Medical Fads

In the 1950s post-menopausal women underwent examinations using a spirometer and the doctors drew conclusions of thyroid activity and many times they extirpated the thyroid.

This was indeed called a “basal metabolism test” or sometimes a “metabolism check.” Doctors often used indirect tools—like a spirometer—to measure oxygen consumption, which they believed could reveal thyroid activity.

The thyroid regulates metabolism largely through thyroxine (T4) and triiodothyronine (T3). Overactive thyroid (hyperthyroidism) accelerates metabolism, while underactive thyroid (hypothyroidism) slows it down. Before modern blood hormone assays, physicians needed indirect ways to measure metabolic rate.

A spirometer measures lung volumes and oxygen consumption. In the mid-20th century, doctors sometimes used it in a closed-circuit setup to measure how much oxygen a patient consumed at rest. The assumption was that high oxygen consumption means high metabolic rate and therefore it is an indication of  possible hyperthyroidism, and low oxygen consumption would mean low metabolic rate, indicating  possible hypothyroidism

Since thyroid hormones strongly influence basal metabolic rate (BMR), this was thought to be a reasonable proxy.

Patients (often women, because thyroid disease is more common in them) were put at rest, sometimes overnight, and their oxygen use was measured. The results were compared against tables of “normal” metabolism indexed by age, sex, and body surface area. Deviations were interpreted as thyroid dysfunction.

However, this test was nonspecific, as oxygen consumption varies with many factors, like fever, anemia, nutrition, anxiety, infection, even room temperature, and the so called  “normal” ranges were broad, so many healthy people were flagged as abnormal. Some physicians, eager for “scientific” precision, used abnormal spirometry results to justify thyroidectomy (surgical removal of the thyroid).

By today’s standards it looks like a mix of genuine science (oxygen metabolism is related to thyroid) and a medical fad, because of the overconfidence in an indirect, noisy test.

Today, thyroid function is assessed directly through TSH, free T4, and T3 blood tests, which are far more accurate and specific. Spirometry no longer has any role in thyroid evaluation. Looking back, the 1950s metabolism check was not fraudulent, but it was an imperfect, indirect method that often led to misinterpretation and overtreatment.

In conclusion, the “metabolism check” so popular in the 1950’s with a spirometer was not entirely fake—it was based on measuring basal oxygen consumption as a rough proxy for thyroid activity. But it was a crude, nonspecific test. In practice, it became something of a fad and often resulted in unnecessary thyroid surgeries.

Also in the 1950s, many children were forced to tonsillectomy, often without anesthesia. Was that necessary and why did they do it? Today there are almost no tonsillectomies. 

The tonsillectomy story is one of the classic examples of how medical fashions shift over time.

In the 1940s–1950s, tonsillectomy was one of the most common surgeries in children in the U.S. and Europe. In some areas, more than half of schoolchildren had their tonsils removed by age 10.

It was believed that the tonsils were a  focus of infection. Doctors thought tonsils “harbored germs” and were a source of repeated sore throats, ear infections, rheumatic fever, and even kidney disease. Even if a child was not sick, some physicians (and schools!) recommended removing tonsils prophylactically—“better out than in.”

Regular school screenings often flagged enlarged tonsils as a reason for surgery.

in the early 20th century, tonsillectomies were sometimes performed with little or no anesthesia (especially in poor or rural settings) because ether and chloroform were risky, and pediatric anesthesiology was not yet well developed. Local anesthesia or severe restraint was sometimes used instead. By the 1950s, general anesthesia with ether was available in hospitals, but not always used for “routine” tonsillectomies done in doctor’s offices. So indeed, many children endured it awake—an ordeal remembered vividly.

By the 1970s–1980s, the routine tonsillectomy craze had collapsed because: Scientific evidence showed that most children “outgrow” recurrent sore throats, and prophylactic removal offered little long-term benefit; Surgery carried risks—bleeding, infection, anesthesia complications—that outweighed the mild benefit for most kids; New antibiotics, penicillin and drugs made treating strep infections safer and easier. Also, instead of viewing tonsils as being “useless lumps,” tonsils were recognized as part of the immune system, helping children develop immunity.

Modern guidelines recommend tonsillectomy only for specific cases, such as: Recurrent, well-documented strep throat infections (7 or more per year);  obstructive sleep apnea caused by enlarged tonsils and rare complications (peritonsillar abscesses, suspected cancer). As a result, the operation is far less common today and is done under safe anesthesia when indicated.

In the 1950s, tonsillectomies were massively overdone—often without proper anesthesia—because doctors believed the tonsils were dangerous “infection factories.” It was not necessary in most children. Once evidence, antibiotics, and immune science improved, the practice sharply declined. Today, tonsillectomy is reserved for clearly defined medical reasons.

Circumcision is similar to tonsillectomy and thyroid “metabolism checks” in that it has often been performed routinely without strong medical necessity, but it’s also different because it carries deep cultural, religious, and social roots that go far beyond medicine.

In the late 1800s in the U.S. and Britain, circumcision was promoted as a cure or prevention for a wide range of conditions: epilepsy, paralysis, syphilis, bedwetting, masturbation (“self-abuse”), and later even mental illness. In the 1950s–1960s in North America, circumcision became routine for newborn boys. The stated benefits included reducing urinary tract infections, preventing penile cancer, lowering cervical cancer risk in partners, and promoting hygiene. Many hospitals offered it as standard, often without detailed parental consent.

On the other hand, in most European countries, circumcision was rare unless required by religion (Judaism, Islam) or for very specific medical problems.

Comparison With Tonsillectomy and Thyroid “Metabolism Checks”:

• All three were heavily influenced by medical fashions and changing standards of what doctors considered “necessary.”

• All three led to large numbers of procedures that would not be done today under modern guidelines.

• All three carried risks that were downplayed at the time.

• Tonsillectomy and thyroid extirpation were primarily medical fads, later abandoned once evidence contradicted them.

• Circumcision has enduring cultural/religious support, so even when the medical justification weakened, the practice continued in many communities.

Although according to some sources, circumcision does offer some modest health benefits — reduced risk of urinary tract infection in infancy, reduced risk of HIV and some STDs and lower risk of penile cancer, these benefits are relatively small in developed countries with good hygiene and access to antibiotics. Complications are rare but real (bleeding, infection, meatal stenosis, psychological issues). The American Academy of Pediatrics (AAP) stated: “Health benefits outweigh risks, but not enough to recommend universal circumcision; decision should be left to parents.” The European medical community generally sees no medical justification for routine circumcision.

Circumcision overlaps with the “fad” category because it was widely medicalized and promoted as routine in the 20th century, despite limited necessity. But it stands apart because cultural and religious traditions sustain it in ways that tonsillectomy and metabolism checks never had.

Similar trends today.

Because history repeats itself in medicine, what looks “necessary” and “scientific” today can, in hindsight, be seen as fad-driven overtreatment.

Here are several modern parallels to the 1950s thyroid “metabolism checks,” routine tonsillectomies, and circumcisions:

1. Cesarean Sections (C-Sections)

In some countries (e.g., Brazil, U.S., China), C-section rates are 2–3 times higher than the World Health Organization’s recommended 10–15%, because of convenience, scheduling, liability fears, patient preference, and hospital incentives.

However, many are not medically necessary and are sources of higher risks of infection, complications in future pregnancies, and longer maternal recovery.

In the future, C-Sections may be judged as a mix of justified care and massive overuse.

2. ADHD and Psychiatric Medication in Children

Lately a dramatic rise in ADHD diagnoses and stimulant prescriptions (e.g., Ritalin, Adderall), fueled by broader diagnostic criteria, school pressures and pharmaceutical pressure lead to risk of overdiagnosis and overtreatment in children with normal behavioral variation.

In the future, it could be seen like tonsillectomy — a response to perceived “problem behavior” that may settle naturally.

3. Prostate-Specific Antigen (PSA) Screening.

For decades, PSA tests were recommended routinely for men to detect prostate cancer early, with the promise of early detection. This led to massive overdiagnosis, unnecessary biopsies, and treatments with severe side effects (impotence, incontinence).

Guidelines are already rolling back to a targeted, not routine level. This is a classic parallel to thyroid overdiagnosis.

4. Opioid Prescriptions (1990s–2010s).

Pain was redefined as the “fifth vital sign” and doctors were urged to treat it aggressively, mostly because of pharmaceutical marketing and severe underestimation of addiction risk. This resulted in massive overprescribing, that  led to the opioid crisis.

Opioid Prescriptions are already recognized as one of the biggest medical missteps of recent decades.

5. Plastic and Cosmetic Surgery Enhancements

Botox, fillers, breast implants, labiaplasty, and other “routine” procedures are often marketed as safe and beneficial for self-esteem, mostly motivated by social media, beauty standards and heavy industry profits.

Many plastic and cosmetic surgery enhancements and procedures are followed by complications, need repeat procedures, or create psychological dependence.

In the future, plastic and cosmetic surgery enhancements and procedures could be seen as a cultural/medical fad like routine circumcision.

The pattern across eras becomes clearly visible: just as the 1950s were characterized by  Thyroid “metabolism checks,” routine tonsillectomy and prophylactic circumcision, today we see over-screening, over-medicating, and “preventive” interventions with shaky evidence.

All started with some scientific truth but expanded far beyond what evidence supported, as it were reinforced by culture, economics, or institutional incentives

Today’s equivalents include C-sections, ADHD medication, PSA screening, opioids and cosmetic surgeries. Like the thyroid/tonsil/circumcision trends of the past, many may later be judged as cases of medical overreach or cultural-medical fashion.