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The madcap in medical research

From MRIs of sexual intercourse, to which specialties are more likely to receive speeding tickets, the BMJ Christmas issues have it all

he annual British Medical Journal (BMJ) double issue is where the learned journal allows itself a certain latitude by encouraging researchers to submit some offbeat studies. Forget large sample sizes and peer review: To get published in this edition requires originality and more than a modicum of zaniness.

The question of what makes a BMJ Christmas paper remains as mysterious as ever. Those who select them will usually say that they know one when they see one, which exasperates authors whose Christmas submissions have been rejected.

And while sexual intercourse isn’t a common topic for a Christmas article (sex makes up just 5 per cent of Christmas article topics), one festive piece with a sexual theme remains one of the most downloaded BMJ articles of all time.

This year marks the 20th anniversary of the publication of ‘Magnetic resonance imaging of male and female genitals during coitus and female sexual arousal’.

My first reaction to the title is, why would you bother?

The main findings, based on 13 experiments performed with eight couples and three single women, were that during intercourse in the ‘missionary position’, the penis is neither straight nor ‘S’-shaped, as had been previously thought, but is in fact the shape of a boomerang.

What’s more, during female sexual arousal, the size of the uterus does not increase, as had been previously reported.

The researchers concluded that taking magnetic resonance images (MRIs) of the male and female genitals during sexual intercourse is feasible and adds to our knowledge of anatomy.

According to the features editor at the time, Tony Delamothe, nobody at The BMJ thought the study, which also won an IgNobel award, was particularly useful clinically or scientifically, but it contained “a striking image using a new technology, and everyone agreed that readers might be interested to see it”.

However, it turned out the main draw was among lay readers. Delamothe reckons that the prospect of seeing coitus on screen (for free) was the attraction, even if all that was on offer was a series of black and white still photographs. 

“If that’s the explanation, it’s hard to think ourselves back to such an innocent age, given today’s explicit online offerings,” he says.

He points out that the IgNobel awards are given to articles that make you smile, then think. How much thinking this article has occasioned since publication is moot, he writes. But it appears to be still making people smile and laugh.

The annual BMJ edition is usually good for research that pits specialist against specialist. This year, US researchers set out to determine whether fast driving, luxury car ownership, and leniency by police officers differ across medical specialties. 

Their principal finding was that psychiatrists are most likely to be fined for extreme speeding, while cardiologists are most likely to drive luxury cars.

Many people believe that medical specialty choices are associated with certain personalities. And so car ownership and driving behaviour tend to follow the usual stereotypes — neurosurgeons are speed merchants, while those in procedure-heavy specialities such as cardiology and gastroenterology can afford to drive the most luxurious of car models. One would have thought psychiatrists would be meek drivers of small cars.

The study findings are based on 5,372 physicians and 19,639 non-physicians issued with a speeding ticket in Florida from 2004 to 2017. Extreme speeding was defined as driving 20mph above the speed limit (!), and luxury car ownership included makes such as Audi, BMW, Ferrari, Maserati and Porsche.

Among doctors who received a ticket, psychiatrists were most likely to be fined for extreme speeding. Only 18.5 per cent of tickets were issued to women, despite women comprising one-third of physicians in the US.

Among drivers who received a ticket, luxury car ownership was most common among cardiologists (40 per cent) and least common among doctors in emergency medicine, family practice, paediatrics, general surgery, and psychiatry (21 per cent). And there was no difference in leniency by police officers across medical specialities or between doctors and lay drivers.

As an observational study, it can’t establish cause, and results may not apply to countries with different driving cultures or policing practices. I wonder what would readers expect from a similar study of Irish doctors?

Truth be told, this year’s BMJ special was less than exciting. So if you have any ideas for a bit of madcap research, now might be the time to dust it off for the 2020 edition.

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