`I was assaulted by a surgeon'

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The Independent Culture
I HAD my tonsils and adenoids out when I was four. It was the 1950s and, like millions of children, I was put to the knife in what is now recognised to have been a surgical assault on an unprecedented scale.

The swollen, angry looking organs at the back of so many young throats, were not a cause of illness as doctors thought but a sign that the body was successfully fending it off. The operation actually weakened our defence against infection rather than strengthening it.

There is a lesson here for Tony Blair whose anxiety about the NHS, and his capacity to modernise it, is becoming daily more palpable. This week he even repeated a pledge made at least a year ago - that all cancer patients would be seen by a specialist within two weeks of diagnosis - as if it were new.

The problem with the cancer pledge, like the costly pledge to cut waiting lists, is that it distorts clinical priorities. Of course people with suspected cancer should be seen quickly, provided treatment for sicker patients is not delayed.

Which brings us back to adenoids. If you want to cut waiting lists, why not cut out unnecessary operations? Although surgery to remove tonsils and adenoids has declined sharply since I lost mine, it remains one of the 10 most commonly performed operations in Britain.

When my own offspring developed the sore throats and ear infections that are as much a part of childhood as birthdays and Christmas, a new operation was in vogue - grommets. The tiny valves, inserted in the ear drum of my older son, were supposed to cure "glue ear", a cause of childhood deafness, by allowing accumulated fluid to drain away. Cynics said the diagnosis was the creation of under-employed ear, nose and throat surgeons anxious to fill empty operating lists after tonsillectomies went out of fashion. The fashion for grommets, too, is now past its peak.

But old habits die hard. A report in yesterday's Journal of the American Medical Association says surgery to remove tonsils and adenoids is still the commonest operation performed on American children aged under 15, with 426,000 cases treated in 1994. The report adds that more than one in seven of the children suffered subsequent complications. So in return for a small reduction in the risk of ear infection, they had to undergo major surgery with a high risk of complications.

Unnecessary surgery in this country is not confined to tonsils or to children. Hysterectomies, removal of wisdom teeth and D & Cs (scraping of the lining of the womb) are all common operations which, studies suggest, are overperformed. Cutting them by even 10 per cent would ease the pressure on the NHS.

The Government's new watchdog of clinical effectiveness - the National Institute of Clinical Excellence - is due to get its teeth into these issues in the autumn. Tony Blair must be hoping it bites as well as barks.

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