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

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

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.