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A tough one to swallow

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  • Contributors EM: was responsible for project concept and design, acquisition of data, manuscript preparation, and critical revision of manuscript for intellectual content. JC, NC, JP and NEA: critically revised the manuscript for intellectual content and was involved in supervision of the project.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Jon Walters, Swansea, UK.

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