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Feature Christmas 2020: The Citadel

Harms and the Xmas factor

BMJ 2020; 371 doi: (Published 16 December 2020) Cite this as: BMJ 2020;371:m4067
  1. Robin E Ferner, honorary professor of clinical pharmacology1,
  2. Jeffrey K Aronson, consultant physician and clinical pharmacologist2
  1. 1University of Birmingham, UK
  2. 2Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
  1. Correspondence to R Ferner r.e.ferner{at}

The Christmas season is associated with preventable harms from cards, tree decorations, and presents, as well as overeating and overdrinking. Given the balance of benefits and harms, Christmas may not be cost effective.

We hope you’re well, that you’ve posted the last of your Christmas cards, decorated the house, and settled down before the fire. Days of feasting and merriment beckon. But what of the harms? A rummage through the archives confirms the existence of several festive health risks.

In our foraging, we ignored Christmas disease (haemophilia B), and reports by authors named Christmas, Chrismas [sic], or Noel. We also ignored festively inspired acronyms such as NO Effect Level and Natural Orifice EndoLuminal technique. Nevertheless, our findings raise concerns.

Causes of Christmas harms

Christmas cards are a source of potential harm. In 1876 a young man painted large festive cards “with colours chiefly of a bright green” and developed acute arsenic poisoning. The paint was Scheele’s Green, copper hydrogen arsenite.1 Posting cards is also dangerous, as the spring-loaded flap of a letter box can amputate the finger tip.2

A Christmas break may be just that, after falls either in the home3 or outside while decking the house with Christmas lights4—a …

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