Research Integrity vs Getting the Joke

In a recent letter to the British Medical Journal, Elaine and John Murphy confessed that their 1974 letter, in which they described a condition called “cellist’s scrotum”, had actually been a hoax, as humorous one-up-man-ship in response to a letter about “guitarist’s nipple”… which appears itself to have been another hoax! Responses to the letter were also witty, including a poetic reprimand, accounts of patients who had given up playing the cello following self-diagnosis (which may or may not have been truthful), and confession of another hoax study (on treatment of headlice) that is still indexed in Medline.

The lesson for readers is that publication in a prestigious journal is no reason for us to suspend our critical faculties. Anyone who actually watched a cellist perform should spot the physical impossibility of the condition. Similarly, anyone reading the paper on headlice should spot the spoof within the first sentence of the method… or even from the cultural reference to Charlie Brown in the name of the study (“PIGPEN”).

So, now the fun’s all cleared up, we can get on with the rest of our lives? Well, perhaps not… I don’t want to seem like a kill-joy; in fact, I’ve written several spoof articles for CRfocus over the years, plus the more overtly jokey “It’s Not All Work, Work, Work…” section at the back of issues since September 2008. The problem is that humour is subjective, and you need a certain level of awareness of the context of readers to be confident they’ll get the joke. Readers of the BMJ are smart, educated people, and within the immediate timeframe of publication they should get the joke… but some might not, and the further away you get from the cultural context of the joke (eg, non-musicians, people who didn’t grow up with the comic-strip culture of the 60s and 70s, non-medics who believe everything they read in medical journals etc.) the larger this latter group is going to get.

Medical literature is a permanent record, as much for the benefit of future physicians as for current ones. If an individual correspondent distorts this record with a hoax, it’s “all a bit of fun”… but if someone looks at a paper without the cultural background or the time to think critically about what they’re reading, patients could be treated differently as a result. If the letters had come from other sources, would “guitarist’s nipple” and “cellist’s scrotum” be considered disease mongering?

Is there a place for humour in medical journals? Can intelligent people with extensive shared knowledge and experience enjoy each other’s wit and feel more of a community as a result of shared jokes? I would like to think so, but perhaps with the addition of a “spoof” keyword to avoid anyone taking it too seriously… not to mention helping those of us who get the joke to find more things to laugh at…