Over at The HealthCare Blog (THCB), Michael Millenson, president of Health Quality Advisors and author of the critically acclaimed Demanding Medical Excellence: Doctors and Accountability in the Information Age, offers a fabulous account of the “Tonsillectomy Riots” You will find it here: http://www.thehealthcareblog.com/the_health_care_blog/2010/09/remembering-the-tonsillectomy-riots.html
Millenson found the story on Tablet, an online magazine of Jewish news and culture, which, he writes, had rescued the tale “from historical obscurity. Piecing together old newspaper accounts in English and Yiddish, the magazine told what happened on New York’s heavily Jewish Lower East Side on a steamy day in June [1906] when 50,000 immigrant mothers descended on their local public schools demanding to see their children, having heard that there was a Board of Health-sanctioned child slaughter taking place.’”
In fact, the children in that particular school were in no danger. But the parents had reason to be worried. Tablet explains: “After tonsillitis reportedly kept scores of Jewish students out of school, principal recommended the children have tonsillectomies.” (“The idea of a contagious sore throat was apparently not part of folk wisdom at the time,” Millenson observes.)
According to the Tablet “When mothers complained they couldn’t afford either the doctor’s fee or taking time off to go see one, physicians were asked to perform tonsillectomies at the schools. Days before the riot, doctors had performed 83 tonsillectomies at one elementary school. That’s when the trouble began.
“The English-language press reported that the operations all had parental consent. But the Yiddish press told of children sent home with slips of paper their parents couldn’t read using terms they couldn’t understand even when translated.
“’All they knew was that when the children returned home from school after their procedures, they did so drooling mouthfuls of blood, barely able to speak,’” Tablet reports. “’Shocked, their parents asked what happened. “Doctors cut our throats,” the children replied.’ Rumors of a wholesale slaughter leapt like wildfire throughout the tenements and shops…and street-corner orators got into the act, screaming about the massacres in the schools, comparing them to the pogroms in Russian-ruled Poland.’”
I remember my own tonsillectomy, at the tail-end of the epidemic of these surgeries. I have a vivid memory of vomiting blood. I cannot even imagine undergoing the operation at school, and returning home alone, without medical help.
If the children had been the offspring of wealthy New York businessmen, I very much doubt that the Board of Health would have approved the plan. But they were the children of immigrants. Plus ca change . . . .
Millenson sums up the story: “The Tonsillectomy Riots also remind us about the durability of profitable medical procedures even in the face of evidence against them. By the mid-1930s, fully one-third of all operations performed under anesthesia in the United States were tonsillectomies. Around that same time, research that included a pioneering study of New York City schoolchildren began to show that the tonsillectomy rate was more dependent on physician preference than on objective indicators. Nonetheless, the growing medical literature on inappropriate and even dangerous tonsillectomies had little effect on actual practice until Congressional hearings in the 1970s spotlighted parents whose children had been harmed or killed. Only then did the profession react. “
Interesting story, Maggie. I grew up in New York and it was accepted practice for all kids to have tonsillectomies. So, at the age of 3, my first bout of tonsillitis landed me in the hospital for surgery. This was 1963, not 1906, and there was no riot or controversy. It was done with my parent’s permission at the recommendation of the doctor. I’m glad to say that things have changed . . . my kids still have their tonsils.
Sheldon–
I, too, had a tonsillectomy in that era.
My children also have their tonsils.
What is striking is how conventional medical wisdom can change –sharply.
This should make us all somewhat wary about the CW.
About statins, for instance, or PSA testing and treatment for early stage prostate cancer when patients are experiencing no symptoms . .
Or mammograms, especially for younger and much older women . . .Or . . .
Unfortunately, there is no “conventional wisdom” in today’s medical practice. It is said that half of what is taught in medical schools turns out to be wrong. The scarier thing is that they do not know which half is wrong when they graduate from medical school. Because of the large numbers of medical and clinical research that goes on every year, things that were considered standard practice will be proved wrong or ineffective as new data starts coming out. Doctors have to go along with the latest recommendation but should keep in mind that it may and will be proved wrong in the near future. You just don’t know when.
This whole tale also highlights the potential harm that can come from fee-for-service medicine, a potential pitfall still with us today, a century later. When doctors get paid for doing procedures, and when the person doing the procedure is the one who decides it needs to be done, the result is more procedures.
Chris, christmas & medtale
Chris–This is very true. And this is one reason that Jack Wennberg was roundly denounced when he first questioned why kids in some places were getting more tonsillectomies–and why pediatricians’ kids were getting many fewer.
A friend just told me that his doctor thinks (isn’t sure) that hte pain in his leg may be caused by hip degeneration. My doctor told my friend that he should “set 7 weeks aside” for hip replacement.
My friend replied: Or, I could set aside 15 minutes and buy a cane.
He’s not in great pain. He can walk perfectly well. They’re not sure whether his hip is causing the pain in his leg. Why would he possibly take on the risk of surgery (and being in the hospital).
Joint replacement is miraculous for people who really need it; it changes their lives. But it seems another example of something that is become a trend rather than a medical reatment.
christmas & medtale-
You’re right that the CW is often wrong- in many areas, not just in medicine.
But once it becomes the cw,it’s hard to shake. Repeat something often enough, and people believe it.
I agree about statins (at least for many people) PSA tests for asymptomatic average risk patients, etc.
And Medtale, You are right that medical science is constantly changing–but I wouldn’t go so far as to say that everything taught in medical schools today will eventually be proven wrong.
We understand some diseases and know how to treat them very well. I think of cataract surgery.
No doubt, some day it will be improved on, but the state of the art seems pretty high.
And I don’t think that at some point in the future someone is going to discover that the way we treat cataracts today is just plain wrong.
That said, you’re right sometimes doctors and patients become accustomed to treatments, protocols and tests that just aren’t doing anyone any good. Or are effective for only a much smaller group of people.
Even the time-honored annual physical is being called into question. Unless a patient has specific symptoms, it’s a fishing expedition, and it’s not clear it improves the health of well patients.
On the other hand, it does seem like a good idea for a patient to spend 30 minutes or more with a primary care doctor once a year to talk about physical or psychological problems that have been bothering him. One of HealthBeat’s physician- readers (Rick Lippin) once suggested that a primary care doctor should always ask two questions: “How is everything at home?” and “How is everything at work?”
These questions could lead to a meaningful conversation that could help many patients. But probably we don’t need to run so many tests on everyone–the tests drive up the cost of the physical. We might better pay the doctor well for his time, talking and listening, rather than paying labs for all of those tests.
Maggie,
Not quite relevant to this topic, but can you comment again on this given this sitaution:
http://news.yahoo.com/s/ap/20100914/ap_on_re_us/us_health_overhaul_lawsuit
NG–
That a Florida judge decides to hear the case is not surprising –it’s a pretty conservative group of judges.
But the vast majority of constitutional law experts say that there is simply no basis in the constitution for overturning the mandate or repealing health care reform.
The only way it could happen is if the Supreme Court decided to take the case, and ruled in favor of those who wanted to overturn the mandate.
But it’s just not likely the Court will take the case. If the Supreme Court got into the middle of this, and ruled to overturn the heart of such major legislation that the majority of Congress and the executive branch backed, that decision could lead to a constitutional crisis.
Under the constitution, the Court isn’t supposed to simply veto legislation that the two other branches have endorsed.
“Checks and balances” means that no one branch of the government has that kind of power. For instance, if the executive branch wants to do something, it has to get the majority of Congress to agree–which it did.
I very, very much doubt that the Supreme Court wants to create a constitutional crisis in the middle of what is a very hard time for the country– high unemployment, the economy . . .
And most Americans definitely don’t want to see the healthcare debate take center stage in Washington in coming months. The public wants everyone in Washington to focus on three things: jobs, jobs, jobs.
There’s a famous study of 1000 children referred to a group of doctors. The doctors recommended tonsillectomies in about 1/3 of them. The 700 who did not have the recommendation were sent to another group of doctors who again recommended tonsillectomies for 1/3 of them. The remaining 450 were then sent to yet another group of doctors who recommened tonsillectomies for 1/3 of them. The process was repeated, each time with about 1/3 of the children being recommended for tonsillectomy, until almost none were left.
Marc–
Wow.
Intuitively, this rings true.
Do you, by any chance, have any info about the source of the study (who, where and when published, etc?)
I would love to find it.
Thanks–
I had a hip replacement from johnson’s & johnson’s company DePuy. DePuy is a franchise of orthopedic and neuroscience companies which provide body part replacements. But its hip replacements ball-socket system had to be recalled and i had to bear pain, suffering and legal headaches.