5 ms·

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

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 8y ago
> 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 8y ago
  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
  - nailer 8y ago
    Weird to hear tonsilectomies being spoken of in thw present tense. It stopped being routine in Australia in the 80s.
    - robbiep 8y ago
      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/2015/11/SAQ201_04_Chapter3_v6_FILM_tagged_merged_3-6.pdf https://www.safetyandquality.gov.au/wp-content/uploads/2015/...
      - tcj_phx 8y ago
        I had a girlfriend who'd had her tonsils out as a child. She was an emotional wreck. I got her some bodywork (massage/etc), which she could have had as a child to prevent the surgery, and she's doing much better these days. She's still a firecracker; I'm glad she's living in the next state over.... > tonsillectomies [are] a highly routine procedure. Hopefully someday the medical profession will figure out how to treat the cause of tonsil problems, instead of treating the symptom.
        panda888888 8y ago
        Any relation between tonsils and your ex's gender/personality ("She was an emotional wreck") is nonsense. Don't post sexist stuff like that here.
  - eletious 8y ago
    That isn't true - body modification has been a facet of human culture for a long, long time.
- kurthr 8y ago
  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.
- gravelc 8y ago
  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.
robbiep 8y ago
Andenoids/Tonsils are organs of the immune system. This is not mechanistically surprising to those in the field
stareatgoats 8y ago
> "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)
- laretluval 8y ago
  > 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 8y ago
    >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.
- vanderZwan 8y ago
  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.

mehrdadn 8y ago

> 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 8y ago
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
- nailer 8y ago
  Weird to hear tonsilectomies being spoken of in thw present tense. It stopped being routine in Australia in the 80s.
  - robbiep 8y ago
    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/2015/11/SAQ201_04_Chapter3_v6_FILM_tagged_merged_3-6.pdf https://www.safetyandquality.gov.au/wp-content/uploads/2015/...
    - tcj_phx 8y ago
      I had a girlfriend who'd had her tonsils out as a child. She was an emotional wreck. I got her some bodywork (massage/etc), which she could have had as a child to prevent the surgery, and she's doing much better these days. She's still a firecracker; I'm glad she's living in the next state over.... > tonsillectomies [are] a highly routine procedure. Hopefully someday the medical profession will figure out how to treat the cause of tonsil problems, instead of treating the symptom.
      - panda888888 8y ago
        Any relation between tonsils and your ex's gender/personality ("She was an emotional wreck") is nonsense. Don't post sexist stuff like that here.
- eletious 8y ago
  That isn't true - body modification has been a facet of human culture for a long, long time.
kurthr 8y ago
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.
gravelc 8y ago
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.

robbiep 8y ago

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

stareatgoats 8y ago

> "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)

laretluval 8y ago
> 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 8y ago
  >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.
vanderZwan 8y ago
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.