The Make America Healthy Again (MAHA) commission's report on children's health has sparked significant discussion, particularly regarding its critique of surgical practices. While much attention has been drawn to the report’s citation errors and focus on ultra-processed foods, smartphones, and stimulant use, a less-discussed aspect is its stance on the "overmedicalization" of American children. The report briefly mentions surgical care but singles out two common pediatric procedures—adenotonsillectomy and tympanostomy tube placement—as surgeries that may cause harm without offering benefits. Despite their prevalence, these procedures have proven benefits when appropriately applied, raising concerns about the report's conclusions.
Pediatric ear, nose, and throat surgeons with extensive clinical and research experience argue that while vigilance against overuse is essential, dismissing the benefits of these surgeries could jeopardize necessary care for children. Adenotonsillectomy and tympanostomy tube placement have been shown to improve sleep, behavior, learning, hearing, speech, and reduce infections in appropriately selected patients. Evidence-based guidelines developed over the years emphasize shared decision-making between families and surgeons, ensuring these procedures are used judiciously.
Historically, tonsillectomies were primarily performed for recurrent throat infections but now predominantly address obstructive breathing and sleep apnea. Similarly, ear tubes are now reserved for persistent middle ear fluid causing hearing loss and speech delay rather than uncomplicated ear infections. These shifts reflect evolving medical understanding and more precise indications.
The MAHA report overlooks substantial evidence supporting the benefits of these surgeries, citing limited studies while ignoring broader findings. For instance, it dismisses adenotonsillectomy's effectiveness for sleep apnea based on one study's inconclusive IQ measure, disregarding consistent improvements in sleep quality, behavior, and physical health reported in other studies. Ear tube surgery, too, has measurable benefits for children with persistent fluid and hearing loss, reducing antibiotic use—a concern highlighted in the report.
To balance vigilance against overuse with access to beneficial surgeries, further research is needed to capture real-world complexities beyond clinical trials. Promoting best practices that minimize risks and account for individual differences in symptom burden and family priorities is crucial. Pediatric surgery should remain under scrutiny, ensuring favorable outcomes, minimal risks, and justified interventions.
Ultimately, the value of these surgeries is evident not only in clinical data but also in the experiences of countless parents whose children have benefited from carefully considered and prudently delivered surgical care. Encouraging a comprehensive review of existing evidence and fostering collaboration between policymakers, clinicians, and families can ensure that children receive appropriate care without unnecessary intervention.