has got us.<!--more--><\/p>\n<p>The expression lends itself to diagnosis: \u201ca cast-iron clinical diagnosis based on radiological findings, operative findings, and clinical follow-up.\u201d And, with a clever allusion, there were \u201ccast iron results\u201d from a meta-analysis of giving iron along with agents to stimulate erythopoiesis in patients with cancer.<\/p>\n<p>But it is a curious metaphor. I imagine that most people would interpret a cast iron guarantee as absolutely unbreakable: rock solid, to use another metaphor. But cast iron is not unbreakable. As I learned from my social history at school, the deficiencies of cast iron led to the invention of steel: to quote from a paper about the structural dynamics of actin, \u201cactin becomes less like cast iron (strong but brittle) and more like steel (stronger and more resilient)\u201d. Who wants a promise that is strong but brittle, ie, liable to shatter if hit hard? But steel is more bendy, and perhaps it\u2019s better to have a guarantee that you know has shattered rather than one that has unsuspectingly mutated into something else.<\/p>\n<p>Part of the reason that cast-iron has stuck may be cadence: the rhythmic flow of sounds or words. My examples are of the written word, but \u201csteel divisions,\u201d \u201csteel guarantees,\u201d \u201csteel diagnoses\u201d just sound odd: the single syllable is not enough and, however strong the material, that syllable peters out in a weak dribble. Carbon fibre is the strong material of the modern world, often lauded as stronger than steel. So should we try for carbon fibre guarantees? It\u2019s got enough syllables but carbon fibre is not strong in all dimensions. Stronger than steel in its one intended dimension, it can, unlike steel, buckle in other dimensions. It is also, like cast iron, brittle.<\/p>\n<p>I think Margaret is right, but the divisions are currently more like Plasticine\u2122.<\/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>The BMJ\u2019s columnist, Margaret McCartney, wrote that we need, \u201ccast iron divisions between healthcare and industry\u201d because their priorities are different. (Being The BMJ, there was no hyphen; but dictionaries [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/08\/19\/neville-goodmans-metaphor-watch-cast-iron\/\">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-37262","post","type-post","status-publish","format-standard","hentry","category-metaphor-watch"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Neville Goodman&#039;s Metaphor Watch: Cast iron - 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\/08\/19\/neville-goodmans-metaphor-watch-cast-iron\/\" \/>\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: Cast iron - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The BMJ\u2019s columnist, Margaret McCartney, wrote that we need, \u201ccast iron divisions between healthcare and industry\u201d because their priorities are different. 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