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Epistle

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There's a phrase which describes things as going ‘From the sublime to the ridiculous’. While I've often been known to speak in clichés, I found myself wondering about this particular saying, because it seems to imply that there is some sort of spectrum, and any comparison with or deviation from the sublime – the brilliant, the transcendent – becomes ridiculous. I've checked the source of the saying in the manner that our guys in IT describe as ‘asking our best friend’ – that is, Google – and it turns out it this phrase begins in ‘The Age of Reason’, published in 1793 by Tom Paine: ‘The sublime and ridiculous are often so nearly related that it is difficult to class them separately.’ The difficulty arises for me in trying to describe in this journal some very different papers which could not be more different, but which are all fascinating.

To start with one ‘sublime’: a Best Practice paper by Sophie Wilne and David Walker looks at a rare variant of a rare condition. Tumours are not common, and spine and spinal cord tumours account for just 2% of them; in the UK just 40 children a year. As a general paediatrician I'm might diagnose one or two in my career – or, perhaps more worrying, I might miss one or two. It does make me sleep more soundly at night knowing that there are people who spend their lives dedicated to understanding these conditions in the detail that Wilne and Walker hint at in their excellent overview. In a different approach to a similar condition, in a Problem Solving in Clinical Practice paper Daniel Hawley and David Walker approach the symptomatology of brain tumours from the perspective of the anatomy affected.

One of the many aspects of cancer care I've always found impressive is the huge proportion of all patients who are enrolled in clinical trials. I'm taking a guess – and I'll perhaps get outraged emails telling me otherwise – but I think the only subset of paediatrics which gets anywhere close to oncological levels of recruitment to trials is inherited metabolic disease – the diagnosis of which is discussed in a paper by Champion in this issue. In any case, this brings me to the paper at the other end of my ‘sublime to what?’ spectrum which is Munib Haroon and Bob Phillips' discussion of evidence-based medicine. While the oncological papers give you important ‘just in case’ knowledge, Haroon and Phillips guide you how to find evidence ‘just in time’. There are a number of prepackaged evidence-based medicine resources, and in this journal we're trying to add to this, in the Interpretations series, which seeks to help people use tests more rationally. When commissioning this series I've tried to get authors to address the situations where a test may be being abused, and Steve McWilliam and Andrew Riordan have tackled the very tricky area of C reactive protein. There is at least one fact in this paper which for me will probably significantly alter my practice – I wonder if anyone can spot it? (If you email me and you're right I'll mention you in my next epistle, which you can put on your CV (this probably isn't true))

In the last issue I asked for feedback, and I'm grateful for those of you who sent helpful emails. I'd be happy to have any further feedback at ian.wacogne{at}bch.nhs.uk. In addition, you might be interested in other ways of keeping in touch; there's a twitter feed for E&P, which is @ArchivesEandP. If you're interested, Bob Phillips is also active with @archiadc - I've set him the challenge of defining statistical terms in the 140 characters allowed in twitter, which I'll collect together here as a ready reckoner when they're complete. In addition, there's an open challenge that if you post a PICO format question to @archiadc then Bob – with help – will try to get a little way towards an answer for it.

So, in the ‘sublime to what?’ spectrum Twitter is probably a bit ridiculous, but surprisingly interesting. If you've never tried it, I dare you to give it a go. However, the main lesson for me is to move away from dull clichés and for inspiration I reach again for that sublime source – George Orwell's 1946 essay ‘Politics and the English Language’. You can easily find this via the IT guys' best friend, and, if you've never read it, make a cup of tea – it will take you about 15 min to read – and consider it this month's extra reading assignment.

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