A doctor responds to Seth Roberts' guest post about tonsillectomy

We recently ran a guest post by Seth Roberts, detailing the case against tonsillectomies as a regularly prescribed treatment for sore throats. I was able to read Roberts' post before it went up here, and comment on it. And Roberts made several changes to the post, which I had suggested, before it ran.

In general, I'm a big fan of basing medical treatment on evidence, rather than conjecture, tradition, or mythology. And, while I have a big problem with woo-woo (shorthand for attempts at medical treatment that are based primarily on conjecture, tradition, and mythology), I do think it's important to point out that woo-woo doesn't always come from hippies. Local doctors don't always follow the evidence, either. In fact, that's one big reason why "evidence-based medicine" has to be called that, rather than just medicine. So while I didn't agree with everything Roberts had to say, I thought his key point—tonsillectomy as a treatment for sore throats isn't actually strongly supported by evidence—was a valuable one.

That said, I R NOT A MEDICAL EXPERT. And neither is Roberts. Steven Novella, however, is a medical doctor and a clinical researcher. He has a very good blog post up that points out some important flaws in Roberts post. Here's the gist of what he has to say: Roberts seems to have misunderstood some of the studies he linked to, and assigned too much importance to others. "Evidence" can mean a range of different things. Some evidence is better than others. Just because a study was published doesn't mean it's evidence worth paying attention to. And it is very easy for people to get confused by this distinction when they start trying to treat themselves with the help of Google.

For instance, Roberts provided a laundry list of potential complications of tonsillectomy and asked why the evidence-based Cochrane Review didn't talk about any of them. The problem:

He seems to take the approach of listing any possible hypothesized risk as if it is established.

The links he uses to defend each risk he cites does not support the claims he is making. Once again he is lead to the conclusion that doctors are ignoring the risks and morbidity from tonsillectomy, while those alleged risks have not been established.

For example, he lists Hodgkins disease with links to evidence for an association with tonsillectomy. He does link to one article from 1972 and disputes the association, but did not link to a 1987 review that found no association between Hodgkins disease and tonsillectomy. As far as I can see this was the last word on the issue. Roberts still gets to list Hodgkins disease as a scary increased risk from tonsillectomy without fairly representing the state of the evidence.

He also lists variant Creutzfeld-Jacob disease, and links to two articles which do not establish a higher risk of developing the disease from tonsillectomy. Rather, the issue is about whether prion disease has an affinity for the tonsils, and whether tonsillar biopsy can be used for diagnosis. The correlation is about the natural history of prion disease, not a cause and effect from having a tonsillectomy. A deeper reading into the literature is needed in order to see this. Roberts, however, simply searched for tonsillectomy and complications and listed everything he found. In none of the cases is a cause and effect established. He wonders why doctors do not list all of the complications he found – that’s why.

You can read Steven Novella's full post at Science-Based Medicine

You can read Seth Roberts' response in the comments of Novella's post. Or read more at his blog

Image: T & A Journey, a Creative Commons Attribution Share-Alike (2.0) image from cjsorg's photostream