[gravelc]

Is there a causal link between the surgery and the increase in long-term disease risk, or were patients who were more likely to get the surgery (because of more severe symptoms or more frequent occurrence of infections) at greater long-term disease risk (whether they had surgery or not)? Without some functional mechanism, I'd be very wary of these kinds of data analyses.

[mehrdadn]

> Without some functional mechanism, I'd be very wary of these kinds of data analyses.

Kind of a tangent, but dumb question: wouldn't the sensible default assumption be that messing with your body is likely to be harmful unless proven harmless? Rather than the other way around? So if you're skeptical, shouldn't you be skeptical that it's harmless?

[robbiep]

It has not been until recent times that any form of messing around the body was for any reason other than self preservation or the improvement of quality of life. I am talking post-enlightenment/age of reason medicine here, not dark ages blood letting. And we still get it wrong, and still do things without enough of an evidence base, but when it comes to removal of adenoids, the reason it is done is because in those it is affecting it is having a harmful effect on.

Whether that be the formation of peritonsilar abscesses (potentially fatal), difficulty breathing (watching a 6 yo struggle to get air into their lungs due to enormous tonsils is not a sight I enjoy seeing) or just missing large numbers of days of school due to repeated illness, with knock on effects to child wellbeing and performance, there is a firm reason why we do this procedure

[eletious]

That isn't true - body modification has been a facet of human culture for a long, long time.

[nailer]

Weird to hear tonsilectomies being spoken of in thw present tense. It stopped being routine in Australia in the 80s.

[robbiep]

There are more than 35,000 tonsillectomies done in Australia every year (and more than half a million in the US). This is a highly routine procedure. In fact there is very clear guidelines on when GPS should refer for tonsillectomy:

Tonsillectomy is indicated When young children have had >7 episodes in one year or >5 episodes in either of the last 2 years, or quinsys, or obstructive sleep apnoea.

Tcj_pcx for some reason I can’t reply to your comment, but there’s almost nothing in it that actually makes sense:

I'll just pass straight over the emotional comments.

Massage doesn’t cure tonsillectomy; and frankly this thing that people say, that ‘doctors treat the symptoms not the cause’ is actually a vein of deep ignorance in the general populace.

The treatment cures (in around 97% of cases) tonsilitis. Which may have lead to (in the above scenarios) a 6-10 year old child missing up to 30-40 days of school a year. And therefore having a severe impact on that child’s learning and progression. It is not treating a symptom: giving analgesia or an ice cream would be an example of that. Is modifying the mechanism by which the condition unfolds and therefore preventing the condition from occurring again.

[0] https://www.safetyandquality.gov.au/wp-content/uploads/2015/...

[nailer]

> Tonsillectomy is indicated when young children have had >7 episodes in one year or >5 episodes in either of the last 2 years, or quinsys, or obstructive sleep apnoea.

Yes. I'm not sure why you're replying to me, as you're essentially agreeing with that I wrote.

As another poster already pointed out, it used to be done on the first or second episode, with the general view that the tonsils were a 'useless' organ (people held/hold similar ideas about the appendix and penile hood). Now it's only done, ad you mention, when the child has had > 7 episodes in one year or > 5 episodes in either of the last 2 years

[tcj_phx]

> Massage doesn’t cure tonsillectomy

Tonsillectomy is prevented by figuring out why the tonsils are becoming inflamed in the first place.

I said "bodywork (massage/etc)" because most people aren't familiar with the different kinds of bodywork that were developed over the course of the 20th century. I would place the emphasis on "etc". Massage is a general treatment, while other forms of manual therapy are more specific in their beneficial effects. You might know some "physical therapists" who can work magic with their techniques.

> The treatment cures (in around 97% of cases) tonsilitis.

Removing the tonsils will prevent the tonsils from becoming inflamed, on account of their removal. But certainly you would agree that if the cause of the inflammation could be determined, it would be better to address that factor than to just remove the part?

The girlfriend I mentioned in the post was born with her umbilical cord around her neck, which is how I knew that she'd probably benefit from "bodywork". When she came back from a class trip to Mexico, a few weeks after we'd met, the lymph glands on her neck were rather puffed out. I'd already made her an appointment with the good "physical therapist" (to hopefully deal with the unresolved somatic problems associated with her tonsil extraction ~15 years before). The "physical therapist" found that one of her ribs was out of place (certainly due to carrying a heavy bag over her shoulder while stomping around the border cities). This displaced rib was pinching on the lymphatic channel (maybe not the correct terminology). After releasing the rib to its proper location, the therapist said the lymph glands would probably go down over the next 1-3 days, and that if they didn't normalize she should seek further medical care (x-ray/etc, to rule out conditions she could have caught in Mexico). The swollen lymph glands entirely went away over the following week.

I recently took a new friend to an actual physical therapist with similar training. This woman sprained her ankle ~6 to 10 years ago. The post-injury surgery made her ankle problem worse (I understand the surgeon accidentally cut a nerve that shouldn't have been cut)... This woman was just trying to hold herself together, but was collapsing. The physical therapist helped this woman out quite a bit, and she was surprised at being able to make several trips to unload her car a few days after the appointment.

My point is simply that people's conditions usually have a broader context than their presenting symptom.

[robbiep]

that would not be an obvious bow to draw from your comments, and frankly, and medical practitioners who are not looking at holistic health when presented with a patient are missing the point.

However, you are so far off point on the tonsillectomy.

Let's take a slightly different condition. A patient has gallstones, causing ascending colangitis. The treatment (which you would describe as treating only the symptoms) is to remove the gallbladder, a cholecystectomy.

The cause in this instance is being a mid 50's woman, slightly overweight, genetic predisposition, high fat diet.

Your implication is that because the Doctor is treating the symptom, they are doing a disservice to the patient?

The reason I am defending this so strongly, is because it is only a stone's throw from the implication you initially started with - 'that doctors treat symptoms, not causes', to 'Doctors/The medical-industrial complex is with-holding the cure for cancer, because if they fix it they don't make any money'.

As though no doctor, or scientist in the field, has ever died or watched a family member suffer through that or some other insidious disease.

Doctors are human, they make mistakes, they act on evidence that is only partially formed (and have to in order to act in a timely manner), and their actions are often not fully explained to those who they are treating.

We can and should do better. But slinging mud on my profession I can not sit idly by and abide.

[DanBC]

> Tonsillectomy is indicated When young children have had >7 episodes in one year or >5 episodes in either of the last 2 years, or quinsys, or obstructive sleep apnoea.

But it used to be a lot more common. It used to happen after the first or second episode.

[astura]

Back in the 60s, in some areas of the US, all kids had their tonsils out, even if they never had an infection. They'd do multiple siblings in a single day.

[tankerslay]

>The treatment cures (in around 97% of cases) tonsilitis.

I feel like this is a kind of doublespeak and a rather misleading way of phrasing things. It of course stands to reason that excising an organ in toto will be very effective at preventing a person from having continued inflammation of that organ, as it is no longer part of their body, in the same way that toenail fungus can almost certainly be "cured" by amputating the affected toe.

The latter rarely happens, because people understand the value of their toes and realize that having toenail fungus is typically better than having no toe at all. But for organs inside the body, whose function is less plain to the lay person, patients are largely at the mercy of doctors to give them an honest appraisal of the life-long risk of removing them, and whether it might be warranted in a particular situation.

It seems that in many of these cases, it would be far more straightforward and honest to simply say "If [organ X] is really bothering you, I can cut it out," rather than cite some pseudo-scientific percentage purporting to describe how often surgery can "cure" some abstracted set of symptoms or "chief complaint." Doctors (especially specialists!) seem reluctant to move beyond this rather myopic way of conceptualizing health care. The idea that medicine is simply a game of "complaint whack-a-mole" might be psychologically comforting to a doctor (as well as financially lucrative in fee-for-service jurisdictions), but, from the perspective of the patient, it makes little sense to fix one symptom only to acquire five more of greater severity.

The question people really want answered is: "If I cut out [organ X], is it going to cause me other problems down the road?" But this is the very thing that doctors/surgeons so often seem so curiously (willfully?) ignorant of, even for "routine" procedures. Isn't it rather bizarre that, despite tonsillectomies and adenoidectomies being performed on millions of children over many decades, often for the most trivial of justifications, the analysis described in the linked paper took until 2018 to be completed, by a trio of PhDs no less?

Is it just too psychologically burdensome for surgeons to worry about the long term health of their patients or the long-term consequences of their procedures?

I think tcj_phx certainly does have a point, that people are not so much interested in "treating symptoms" as they are in doing what will preserve their whole-body health well into old age. If doctors can't say what will best achieve that, either because they don't know or haven't bothered to look into it carefully, they need to be very upfront about their ignorance and inability to provide a well-considered recommendation.

[gravelc]

Who said it was harmless? I'm sure any surgery isn't without risk. The mechanism for the most obvious short-term risk is very well known - infection. For that reason alone one has to weigh the benefits and really consider whether surgery is worth it.

Anyway, my skepticism is not so much with this particular result, it's the experimental design generally. How do we know the sample represents the population when it's not randomly selected? At best, it's the starting point of a possibly interesting research tangent, not something I'd be publishing as a stand alone paper.

[kurthr]

Yes, because walking into a hospital filled with sick people to be cut open is default a dangerous thing to do. Even visiting a hospital is a terrible idea for anyone even remotely at risk (older, immune compromised, etc) due to infections.

[stareatgoats]

> "cases were no less healthy than controls presurgery in the first 9 years of life"

Looks like they addressed that (heading: Testing for Biases in General Health Before Surgery)

[vanderZwan]

And elsewhere, a bit more explicitly:

> Participants in the case and control groups were selected such that their health did not differ significantly prior to surgery.

[laretluval]

> Participants in the case and control groups were selected such that their health did not differ significantly prior to surgery.

And yet some of them got the surgeries and some didn’t, so it’s unclear if the control was adequate.

[tankerslay]

>And yet some of them got the surgeries and some didn’t, so it’s unclear if the control was adequate.

It is what it is. The documented evidence suggests that the medical histories of the two groups diverged strongly at the moment of surgery.

It is possible that the decision to have surgery depended primarily upon an arbitrary judgment of the surgeon, in which case the randomization is adequate.

It is also possible that the pre-surgery health of the two groups diverged in a way that was not well-documented in the medical record, in which case the control is inadequate.

However, this latter possibility is still not flattering to the medical community. If the conclusion of the study is even possibly correct, it raises a serious question of why such a flimsy paper trail accompanied such a momentous cost-benefit decision in the lives of these children.

[robbiep]

Andenoids/Tonsils are organs of the immune system. This is not mechanistically surprising to those in the field