The Fist Bump Manifesto

Bumping fists has a negative bro-stigma, but it's better than shaking hands—in that it transmits significantly fewer bacteria. At a time of global concern that our antibiotics are becoming obsolete, new research shows how fist bumping could save lives.
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Bacterial cultures of a hand (top) and fist (bottom) after 20 handshakes and 20 fist bumps, respectively (Journal of Hospital Infections)

"Closed-fist high-fives." In 2008, that's how a wide-eyed New York Times article described the confounding gesture Barack Obama was sharing with members of the media on the campaign trail, and later, famously, his wife.

The world, though, had for years been calling this a fist bump. (Or, Wikipedia offers: "dap, pound, fist pound, bro fist, spudding, fo' knucks, box, bust, pound dogg, props, bones, or respect knuckles.")

The origin of the fist bump is a subject of concentrated but heated disagreement. Many narratives center on athletics, with historians of various sports claiming the fist bump as their creation. Athletes wanted to minimize the risk of dislocating a finger in a passing or celebratory handshake. The more aggressive, less formal fist bump was better suited to the cause, and it continues to evoke machismo and bro-ness.

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Yahoo CEO Carol Bartz tried a fist bump with Nokia CEO Olli-Pekka Kallasvuo in 2010. (Chip East/Reuters)

It is being re-appropriated gradually.

Rejecting the patriarchy aside, the fist bump has science behind it—reason to hasten its integration as a formal gesture of gender-neutral respect. The handshake, its alternative, is unsanitary. The handshake is outdated in most places, born of a time when we might all be expected to be concealing sabers. It would make more sense for us to casually intertwine almost any other part of our bodies with those of strangers, lips and genitals the notable exceptions.

In research published recently by The Journal of Hospital Infection, surgeons at the West Virginia University set out to see if they can reduce the spread of infection by fist bumping instead of shaking hands.

Tom McClellan, the lead researcher, is a web-savvy West Virginia plastic surgeon. McClellan is the increasingly common Internet-present physician: He has a Tumblr, spends "a lot of time generating amazing content for [his] website," and makes jokes on Twitter. ("Just saw Sam Jackson do a capital one visa commercial. Whaaaat... #whatsinyourmotherfuckingwallet").

His open-mindedness to integrating popular culture and physician identity is evident. These are the media platforms used by real people, and the language used by real people. Fist bumps are gestures real people use(d). Doctors can embrace these things and also take seriously an approach to preventing life-threatening infections.

So McClellan's team had a small group of clean-handed research subjects shake and fist bump at various intervals. They then cultured the bacteria grown on their hands. The handshake exposed more than three times as much skin surface area as the fist bump, and the contact averaged 2.7 times longer. More bacteria were transmitted, as expected, with the handshake.

(Swoan Parker, Jason Reed, Jeff Haynes, Jim Young, Mike Stone, Ho New/Reuters)

"We surmise that the fist bump is an effective alternative to the handshake in the hospital setting," McClellan et al. wrote in the journal. "[Bumping] may lead to decreased transmission of bacteria and improved health and safety of patients and healthcare workers alike."

This is in keeping with prevention methods based around the most-feared bacterium of all, Methicillin-Resistant Staphylococcus aureus (MRSA), which spreads by direct contact. Door handles, for example, have up to five times more bacteria than push-plate doors, so many hospitals have done away with knobs and handles. In 2005, almost ten percent of hospital door handles were shown to contain MRSA.

Now is a time of unprecedented concern about MRSA and other drug-resistant bacteria. Just this week in The Lancet, an esteemed group of British physicians wrote about the need for a global strategy: “Rarely has modern medicine faced such a grave threat. Without antibiotics, treatments for minor surgery to major transplants could become impossible. Infection-related mortality rates in developed countries might return to those of the early 20th century." Preventive behavioral modifications, however small, could actually prove consequential.

"I think this makes sense to study," Dr. Tim Lahey, an infectious disease specialist at Dartmouth, told me. "If a clinician washes their hands then shakes hands with a patient who has not washed their hands, it seems plausible to me that the patient's surgical incision or whatever might be more likely contaminated as a result."

"Of course handshakes in other contexts should be fine," he said, "because between them and patient care there should be some handwashing."

McClellan did consider that. "Handwashing has become a major initiative throughout healthcare systems to reduce transmission rates," he wrote, "but as many as 80 percent of individuals retain some disease-causing bacteria after washing." Almost no one washes their hands appropriately—you're supposed to scrub long enough to sing the alphabet song twice. Health professionals are usually somewhat better than average, but far from perfect.

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2008 (Eric Miller/Reuters)

Dr. Tom Feasby, dean of medicine at the University of Calgary, agrees that fist bumping is "a nice replacement of the handshake" as a flu-prevention strategy. "Because you can't just refuse to shake someone's hand. It's rude and seems almost un-Canadian."

It is awkward to refuse to shake someone's hand, that's true. If they offer an open hand, though, and you reciprocate with a closed fist, they should respect it. If they don't acknowledge your fist and match it, you can whisper "Think of the children."

"Some have even advocated for an elbow tap," Lahey added. Earlier this year in New York, a youth soccer league banned high-fives and bumps in fear of flu transmission, but allowed elbow taps. The mid-air hip bump is also popular in Major League Baseball, especially when a player is crossing the plate after a home run, but poses logistical challenges in many workplaces.

Most people don't like being touched much, but a professional gesture that involves some kind of physical contact can be importantly icebreaking, humanizing. It's novel: I'm extending my arm to touch you. Please do the same. This is the one moment where we can—must—touch one another, and then after that it goes back to being weird.

"The fist bump is not only plausibly hygienic," Lahey said, "but it has the advantage of also being kind of cool. Perhaps our patients will appreciate our attention not only to their health but also to hipness."

Attentiveness to hygiene is the definition of cool. The doctor is not trying to bro down; it's even bigger than that. Respect knuckles.

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James Hamblin, MD, is a senior editor at The Atlantic.

 
 
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