We argue why interpretability should have primacy alongside empiricism for several reasons: first, if machine learning (ML) models are beginning to render some of the high-risk healthcare decisions instead of clinicians, these models pose a novel medicolegal and ethical frontier that is incompletely addressed by current methods of appraising medical interventions like pharmacological therapies; second, a number of judicial precedents underpinning medical liability and negligence are compromised when ‘autonomous’ ML recommendations are considered to be en par with human instruction in specific contexts; third, explainable algorithms may be more amenable to the ascertainment and minimisation of biases, with repercussions for racial equity as well as scientific reproducibility and generalisability. We conclude with some reasons for the ineludible importance of interpretability, such as the establishment of trust, in overcoming perhaps the most difficult challenge ML will face in a high-stakes environment like healthcare: professional and public acceptance.

Obtaining informed consent before providing treatment is a routine part of modern clinical practice. For some treatments, however, there may be disagreement over the requirements for 'informed' consent. Electroconvulsive therapy (ECT) is one such example. Blease argues that patients 'should surely be privy to the matters of fact that: (1) there is continued controversy over the effectiveness of ECT; (2) there is orthodox scientific consensus that there is currently no acknowledged explanation for ECT and (3) there is a serious (mainstream) debate over whether the response to ECT may be a placebo response.' Before embracing these suggestions, two key questions must be asked. Are these claims a reasonable representation of current ECT research? And if so, will this information be of benefit to patients? The evidence-based support for ECT from both National Institute for Health and Care Excellence and the Royal College of Psychiatrists appears to undermine the validity of claims (1) and (3), and therefore the rationale for providing this information. Concerning assertion (2), it is true that the mechanism by which ECT has its therapeutic effect is not yet established, although the importance of conveying this fact to the patient is questionable. Of greater certainty is that the same irresolution surrounds the mechanism of action of pharmaceutical antidepressants, and so a double standard in patient care should be mindfully avoided if provision of this information is deemed a prerequisite for proper 'informed' consent.

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SURGEON TO THE NEWCASTLE-ON-TYNE THROAT AND EAR INFIRMARY. Miss A. P-, aged twenty-four, consulted me in October, 1880, for loss of voice of nearly five years' standing. She looked delicate, but did not complain of weakness, and informed me that she had had an ulcerated sore-throat, and lost her voice on leaving a heated room in November, 1875. On recovering from the sore-throat, her voice did not return, when the regular medical attendant applied caustic two or three times, but without any beneficial effect. She then consulted several eminent practitioners, and amongst them a leading physician in Dublin, who recommended galvanism to be applied by means of a battery, but the result was the same as before. Preparatory to my making a laryngoscopic examination, it may be stated that the fact was proved that the loss of function was not due to hysteria, as she was placed completely under the influence of chloroform, when she did not speak, but continued to whisper. The instrument then showed that the vocal cords were in a very relaxed state, and crumpled up as it were near their middle, but otherwise apparently quite healthy, and galvanism seemed clearly indicated in the case. It was therefore strongly recommended to apply it for some time by one of Pulvermacher's chains, but this failed, when it was continued by means of a metallic brush for a much longer period, but there was not the least return of the voice. Knowing that the alternation of topical remedies often proved efficacious in the treatment of chronic inflammation of mucous passages, they were prescribed during the whole of this time, but neither of them, combined with the former, produced any good effect. The cords were then faradised bv means of Mackenzie's electrode, when after very few applications of the electro-magnetic current the voice was partly restored, but as a very harsh " croak" at first, and very monotonous. She was asked to sing over a scale of music, but every note was pronounced in the same tone, and she could not modulate her voice either piano or fortissimo. After the current had been repeated at gradually lengthening intervals, however, the voice was permanently restored, and now she speaks in a clear and natural tone, which had been lost for nearly five years. She was seen a few weeks ago, and I heard from her own lips that the cure had been permanent..EMMM-As.—This patient, anxious to regain her voice, had previously given everything prescribed for her, both local and constitutional, a fair trial. Tonics and zinc pills were persevered in for a very long time, as well as the inhalation of vapours impregnated with different volatile principles. Powders were introduced by insufflation, and this again followed by various escharotics, but without the least benefit resulting until the vocal cords were faradised, which proved there had been no structural disease, but that the case resolved itself into one of functional aphonia or vocal weakness. The case requires no further comment, but the superiority oi the internal method of farad...