tankerslay

can I ask what make/model you settled on?

"Scandal" should be avoided because it "degrades the trust of the public in the profession." An age-old saw trotted out to justify the cover-up of diverse kinds of negligence and malfeasance in all manner of professions the world over.

It works precisely until there is a scandal too big to cover-up.

>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.

>The treatment cures (in around 97% of cases) tonsilitis.

I feel like this is a kind of doublespeak and a rather misleading way of phrasing things. It of course stands to reason that excising an organ in toto will be very effective at preventing a person from having continued inflammation of that organ, as it is no longer part of their body, in the same way that toenail fungus can almost certainly be "cured" by amputating the affected toe.

The latter rarely happens, because people understand the value of their toes and realize that having toenail fungus is typically better than having no toe at all. But for organs inside the body, whose function is less plain to the lay person, patients are largely at the mercy of doctors to give them an honest appraisal of the life-long risk of removing them, and whether it might be warranted in a particular situation.

It seems that in many of these cases, it would be far more straightforward and honest to simply say "If [organ X] is really bothering you, I can cut it out," rather than cite some pseudo-scientific percentage purporting to describe how often surgery can "cure" some abstracted set of symptoms or "chief complaint." Doctors (especially specialists!) seem reluctant to move beyond this rather myopic way of conceptualizing health care. The idea that medicine is simply a game of "complaint whack-a-mole" might be psychologically comforting to a doctor (as well as financially lucrative in fee-for-service jurisdictions), but, from the perspective of the patient, it makes little sense to fix one symptom only to acquire five more of greater severity.

The question people really want answered is: "If I cut out [organ X], is it going to cause me other problems down the road?" But this is the very thing that doctors/surgeons so often seem so curiously (willfully?) ignorant of, even for "routine" procedures. Isn't it rather bizarre that, despite tonsillectomies and adenoidectomies being performed on millions of children over many decades, often for the most trivial of justifications, the analysis described in the linked paper took until 2018 to be completed, by a trio of PhDs no less?

Is it just too psychologically burdensome for surgeons to worry about the long term health of their patients or the long-term consequences of their procedures?

I think tcj_phx certainly does have a point, that people are not so much interested in "treating symptoms" as they are in doing what will preserve their whole-body health well into old age. If doctors can't say what will best achieve that, either because they don't know or haven't bothered to look into it carefully, they need to be very upfront about their ignorance and inability to provide a well-considered recommendation.

A very limited number of features have improved (e.g. if you have HepC). At the same time there has been massive price inflation for things that are marketed as "improvements" without convincing evidence of actually being better (e.g. nexium vs prilosec, many medical devices).

Our system is such a disaster, even "preventative care" can be a wolf in sheep's clothing. There's basically nothing to disincentivize doctors or pharma from aggressively selling drugs and procedures that give no benefit or even cause harm.

>these days it seems to be mostly about generating clickbait.

Yes it's a bastardization of their profession, but everyone needs to eat.

Who knows if we'll ever get back to the quality of journalism in the Woodward/Bernstein era, when the large majority of middle-class Americans paid a monthly subscription to have professionally composed news delivered to their doorstep every morning.

How is the marshmallow test (or "The Boy Who Ate the Marshmallow") different from "The Boy Who Cried Wolf"? Both teach a lesson with a nugget of wisdom, the former about the perils of self-indulgence, the latter about the foolishness of sounding a false alarm. Both lessons are supported by numerous examples--far more than 90--that each of us has observed in our own lives. But one is presented as a self-contained fictional story, while the other is told as the result of an experiment that revealed some kind of natural law.

Why is our culture so drawn to presentations of basic life lessons as if they were the results of scientific experimentation? It's as if we have some sort of self-consciousness about "believing in" fables that drives us towards the telling of "fables-as-science".

Is this field even about "science" per se? It seems more oriented towards fashioning just-so-stories that lend a scientific veneer to some piece of folk wisdom in order to generate a buzz.

My own "experimentation" suggests that the character trait that predisposes one to bandy about pop allegories such as "marshmallow test" is a portentous sign in potential managers.

Paper records, human memory....

Comparing growth in data storage versus energy usage per capita is interesting.

Even if you look back to the founding of the U.S., the change in energy use per person is actually only a few fold, definitely less than an order of magnitude.

Harder to compare quantity of data storage but the change would seem much larger. How much data is there, per U.S. person?

>The traditional routes and social contract are broken.

There is definitely some truth here. Can you find a partner and/or community of people who share your understanding of the traditional social expectations?

PUA is a community of sorts, but also has core beliefs so inimical to the opposite sex that it doesn't seem very sustainable.

Doesn't this already violate a bunch of laws? (undisclosed advertising, wire fraud or something like it, etc) Just enforce them. Can't do much about overseas people but you can penalize the businesses that purchase fraudulent marketing. E.g. if doctors started getting medical licenses permanently revoked for buying fake "testimonials" I imagine it would end fairly quickly.