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Seven in 8 children's tonsillectomies are unnecessary
Researchers analysed the electronic medical records of over 1.6 million children from more than 700 UK general practices dating between 2005 and 2016. They found that out of 18,271 children who had their tonsils removed during this time, only 2,144 (11.7 per cent) had enough sore throats to justify surgery.
The researchers at the University's Institute of Applied Health Research concluded that their evidence, published today (Nov 6th) in British Journal of General Practice, showed that annually 32,500 children undergo needless tonsillectomies at a cost to the NHS of £36.9 million.
What's more, they found that many children who might benefit from having their tonsils removed are not having the surgical procedure. They found that of 15,764 children who had records showing sufficient sore throats to undergo a tonsillectomy, just 2,144 (13.6 per cent) actually went on to have one.
[...] Tom Marshall, Professor or Public Health and Primary Care at the University of Birmingham, said: "Research shows that children with frequent sore throats usually suffer fewer sore throats over the next year or two. In those children with enough documented sore throats, the improvement is slightly quicker after tonsillectomy, which means surgery is justified.
"But research suggests children with fewer sore throats don't benefit enough to justify surgery, because the sore throats tend to go away anyway.
"Our research showed that most children who had their tonsils removed weren't severely enough affected to justify treatment, while on the other hand, most children who were severely enough affected with frequent sore throats did not have their tonsils removed. The pattern changed little over the 12 year period.
"Children may be more harmed than helped by a tonsillectomy. We found that even among severely affected children only a tiny minority of ever have their tonsils out. It makes you wonder if tonsillectomy ever really essential in any child."
Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records (DOI 10.3399/bjgp18X699833$)
(Score: 2) by bzipitidoo on Wednesday November 07 2018, @07:14PM (9 children)
Until medicine moves away from the "fee for service" system, it will be perpetually dogged with this question of how many procedures and tests are performed out of a desire for profit rather than an honest need.
Mammograms and prostate exams should be done every year starting at age 40, or every 2 years starting at age 50, or something else? There's an epidemic of ADHD in children, or is there? But in the latter case, there can be other motivations, such as teachers wanting to get rid of students they don't like and think are troublesome.
(Score: 0) by Anonymous Coward on Wednesday November 07 2018, @07:27PM (2 children)
It's silly, because you have to account for resources; you can't move away from a fee-for-service system.
Secondly, it's wrong, because all of these problems are caused by the very attempt to move away from a fee-for-service system. The UK has its NHS, where people don't have to think all that much about fees for services; they just do what the officials say to do, and money changes hands... somehow.
The same problem occurs in the United States, where "insurance" companies have nothing to do with mitigating risk, and have been transformed over almost a century into specialized payment networks; nobody knows what anything costs, and they just do whatever the white coats say, with money changing hands and being negotiated by third parties.
And, ironically, here you are telling us that we need even more of this insane non-accounting system.
(Score: 2) by Immerman on Wednesday November 07 2018, @08:41PM (1 child)
>you can't move away from a fee-for-service system.
The fact that the Chinese medical system was traditionally NOT fee-for-service says otherwise. You paid your doctor when you were healthy, and stopped paying him when you were ill. Gave him a direct economic incentive to practice preventative medicine, and get you healthy again as soon as possible, and as cheaply.
Such a system would likely not scale directly to modern size and specialization, but it provides solid evidence that their are functional alternatives, the challenge is in developing them for modern realities.
(Score: 0) by Anonymous Coward on Wednesday November 07 2018, @08:45PM
Those people were paying for services that would keep them healthy, such as the production of herbal teas.
Naturally, when you get sick despite drinking herbal teas, you take your business elsewhere.
(Score: 1, Offtopic) by VLM on Wednesday November 07 2018, @07:46PM (4 children)
There's also the curious problem of false positives. Not to mention radiation exposure for mammograms, if zapping the girls every six months for a lifetime causes more cancers across the population than it cures...
The side dish of false negatives and legally defensible medical care means my daughter needed a MRI for heat exhaustion not for medical needs but because the cost to a doc of asking the patients insurance co to pay for a MRI (roughly $0) is less than the 1 in a million chance she passed out from a brain tumor and will malpractice sue if he can't prove she didn't have a tumor at the time of visit, so spend all day in the ER spending thousands of insurance dollars over legal CYA stuff not over actual medical need.
So not taking a mammogram means the patient might have cancer and will sue for millions when she dies, but taking a mammogram means the patient will eventually die of cancer caused by frequent radiation exposure but the doc won't be sued, well... guess how this balances out?
When you put the lawyers in charge instead of the docs, medical care gets weird, unpleasant, and expensive.
(Score: 0) by Anonymous Coward on Wednesday November 07 2018, @08:24PM (3 children)
Did anyone else read the above and just sit in stunned silence for a minute?
(Score: 1, Insightful) by Anonymous Coward on Wednesday November 07 2018, @09:08PM (1 child)
Just disappointed by the lack of references.
Ill-informed conclusions on biomedical topics seems to be the norm here.
(Score: 0) by Anonymous Coward on Thursday November 08 2018, @01:07AM
Give us examples that lead you to that conclusion.
(Score: 0, Offtopic) by kurenai.tsubasa on Thursday November 08 2018, @12:17AM
Yeah.
Something like that was once expressed during a committee meeting of a local breast cancer charity by the one man (an MD) in a committee of 15 or so women (and whatever you want to classify me as—I was presenting male and had said nothing about being trans or having breasts… many years before this when a womyn-born-womyn sexually assaulted me for being trans, I had been made to understand that my breasts are not “real”).
The MD was talking about the then recent guidance published by the WHO that screening mammograms should only be given every other year. I said not one goddamned thing, because what was I supposed to do? Argue with an MD 20–30 years my senior about medical guidance despite my lack of any kind of medical qualifications? I'd figured the woman who put him in his place had said what needed to be said, and that was that.
A few weeks later I went to refill my meds and found that my access to HRT had been cut off. My bank wasn't able to give me a straight answer about why they had told the pharmacy my account was closed. I now have to drive 150 miles away to the big city for medical care.
I can only figure that the strategy employed by feminists of collective and several punishment is not effective at teaching boys like VLM their lesson. However, it has sure as fuck taught me some things….
(Score: 3, Interesting) by kazzie on Thursday November 08 2018, @05:35AM
This report is from the UK, which moved away from the "fee for service" model to one of "free at point of use" seventy years ago.
The title for the Soylent article's got things a bit wrong. From TFS: of those who had tonsillectomies, only 1 in 10 (11%) had met the guidelines of how many sore throats in a year warrant surgery. Separately, of those who had enough sore throats to meet the guidelines, only 1 in 8 (13.6%) had the operation.
(From TFA: "Current UK health policy, based on the best scientific evidence, is that to meet the criteria to benefit from a tonsillectomy children must suffer from either more than seven documented sore throats in a year; more than five sore throats per year for two successive years; or three sore throats per year for three successive years.")
So of those children suffering from chronic sore throats, 7 out of 8 didn't have a tonsillectomy. (But I bet most of them survived in spite of this.) The ratio of those who had a tonsillectomy unnecessarily is worse than the title used: 9 out of 10 of those are unnecessary!
TLDR: According to our guidelines, we're doing most of our tonsillectomies to the wrong group of people. (Corollary: maybe we don't need to be doing tonsillectomies as often / at all.)