Somewhere right now, a highly trained professional with 12 years of education, $400,000 in student loans, and a brand-new piece of equipment is staring at your perfectly normal child and thinking: “I bet I could fix something here.”
Welcome to one of medicine’s oldest and least discussed traditions: finding problems that fit the tools we already own. I say this with love, as a member of the club. Most doctors went into medicine to help people. But we are also human beings who spent years learning very specific skills, and nothing makes a skill feel more pointless than not using it.
A surgeon who doesn’t operate is just a person with excellent hand washing technique. A specialist with a fancy scope is a scope owner with a payment plan. And a profession that pays for doing things, not for wisely choosing not to do them, will reliably produce… more things.
The old saying goes, “When all you have is a hammer, everything looks like a nail.” In modern medicine, the hammer bills by the swing.
The Tongue Tie Gold Rush
Let’s start with my favorite pediatric example, because nothing says “evidence based medicine” like a tenfold increase in a congenital condition over 15 years. Ankyloglossia, better known as tongue tie, is real. Some babies truly have a tight frenulum that makes feeding hard, and a quick snip can help. Nobody disputes that.
What’s harder to explain is the math. Researchers at Johns Hopkins looked at national hospital data and found that tongue tie diagnoses jumped 834% between 1997 and 2012, and frenotomy procedures rose 866%. Did human tongues suddenly evolve shorter tethers in the late ’90s? Was there a frenulum tightening chemical in the water? Did Y2K break babies’ mouths? Probably not.
The same study found these diagnoses and procedures were more common in privately insured children from higher-income zip codes. The authors politely said this “may reflect local practice patterns, or imply cultural and socioeconomic bias.” That’s academic code for “Funny how the epidemic follows the good insurance.” Then came lip ties, buccal ties, cheek ties, and, I can only assume, the soon to be diagnosed “earlobe tie.” Each new tie has its own laser, its own consultation fee, and its own Instagram account full of crying babies and grateful testimonials. Testimonials are great. They’re also not data.
Medicine’s Embarrassing Habit of Being Wrong
If you think this is just a tongue tie problem, buckle up. In 2013, researchers reviewed ten years of articles in the New England Journal of Medicine, arguably medicine’s most prestigious journal. They looked at the studies that tested treatments doctors were already using, and 40.2% of those studies found the established practice didn’t work any better than the older or lesser alternative. Read that again. Of the standard practices that actually got tested, roughly four in ten flopped.
The authors called these “medical reversals”: practices that were widely adopted, confidently recommended, and later shown to offer no net benefit. They weren’t old treatments replaced by better ones. They were treatments that, as far as anyone could tell, never really worked in the first place. That’s not a rounding error. That’s a business model.
The Sham Surgery That Beat the Real One
My all time favorite example of medical overconfidence comes from knee surgery. For years, arthroscopic “cleanups” for knee osteoarthritis were routine. Patients said they felt better. Surgeons said patients felt better. Everybody felt better. So in 2002, researchers asked a rude question: what if we just pretended to do the surgery?
They randomized 180 patients to real arthroscopic debridement, arthroscopic lavage (basically rinsing the joint), or placebo surgery, which meant skin incisions and a simulated procedure with no scope ever entering the knee. The result: at no point over two years did the real surgery groups report less pain or better function than the fake surgery group. So, to sum up: a small cut in the skin and some theatrical knee wiggling performed just as well as the real thing. Somewhere, a magician is asking why he didn’t go to medical school.
Why This Keeps Happening
Before anyone sends me angry emails in all caps, let me be clear: most doctors aren’t villains rubbing their hands over a pile of unnecessary procedure codes. The problem is quieter and more human than that. We’re trained to act (and paid for the act). Medical training rewards doing something. “Watchful waiting” sounds like laziness to anxious parents and to doctors who feel useless sitting on their hands. We pay for activity, not wisdom. Our system pays far more for procedures than for a 30 minute conversation explaining why your child doesn’t need one.
You’ll never see a billing code called “Talked Family Out of Unnecessary Surgery, Level 5.” Parents want answers. When your baby is fussy, feeding is a nightmare, and you haven’t slept since the Obama administration, a concrete fix sounds a lot better than “babies are hard and this usually gets better.” Anecdotes feel like proof. “We did the procedure and things improved!” Maybe. Things also improve because babies grow, mouths mature, parents get practice, and most problems resolve on their own. The procedure gets the credit either way.
New skills need customers. Spend a weekend learning a new technique, buy a $50,000 device, and suddenly you start seeing the condition everywhere. That’s not necessarily greed. It’s how human brains work. But your child shouldn’t pay for your doctor’s confirmation bias.
How to Protect Your Kid From Enthusiastic Medicine
You don’t need to distrust every doctor. You just need to ask the questions we sometimes forget to ask ourselves:· “What happens if we wait?” If the honest answer is “probably nothing bad,” that’s a great answer. “What’s the evidence this helps, and compared to what?” Not testimonials. Studies, ideally ones with a control group. “Who else agrees this is needed?” A second opinion from someone who doesn’t perform the procedure is worth its weight in gold. “What are the risks?” Every intervention has some. “Minor” and “zero” aren’t the same word.
“Do you do a lot of these?” If the answer is “Oh, tons, on almost every baby,” be suspicious. The best doctors I know aren’t the ones who do the most. They’re the ones who know when to do nothing, explain it well, and are comfortable with the very unglamorous phrase: “Let’s give it time.”
Because sometimes the most skilled thing a doctor can do is put down the laser.
Disclaimer: This blog is for educational purposes only and is not a substitute for individualized medical advice. Always talk with your child’s healthcare provider about specific concerns, symptoms, or treatment decisions.
Sources:
Walsh J, Links A, Boss E, Tunkel D. Ankyloglossia and Lingual Frenotomy: National Trends in Inpatient Diagnosis and Management in the United States, 1997-2012. Otolaryngol Head Neck Surg. 2017;156(4):735-740. https://pmc.ncbi.nlm.nih.gov/articles/PMC6475619/
Prasad V, Vandross A, Toomey C, et al. A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices. Mayo Clin Proc. 2013;88(8):790-798. https://ohsu.elsevierpure.com/en/publications/a-decade-of-reversal-an-analysis-of-146-contradicted-medical-prac/
Moseley JB, O’Malley K, Petersen NJ, et al. A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. N Engl J Med. 2002;347:81-88. https://www.nejm.org/doi/full/10.1056/NEJMoa013259