There are warnings everywhere. A label on my toaster declares that I should beware of hot surfaces. My peanut package warns of the possible presence of peanuts inside. And in London, while using the tube (the underground train), the overhead system constantly reminded me to mind the gap (between the platform and the train, that is).
Therefore, I was not completely taken by surprise when I read that the universe of warnings has recently expanded to include two human activities that are usually associated with joy.
R. E. Ferner, an honorary professor of clinical pharmacology from the UK, embarked on a mission to explore the benefits and harmful effects of laughter. The results were recently published in the Christmas edition of the distinguished British Medical Journal.
Shahar Madjar, M.D.
Ferner searched the medical literature using the search term 'laugh' and found not less than 4,961 scientific articles. Then, articles by researchers by the names 'Laughing', 'Laughter' and 'Laughton' were removed from the analysis and so were other irrelevant articles including research on the Caribbean sponge prosuberites laughlini.
After reviewing the remaining articles, Ferner concluded that the potential benefits associated with hearty laughter include a decrease in the levels of anxiety, depression and anger, and a reduced risk of myocardial infarction (a heart attack).
Turning to examine the potential harms of laughter, the distinguished professor declared that the results were no laughing matter, or to put it in Ferner's words: "laughter is no joke." The potential complications caused by laughter on the heart, for example, include the development of a syncope, cardiac arrhythmias, cardiac rupture, asystolic arrest, and even death.
There are also potential negative effects on the respiratory system (triggering an asthma attack, for example), on the central nervous system (cataplexy or sudden loss of muscle tone, and even a cerebral infarct), the gastrointestinal tract and the urinary tract. It seems that no system in our body is immune to the devastating effects of laughter.
The good news, though, is that these severe adverse events have been rare, have usually occurred in patients with medical conditions that made them susceptible to such complications, and have taken place only after an episode of intense and sustained laughter.
Professor Ferner's article itself is entertaining. Reading it, I found myself smiling at first, then giggling, and then bursting into short, syncopal episodes of rumbling laughter. In short, I almost fell victim to some of the more serious harmful effects so well described in the article.
It seems that laughter is not the only pleasurable human activity that carries rare, yet significant risks; for another article, from the University Department of Emergency Medicine in Bern, Switzerland, suggests that sexual activity may lead to side effects so serious that you may end up in a hospital bed.
Altogether 445 patients with sexual activity-related emergency department admissions were studied. More men than women were injured during sexual activity and most were young - the oldest individuals in the study were a 71-year-old man, and a 70-year-old woman. Some patients presented with the usual, expected side effects that are occasionally associated with sexual intercourse - bladder infection, urethritis and sexually transmitted disease.
Others presented with serious complications such as cardiovascular emergencies or trauma. More peculiar injuries associated with sexual activity included injuries sustained in patients who seemed to have used their head for other than its intended purpose: 27 patients presented with a simple headache, but 12 had subarachnoid hemorrhage, and 11 suffered from transient global amnesia (perhaps some experiences are better left forgotten). "Sexual activity," the authors claimed, "is mechanically dangerous, potentially infectious, and stressful for the cardiovascular system."
In the sea of warnings around us, one should design a strategy to stay afloat. I ask myself what risks should be ignored, and which should be considered an unavoidable cost of participation in the business called life. What action should we take in order to avoid the risks presented in these articles? Should we wear a frown rather than an occasional burst of hearty laughter? Should we be wearing a helmet in the bedroom?
In order to stay afloat in the perpetually expanding sea of warnings, I always mind the gap, the gap between the risks we have come to know, and those which are worthwhile avoiding.
Editor's note: Dr. Shahar Madjar is a urologist at Bell Hospital in Ishpeming. Read and comment on prior columns by Dr. Madjar at DrMadjar.com.