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Press releases Saturday 23 - 30 December 2006

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's web site (http://bmj.com).

(1) Sword swallowers more likely to be injured when distracted or swallowing ±unusual± swords

(2) Surgeons are taller and better looking than other doctors

(3) Mistletoe is not an anti-cancer drug, say doctors

(4) Why are Danes the world±s happiest nation?

(5) Five new technologies that promise to transform medicine

(6) Strong emotions in Shakespeare±s plays lead to fits and fatalities

(1) Sword swallowers more likely to be injured when distracted or swallowing ±unusual± swords
(Sword swallowing and its side effects)
http://www.bmj.com/cgi/content/full/333/7582/1285

Sword swallowers are more likely to sustain an injury ± such as a perforation of the oesophagus ± if they are distracted or are using multiple or unusual swords, finds a study in this week±s Christmas issue of the BMJ.

Sword swallowers who can swallow a non-retractable solid steel blade at least two centimetres wide and 38 centimetres long are recognised by the SSAI (Sword Swallowers± Association International). Despite the obvious dangers of the profession, English medical literature contains only two case reports of injury resulting from sword swallowing.

The authors set out to explore the techniques and side-effects of sword swallowing. Forty-six SSAI members took part in the study, 19 had experienced sore throats whilst learning, many had suffered lower chest pain following some performances, and six had suffered perforation of the pharynx and oesophagus, one other was told a sword had ±brushed± the heart.

The research found that these injuries occurred either when swallowers used multiple or unusual swords, or when they were distracted. For example one swallower lacerated his pharynx when trying to swallow a curved sabre whilst another suffered lacerations after being distracted by a ±misbehaving± macaw on his shoulder.

The average age of those taking part in the study was 31, most were self-taught and had learnt the skill at an average age of 25 years, with nine learning the skill as teenagers. There was no apparent correlation between height and the length of sword swallowed and the longest sword swallowed was 60 centimetres.

The cost of medical care was a concern for the group, with three members receiving medical bills ranging from ±12,000 ± ±37,000 (23,000 ± 70,000 US dollars).

Contact:
Brian Witcombe, Consultant Radiologist, Gloucestershire Royal NHS Foundation Trust, Gloucester, UK
Email: brian.witcombe@glos.nhs.uk


(2) Surgeons are taller and better looking than other doctors
(Phenotypic differences between male physicians, surgeons and film stars: comparative study)
http://www.bmj.com/cgi/content/full/333/7582/1291

Surgeons are taller and more handsome than physicians, finds a study in this week±s Christmas issue of the BMJ.

Doctors at the University of Barcelona Hospital noticed that the tallest and most handsome male students were more likely to go for surgery, and the shortest (and perhaps not so good looking) ones were more likely to become physicians.

So they decided to test the theory that, on average, surgeons are taller and better looking than physicians.

They selected a random sample of 12 surgeons and 12 physicians from the hospital plus four external controls (well known film stars who played surgeons or physicians). All subjects were matched by age (52 +/- 7 years) and sex (all men), their height was recorded and they were asked to submit a digital picture.

Pictures of all subjects were then randomly organised and shown to an independent group of eight female observers (all in the same age group as the study subjects). Observers used the ±good looking score± to classify each participant (ranging from 1, ugly to 7, very good looking).

The results show that, on average, senior male surgeons are significantly taller and better looking than senior male physicians. They also show that film stars who play doctors are significantly better looking than real surgeons and physicians.

There are several potential explanations for these findings, say the authors. For example, surgeons spend a lot of time in operating rooms, which are cleaner, cooler, and have a higher oxygen content than the average medical ward, where physicians spend most of their time. They also often wear clog-type shoes that adds 2-3 cm to their perceived height.

In contrast, physicians have a tendency to hang heavy stethoscopes around their necks, which bows their heads forward and reduces their perceived height.

Further studies are needed to assess if these findings also apply to junior male surgeons and physicians, as well as to senior and junior female staff, they add.

Contact:
Antoni Trilla, Director, Hospital Clinic - University of Barcelona, Villarroel, Barcelona, Spain
Email: atrilla@clinic.ub.es


(3) Mistletoe is not an anti-cancer drug, say doctors
(Case report: Subcutaneous inflammation mimicking metastatic malignancy induced by injection of mistletoe extract)
http://www.bmj.com/cgi/content/full/333/7582/1293
(Editorial: Mistletoe as a treatment for cancer)
http://www.bmj.com/cgi/content/full/333/7582/1282

The belief that mistletoe can help treat cancer is a myth which can cause harm, warn doctors in this week±s Christmas issue of the BMJ.

The warning follows the case of a cancer patient who attended hospital with a tumour-like growth under the skin induced by mistletoe.

Some patients with cancer inject themselves mistletoe extract in the hope of improving their condition, writes complementary medicine expert, Professor Edzard Ernst in an accompanying editorial. In continental Europe, at least 30 different mistletoe preparations are available and in Germany, the insurance system pays for this treatment. A Google search also showed that 145,000 websites promote or mention mistletoe as a treatment for cancer.

So, is mistletoe an effective anticancer drug and how safe is it?

The theory that mistletoe might help treat cancer is based on the fact that, like cancer, mistletoe is a parasitic growth that eventually kills its host, says Ernst. Despite the implausibility of this idea, studies have shown that mistletoe or its main constituents do have anticancer activity. However, many plants have some sort of anticancer activity, but in most cases the compounds cannot be used.

Proponents claim that regular injections of mistletoe extract improve the natural course of cancer by slowing down or stopping tumour growth and improve quality of life.

Yet a wide range of serious adverse reactions have been noted, such as anaphylaxis, breathing difficulties, joint pain and kidney failure. Some studies even suggest that mistletoe extract may enhance the proliferation of some cancers.

So the claim that mistletoe injections have no serious risks is misleading, argues Ernst.

Mistletoe has been tested extensively as a treatment for cancer, but the most reliable trials fail to show benefit, and some reports show considerable potential for harm. The costs of regular mistletoe injections are also high.

He therefore recommends mistletoe as a Christmas decoration and for kissing under but not as an anticancer drug.

Contacts:
Case report: Alison Finall, Specialist Registrar, Department of Histopathology, University Hospital of Wales, Cardiff and Vale NHS Trust, Cardiff, Wales
Email: alison.finall@cardiffandvale.wales.nhs.uk

Editorial: Edzard Ernst, Professor of Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK
Email: edzard.ernst@pms.ac.uk


(4) Why are Danes the world±s happiest nation?
(Why Danes are smug: comparative study of life satisfaction in the European Union)
http://www.bmj.com/cgi/content/full/333/7582/1289

Earlier this year, Denmark came top in a world map of happiness (the UK ranked 41st out of 178 nations). And for more than 30 years it has ranked first in European satisfaction surveys. So what makes Danes so content?

Researchers in this week±s Christmas issue of the BMJ decided to find out why life satisfaction in Denmark substantially exceeds that in Sweden and Finland, the two countries most similar to Denmark.

Their hypotheses range from the unlikely (hair colour, genes, food and language) to the more plausible, such as family life, health and a prosperous economy.

However, their analysis points to two explanatory factors. Firstly, winning the 1992 European Football Championship put Danes in such a state of euphoria that the country has not been the same since. This may explain the high level of life satisfaction in Denmark after 1992, they write.

Secondly, while Danes are very satisfied, their expectations for the coming year are rather low. In contrast, Italy and Greece, which rank low on life satisfaction, rank high on expectations for the year to come, together with Swedes and Finns.

The causes of the stolid depth of Danish wellbeing are undoubtedly multifactorial, they say. The Danish football triumph of 1992 has had a lasting impact, but the satisfaction of the Danes began well before 1992, albeit at a more moderate level. The key factor that explains this, and that differentiates Danes from Swedes and Finns, seems to be that Danes have consistently low (and realistic) expectations for the year to come.

So the key to happiness may lie in the fact that if you lower your expectations enough you might feel a bit better next Christmas, they conclude.

Contact:
Professor Kaare Christensen, Danish Twin Registry, Institute of Public Health, University of Southern Denmark, Odense, Denmark
Email: kchristensen@health.sdu.dk



(5) Five new technologies that promise to transform medicine
(Five startling technologies promise to transform medicine)
http://www.bmj.com/cgi/content/full/333/7582/1308

Fat zapping to shed excess weight, miniature telescopes to restore vision, and smart nappies to detect common childhood infections: these are some of the new technologies that promise to transform medicine, according to this week±s Christmas issue of the BMJ.

The forecasts are made by Professor Donald Combs of the Eastern Virginia Medical School and are based on existing technologies that are in varying stages of development and on extensions of those technologies.

His vision for the future includes airport x-ray style devices that ±fry± excess fat with a laser. An overweight patient simply walks through the device and emerges several pounds lighter. No side effects are seen apart from the resizing of his wardrobe.

Patients with chronic diseases who need regular medication will benefit from a miniature implant that monitors and transmits data on heart and breathing rates, blood pressure, and blood sugar levels. And further into the future are links smart pumps that, when signalled, instantly deliver the correct medication.

Another prediction is the use of miniature telescopes that restore vision for patients with degenerative eye disease. The telescopes are powered by sunlight passing through the pupils to microscopic solar battery panels attached to the retinas.

These scenarios illustrate potential clinical applications of technologies currently under development, says Professor Combs. For instance, devices that can sense and transmit heart and breathing rates already exist and implantable lenses are well-known.

Other emerging technologies include wave technology to isolate cancer cells, fabrication technology to manufacture customised body parts, and the use of miniature robots to track and destroy infections before they cause disease.

The individual and collective impact of these technologies is already present in some aspects of contemporary medicine and the rate of their impact is increasing, he concludes.

Contact:
Professor Donald Combs, Associate Dean, Eastern Virginia Medical School, Norfolk, Virginia, USA
Email: combscd@evms.edu



(6) Strong emotions in Shakespeare±s plays lead to fits and fatalities
(Faints, fits and fatalities from emotion in Shakespeare±s characters: a survey of the canon)
http://www.bmj.com/cgi/content/full/333/7582/1335

Shakespearean characters experiencing strong emotions are prone to fits, faints and even death, according to research published in this week±s Christmas issue of the BMJ.

A review of all 39 canonical plays and three narrative poems by Shakespeare show ten deaths from grief (three on stage), with another 29 emotionally-induced deaths also mentioned by Shakespeare±s characters. Transient loss of consciousness is staged or reported in 18 cases and near-fainting in a further 13.

The author argues that whilst Shakespeare±s tendency to attribute faints and death to strong emotions reflects an early modern belief system, the dramatic effects of emotions in his plays are also plausible today. For example, the author points to a group of diseases ± ±ion channelopathies± which can lead to sudden death if a person is startled (Long QT syndrome) or while a person is suffering emotional stress.

The author argues that whilst Shakespeare was working at a time when it was widely believed that strong emotions could have dramatic or even fatal effects, the works of the Bard still have a relevant message for today±s doctors ± never underestimate the power of emotions to disturb bodily functions.

Contact:
Dr Kenneth Heaton, Formerly Reader in Medicine, University of Bristol, UK
Email: kenheaton@compuserve.com

Please note, this is a double issue. The next issue of the BMJ will be 6 January 2007


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