May we say this in a prominent medical journal such as CHEST? Is it audacity or truthful metaphor? For the two of us from Brooklyn, the phrase “pissin’ in the wind” means doing something that is essentially futile and possibly detrimental. Our third colleague assures us that the Japanese equivalent, “spitting in the sky,” also holds the same meaning. (Does all deep philosophy reduce down to body fliuds?) However it may be, in discussing an article where urine drug screening reveals nonadherence to therapy, we believe the phrase is apt.