Insights from the Make America Healthy Again Commission Report on Pediatrics
The recent report by the Make America Healthy Again (MAHA) commission has sparked considerable discussion due to its citation errors and emphasis on ultra-processed foods, smartphone use, and stimulants among children. However, what caught our attention more was its commentary on the “overmedicalization” of American youth. Although the report touches on surgical care superficially, it specifically highlights adenotonsillectomy and tympanostomy tube placements as procedures that “cause harm without providing benefits.” This is notable, as these are some of the most frequently performed surgeries in children.
As pediatric ear, nose, and throat surgeons with extensive experience in both clinical settings and research, we recognize the importance of vigilance regarding the overuse of these surgeries. One of us (EB) focuses on parental decision-making related to elective surgeries, while the other (DT) has worked on developing national clinical practice guidelines aimed at ensuring surgical care is appropriate. We both agree that while these procedures are often performed, a thoughtful approach to their use is essential.
Yet, the MAHA report seems to lack a comprehensive view on this subject, overlooking the recognized benefits of these surgeries. For example, adenotonsillectomy can lead to better sleep, improved behavior, and enhanced learning, while tympanostomy tubes often result in better hearing, clearer speech, and reduced ear infections. When performed on properly selected children, these surgeries can substantially enhance quality of life and decrease healthcare visits and antibiotic usage. Dismissing the positive impacts of surgery could jeopardize access for kids struggling with issues like sleep apnea or hearing loss.
The debate surrounding the appropriate use of adenotonsillectomy and ear tube surgery has been ongoing for many years. In 2009, President Obama suggested that financial incentives might affect a surgeon’s recommendation for tonsillectomy. A few years later, a National Summit on Overuse brought attention to the misapplication of ear tubes for temporary fluid retention in the ears. These discussions led to the creation of evidence-based guidelines, shaped by clinical research and patient outcomes. These guidelines clearly outline when surgery is warranted and stress the importance of shared decision-making between families and healthcare providers. While surgeries are still common, their frequency has declined, and the criteria for performing them have become more precise. Now, tonsillectomies are primarily carried out to address obstructed breathing and sleep apnea, whereas ear tubes are used mainly for persistent fluid that causes hearing loss and delays in speech, rather than for infrequent, uncomplicated ear infections.
There’s no doubt that adenotonsillectomy and ear tube surgery can have significant, life-enhancing effects for many children. In fact, this procedure is performed on nearly 300,000 kids in the U.S. annually and addresses pediatric obstructive sleep apnea, a common condition that can lead to serious issues like heart and lung stress, fatigue, and even learning delays.
While the MAHA report claims that adenotonsillectomy offers no benefit for sleep apnea, it cites a single study that showed no change in a generic IQ screening. However, the same research also indicated marked improvements in behavior and overall health for children who underwent the surgery—details that the MAHA report fails to include. Moreover, it neglects numerous other well-conducted studies that consistently highlight the positive outcomes in health, sleep, learning, and life quality post-surgery. Large-scale randomized trials confirm that although some children with sleep apnea might improve without intervention, the majority continue to suffer unless they undergo surgery.
Ear tube surgeries reflect a similar narrative. Yes, there has been overuse, particularly in cases of recurrent infections or temporary ear fluid, and contemporary guidelines advise caution in such situations. However, for children with ongoing fluid and hearing loss, ear tubes can make a measurable difference, reducing unnecessary antibiotic use—an issue that the MAHA report rightly identifies.
The challenge ahead lies in how we can effectively balance efforts to prevent overuse while still offering surgery to those who truly need it. We need a deeper understanding of the complexities involved with children undergoing these procedures. Research must broaden to include real-world data beyond the confines of clinical trials, and we must advocate for best practices that lower risks while acknowledging that two children with the same diagnosis may present unique symptoms and priorities.
Surgical interventions in children must always be examined closely. It’s our commitment to ensure that these procedures are conducted only when the expected outcomes are favorable, the risks are manageable, and the burden of disease justifies the intervention. While we support the MAHA policymakers’ focus on overuse, we advocate for a more extensive review of research, systematic analyses, and clinical guidelines. Tonsillectomy and ear tube surgeries offer valuable benefits to many children. This is something we know not just from a more thorough analysis than MAHA provided, but also through years of clinical experience treating thousands of children.
If statistics and our professional insights aren’t compelling enough, just ask the parents. They can recount stories of children who sleep better, hear more clearly, communicate effectively, excel in school—all thanks to surgeries that were thoughtfully considered and appropriately performed.
