Odd this day
It’s the sixth anniversary today of the publication of the learned scientific paper ‘Everything is awesome: Don’t forget the Lego’ in the Journal of Paediatrics and Child Health, which told how six “paediatric health-care professionals were recruited to swallow a Lego head”, and to measure how long it took to pass through their digestive systems.
The heroes of this tale are Andrew Tagg, Damian Roland, Grace Leo, Katie Knight, Henry Goldstein, and Tessa Davis, and it begins with Tagg giving a lecture at a children’s hospital “about the danger of swallowing or ingesting foreign bodies”. Unfortunately, of the 300 people at the event, only 15 were at Tagg’s talk about how — as the paper points out:
1. Children frequently ingest foreign objects.
2. Parents worry about transit times and complications from ingestion.
Not only did he want to get his message Out There a bit more, he and his colleagues also really, really wanted to get into the Christmas issue of the BMJ. Normally a fairly straight-faced publication, as you can probably imagine, the festive edition is legendary in the medical community for still being proper science-y but also for letting its hair down a bit. One paper in the 2017 issue, for example, investigated whether Doctor Brown Bear, the GP on Peppa Pig, contributes to unrealistic expectations of primary care in his practice, such as the time he turned on the sirens of an emergency vehicle on his way to see a 3-year-old pony who had coughed three times.
These two strands of thought came together, and Tagg suggested to his friends/colleagues that they each swallow a Lego head and see how long it took to… re-emerge, blinking into the light.
A 1971 paper in the BMJ, the arguably less snappily titled Management of Ingested Foreign Bodies in Childhood, had shown
that most coins pass within 3.1–5.8 days with no adverse effects. The authors wondered if smaller, lighter toy parts might pass more rapidly and with a similar safety profile.
Tagg et al. were building on this, and on the fact that
There has been a noble tradition of self-experimentation in the field of medicine
(citing the guy who swallowed Helicobacter pylori to prove that it was that that caused stomach ulcers). So, they all agreed, quite rightly, that this was a marvellous plan, and each of them did indeed (after a little planning) swallow a Lego head. Presumably they were grateful not to be living in the 1970s like the coins guy...
In the planning stages, Henry Goldstein devised a couple of acronyms to make the findings more… accessible to a general audience, let’s say:
To standardise bowel habit between participants, we developed a Stool Hardness and Transit (SHAT) score to look at stool consistency over time … The primary outcome was the Found and Retrieved Time (FART) score.
…in fact, one of the pleasures of reading the paper is the way it walks the fine line between the language of academic research and “here’s a story about shit”. I particularly like this bit, for example:
Post-ingestion, stools were monitored and examined in search of the excreted item. The search was conducted on an individual basis, and search technique was decided by the participant.
An oral history of the experiment describes a preliminary
long discussion about the most effective way to find the Lego head. I would say we had pages and pages and pages of communication, which easily could have been an entire other paper on what is the most effective way to catch a poo.
One of our protagonists, Tessa Davis, used the cardboard vomit bowls you find in hospitals.
I basically mashed up the poo to try and find the Lego head. It was really disgusting. Thankfully mine was in my second poo.
Another, Katie Knight, also used a vomit bowl, but transferred her poo into
a Ziploc bag, so it was all sealed but the bag was see-through. You could push around to find the Lego head.
For some inexplicable reason, Goldstein
committed our family’s best flour sieve … and decided that I was going to use chopsticks to search through … There was some unhappiness about using the sieve. It was a good sieve.
When his Lego head emerged, he took a photo and shared it with the group. Damian Roland’s response to this is:
Yes. I remember that.
Which seems unsurprising. Anyway, the paper’s conclusions are that it takes 1–3 days for a Lego head to pass through an adult, and that “This should offer reassurance for parents … who may worry that transit times may be prolonged and potentially painful for their children”. None of the scientists appeared to experience any discomfort at all. Well, no physical discomfort. When it came to his turd, Damian Roland
kind of looked at it, maybe prodded it around, but I certainly wasn’t going to open up the poo to see if it was inside
…and has never been allowed to forget the fact that he didn’t return the crucial data. Still, that was as nothing compared to the chagrin of the group as a whole when
The Christmas BMJ said no outright.
Several other journals turned them down, too, before the Journal of Pediatrics and Child Health finally did the right thing and brought the paper to public attention. It proved to be a very popular piece of research. You can still see Dr Roland on the BBC website describing their work:
(The only distressing thing about this for me is that my sainted consultant paediatrician grandmother wasn’t alive to see it. She once proudly told me of a day when she took a jar into her colleague’s office. It was quite a large jar, and was filled almost to the brim with a tapeworm which one of her young patients had just ‘passed’. She placed it on the chap’s desk with the words “What do you make of that?”, and he looked at it thoughtfully for some time before pronouncing: “I hope it’s not spaghetti for lunch”. No, that wasn’t strictly relevant, was it? But it is about things passing through children, and concerns doctors, and I like it, and it’s my blog. So.)
