Picking on trans youth

If Oz's CMS wants to investigate hospitals for failing to meet quality standards, he should look elsewhere.

Mehmet Oz, the television doctor now in charge of the Centers for Medicare and Medicaid Services, yesterday launched an investigation into hospitals that conduct sexual transition surgeries for minors.

He gave hospitals 30 days to respond with details about their informed consent procedures, parental involvement and clinical guidelines. He also demanded documentation of adverse outcomes “including cases involving regret,” and reports on the revenue and profits made from the operations.

The press release and accompanying letter did not reveal how many hospitals received these demands, which were clearly aimed at intimidating not just those that perform the procedures but at any that might consider it.

Sexual transition surgeries among youths under 18 are extremely rare. According to a study that appeared in JAMA last July, the vast majority (97%) of breast reduction surgeries performed in 2019 for youths under 18 were among cisgender males bothered by man-boobs (the circumlocution used in a famous Seinfeld episode). There were fewer than 100 such surgeries among teenage women who identify as male.

But that didn’t stop Oz’s CMS from accusing hospitals that conduct those surgeries from putting profits ahead of adhering to quality standards. “Hospitals accepting federal funds are expected to meet rigorous quality standards and uphold the highest level of stewardship when it comes to public resources,” he said in the agency press release. “We will not turn a blind eye to procedures that lack a solid foundation of evidence and may result in lifelong harm.”

The press release failed to mention any evidence that these operations cause lifelong harm. His letter did include a long list of billing codes that could be used in such surgeries.

Overuse is the real problem

While Oz pursues hatreds hatched in rightwing fantasyland, here’s a list of some of operations he ought to investigate should he ever open his eyes “to procedures that lack a solid foundation of evidence and may result in lifelong harm.”

Spinal fusion and back surgeries: Multiple high-quality trials have shown spinal fusion surgery is no better than physical therapy for treating back pain. Nearly a half million such surgeries are done each year.

Arthroscopic knee surgery for partial meniscus tears: Performed hundreds of thousands of times per year, the FIDELITY trial showed it provided no meaningful benefit over sham surgery.

Stenting for stable heart disease: Again, performed hundreds of thousands of times each year, yet studies show it is no better than taking pills for reducing the risk of heart attacks or death.

Caesarean sections: Around a third of U.S. mothers deliver their babies via this operation, often due to physician or maternal preference which means they entail risk without benefit. In Europe and Asia, the rates are anywhere from 10% to 25%. The World Health Organization, which the Trump administration quit, suggests a 10% rate is optimal for maximizing positive outcomes for both mother and child.

Or, he could begin looking into the overuse of hysterectomies; episiotomies; pacemaker implants; tonsillectomies; and cholecystectomies (gall bladder removals).

Questions he might ask:

Are all these operations being performed when clinically appropriate?

Is there wide variation in the rates for these operations at hospitals?

What accounts for that variation?

Are hospitals and surgeons pursuing profit at the expense of patient-centered care?