Mathematics in medicine: beyond iatromathematics.

www.thelancet.com Vol 383 February 8, 2014 513 polar-bearing, polar-bear hunting, and happy slapping. While media reports of this type of assault vary, it typically involves either one forceful punch to the head or a more generalised assault to a random individual (typically standing or walking alone) without any warning or provocation, and without any ulterior motive such as theft or retaliation. Instead, the overall goal of the game is to result in the victim’s unconsciousness, and assailants might video record the assault and boast about their involvement for notoriety. Given that many assaults occur in public places, surveillance videos often capture the incidents and are subsequently used in media reports or as criminal evidence to identify and prosecute assailants, nearly all of whom are teenage boys. Medical case reports and boxing and fighting matches support the mechanism of a single blow to the head or neck resulting in temporary unconsciousness, coma, or death. These injuries typically include profound autonomic dysfunction with disruption of the reticular activating system, but often without intracranial haemorrhage. It is challenging to identify the overall incidence of the knockout game. Not all apprehended assailants endorse their assault as part of the game and these assaults might not be captured by video or identifi ed as a result of the game. Although the medical literature does not describe “knockout” by name, internet queries identify six reported deaths as a result of the game, all involving head injury in adult victims, one with a secondary spinal cord injury, and another with a penetrating injury of the heart. Additionally, a search in the US National Violent Death Reporting System database for fatal injuries by a stranger assailant using only hands or feet as a method of assault yields ten or fewer cases annually for 2005–10. Although social media has focused recent attention on the game and its increasing popularity, difference between predicting and explaining events: a cardiovascular risks score might perfectly predict mortality, even if it is based on noncausal factors, such as cholesterol. Regarded as highly complex, math ematics has not received the recognition it deserves in medicine. This is paradoxical: mathematics is about ideas in the first place, not about technical tools, and many mathematical, especially geometrical , 4 concepts await experimental challenge. Conversely, unsolved problems call for different mathematics. 50 years after Foucault asked: do we even know the geometry of pathology?—the question remains unanswered.