How Appropriate Are Surgically Inserted Tubes for Otitis Media?
The April 27, 1994 issue of the Journal of the American Medical Association (JAMA) revealed that most tympanostomy tube surgery may not be appropriate for children. In their paper, "The medical appropriateness of tympanostomy tubes proposed for children younger than 16 years in the United States," the authors examined 6,429 cases utilizing "explicit criteria developed by an expert panel using the RAND/University of California - Los Angeles, modified Delphi method."
The results:
"A total of 6,429 (97%) of the cases were proposed for recurrent acute otitis media, otitis media with effusion, or both. Making generous clinical assumptions, 41% of the proposals for these reasons had appropriate indications, 32% had equivocal indications, and 27% had inappropriate ones. Considering the additional information available from the subsample review, the proportion appropriate was 42%, equivocal 35%, and inappropriate 23%."
With less than half of the surgeries deemed appropriate, parents would do well to consider the risks involved before making the decision to allow their child to undergo surgery. While the chiropractic research community is just beginning to conduct the necessary studies to examine the effectiveness of chiropractic treatment for otitis media, conservative care has a great appeal.
The authors further stated: "Otitis media affects two-thirds of American children by 2 years of age, making it the most common diagnosis of children and the second most common diagnosis in medicine. Approximately 670,000 surgeries to insert tympanostomy tubes were performed in the United States in 1988, making it the most common operation for children."
These surgeries all took place in 1988. If 388,600 of these surgeries were apparently unnecessary, one must wonder about their economic impact on the families of these children, as well as the ramifications within the health care system in general.
Over Drugging -- Placing the Elderly at Risk A recent paper in the Canadian Medical Association Journal,1 "Questionable prescribing for elderly patients in Quebec," revealed the alarming percentage of elderly people who are placed at risk by current prescribing practices within the medical community. The study took a stratified, regional, random sample of 63,268 elderly medicare registrants who made at least one visit to a physician in 1990 and were not living in a health care institution for the entire year."
The results should shock everyone, particularly those who have elderly loved ones:
"Overall, 52.6% of the patients experienced one or more events of high-risk prescribing, and 45.6% experienced at least one that was questionable. High-risk prescribing was most prevalent for psychotropic drugs, and questionable prescribing was more frequent than rational prescribing in this drug group. An estimated 30.8% of the total elderly population in Quebec received benzodiazepines for more than 30 consecutive days, 12.9% received a long-acting benzodiazepine, and 13.0% received a questionable high-risk psychotropic drug combination. The prevalence of high-risk prescribing was higher among the women than among the men and increased with age until 75 to 84 years. There were significant unexplained differences between regions in the regional prevalence of high-risk prescribing, particularly of psychotropic drugs."
Not only is this a quality of life concern, but it may also be a very significant cost factor. The authors concluded: "This may be a potentially important and avoidable risk factor for drug-related illness in elderly people."
Reference
1. Tamblyn RM et al: Questionable prescribing for elderly patients in Quebec. Can Med Assoc J, 150:(11), 1994.
