Surgical operations may be done even though there is no clear medical evidence that the intervention is justified. In the case of Caesarean operations reasons for the increase are related to fear of litigation by surgeons should normal deliveries develop complications or the babies suffer from brain damage that can be claimed to be due to normally assisted delivery procedures. Such operations may also be encouraged for the financial convenience of hospitals preferring birth to take place during normal operating hours. Other operations are undertaken for purely cosmetic reasons.
There are twice as many operations per head in America as in the UK. By the time American women reach 60, more than a third of them have had a hysterectomy, surgical removal of uterus. Removal of children's tonsils in the USA reduced by 75% between 1980 and 1989. Over the same period, the rate of birth by caesarean section increased by 50%.
In 1987 more than 230,000 Americans had coronary bypass operations, twice as many as in 1980, but only few are life-and-death affairs performed on patients who have just had heart attacks. It has been estimated that 44% of bypass operations are inappropriate. Life expectancy is improved only if the left main artery was diseased and if there was damage to the left ventricular muscle. The operation does give significant relief from chest pain, but for that purpose the alternative methods are less costly and sometimes as effective.
Glue ear involves a painless accumulation of mucus-like fluid in the ear and can cause partial deafness. Some 100,000 operations are conducted each year in England and Wales. A controlled trial involving 149 children found that about one-third of the operations were inappropriate, as surgery was effective only for those with a severe form of the disease.