Counsellors And Acolytes

The case of the missing data

BMJ 2002; 325 doi: (Published 21 December 2002) Cite this as: BMJ 2002;325:1490
  1. James Le Fanu, retainer general practitioner
  1. Mawbey Brough Health Centre, 39 Wilcox Close, London SW8 2UD

    “Is there any point to which you would wish to draw my attention?”

    “To the curious incident of the dog in the night time.”

    “The dog did nothing in the night time.”

    “That was the curious incident,” remarked Sherlock Holmes.

    Sir Arthur Conan Doyle. Silver Blaze1

    “The term ‘non-barking dog’ refers to a species of anomaly—detail that could reasonably have been expected to appear in evidential text but which, for whatever reason, is absent.”

    Eric Shepherd. Non barking dogs and other odd species. Med Sci Law 19992

    (It is the morning of 26 February 2000. The famous detective Sherlock Holmes has just been joined in the breakfast room of his flat at 221b Baker Street by the ever reliable, if unimaginative, Dr Watson.)

    Holmes: Why, Watson, you don't seem your usual cheerful self this morning. Something preying on your mind? Out with it, man. I don't want my day ruined by one of your black moods.

    Watson: I am, as you so astutely observe, much vexed. You will know I have been much persuaded by those distinguished members of my profession who claim I would avoid the misfortunes of suddenly dropping dead from a heart attack were I to adopt what they like to call a “healthy lifestyle.”3 So now I start the morning with a brisk walk round Regent's Park, have controlled my tobacco addiction with those marvellous nicotine patches, and have given up the pleasures of bacon and eggs for breakfast and of Mrs Beeton's powerful puddings.

    It must be said the value of such measures has not been confirmed by clinical trials4—indeed, there is even a rumour that heart disease may be a biological phenomenon caused by a newly identified strain of bacterium5—but I have always been impressed by how …

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