[jkat]

A nice piece which stands in stark contrast to the alarmist and shallow FUD that so often accompanies this topic.

It's amazing how little we know about nutrition and biology. A lot seems to come down to common sense: breast feeding is good, exposure to microbes is good, being overweight is bad.

Hopefully the era of tonsil-removing and antibiotics overdosing is behind us

[pyre]

  | breast feeding is good

I'm often amazing that there are people out there that are so extremely against breast-feeding. I'm not even talking about breast-feeding in public, either. For example, I met someone from France whose friend had to argue with the nurses in the hospital about whether or not she would be 'allowed' to breast feed her child. [According to this acquaintance there is a lot of breast-feeding == BAD sentiment in France.]

  | tonsil-removing

Is tonsil-removing something in over-abundance? So far as I understand it, it's possible for your tonsils to be really infected (I've heard of holes in your tonsils that excrete puss), which would seem like a removal is a good thing.

[rdtsc]

> she would be 'allowed' to breast feed her child.

It seems that was also the thought in the 70s to mid 80s in in US. My mother in law for example (as a retired nurse even!) thinks breastfeed is "disgusting" and how "it can kill babies because they can get smothered". I was just floored when I heard that from her telling it to my wife. Now we didn't listen of course to such crazy talk. But I wonder where it came from. One suspicion is lobbying and re-education campaigns of formula manufacturers. What better way to make a pretty penny than convince women to stop feeding their children like they have since the dawn of time and instill in them the belief that it is "disgusting" and "animalistic". It would take an enormous drive and a sustained campaign to do that. But I don't really have any other explanation for it.

[rz2k]

My mother, as an assisting nurse in the late 60s, said she could probably do a tonsilectomy in her sleep (though of course she never did one conscious either). My dad did hundreds, or thousands, of appendectomies over a career as a surgeon, but they took a lot of effort.

There's little evidence of a useful role for an appendix, and most theories involve supposition about some past role.

Whether something is easy or not should not play a role.

It's like looking for your lost keys under a street lamp, because it is lighter there. Terribly harmful food-born diseases were contained by giving the animals that became food antibiotics themselves. Yet, that meant the meat ends up giving a dose to the people who eat it, and there have been fewer studies about how those antibiotics affect our symbiotic partners (the bacteria that by count make up most of our bodies).

Once you take something that might have a small effect, but spread it across hundreds of millions or even billions of people, then there should be increased sensitivity with regard to even the most outlandish effects, and they should be studied carefully.

[beagle3]

> There's little evidence of a useful role for an appendix, and most theories involve supposition about some past role.

Oh, the hubris of modern medicine. There is a very useful role for the appendix, but our modern (as in, last 2000 years) lifestyle has rendered it mostly ineffective. http://www.news-medical.net/news/2007/10/08/30907.aspx

While verified discoveries about the role of the appendix are quite recent (2007 or so), I've read about similar theories back in 1996, and they were old (as in, 40 years old) at the time.

[rz2k]

I was overly subtle, because that was my point.

As a data-disposed person, my first response to practicing physician's regular resistance to "evidence-based" medicine has often been one of astonishment. Those on the ground with patients are very careful, and also figure out how to manage incomplete information pretty well.

You may especially have missed my points that tonsils are rarely, if ever, removed anymore, and appendices are removed less often, too. I don't know if anyone knows why we need these organs, yet currently practicing physicians just choose to assume that we shouldn't remove stuff without a very grave reason.

[beagle3]

Indeed, it was too subtle for me to detect (even on second reading, probably my bad)

> As a data-disposed person, my first response to practicing physician's regular resistance to "evidence-based" medicine has often been one of astonishment.

As an engineer and stats person, I find blind acceptance of "evidence based" medicine astonishing. The idea is robust and noble, but the execution is beyond horrible - to the point that it ISN'T clearly better than the alternatives. (It's practically impossible to compare false-negative=wrongly-rejected-treatment vs. false-positive=wrongly-accepted-treatment of today's EBM; but if the now-known-false-positives are any indication, we're in really bad shape).

> tonsils are rarely, if ever, removed anymore, and appendices are removed less often, too.

That's only true if you compare to 1940-1980. If you assume they are needed, both are still removed with alarming frequency.

> I don't know if anyone knows why we need these organs,

The functions of both are known. Tonsils are an "early warning" outpost of the immune system - they sample pathogens while still in the throat, to give a "heads up" to the immune system in the gut. Removal of tonsils is associated with higher all cause mortality (especially heart attacks). The appendix is a curated cache of the good bacteria that the body needs in the gut (and possibly in other places), and there are circumstances in which the body will release another dose of good bacteria (though those are not well characterized yet, to the best of my knowledge).

> yet currently practicing physicians just choose to assume that we shouldn't remove stuff without a very grave reason.

I don't think that's really true. For one, most physicians in the US are still antibiotics-trigger happy (for whatever reason, even though most of them surely know it's harmful). That removes symbiotic organisms much more efficiently than it does harmful organisms, causing such things as yeast infections, the low B12 epidemic, and more.

They are more careful now with surgically removing stuff, true, but only recently, and only just.

[rz2k]

Analogies are an excellent way to explain things to people.

However, once you start using phrases like:

>Tonsils are an "early warning" outpost of the immune system

with people who may be even moderately familiar with biology, you lose your voice.

Cells don't respond to "cute", and the intricate false model stuff is also boring.

[derleth]

If your appendix gets infected and ruptures, you will likely die in horrible agony. The fact we know (not suspect, know) you can live a healthy, full life without an appendix means that once it begins to cause problems, there's really no reason to risk keeping it.

[sopooneo]

There are times when removing tonsils makes sense, but they used to removed almost as a matter of course from children.

[yannk]

France scores pretty poorly in terms of breast-friendliness. I have the feeling it comes a lot from formula-making companies capitalizing on feminist movements back then.

The marketing terms are way more pervasive in France than in the US (Where I have most of my experience). This is biased, of course, but most often I heard about "Formula" here, but in France I heard: "Lait de croissance (growing up milk)", "Lait Maternise (`maternalized` milk)", "lait infantile (infantile milk)", etc...

[angstrom]

Had my tonsillectomy when I was 4 due to a severe tonsillitis infection. Never gave it much thought. It sucked and I got to have a lot of popsicles.

[dmishe]

I thinkg that tonsils is one of first line defenses against bacteria/infections, so removing them would be suboptimal, although necessary

[rdtsc]

The idea is that at some point they (being the first line) succumb to infection and can be come the site of a persistent infection that in turns causes more sore throats and re-infections.

At least that was my experience. I was advised to take them out in my mid 20's. It does seem that there is correlation, now that they are out I get less colds and sore throats.

[dmishe]

Were you advised because of some condition where it was clear tonsils was the problem, or just a routine operation?

[rdtsc]

Switched to a different doctor and went for a consultation. Complained about by frequent sore throats. He looked in and said, we should take these out. (This wasn't in US but in Europe)

[beagle3]

See, e.g. http://boingboing.net/2012/01/10/tonsillectomy-confidential-...

There's been some back and forth on Seth's piece - you can google if you are interested. Personally, I find Seth's arguments much more compelling.

[jkat]

Let's just say I wouldn't have wanted to be a tonsil in the 80s living in Canada. I assume it wasn't Canada-specific though, anyone confirm?

[rogerbinns]

I lived in the third world (Africa) and mine were taken out in 1975. Amusingly several years later a doctor looked down my throat and asked if they had been taken out. When I said yes, he said they left some behind!

[Evbn]

US too. I imagine better drugs have diminished the need for tonsilectomies.

[Evbn]

Microbes cause ulcers, stomach cancers, etc, also, so common sense isn't so simple.