It is unnecessary to do what is unnecessary

Anyone who writes risks error and should be grateful to editors who point out his errors to him, for it is preferable to be corrected before rather than after publication. American editors are better in this respect than British, perhaps because they are assisted by those lowly creatures unknown in Britain called fact-checkers. They can be irritating or absurd at times – I was once asked to provide evidence that Napoleon had been an emperor – but they have several times saved me from egregious error. I thought I remembered a statistic or a fact that was not so; and the fact is (please do not ask me for a reference to prove it) that memory, even one’s own, is fallible.

But while American editors are better or more thorough than British, they are not perfect. One might have thought that the editors of one of the two most famous medical journals in the world, the New England Journal of Medicine, would be more than averagely conscientious, but error or absurdity escapes their net with surprising frequency.

Last week, for example, I was reading in the Journal and article about the neurotoxicity of anaesthetics in very young children. Experiments in animals, from nematode worms to primates, have shown that anaesthetics administered to young creatures can cause damage to neurones, with subsequent behavioural disturbance. There is, apparently, some slight, though as yet inconclusive evidence, that anaesthetics administered to children under the age of three can cause long-term problems and lower their intelligence.

So far so good (or bad). There is nothing intrinsically implausible about it, and the evidence present entirely reasonable. But a recommendation at the end of the article caught my attention. A group of experts had gathered to consider the problem. The article says:

The group produced a statement recommending that surgical
procedures performed under anesthesia be avoided in children
under 3 years of age unless the situation is urgent or potentially
harmful if not attended to.

A good test of the value of the statement is whether its opposite would be surprising: in this case that non-urgent operations or those that avoid no harm are perfectly advisable in children under the age of 3. We surely need no research to tell us that this is absurd. We don’t need experiments on nematodes to prove that unnecessary operations on infants are wrong. This is not to say that the research is without value: but its value lies elsewhere, for example in the possibility of preventing anaesthetic damage to infants who must be operated upon.

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