The evidence is really weak on the claim made in the headline, as the story later acknowledges. We wish the story had spent a little more time on costs and quantifying benefits instead of paying so much attention to one anecdotal case where a surgery was done to alleviate snoring.
The health care system needs to continue to be critical of interventions that don’t work or are harmful. It’s clear that we haven’t had good evidence for much of how this old procedure has been done.
Parents worry when their children can’t sleep well or have other problems related to enlarged tonsils, but surgery, as this story notes, is not without complications. Instead of giving the subject a light touch, the story dug into some of the details necessary to give parents the information they need to make good decisions. Writers should be careful, though, to distinguish between the real health problems related to tonsil problems and mere snoring, which is harmless in most cases. The headline for this story was a real shame, because the story itself contained good information.
Oddly, the story mentions physician reimbursements for tonsil surgery but makes no mention of patient costs. “Rosenfeld disputes Obama’s claim, saying that insurers usually pay a surgeon $200 to $300 for tonsil surgery.”
The benefits are never quantified, which is a big problem in this case because so much time is spent on the anecdotal family in the lead. We can’t understand why a headline this bold was put on a story that actually takes pains to point out the lack of evidence supporting tonsil surgeries.
The story could have done much more to evaluate the quality of the evidence, but we give it points here for addressing the lack of support for tonsil surgeries, which most parents likely assume are a standard part of growing up. “Then doctors started noticing that kids were still getting sore throats, even after having their tonsils taken out. But it wasn’t until clinical trials were completed in the early 1980s that there was proof that tonsillectomy really only helped children with severe, recurrent throat infections.” Later it says, “Despite hundreds of studies, there’s still surprisingly little research on whether tonsillectomy really helps reduce the risk of sore throats. The operation continues to be controversial.”
And it says, “There have been very few randomized studies on the effects of tonsillectomy for sleep-disordered breathing. Most of the researchers have asked parents or children if they noticed improvements, and looked at a single measure, like behavior or quality of life. Still, the ENTs recommend tonsillectomy for sleep-disordered breathing, saying it reduces symptoms in most children.”
The story does not engage in overt disease-mongering. Good caveats that “not all children with big tonsils have sleep-disordered breathing or frequent throat infections. Because of that, in 2002 the American Academy of Pediatrics recommended that children have a sleep study before surgery is considered. About 530,000 tonsillectomies are performed in the United States each year.”
The story only quotes one physician, and that source is a surgeon We would have liked to have seen more independent sources tapped – a pediatrician or family medicine doctor would have been helpful.
No meaningful discussion comparing alternative treatments.
The story was focused on surgery. There was no discussion of prevention – of indoor allergens (and avoiding/treating them with antihistamines) or of obesity.
The story does a great job explaining how tonsil surgery as a first resort has evolved over the years.
It is clear from the story that surgery is not novel.
The story definitely does not rely on a news release.