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See Inside March 2008

Nothing to Sneeze At

And other interesting results from researchers with some operating room



Illustration by Matt Collins

It’s a problem faced by Yogi Berra, welders and surgeons: How do you sneeze with a mask covering your face? Catchers and welders, however, only have to deal with the unpleasant bounce-back effect. Surgeons need to worry about ejecting multitudinous microbes directly into the gaping hole they’ve carved in a patient. Not good. And with “uh-oh” being among the worst words a surgeon can say at work (“Where’s my watch?” is also bad, as is the simple and direct “oops”), how best then to avoid an uh-oh following an achoo?

The answer to this and other pressing questions in science and medicine can be found in the year-end issue of the British Medical Journal, well known for its unusual array of offbeat articles. (Had the Puritans never left Britain for New England, they might later have fled the British Medical Journal to found the New England Journal of Medicine.)

First, the case of the surgical sneeze. The accepted wisdom was that the surgeon should in fact sneeze facing the area being operated on—because the mask will redirect the ejecta and send it backward out of the sides of the mask, away from the open wound. But two plastic surgeons from a British hospital checked the literature and found no actual evidence that the masked sneeze did in fact fling the phlegm sideways. They thus phlegmatically set out to test the hypothesis, using high-speed photography and some finely ground pepper to encourage sneezing by masked volunteers.

The result: very little of the blast escapes out the sides, and a bit sneaks out of the bottom, onto the surgeon’s upper chest. Most of the debris appears to stay safely within the doctor’s domain, leaving the patient pristine. Unable to offer any clear direction to surgeons, the authors offer these clear directions:

 “Surgeons should follow their instincts when sneezing during operations.” One might call such instruction the gesundheit of reason.

BMJ also featured a review of commonly held medical myths that showed that the drowsiness commonly induced by the Thanksgiving meal is probably not a function of the tryptophan in the turkey. That amino acid has been getting a bad rap for years for Uncle Dave’s open-belted couch coma during the second game of the turkey-day NFL doubleheader. But a given weight of turkey actually has the same amount of tryptophan as does chicken and beef, whereas pork and cheese have even more. In reality, any big meal diverts blood, and therefore oxygen, from the brain, inducing sleepiness. And, as the authors point out, “wine may also play a role.”

In a short item entitled “A Day in the Life of a Doctor: The PowerPoint Presentation,” two British physicians reveal that “the main purpose of a PowerPoint presentation is entertainment. Intellectual content is an unwarranted distraction.” They go on to advise that “the more lines of writing that can be coerced onto a slide and the smaller the font, the lower the risk of anyone criticising any data which has accidentally been included” and that “the number of slides you can show in your allotted time is inversely proportional to the number of awkward questions which can be asked at the end.”

Then there was a study that questioned the efficacy and purpose of the intensive screening of travelers at airports. The researchers, from Harvard University, the Massachusetts Institute of Technology and the Washington University School of Medicine in St. Louis, note that no scientific evaluation has ever been done of the “screening tools currently in place.” They ask the arch yet brief question, “Can you hide anything in your shoes that you cannot hide in your underwear?” And they point out that spending on “airport security ($9 per passenger) is 1,000 times higher than for railway security ($0.01 per passenger), even though the number of attacks on trains is similar to that in planes.” Which, they explain, is “analogous to committing mammography resources to screening only the left breast.” Indeed, whenever I fly and see signs at the airport claiming that the risk of a terrorist attack that day is “high,” I think, “Compared to what?” I don’t say it out loud, of course, because I want to be allowed to board my flight. 

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