Yes, Virginia, There Is a Santa Claus in the Medical Literature

The Great Santa Search (in PubMed)

 The definitive source for all things Santa (outside of PubMed).

The definitive source for all things Santa (outside of PubMed).

 Figures from the chapter "How Reindeer Fly."

Figures from the chapter "How Reindeer Fly."

Last year at Christmas, my parents gave me a reprint copy of a beloved book from my childhood: The Santa Claus Book by Alden Perkes, Ph.D.S. which we would borrow from the library and reference all December long. It’s filled with brief, academically minded chapters titled “Why Santa says ‘Ho, Ho, Ho!’,” “Why Santa Lives So Long,” “Loading the Sleigh,” and “How Reindeer Fly.” Each of these chapters had diagrams, figures, and even a list of cited sources. For a budding scientist like me, this book essentially closed the case on Santa: he is real; the proof is right there in that heavily referenced academic tome.

Now, as a medical editor, I have an appreciation for works cited and the credibility they lend to a concept beyond what I grasped as an 8-year-old. The academic literature is our vast, roiling, churning, yet ever-advancing body of human understanding about the world and ourselves. We rely on the academic literature to guide us, muck like Virginia O’Hanlon and her Papa relied on the certainty of anything printed in The Sun back in 1897. It was her Papa that told her to contact the editors of The Sun to set the record straight: Is there a Santa Claus?

The reply, written by Francis P. Church, is now iconic. Please read it if you’re unfamiliar with the response.

Today, I wondered what the academic literature says about Santa Claus. I went to that excellent resource, PubMed, and entered Santa Claus in the search bar and hit “Search.”

 A screenshot of on December 20, 2016.

A screenshot of on December 20, 2016.

At the time of this writing (when there are presents to wrap, holiday errands to run, administrative tasks, and other chores that might make better use of my time between editing projects), the search yielded 82 results, with articles dating back as far as 1950. Many of the studies in the search results have authors with either “Santa” or “Claus” in the name and have nothing to do with the famous old elf. However, more than a few academic, peer-reviewed articles do address Santa Claus, that famous and beloved Christmas gift-giver, and important aspects of his life.

Here are a few highlights from those articles, in order of publication.

Halvorsen O. Epidemiology of reindeer parasites. Parasitology Today. 1986;2(12):334-339.

Halvorsen and colleagues tackle the notable, if not troubling, aspects of the most famous reindeer nose in the world: the glowing, beacon-like red nose of Rudolph. The authors suspect a parasitic infection, which may provide an adequate explanation for a shiny red nose, but raises a whole host of questions about the sanitation and cleanliness of the live animal stables at the North Pole. Halvorsen notes, “The general consensus is that Rudolph has caught a cold, but as far as I know, no proper diagnosis has been made of his abnormal condition. I think that, rather than having a cold, Rudolph is suffering from a parasitic infection of his respiratory system. To some, this may seem a bit far-fetched as one would not expect an animal living with Santa Claus at the North Pole to be plagued by parasites, but I shall show otherwise.”

Grills NJ, Halyday B. Santa Claus: a public health pariah? BMJ. 2009;339:b5261.

This 2009 article from the British Medical Journal raises what appears to be the first of a series of studies examining Santa’s health. Grills and company write, “Santa studies is a developing field in public health, and currently, there is a disappointing lack of rigorous research…”

 Highfield M. "Here Comes Santa Claus": What is the evidence? Advanced Emergency Nursing. 2011; 33(4). [page numbers unknown].

This article in Advanced Emergency Nursing examines the strength of evidence regarding the existence of Santa Clause and the opportunities for “new descriptive correlation, or experimental research on SC.” The authors conclude that, while existing evidence generally supports Santa Claus, we may only reasonably conclude what F. Church wrote in 1897: “The most real things in the world are those that neither children nor men can see.”

Ince C, van Kuijen AM, Milstein DMJ, et al. Why Rudolph’s nose is red: observational study. BMJ. 2012;345:e8311

 From Ince Fig. 3: Infrared image of reindeer after treadmill test shows the presence of a red nose.

From Ince Fig. 3: Infrared image of reindeer after treadmill test shows the presence of a red nose.

This 2012 study conducted in Trosmo, Norway (“near the North Pole,” per the paper) and Amsterdam, Netherlands and published in the British Medical Journal revisits the cause of Rudolph’s red nose in a refutation of the 1986 paper in Parasitology Today. The new study was approved by the Norwegian Animal Research Authority of Norway for the reindeer experiments (Permit no 4414). Ince et al determine the heavy, rich vascularization (lots of tiny blood vessels) “highlight the intrinsic physiological properties of Rudolph’s legendary luminous red nose, which help to protect it from freezing during sleigh rides and to regulate the temperature of the reindeer’s brain, factors essential for flying reindeer pulling Santa Claus’s sleigh under extreme temperatures.” The authors even thank Santa Claus by name in the acknowledgments section of the paper, noting he was “keen to unravel the mystery of his friend’s nose.”  

Donath L, Roth R, Lichtenstein E, Elliot C, Zahner L, Faude O. Jeopardizing Christmas: Why spoiled kids and a tight schedule could make Santa Claus fall? Gait & Posture. 2015;41:745-749.

Donath’s 2015 paper in Gait & Posture takes a close look at potential dangers Santa faces given his age, weight, and the burden of heavy gifts in his bag while navigating dark and unfamiliar spaces. Essentially, they are afraid that Santa will fall and hurt himself in the line of duty. Donath and the researchers simulated Santa’s experience, and concluded that “Santa Claus faces tremendously increased risks of falling when carrying his Christmas sack with 20 kg of presents. Cognitive loads also impair his neuromuscular performance. It is recommended that Santa trains his strength and balance before Christmas and to avoid filling his sack with more than 20 kg of presents. Also, cognitive training may help improve his dual-task performance” (ie, checking his list while steering the sleigh). The authors are baffled by Santa’s appearance as a jolly, heavy-set old man. Their findings suggest “only a tough, healthy, and sporty Santa Claus could face the difficulties of the overnight global delivery of billions of toys: Steering a sleigh with high velocities (just below light speed), carrying heavy weights, motivating reindeer and managing a tight delivery schedule require a physical conditioning that is nothing short of a Greek God.” With this kind of flattery in print, I wouldn’t be surprised at all if Drs. Donath, Roth, Lichtenstein, Elliot, Zahner, and Faude all made out like bandits with piles of presents on that 2015 Christmas morning.

Straube S, Fan X. The occupational health of Santa Claus. Journal of Occupational Medicine and Toxicology. 2015;10:44-46.

This recent study suggests that previous publications in the field of Santa Studies have placed adequate focus the unique health and safety issues at Santa’s North Pole workshop. The study discusses sleigh safety and the transportation-related hazards not currently present for other workers in more regulated transportation industries. The authors wring their hands over the lack of seatbelts, airbags, and high-speed capabilities of the sleigh. They also worry that Santa must compete with increasingly congested airspace over major cities, and wonder if Rudolph’s famous red nose really does provide enough light to be an adequate beacon visible to other aircraft. If Santa should get into a wreck (the man has a perfect flying record for over a century, but I suppose is a first time for everything), the authors worry that the attending physician would be at a disadvantage given Santa’s health records are locked away at the North Pole. They worry about heat stress, when traveling through the tropics, for someone dressed for the arctic. They even discuss concerns over the ergonomics of the workshop: surely the work conditions tailored to elves would be cramped and restrictive to Santa’s movements, and they suggest these work conditions can cause progressive-onset musculoskeletal disorders for someone his size. The authors also note the psychiatric toll of being monitored by the government, stating the North American Aerospace Defence Command openly admits Santa’s December travels have been tracked since 1955. The authors conclude it’s time to “adopt an evidence-based approach to develop a comprehensive workplace occupational health program” for Santa, his reindeer, and his elves.

Evers JL. Santa Claus in the fertility clinic. Human Reproduction. 2016;31(7):1381-1382.

Despite the scandalous prospects of the title, this paper deals with what amounts to "therapeutic illusion"; the idea that a patient who will get better without treatment will also get better with treatment, causing the physician to attribute the recovery to his good decision-making and treatment choice as a physician.

To this, I say, “Leave Santa out of it.” Let’s move on.

Morley J, Taylor A. Is it time to retire Santa Claus? JAMDA. 2016;17(2):1069-1072.

Finally, this 2016 editorial in the Journal of the American Medical Directors Association seems to take an extreme stance: Retire Santa Claus. I know. I can hear you reacting the same way I did. The author states Santa is somewhere between 153 to 193 years old—well beyond retirement age, and states Santa receives no reimbursement for his labor of love (ie, Santa doesn’t work to make money), but points out that Santa has never released his tax returns, so “how can we be sure?”

Morely writes, “the main reason for the need to retire Santa Claus is he represents one of the major public health menaces in the world today.” I know, right? Morely goes on to mention Santa’s obesity and how he is inexplicably happy despite it. “Santa is no role model for the youth of America,” writes Morely. He implies Santa likely suffers from sleep apnea, mild cognitive impairment, and, get this, dementia. The author worries about deep vein thrombosis during the long flights over the Atlantic and Pacific oceans. Morely really paints a grim picture in one graphic example: Santa suffers a pulmonary embolus one Christmas Eve, leaving the sled to fly aimlessly through the sky until Rudolph and the exhausted reindeer crash into the ocean. The author suggests it’s time to retire Santa Claus to his rocking chair in his nursing home in the North Pole, and that his replacement should not be overweight, not smoke, have modern resources to prevent injury; Morely even suggests the new guy use a jet pack. This sounds like the author is suggesting Iron Man should take over as the new Santa.

Full disclosure: this article was behind a paywall, so I only had access to the first page. I hope, for the author’s sake, that this was either a prank to be revealed on the second page, or that the author, while writing, was visited by three spirits and/or points of statistically significant data causing a massive change of heart by the time he reached a conclusion. Retire Santa? As Church wrote, “How dreary would be the world if there were no Santa Claus…There would be no childlike faith then, no poetry, no romance to make tolerable this existence. We should have no enjoyment, except in sense and sight.”

The Point of All This

Despite some scientific uncertainty on the big question about Santa Claus, it’s safe to conclude that Santa is a topic of discussion within respected medical and academic literature. Santa, if you are reading this (of course you are), I know the thought of an international mob of white-coated doctors and researchers clamoring for access to your vitals is terrifying, but each of them is really a grown-up product of the joy you brought to them as children, and they only want to make sure you’ll be around for years to come.

Conflict of Interest: This author declares that, while reason and fact rule most of the year, deep in the foxhole of late night Christmas Eve, I am a True Believer.