It was J. Alison Glover who first noted variation in rates of tonsillectomy across Britain more than 75 years ago.1 He noted that the variation was because of the school health officers who would refer (or not refer) students for tonsillectomy. Fast forward to Wennberg and Gittelsohn’s article2 35 years later that again documented variation in rates of tonsillectomy, this time across Vermont. In this issue of JAMA Otolaryngology–Head & Neck Surgery, Hall and colleagues3 report on high variability in rates of thyroidectomy within the province of Ontario, Canada. They propose that Chassin’s enthusiasm hypothesis4 may help explain high rates of thyroidectomy in certain geographic regions of Ontario.

Original Article