No working organ should be removed (e.g., a thyroid with nodules that still functions); one should stay away from the scalpel, and Elawady is 'against any operation, including caesarean section'.
Original statement
دكتور ايه رايك في عمليات تكميم المعده انا ضد اي عمليه بما فيهم القيصريه سهله سهله انا انا ضد اي مشرط يضرب في جسم حضرتك
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
No working organ should be removed (e.g., a thyroid with nodules that still functions); one should stay away from the scalpel, and Elawady is 'against any operation, including caesarean section'.
Origin
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr.D Clinics - Diaa Al Awady is live! (Open source)
- Published
- 25 February 2025
- Timestamp
- 0:35:16 (location in the original video’s automatic YouTube caption track; confirms where the words occur, not who speaks)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
- Claimed mechanism
Body organs all have function; removal disturbs the body.
- Claimed health effect
Harm from any surgery.
- Population concerned
Everyone
- Geographic restriction by Elawady
none found
Diverging source versions
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr.D Clinics - Diaa Al Awady is live! الدورة المعوية مسار تحول (Open source)
- Published
- 16 April 2025
- Timestamp
- not available (transcript has no timings)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr.D Clinics - Diaa Al Awady is live! نوبة النهجان و ضيق النفس (Open source)
- Published
- 19 January 2025
- Timestamp
- not available (transcript has no timings)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
Scientific assessment
Mostly false – Essential parts of the statement are not supported by the evidence or are strongly exaggerated.
Certainty of evidence: moderate – Further research may still affect the assessment.
1. What was claimed?
Never remove a functioning organ; against any operation including caesarean.
2. What is demonstrably correct?
Partly aligned with evidence: overdiagnosis and overtreatment of thyroid cancer are real (A-ORG-19, I-ORG-02, I-ORG-03); watchful waiting is guideline-recommended for many sore-throat cases (I-ORG-06); antibiotics can replace appendectomy in some uncomplicated appendicitis (I-ORG-07); the archive itself states that indicated operations should be done 'without hesitation'.
3. What is wrong or exaggerated?
As a blanket rule it is false: surgery shows clear benefit in indicated situations (A-ORG-03, I-ORG-05, I-ORG-101). For caesarean section, WHO states that a caesarean prevents maternal and perinatal deaths when medically justified and must be available to all women in need, and that lack of timely caesarean can cause asphyxia, stillbirth, uterine rupture or obstetric fistula (I-ORG-110); NICE defines category 1 caesarean as an immediate threat to the life of the woman or baby, to be performed within about 30 minutes. For thyroid nodules, the ATA guideline recommends observing most benign nodules but operating on confirmed cancers larger than 4 cm or with spread, and on compressive nodules (I-ORG-114).
4. What remains unclear?
n/a
5. Which studies support it?
A-ORG-19, I-ORG-02, I-ORG-03, I-ORG-06 (overdiagnosis, watchful waiting); I-ORG-111 (very high caesarean rates, Egypt 51.8% vs world 21.1%, consistent with overuse); I-ORG-114 (most benign thyroid nodules should be observed).
6. Which studies contradict it?
A-ORG-03, I-ORG-05, I-ORG-07, I-ORG-101 (benefit of indicated operations); I-ORG-110 (WHO: medically necessary caesarean saves lives); I-ORG-114 (surgery for thyroid cancer and compressive nodules); I-ORG-106, I-ORG-109 (appendicitis must be treated; surgery remains standard).
7. What applies to Germany and Europe?
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
8. What is known about Egypt?
Egypt has one of the highest caesarean section rates in the world (51.8%, about 2.5 times the world average of 21.1%; I-ORG-111), so concern about unnecessary caesareans is particularly relevant in Egypt. This does not justify refusing a caesarean that is medically indicated.
9. What practical conclusion is appropriate?
Ask whether an operation is indicated and what alternatives exist; do not refuse indicated surgery on principle.
Assessment details
- Rationale for certainty of evidence
Blanket rejection conflicts with RCT evidence of benefit for indicated surgery; partial alignment with evidence on overtreatment of small thyroid cancers and watchful waiting.
- Source quality
Transcript statements.
- Regional transferability
Universal.
- Individual exceptions
Low-risk thyroid nodules and small papillary cancers can often be monitored (USPSTF notes similar outcomes for treated vs monitored common tumour types).
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
Scientifically refuted – High-quality evidence shows the opposite, or the claim contradicts well-established physiology.
Research question: Is it justified to avoid all surgery, including caesarean section and removal of 'working' organs such as a nodular thyroid, or do indicated operations improve outcomes?
Research question in detail (PICO)
- Population
- People with surgical indications (obstetric, thyroid, appendicitis, tonsils, gallstones)
- Intervention or exposure
- Refusing all surgery (the claim)
- Comparison
- Indicated surgery
- Geographic scope
- universal; caesarean overuse is country-specific (Egypt among the highest rates)
- Outcomes
- Maternal and perinatal mortality
- Cancer outcomes
- Symptom control
- Complications
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
Caesarean rates around the world
Betran AP et al.. BMJ Glob Health 2021 · PMID 34130991 · DOI 10.1136/bmjgh-2021-005671 Ecological studyabstract checkednewly addedGlobal CS trends: Egypt 51.8%, one of the highest rates worldwide, consistent with overuse.
- Actual result
- World 21.1%; Egypt 51.8%.
- Methodological quality
- moderate (national data)
- Relevance
- direct for overuse
- Limitations
- Does not identify which CS were unnecessary.
US task force: do not screen healthy adults for thyroid cancer
US Preventive Services Task Force. JAMA 2017 · PMID 28492905 · DOI 10.1001/jama.2017.4011 Guideline / position statementabstract checkedUSPSTF: screening for thyroid cancer not recommended; treated vs monitored outcomes similar for common tumour types.
- Actual result
- Net benefit of screening negative.
- Methodological quality
- high (guideline)
- Relevance
- direct for overtreatment
- Limitations
- Applies to screening of asymptomatic adults.
What speaks against the claim?
WHO statement on caesarean section rates
Betran AP et al.. BJOG 2016 · PMID 26681211 · DOI 10.1111/1471-0528.13526 Guideline / position statementfull text checkednewly addedWHO: caesarean section prevents maternal and perinatal deaths when medically justified and should be provided to all women in need.
- Actual result
- Policy statement based on systematic review.
- Methodological quality
- high (WHO statement)
- Relevance
- direct
- Limitations
- Population-level data.
Tonsil and adenoid surgery for children who snore or have sleep apnoea
Venekamp RP et al.. Cochrane Database Syst Rev 2015 · PMID 26465274 · DOI 10.1002/14651858.CD011165.pub2 Systematic reviewabstract checkednewly addedCochrane: indicated adenotonsillectomy improves symptoms and sleep studies in childhood OSA.
- Actual result
- RD 33% PSG normalisation.
- Methodological quality
- high
- Relevance
- direct
- Limitations
- Mild cases may wait.
US thyroid guideline on nodules and cancer
Haugen BR et al.. Thyroid 2016 · PMID 26462967 · DOI 10.1089/thy.2015.0020 Guideline / position statementabstract checkednewly addedATA: surgery recommended for confirmed thyroid cancers > 4 cm, with extension or metastases.
- Actual result
- Recommendation 35A (strong).
- Methodological quality
- high (guideline)
- Relevance
- direct
- Limitations
- Benign nodules usually observed.
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
Overuse of some operations is real (caesarean section in Egypt, thyroid surgery for overdiagnosed cancers), but indicated operations, including emergency caesarean section, save lives and improve health.
Why some studies weigh more
WHO, NICE and ATA guidance and RCT evidence directly address indicated surgery.
Is a causal relationship established? Yes, established Benefits of indicated caesarean and other surgery are established; the claim's absolute refusal is not testable ethically but contradicts clear evidence.
Remaining uncertainty
Optimal facility-level caesarean rates; which thyroid nodules can be safely observed.
Justified conclusion
Caution and second opinions are reasonable; refusing all surgery is not.
Why do studies seem to disagree?
Evidence of overuse (high CS rates, thyroid overdiagnosis) and evidence of benefit (WHO, NICE, RCTs) do not conflict: they concern different patients (no indication vs clear indication).
Does this depend on the country?
- General biological effects
- Universal.
- Eating habits
- Not relevant to this claim.
- Origin of the food
- Not applicable.
- Contaminants
- Not applicable.
- National production conditions
- Egypt has one of the world's highest caesarean rates (51.8%, Betran 2021), so concern about overuse is particularly relevant there.
- Legal rules
- Not applicable.
- Actual monitoring data
- Egypt CS rate from national survey data cited in Betran 2021.
A regional difference is supported by robust data.
Statistical re-check
- Egypt CS rate relative to world average and historic reference range – 2.5 x world average; 3.5-5.2 x 10-15% range recalculated
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- Benefit of indicated surgery (including emergency caesarean) vs refusal
- Starting level
- high (randomised trials)
- Reasons for downgrading
- indirectness (refusal of all surgery not directly studied)
- Result
- moderate
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Clinical guidelines and official statements checked
- WHO: WHO Statement on Caesarean Section Rates (BJOG 2016) (2015/2016) · Original publication
CS rates above 10% at population level are not associated with lower maternal/newborn mortality; CS should be undertaken when medically necessary and provided to all women in need; inadequate access to timely CS can cause asphyxia, stillbirth, uterine rupture or obstetric fistula (I-ORG-110). - NICE: Caesarean birth (NG192), Recommendations (2021 (last updated 10 June 2025)) · Original publication
Defines category 1 caesarean birth as immediate threat to the life of the woman or fetus, to be performed as soon as possible and in most situations within 30 minutes of the decision; requires evidence-based information to support informed decisions about mode of birth. - American Thyroid Association: 2015 ATA Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer (2015/2016) · Original publication
Most asymptomatic benign nodules with modest growth should be followed without intervention (strong); surgery may be considered for growing benign nodules > 4 cm or with compressive symptoms; total/near-total thyroidectomy for cancers > 4 cm, extrathyroidal extension or metastases (I-ORG-114). - USPSTF: Screening for Thyroid Cancer: Recommendation Statement (2017) · Original publication
Recommends against screening asymptomatic adults for thyroid cancer (registered as I-ORG-03). - World Society of Emergency Surgery: Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the WSES Jerusalem Guidelines (2025) · Original publication
Non-operative management with antibiotics is safe and effective in selected patients with uncomplicated appendicitis; clinical scores and imaging reduce negative appendectomies; laparoscopic appendectomy remains the standard surgical approach (abstract; I-ORG-109). 2020 edition (full text, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386163/): NOM recommended as a safe alternative in selected adults without appendicolith (strong, high quality) and suggested for children without appendicolith (weak, moderate), recurrence up to 39% at 5 years; NOM not suggested in pregnancy.
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| Europe PMC | 26 October 2026 | (TITLE:"caesarean section rate" OR TITLE:"cesarean section rate" OR TITLE:"caesarean section rates" OR TITLE:"cesarean delivery rate") AND (mortality) AND (TITLE:optimal OR TITLE:"population level" OR ecological) | both directions | 12 | |
| Europe PMC | 26 October 2026 | (caesarean OR cesarean) AND Egypt AND (TITLE:rate OR TITLE:rates OR TITLE:trends OR TITLE:overuse) | both directions | 105 | |
| PubMed | 26 October 2026 | (cesarean section[ti] OR caesarean section[ti]) AND (global[ti] OR worldwide[ti]) AND (trends[ti] OR projections[ti]) | supporting evidence | 4 | |
| PubMed | 26 October 2026 | American Thyroid Association management guidelines thyroid nodules differentiated thyroid cancer[ti] | guidelines | 38 | |
| PubMed | 26 October 2026 | (caesarean[ti] OR cesarean[ti]) AND (emergency[ti] OR indicated[ti]) AND (mortality[ti] OR outcomes[ti]) AND (systematic review[pt] OR meta-analysis[pt]) | contradicting evidence | 2 | |
| PubMed | 26 October 2026 | (thyroid nodule*[ti] OR papillary microcarcinoma[ti]) AND (active surveillance[ti]) | supporting evidence | 38 |
Open questions
Robson-group caesarean data for Egypt.
How deeply was this checked?
13 linked studies: 3 checked in full text (2 of them with a structured risk-of-bias assessment), 10 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: Mostly false (moderate)
- 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: Mostly false (moderate)
Verdict unchanged (“Mostly false”, moderate). Caesarean section is now assessed directly (WHO statement, NICE NG192, Betran 2021): overuse is real, especially in Egypt, but refusing indicated caesareans is incompatible with the evidence. Bottom line sharpened.
New sources: I-ORG-111 I-ORG-101 I-ORG-106 I-ORG-109 I-ORG-110 I-ORG-114
In plain language
Elawady said he is against any operation, including caesarean section, and that no working organ should be removed, for example a thyroid with nodules. Some caution is justified: many small thyroid cancers and nodules are found by chance and may not need surgery. But as a general rule this is not supported: in many situations, operations clearly help or save lives. Even the archive itself says that operations that are really needed should be done without hesitation.
Studies on this claim
Studies supporting the claim (5)
-
US thyroid cancer: more diagnoses, same deaths
Davies L et al.. JAMA Otolaryngol Head Neck Surg 2014 · PMID 24557566 · DOI 10.1001/jamaoto.2014.1Ecological studycited by the Tayebat archiveabstract checked★ key studyDiagnoses nearly tripled from 1975 to 2009 while deaths stayed at about 0.5 per 100,000.
Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Overdiagnosis
- How was the study done?
Trend analysis
- How many people, animals or samples were studied?
SEER 9
- What was actually found?
Incidence up, mortality flat
- How large was the observed effect?
RR 2.9
- What do the results mean in everyday life?
Many small cancers found would never have caused harm
- What are the study's limitations?
Ecological
- What does it say about Elawady's specific claim?
Supports
- Do the results apply to Germany and Europe?
Similar in Europe (not verified here)
- What can explicitly not be concluded from this study?
Which individual tumours are harmless
-
Korea: thyroid screening and cancer diagnoses
Ahn HS et al.. Thyroid 2016 · PMID 27627550 · DOI 10.1089/thy.2016.0075Ecological studyindependent cross-checkabstract checked★ key studyRegions that screened more found far more small papillary cancers, without any effect on thyroid cancer deaths.
Does the study support the specific claim? Yes · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Screening effect
- How was the study done?
Ecological
- How many people, animals or samples were studied?
16 regions
- What was actually found?
Screening drives incidence
- How large was the observed effect?
r=0.77
- What do the results mean in everyday life?
Screening healthy people finds harmless cancers
- What are the study's limitations?
Ecological
- What does it say about Elawady's specific claim?
Supports overdiagnosis claim
- Do the results apply to Germany and Europe?
Less screening in Europe
- What can explicitly not be concluded from this study?
Individual harm
-
US task force: do not screen healthy adults for thyroid cancer
US Preventive Services Task Force. JAMA 2017 · PMID 28492905 · DOI 10.1001/jama.2017.4011Guideline / position statementindependent cross-checkabstract checkedScreening does more harm than good because it finds many harmless cancers.
Does the study support the specific claim? Yes · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Screening policy
- How was the study done?
Guideline
- How many people, animals or samples were studied?
n/a
- What was actually found?
Net harm
- How large was the observed effect?
D recommendation
- What do the results mean in everyday life?
Avoid screening without symptoms
- What are the study's limitations?
Indirect evidence
- What does it say about Elawady's specific claim?
Supports overdiagnosis claim
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Management of symptomatic nodules
-
US guideline on tonsil surgery in children
Mitchell RB et al.. Otolaryngol Head Neck Surg 2019 · PMID 30798778 · DOI 10.1177/0194599818801757Guideline / position statementindependent cross-checkabstract checkedWatchful waiting is recommended unless infections are very frequent; surgery is recommended for documented sleep apnea.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Indications
- How was the study done?
Guideline
- How many people, animals or samples were studied?
n/a
- What was actually found?
Clear thresholds
- How large was the observed effect?
n/a
- What do the results mean in everyday life?
Not every child needs surgery; some clearly do
- What are the study's limitations?
US
- What does it say about Elawady's specific claim?
Partly aligns
- Do the results apply to Germany and Europe?
Similar principles
- What can explicitly not be concluded from this study?
Individual decisions
-
Caesarean rates around the world
Betran AP et al.. BMJ Glob Health 2021 · PMID 34130991 · DOI 10.1136/bmjgh-2021-005671Ecological studyindependent cross-checkabstract checkedAbout 1 in 5 births worldwide is by caesarean; in Egypt it is about half of all births, one of the highest rates globally.
Documents very high CS rates (Egypt 51.8%), consistent with overuse; does not support refusing indicated CS.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Describe global caesarean trends
- How was the study done?
Analysis of national data from 154 countries
- How many people, animals or samples were studied?
94.5% of world births
- What was actually found?
21.1% global rate; Egypt 51.8%
- How large was the observed effect?
n/a
- What do the results mean in everyday life?
Caesarean is likely overused in some countries such as Egypt
- What are the study's limitations?
Data quality varies
- What does it say about Elawady's specific claim?
Supports concern about overuse; not refusal of all caesareans
- Do the results apply to Germany and Europe?
Europe also included
- What can explicitly not be concluded from this study?
Does not show which individual caesareans were unnecessary
No study in this group is marked as key.
Studies contradicting or limiting the claim (6)
-
Trial: tonsil/adenoid surgery for children with sleep apnea
Marcus CL et al.. N Engl J Med 2013 · PMID 23692173 · DOI 10.1056/NEJMoa1215881Randomised controlled trialcited by the Tayebat archivefull text, structured risk-of-bias assessmentSurgery normalized sleep studies in 79% vs 46% with waiting and improved behaviour and quality of life.
Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
OSA treatment
- How was the study done?
RCT
- How many people, animals or samples were studied?
464
- What was actually found?
Symptom, QoL and sleep-study benefit; no cognitive benefit; 46% normalized with waiting
- How large was the observed effect?
79% vs 46%
- What do the results mean in everyday life?
Surgery helps children with sleep apnea
- What are the study's limitations?
7 months
- What does it say about Elawady's specific claim?
Contradicts blanket rejection of surgery, but supports watchful waiting as a valid option for many children
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Long-term cognition
-
UK trial: tonsil removal in adults with repeated tonsillitis
Wilson JA et al.. Lancet 2023 · PMID 37209706 · DOI 10.1016/S0140-6736(23)00519-6Randomised controlled trialindependent cross-checkfull text, structured risk-of-bias assessment★ key studySurgery roughly halved sore-throat days over 2 years, but 19% had bleeding complications.
Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Adult tonsillitis
- How was the study done?
RCT
- How many people, animals or samples were studied?
453
- What was actually found?
Fewer sore-throat days
- How large was the observed effect?
IRR 0.53
- What do the results mean in everyday life?
For frequent tonsillitis, surgery helps despite risks
- What are the study's limitations?
Open label; self-reported outcome; many switched groups; missing weekly data
- What does it say about Elawady's specific claim?
Contradicts 'should not be removed'
- Do the results apply to Germany and Europe?
European
- What can explicitly not be concluded from this study?
Very long-term risks
-
Antibiotics instead of surgery for appendicitis
CODA Collaborative; Flum DR et al.. N Engl J Med 2020 · PMID 33017106 · DOI 10.1056/NEJMoa2014320Randomised controlled trialindependent cross-checkabstract checked★ key studyAntibiotics worked about as well for overall health at 30 days, but 29% still needed surgery within 90 days.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Appendicitis treatment
- How was the study done?
RCT
- How many people, animals or samples were studied?
1552
- What was actually found?
Antibiotics noninferior; many later surgeries
- How large was the observed effect?
29% appendectomy by 90 d
- What do the results mean in everyday life?
Surgery is not the only option, but appendicitis must be treated
- What are the study's limitations?
Unblinded
- What does it say about Elawady's specific claim?
Partly supports 'not always remove'
- Do the results apply to Germany and Europe?
Applicable
- What can explicitly not be concluded from this study?
Diet-based treatment
-
Tonsil and adenoid surgery for children who snore or have sleep apnoea
Venekamp RP et al.. Cochrane Database Syst Rev 2015 · PMID 26465274 · DOI 10.1002/14651858.CD011165.pub2Systematic reviewindependent cross-checkabstract checked★ key studySurgery normalised sleep studies in 79% versus 46% with watchful waiting and improved symptoms, but did not improve attention or thinking tests.
Indicated adenotonsillectomy improves symptoms and quality of life.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Compare tonsil/adenoid removal with no surgery in children with sleep-disordered breathing
- How was the study done?
Cochrane systematic review of randomised trials
- How many people, animals or samples were studied?
3 trials, 562 children
- What was actually found?
Better symptoms, quality of life and sleep studies after surgery; no gain in cognition; many untreated children improved
- How large was the observed effect?
PSG normalisation RD 33% (24-42%); OSA-18 MD -17.7
- What do the results mean in everyday life?
For children with sleep apnoea, surgery helps symptoms, but waiting and re-checking is a reasonable option in mild cases
- What are the study's limitations?
Few trials, short follow-up, no data under age 5
- What does it say about Elawady's specific claim?
Supports caution but not a rule that tonsils must never be removed
- Do the results apply to Germany and Europe?
Directly applicable
- What can explicitly not be concluded from this study?
Cannot say anything about diet as a treatment; not tested
-
Antibiotics instead of surgery for simple appendicitis
Doleman B et al.. Cochrane Database Syst Rev 2024 · PMID 38682788 · DOI 10.1002/14651858.CD015038.pub2Meta-analysisindependent cross-checkabstract checked★ key studyAbout two thirds of adults treated with antibiotics avoided an operation in the first year, but treatment failed more often than with surgery.
Antibiotics are a medical treatment, not abstention; appendicitis still needs treatment and some need surgery.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Compare antibiotics with appendix removal
- How was the study done?
Cochrane review of 13 randomised trials
- How many people, animals or samples were studied?
About 3,360 mostly adult patients
- What was actually found?
More failures with antibiotics; fewer wound infections; 30.7% needed surgery within a year
- How large was the observed effect?
76 more failures per 1000
- What do the results mean in everyday life?
Antibiotics are an option for selected simple appendicitis
- What are the study's limitations?
Mostly low-certainty evidence
- What does it say about Elawady's specific claim?
Supports that surgery is not always needed; not that appendicitis can be left untreated
- Do the results apply to Germany and Europe?
Directly applicable
- What can explicitly not be concluded from this study?
Not about diet; not about complicated appendicitis
-
International guideline on appendicitis (2025)
Podda M et al.. JAMA Surg 2026 · PMID 41604201 · DOI 10.1001/jamasurg.2025.6218Guideline / position statementindependent cross-checkabstract checked★ key studyAntibiotics can be used in selected simple cases and better diagnosis reduces unnecessary operations, but surgery remains the standard treatment.
Laparoscopic appendectomy remains the standard surgical approach; appendicitis needs treatment.
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Give evidence-based advice for appendicitis care
- How was the study done?
GRADE-based international guideline
- How many people, animals or samples were studied?
19 questions, 35 recommendations
- What was actually found?
Antibiotics an option in selected cases; laparoscopic surgery standard
- How large was the observed effect?
n/a
- What do the results mean in everyday life?
Both treatments are accepted; appendicitis must be treated
- What are the study's limitations?
Full text not read
- What does it say about Elawady's specific claim?
Partly supports avoiding unnecessary removal
- Do the results apply to Germany and Europe?
Applies in Europe and elsewhere
- What can explicitly not be concluded from this study?
Not about diet
No study in this group is marked as key.
Studies with mixed or unclear results (2)
-
WHO statement on caesarean section rates
Betran AP et al.. BJOG 2016 · PMID 26681211 · DOI 10.1111/1471-0528.13526Guideline / position statementindependent cross-checkfull text checked★ key studyCaesareans save lives when medically needed, but rates above about 10% in a population do not further reduce deaths.
Supports concern about overuse; contradicts rejecting caesarean section when medically necessary.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
State WHO's position on caesarean rates
- How was the study done?
Policy statement based on systematic review and ecological analysis
- How many people, animals or samples were studied?
Population data worldwide
- What was actually found?
No mortality gain above about 10% at population level; necessary CS prevents deaths
- How large was the observed effect?
n/a
- What do the results mean in everyday life?
Caesarean should be done when needed, not routinely
- What are the study's limitations?
Ecological data only
- What does it say about Elawady's specific claim?
Supports caution about overuse, refutes refusing all caesareans
- Do the results apply to Germany and Europe?
Applies in Europe and Egypt
- What can explicitly not be concluded from this study?
Cannot say what is right for an individual woman
-
US thyroid guideline on nodules and cancer
Haugen BR et al.. Thyroid 2016 · PMID 26462967 · DOI 10.1089/thy.2015.0020Guideline / position statementindependent cross-checkabstract checked★ key studyMost benign thyroid nodules can simply be monitored, but surgery is recommended for confirmed cancer and for large or compressing nodules.
Supports conservative follow-up of benign nodules; contradicts a rule never to operate (cancer, compression).
Does the study support the specific claim? Partly · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Guide care of thyroid nodules and cancer
- How was the study done?
Clinical practice guideline
- How many people, animals or samples were studied?
n/a
- What was actually found?
Monitor most benign nodules; operate on cancers and symptomatic nodules
- How large was the observed effect?
n/a
- What do the results mean in everyday life?
Not every nodule needs surgery, but some do
- What are the study's limitations?
Only selected parts read; 2015 version
- What does it say about Elawady's specific claim?
Supports caution, not a ban on surgery
- Do the results apply to Germany and Europe?
Applicable in Europe
- What can explicitly not be concluded from this study?
Not about diet
No study in this group is marked as key.
Regional context
Germany / EU
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
Egypt
Egypt has one of the highest caesarean section rates in the world (51.8%, about 2.5 times the world average of 21.1%; I-ORG-111), so concern about unnecessary caesareans is particularly relevant in Egypt. This does not justify refusing a caesarean that is medically indicated.
What applies in my country?
General scientific assessment
Mostly false As a general rule this is false: indicated operations, including emergency caesarean section, save lives; the correct part is that some operations, such as caesareans in Egypt and surgery for small thyroid cancers, are overused.
This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.
References
- Current thyroid cancer trends in the United States.. Davies L et al.. JAMA Otolaryngol Head Neck Surg 2014 · PMID 24557566 · DOI 10.1001/jamaoto.2014.1
- Thyroid Cancer Screening in South Korea Increases Detection of Papillary Cancers with No Impact on Other Subtypes or Thyroid Cancer Mortality.. Ahn HS et al.. Thyroid 2016 · PMID 27627550 · DOI 10.1089/thy.2016.0075
- Screening for Thyroid Cancer: US Preventive Services Task Force Recommendation Statement.. US Preventive Services Task Force. JAMA 2017 · PMID 28492905 · DOI 10.1001/jama.2017.4011
- Clinical Practice Guideline: Tonsillectomy in Children (Update).. Mitchell RB et al.. Otolaryngol Head Neck Surg 2019 · PMID 30798778 · DOI 10.1177/0194599818801757
- Trends and projections of caesarean section rates: global and regional estimates.. Betran AP et al.. BMJ Glob Health 2021 · PMID 34130991 · DOI 10.1136/bmjgh-2021-005671
- A randomized trial of adenotonsillectomy for childhood sleep apnea.. Marcus CL et al.. N Engl J Med 2013 · PMID 23692173 · DOI 10.1056/NEJMoa1215881
- Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial.. Wilson JA et al.. Lancet 2023 · PMID 37209706 · DOI 10.1016/S0140-6736(23)00519-6
- A Randomized Trial Comparing Antibiotics with Appendectomy for Appendicitis.. CODA Collaborative; Flum DR et al.. N Engl J Med 2020 · PMID 33017106 · DOI 10.1056/NEJMoa2014320
- Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children.. Venekamp RP et al.. Cochrane Database Syst Rev 2015 · PMID 26465274 · DOI 10.1002/14651858.CD011165.pub2
- Appendectomy versus antibiotic treatment for acute appendicitis.. Doleman B et al.. Cochrane Database Syst Rev 2024 · PMID 38682788 · DOI 10.1002/14651858.CD015038.pub2
- Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines.. Podda M et al.. JAMA Surg 2026 · PMID 41604201 · DOI 10.1001/jamasurg.2025.6218
- WHO Statement on Caesarean Section Rates.. Betran AP et al.. BJOG 2016 · PMID 26681211 · DOI 10.1111/1471-0528.13526
- 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.. Haugen BR et al.. Thyroid 2016 · PMID 26462967 · DOI 10.1089/thy.2015.0020