Headlines: April 12, 2011
by Meg Larkin
First, in adolescent health news, new guidelines from the American Academy of Ontolaryngology recommend fewer tonsillectomies. The new guidelines recommend tonsillectomies only for frequent or severe recurrent sore throats, or for children who have trouble breathing during sleep. The guidelines reflect changes that have taken place in clinical practice since the 1950s and 60s when the operation was considered routine. Many of the problems that were once thought to indicate the need for a tonsillectomy are now dealt with through watchful waiting. While doctors are more hesitant to recommend the operation for recurrent sore throats, they are now more likely to recommend it for sleep-disordered breathing, which can lead to long term developmental issues if left untreated.
In other adolescent health news, some hospitals are now performing weight loss surgery on severely overweight teenagers. Children’s Hospital Boston has begun offering the surgery to teenagers between the ages of 13 and 19 whose body mass index is in the 99th percentile, and who have been unable to lose weight through other methods. The Boston Globe reported that, “Surgeons plan to operate on 20 to 25 teens a year who meet the program’s criteria, which include the maturity and motivation to stick with the lifelong post-surgery diet of eating only tiny portions of food and avoiding altogether some foods such as ice cream and soda.” Massachusetts General Hospital started a similar program in 2009 and has operated on 11 patients with largely positive results. Some hospitals are hesitant to perform the surgery on adolescents because of uncertainty regarding the lifelong effects, including the need to take vitamin supplements. Insurers are also frequently unwilling to cover the procedure for adolescent patients, even those who are considered severely obese. The first nine patients from the MGH program dropped significant amounts of weight and saw a decrease in weight-related health problems, such as diabetes, hypertension, and acid reflux.
A couple of studies out this week focused on the health of physicians. First, the Wall St. Journal reported that doctors weigh treatment options differently for themselves than for their patients. When treating themselves, doctors were more likely to choose a therapy that had a higher risk of death, but a lower risk of serious side effects. A recent survey of 940 primary care physicians published in the Archives of Internal Medicine used two different scenarios, one involving colon cancer and one involving avian flu, to evaluate doctors’ treatment decisions. The Journal reported that in the colon cancer scenario, “38% of physicians tasked with weighing the decision for themselves picked the treatment with the higher death rate—preferring not to risk complications. Only 25% of the physicians in the other group said they would recommend a patient go that route. In the avian-flu scenario, 63% picked the treatment with the highest chance of death for themselves, with 49% recommending it for patients.” The authors of the study recommend that patients make sure that their doctors understand their treatment priorities and quality of life concerns, and that patients ensure that they are well informed about the risks and benefits of all potential treatments before making a decision.
Second, as the New York Times reports, there is a lack of clear evidence that shorter resident hours are improving patient care. Since 2003 hospital residency programs in the United States have been forced to limit junior doctors to working 80 hours a week, and in the European Union, that limit is even lower, at 50 hours. The limits were put in place because of concerns about doctor fatigue and its effect on patient care, but a new study published in the British Medical Journal found that while the decrease in hours has improved the lifestyle of residents, it has had little effect on patient outcomes. Part of the problem in evaluating the situation is the lack of an adequate control group. All residency programs must meet the same hourly criteria, so it isn’t possible to compare residents working 80 hours a week with others working 100 hours a week under similar conditions. As the New York Times reported, “The researchers found 34 published studies from the past decade that focused on how patients fared, but few were comparative and of a large enough scale to offer useful and definitive evidence. Only one was a large randomized controlled study.” Therefore, the controversy over whether restricted hours for residency programs are a good thing may continue for a while longer.
Meg Larkin is a third year law student at Boston University. Please feel free to email her with any questions, comments, suggestions or concerns.