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A Case Study in Barbecue and Toothpicks

By Bret Stetka | 5.21.07

I've mentioned previously on the electronic pages of Litmus my affinity for swine – specifically swine in the form of barbecue. I'm most partial to the vinegar-heavy pulled stuff out of Carolina (the northern one of course) but am happy gorging on just about any variation, whether it be sweet and saucy Memphis chopped pork, tomato-y Kansas City baby backs, or mustard-soaked South Carolina pulled pork. And if you'll allow me another species, I'm also a sucker for Texas-style beef brisket. Really the only regional BBQ I don't like is Alabama’s, because mayonnaise is sometimes involved and mayonnaise is disgusting.

Now I know from experience that barbecuing is a science. Producing a fine piece of BBQed meat often requires a precise collaboration between cut selection, spice rubs, sauce, proper smoking technique, and last but not least, fat content. I recently slow-cooked a pork shoulder from which I'd removed much of the fat to see if there’s such a thing as healthier pulled pork. Well there is, it just tastes like ass. So you really have to respect procedural complexities of barbequology. And it’s precisely this near-scientific approach to carnivorism that has once again lead me to Pubmeditate on what the world’s science geeks have to say about barbecuing.

Medline returns a surprising 73 hits when I search for the term “barbecue,” mostly relating to the so-called “barbecue maneuver,” a head-rolling exercise effective in treating vertigo. But the remaining hits have me wondering how I’ve made it to the ripe old age of twenty eight having eaten so much ‘cue. It appears that both eating BBQed meat and participating in the ceremonious act of barbecuing are both highly dangerous behaviors.

First, a team of researchers out of Honolulu uncover what we already know: that the American diet sucks and gives us cancer, while the Asian diet leads to a long and happy malignancy-free existence. The Hawaiians demonstrated that cooking meat with traditional Asian marinades such as teriyaki and turmeric-garlic sauce greatly reduces the formation of heterocyclic aromatic amines (HAAs), a class of compounds produced when meat is cooked at a high temperature known to increase the risk of colorectal cancer. This anti-carcinogenic activity is thought to arise from inherent chemical properties in tumeric, garlic, and soy (a major component of teriyaki sauce) which the paper fails to describe in detail. Good old American barbecue sauce on the other hand actually increased HAA formation, most likely because the commercial brand used in the study was loaded with high-fructose corn syrup and honey. Both HFCS and honey contain fructose, which is a more efficient chemical precursor to HAA formation than sucrose (as found in plain sugar).

But not only is the meat a threat; it seems the barbecuing milieu itself is conducive to severe bodily harm. An article in a criminology journal reports on a thoracic stab wound caused by a barbecue skewer, an object which the authors conclude is a “non-typical stabbing tool” generally used “coincidentally in capital crimes.” But it gets better. And thus I’ll be focusing the remainder of this piece on a letter with perhaps the best journal publication title I’ve ever seen: “Right coronary perforation due to a toothpick ingested at a barbecue.”

In general, right coronary artery perforations aren’t funny – the coronary arteries are responsible for delivering blood and oxygen to the heart muscle, so perforating them is never a good idea – but come on, did the authors really have to specify in the title that the event occurred at a barbecue?! I should also mention that this letter appeared in the New England Journal of Medicine, perhaps the most widely respected medical journal in the world.

Here’s how it happened:

A 67 year-old women presented to the ER with chest pain, muffled heart sounds, low blood pressure and vasoconstriction (constriction of the blood vessels), all signs of cardiac tamponade, or the build up fluid in the cavity surrounding the heart to the point where heart function is impaired. An echocardiogram – essentially an ultrasound of the heart - detected massive amounts of fluid in the pericardial cavity and surgery was performed to remove what ended up being 600ml of clotted blood, equivalent in quantity to roughly 1.66 cans of Budweiser. At this point the culprit was identified. It seems an ingested toothpick had passed through the stomach wall, the diaphragm and the pericardium (the fibrous sac surrounding the heart), before puncturing the women’s right coronary artery. The bleeding was stopped, an arterial bypass procedure was performed, and the patient recovered.

The authors then expound on some shocking toothpick statistics. Apparently a survey published in JAMA in the early 80s found 8176 reported toothpick-related injuries occurring between 1979 and 1982, five percent of which involved internal organs. A second Medline search for “toothpick injury” reveals 97 hits! It seems toothpicks are even more dangerous than barbecue skewers, over the years conspiring against humans to cause all sorts of bodily devastation, from gastric wall abscesses, to inflammatory tumors of the liver, even septic arthritis of the knee due to a toothpick stab wound. But back to the case.

Upon questioning, the women remembered eating meat rolls (not sure what these are) held together by toothpicks at a barbecue the previous night. And while I’m sincerely relieved the patient recovered from this strange and tragic occurrence, I must respectfully acknowledge the ridiculousness of the case, highlighted by this insightful and informative gem dropped by the authors in final sentence of their correspondence: “This unusual case emphasizes the uncommon but serious hazards associated with the ingestion of toothpicks.”

No comment.

Recipe adapted from here.


PubMed is the search engine of choice for most scientists and doctors, and is the reason why science libraries are usually empty these days. With archives of abstracts that go back decades and links to full journal article PDF files, PubMed is the gateway to science history, the tool for inflating your reference list, or making the painful discovery that your experiment has already been done. For this recurring column, we exploit its power for fun and mischief.

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