Intended for healthcare professionals

Feature Christmas 2016: In the Literature

Christmas crackers: highlights from past years of The BMJ’s seasonal issue

BMJ 2016; 355 doi: (Published 15 December 2016) Cite this as: BMJ 2016;355:i6679
  1. Navjoyt Ladher, clinical editor
  1. The BMJ
  1. nladher{at}

Navjoyt Ladher takes a trip through The BMJ’s archive and revisits some memorable Christmas papers

Orthopaedic surgeons are smarter than anaesthetists.1 Twenty seven is not a dangerous age for famous musicians.2 The oral health of British people is as good as, if not better than, that of Americans.3 Men are idiots.4

These might at first seem rather controversial statements, but all are findings of papers published in Christmas issues of The BMJ. For more than 30 years the festive issue of the journal has answered quirky research questions, waxed philosophical, and given us a good dose of humour and entertainment along the way. For the past 11 of those years the Christmas issue was overseen by former deputy editor Tony Delamothe, but since his retirement earlier this year he has handed the reins over to others. With this changing of the guard, and mindful of Tony’s high standards, it seems incumbent on us to look through the archive for a Christmas history lesson.

The first issue of The BMJ dates to 1840, then the Provincial Medical and Surgical Journal. In 1880 we see the first mention of a primitive Christmas appeal in the form of a letter from a reader suggesting that all BMA members contribute five shillings to the British Medical Benevolent Fund.5 The Christmas charity appeal became a regular feature of the journal from the 1930s and remains so today.6 There is a smattering of Christmas themed articles and quizzes in the 1960s, but it’s not until 1982 that we see the first dedicated Christmas issue. Devised under the then editor, Stephen Lock, it was intended as a break from the usual mix of serious research and scholarly comment, though adhering to the same criteria of novelty, rigour, and readability as apply in the regular issue. It has now become a much anticipated annual tradition.

Specialty interests

A recent count found more than 1000 articles in The BMJ’s Christmas back catalogue. A look through these shows some common themes returning year after year. Professional concerns crop up often, and we seem to be endlessly fascinated by the differences between medical specialties. Past studies have looked at how specialties vary by the cars they drive,7 their ability to predict the future,8 and their coffee buying habits.9 Sometimes the research findings can challenge popular stereotypes. How many people, “orthopods” included, could have predicted that anaesthetists, with their regular diet of Sudoku and crosswords, would fare worse than orthopaedic surgeons in an intelligence test?1

Sometimes the study findings come as less of a surprise. A case-control study from 2010 compared the urine output of doctors with the patients they clerked and found that it was the doctors who were more likely to be oliguric, confirming what every junior doctor who has spent a day on call already knows.10 Those same junior doctors will also know that an open box of chocolates doesn’t last very long on a medical ward. They may also suspect that it is the healthcare assistants and nurses who eat the lion’s share. But would they have known that Roses chocolates are munched more quickly than Quality Street? Thanks to a popular Christmas BMJ paper, now we all do.11

It’s not just the lives of jobbing doctors that are the focus of articles. Academics get a look-in too, and the popularity of last year’s rejection of a rejection letter suggested that some professional experiences are almost universal.12 Written (but not sent) after a particularly harsh note from a reviewer, the letter is a polite rebuttal of a journal’s rejection decision and a tonic to anyone who has dealt with the dejection and frustration of having a manuscript rejected. The enthusiasm with which the article was read and shared took even the authors by surprise. Coauthor Cath Chapman told me how she has received emails from people asking for a copy of the letter so they can send it to an editor in earnest, but she added, “We’re really sorry if any editors actually ended up with it in their inbox.”

Big themes

Beyond medical and academic matters, enduring Christmas themes also reflect the universal big issues that preoccupy us all: food, drink, religion, death, love, and sex. This last subject was the theme of two of the most widely read BMJ papers of all time. In 2014 Ben Lendrem and colleagues explored differences between the sexes in idiotic risk taking behaviour, by studying past winners of the Darwin Awards.4 As the paper describes: winners of these awards must die in such an idiotic manner that “their action ensures the long-term survival of the species, by selectively allowing one less idiot to survive.” There was a clear preponderance of men among the Darwin Award recipients, leaving the authors to conclude that men are idiots. Despite being published only two years ago, the paper is one of the most read articles in The BMJ archive. A look through the article’s rapid responses suggests that it is also one of the more controversial.

No less controversial is the second of our sex themed big hitters, 1999’s “Magnetic resonance imaging of male and female genitals during coitus and female sexual arousal.”13 The authors’ stated aims, as described in the paper, sounded straightforward enough: “To find out whether taking images of the male and female genitals during coitus is feasible and to find out whether former and current ideas about the anatomy during sexual intercourse and during female sexual arousal are based on assumptions or on facts.” However, as they went on to report in the paper, there were technical difficulties, performance issues, and unwanted publicity to overcome. After several years they were finally able to obtain the images, which revealed new insights into female anatomy during sexual arousal and confirmed the shape of the penis during “missionary position” intercourse (a boomerang).

The paper also has the honour of being the recipient of an Ig Nobel award. The prize is given each year by the Annals of Improbable Research for studies that are particularly unusual and imaginative. In her acceptance speech for the award, author and research participant Ida Sabelis described seeing the MRI images for the first time: “Not so much a passport photo for daily use but surely a shot that shows so much that it makes me speechless.”14

Perhaps unsurprisingly, given the focus on quirky research questions, several other Christmas BMJ papers have also received the prize (box 1). These papers have examined the effect of different foods on the appetite of leeches,15 explored the occupational hazards of sword swallowing,16 and assessed the predictive value of abdominal pain in people with appendicitis when they go over speed bumps.17

Box 1: Christmas BMJ papers awarded the Ig Nobel prize

  • Effect of ale, garlic, and soured cream on the appetite of leeches (winner 1994)15

  • Magnetic resonance imaging of male and female genitals during coitus and female sexual arousal (1999)13

  • Sword swallowing and its side effects (2006)16

  • Pain over speed bumps in diagnosis of acute appendicitis (2012)17

This small selection of Christmas articles is just a fraction of those in The BMJ archive, all of which have contributed to the festive issue becoming a much loved Christmas tradition over the past three decades. Long may it continue.


  • Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance: Not commissioned; not externally peer reviewed.

  • I thank Georgia Raniolo of Queen Mary’s University London, for her help going through The BMJ’s archive and compiling a list of papers of Christmas past, and Tony Delamothe.


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