Ingested foreign bodies and societal wealth: three year observational study of swallowed coins

Strengths and limitations

We used a sensitive and well recognised marker of environmental conditions: the objects ingested by children.1 2 3 4 5 7 8 9 Indeed, the validity of this model is illustrated by the fact that our 27% penny aspiration rate (n=3/11) was lower than the 36% penny pinching rate reported in 1982.6 This is exactly as one would predict, given inflation rates over time. Our inability to detect a change in coin ingestion might, however, be credited to a unique confounder expected to influence both the risk factor (changes in stock market value) and the societal wealth marker (paediatric coin ingestion): the supply of credit. A reduction in credit supply will mean that, to meet household obligations, the use of relatively difficult to ingest credit cards will be swapped for more palatable hard cash denomination. This credit denomination swap obligation could result in a paradoxical increase in the rate of paediatric wealth consumption, while lack of credit simultaneously restricts economic growth and depresses the stock market. This potential confounder might influence the risk factor and the societal wealth marker in opposite directions, hence masking a relation between them.

Other studies

Despite the thousands of articles about aerodigestive foreign bodies, there is surprising little gastropecuniary literature. This might be because of non-standardisation of numisluminal terminology and measurement. East of the Atlantic, the diphthong is widely used (oesophagus, aetiology, paediatric, for example), while on the western fringes (edema, anesthesia, humor, by illustration), its employment is typically limited to Miami Beach. The introduction of the euro brought a welcome standardisation of units of ingestion, at least in the eurozone.7 8 9

Clinical practice

The fate of an aspirated coin can be followed on x ray film. The asymptomatic child can be re-examined later to see if there is any change, but symptomatic coins or those lodged in the oesophagus need to be removed. The positioning of the x ray plate affects the image,11 such that, for example, an anterior-posterior view can produce an apparent increase in the size, and hence value, of deposits in the anterior abdomen (the Madoff effect) (fig 1⇓). A small overestimation of the diameter of a penny can lead to the misassumption that it is a nickel (5c), or similarly that a nickel is a quarter (25c), a Madoff effect of 400% (fig 2).⇓ While this insider information might be marginally more reliable than a parliamentarian’s expense account, this insight can be turned to good use when wagering on the value of the coin to be extracted. Parenthetically, before placing one’s retirement funds on gastroesophaegal futures or derivatives, attention should be directed to the more proximal gastrointestinal tract to ensure the tongue is firmly in the cheek.

Fig 1 X ray pictures can easily detect an ingested coin. Position of coin on lateral view (left), relative to anterior (right) or posterior picture affects size of image on film

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Fig 2 Coin denominations extracted

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Implications and future research

An observational study cannot determine causality or even the direction of association. While we anticipated a change in coin ingestion related to the stock market, we did not set out to look for the reverse effect. A basic understanding of monetary theory is useful in ruminating on this.12 An economy’s money supply has several definitions. In particular, the most basic definition, M0 (currency), refers to notes and coins in circulation and in bank vaults, while MB (the monetary base) also includes reserves that commercial banks hold with the central bank but have not loaned out. In turn, M1-M3 (various types of commercial bank money) are created through the fractional reserve system when a commercial bank makes a loan. For example, a commercial bank with $100 deposit and a mandated 10% reserve can “create” $90 of commercial money by loaning out 90% of the deposit. Thus, even small changes in the physical currency available might, under some circumstances, lead to disproportionately large changes in the broader measures of money supply and, in turn, overall economic activity. The realisation that major institutions did not have sufficient physical currency or reserves of central bank money to cover their debts in commercial money was a trigger for the credit crisis, prompting the central banks of various countries to transfer large amounts to commercial banks to prevent their collapse.

Chaos theory suggests that tiny differences in a starting state of a dynamic system can lead to massive changes in final outcome.13 This sensitivity, commonly known as the butterfly effect, can be amplified in an economy where transactions are increasingly performed entirely by computer,14 producing exponential changes that give the impression of random or chaotic behaviour. Could small changes in the availability of small change caused by children eating into the M0 supply lead ultimately to a catastrophic imbalance of debt and collateral? As long as the inter-relation of microeconomic and macroeconomic conditions remains unclear, the possibility of the fluttering butterfly wings of paediatric piconomic perturbations leading to a global credit tornado must remain food for thought for gastroeconomists.

In conclusion, while our population, patients, and fiscal fluctuations might be small, the potential implications are huge. Further numismedical studies are urgently indicated to stress test these possibilities, perhaps funded by a tiny fraction of the government financial bailout and, ideally, conducted from tax havens favoured by the financial set, such as Monaco, Bermuda, or the Virgin Islands.