“A word to the wise ain’t necessary, it’s the stupid ones who need the advice.”

– Bill Cosby

In one of her most recent Dear Abby letters, Jeanne Philips (aka “Abby”) received a letter from a certified operating-room nurse regarding the risks of tongue piercing. Philips, adding a better safe than sorry response posted the letter to her column which ran with a large headline proclaiming “tongue rings can lead to heart surgery”.

Dear Abby is syndicated in over 1,200 papers and has a readership of approximately 95 million people, who all just got collectively stupider because of her largely unquestioning parroting of this misleading nurse’s claims.

According to the nurse, Karen Murphy from Morten Plant Hospital in Florida, “tongue studs can lead to endocarditis” in “otherwise healthy young people”. Saying that tongue piercing can lead to heart disease is like saying that having a dog can lead to fatal allergic response — yes, it’s true, but you have to have a pre-existing medical condition. In my example, you have to have a pet dander-type allergy, and in Murphy’s tongue piercing example, you have to have already have a valvular heart disease. It is extremely rare for endocarditis to affect someone who doesn’t already suffer from heart disease, and those that are tend to be older with already failing health.

Endocarditis is usually caused by a staph or strep infection, which admittedly are the types of bacteria common with body piercing infections. If an infection from a piercing has these bacteria enter the bloodstream (which is certainly possible from tongue piercing), those bacteria can lodge in the heart’s lining or valves. If the person has congenital heart defects, problems with the heart musculature such as hypertrophic cardiomyopathy, valve damage from diseases such as rhematic fever, or artificial heart valves, they are at risk of these infections. Anything that can cause oral injury — even teeth cleaning — requires the individual to first take a course of antibiotics to reduce their risk level. Other injuries (even papercuts) can lead to endocarditis in these individuals. Luckily, according to the American Heart Association (americanheart.org), endocarditis is extremely rare in people who do not suffer from the heart conditions I’ve just mentioned.

To be very clear, telling normal people that they shouldn’t get tongue piercings because of the risk of heart surgery is like telling them they should stop going to the dentist for the same reason! While it is important to point out that the Dear Abby column did disclaim in their response that they’d been informed by the AHA that only “certain individuals, people with a medical history of rheumatic fever or rheumatic valve disease — or any heart valve disease” are at risk, Jeanne still concluded that all her readers are “better to be safe than sorry”. Given the screaming headline and the page real-estate given to the misleading nurse, it is safe to assume that this will be yet another thing that will make educators, legislators, and parents behave even more ignorantly toward body piercing.

Estimating from body jewelry sales (straight ¾” and ½” barbells are almost all used for tongue piercing), there are millions of people with tongue piercings, and only a handful of those have had this complication, whereas the rate of infective endocarditis in the general public is between 1.7 and 4 per 100,000 — meaning there is no statistical evidence that tongue piercing leads to health complications in any meaningful numbers.

I have a letter I think I need to mail in.

Dear Abby,

Should I go outside? Every year, approximately one thousand people in the United States are struck by lightning, and about a hundred of them are actually killed! You recently said that “otherwise healthy” people might be “better safe than sorry” and should avoid tongue piercing because of the risk. Given that going outdoors — or using the telephone while it’s raining out — is far, far, far more dangerous, surely you must agree that it would be best if I didn’t go to work today.

Frank O’Derby

PS. I’m a little concerned that three hundred people have died from bee stings over the past couple decades. Do you think it would be a good idea to ask my Senator to ban honey?

There’s one thing the world desperately needs more of, and that’s common sense. It’s one thing to expect without fulfillment that Ms. Dear Abby had the “uncommon common sense and youthful perspective” she claims to have, but entirely another thing to wish that the OR nurses had it as well. If they can’t think clearly about tongue piercing, can we really trust nurses like Karen Murphy to think clearly about our emergency health care?

Note to self: don’t get hurt in Clearwater, Florida.

Shannon Larratt
BME.com