Thursday, August 30, 2012

The worst case scenario version of FGM, or the argument of whether comparing male circumcision and female circumcision is wrong

What everybody "knows" about female circumcision:

"There are no health benefits to female circumcision. That practice exists to limit or eliminate sexual desire in women. They're two very different things. It's performed on girls 8-12 years in  the bushes with rusty blades and pieces of glass with the girls crying and no pain management."

What people don't know about female circumcision:

It's not so different. There are 4 identified types of female circumcision. One of them is the removal of the clitoral hood, which is the exact same structure as the male foreskin. Other form of "circumcision" scratches the surface of the clitoris.

Even the AAP, in 2010, acknowledged that "some forms of FGC are less extensive than the newborn male circumcision commonly performed in the West".

The thing is, everybody has seen the photos of the teenage girls restrained and crying in the bushes in Africa with a puddle of blood. But in other places, such as Malaysia and Egypt, female circumcision is practiced in hospitals and doctors office, with sterile equipment, on babies (usually around 3 months), and it looks SO MUCH just like male circumcision in the West.

As for female circumcision being meant to "limit or eliminate sexual desire", I saw one Malaysian woman (who was circumcised and took her daughter to circumcise) affirm that she did not believe that. Very much like a lot of circumcised men who affirm "I'm just fine".

And yet you may not know that male circumcision was always meant to reduce male pleasure (and also make sex less pleasurable for the female partner). Per "The Guide For The Perplexed" by Moses Maimonides (XII Century Jewish philosopher): “As regards circumcision, I think that one of its objects is to limit sexual intercourse, and to weaken the organ of generation as far as possible, and thus cause man to be moderate."

First century C.E. Jewish philosopher Philo, said that "circumcision represents the excision of the pleasure of sex, which bewitches the mind... thus making circumcision the figure of the excision of excessive and superfluous pleasure" (Philo, Special Laws 2-11.)

And if we move to US and UK and the beginning of the "medical practice" of circumcision, late XIX and early XX century, you will find gems like this: "In cases of masturbation we must, I believe, break the habit by inducing such a condition of the parts as will cause too much local suffering to allow of the practice to be continued. For this purpose, if the prepuce is long, we may circumcise the male patient with present and probably with future advantages; the operation, too, should not be performed under chloroform, so that the pain experienced may be associated with the habit we wish to eradicate." On An Injurious Habit Occasionally Met with in Infancy and Early Childhood, Athol A. W. Johnson. The Lancet, vol. 1 (7 April 1860): pp. 344-345.

And in 1935 (75 years later): "I suggest that all male children should be circumcised. This is "against nature", but that is exactly the reason why it should be done. Nature intends that the adolescent male shall copulate as often and as promiscuously as possible, and to that end covers the sensitive glans so that it shall be ever ready to receive stimuli. Civilization, on the contrary, requires chastity, and the glans of the circumcised rapidly assumes a leathery texture less sensitive than skin. Thus the adolescent has his attention drawn to his penis much less often. I am convinced that masturbation is much less common in the circumcised. With these considerations in view it does not seem apt to argue that 'God knows best how to make little boys.'" R.W. Cockshut. Circumcision. British Medical Journal, Vol.2 (1935): p.764.

It's only since the 60's that the doctors have been insisting that male circumcision does not affect sexual pleasure, but then at that time, those doctors had been circumcised as babies and didn't know any different.

As for supposed health benefits (and I'm not advocating female circumcision), the main "new" argument for male circumcision is that it "reduces the chance of contracting HIV by up to 60%" (which is the result of very flawed experiments. However by the same time those experiments were ran, this took place:

A study in Tanzania ("Female Circumcision and HIV Infection in Tanzania: for Better or for Worse?
Rebecca Y. Stallings and Emilian Karugendo"), which had the purpose of finding if female circumcision increased the risk of HIV, found a "surprising and perplexing significant inverse association between reported female circumcision and HIV seropositivity", which would seem as a benefit, but they concluded that "no biological mechanism seems plausible, we conclude that it is due to irreducible confounding".

If we are to consider the theory (which has not been proved) that HIV targets the Langerhans cells present in the inner part of the foreskin, well those cells are also present in the female clitoral hood, so in a way it would make sense that the removal of those cells would have the same effect on both genders, whether the effect is beneficial, detrimental or neutral. Of course there's more to the male to female transmission of HIV.

Many of the supposed health benefits of male circumcision are overinflated. For example, penile cancer is not common and only happens in old age. You would need thousands of circumcisions to prevent a single case of penile cancer - and there would be a lot of collateral damage.

HPV can be prevented with a vaccine rather than an amputation. UTIs can be treated with antibiotics, just like in females.

Similarly, those who advocate FGM argue "health benefits" such as: "protects the health of a woman. Infibulation prevents the uterus from falling out [uterine prolapse], leaving a girl intact endangers both her husband and her baby. If the baby's head touches the uncut clitoris during birth, the baby will be born hydrocephalic [excess cranial fluid]. The milk of the mother will become poisonous. If a man's penis touches a woman's clitoris he will become impotent." We consider those statements are simply false. But just like that, most of the world consider the claimed benefits of male circumcision to be just not worth.

The core of the issue




Whether male or female circumcision have or not any health benefits, and whether they are more or less severe, it remains true that both are performed on vulnerable minors without regard for their well being, generally with good intentions from their parents. Both are invasive procedures that are not essential for the well-being of the child, that are risky for the child, and that may affect the child's future sexual life.



According to Wikipedia: "FGM has immediate and late complications. Immediate complications are increased when FGM is performed in traditional ways, and without access to medical resources: the procedure is extremely painful and a bleeding complication can be fatal. Other immediate complications include acute urinary retention, urinary infection, wound infection, septicemia, tetanus, and in case of unsterilized and reused instruments, hepatitis and HIV."

Male circumcision, however, is also extremely painful, the main two risks are bleeding and infections, a complication of the plastibell method is urinary retention, septicemia is also a major life-threatening risk, and in the case of unsterilized and reused instruments (as in ritual circumcision in Africa), HIv is also a risk.

See the difference there? I don't see it either.

Circumcision: Parents Know the facts BEFORE

If you are a parent deciding "should I circumcise my baby", these are important facts to know. You might want to know that the AAP changed its stance in 2012 from what this video says though. They now are suggesting more benefits which in their opinion outweigh the risks. But their new statement is being met with a lot of skepticism, as you will be able to read if you scroll a few entries down in this blog. But first watch the videos. 

Part 1


Part 2
Part 2 does not allow embedding, so this is the link:
http://www.youtube.com/watch?v=NPxjhLq3eUQ&feature=channel&list=UL

T.J. Walker speaks about the 2012 AAP Policy on Circumcision



Also The AAP report on circumcision: Bad science + bad ethics = bad medicine - Practical Ethics, Oxford University Blog, which states:

In view of this empirical uncertainty on the medical question, it is problematic to assert, as the AAP does in its new report, that a person does not have the right to decide whether he wishes to keep his own healthy foreskin at birth, and that the right belongs instead to his parents. A more reasonable conclusion is that the owner of the foreskin should be allowed to consider the evidence (in all its murkiness) for himself—when he is mentally competent to do so—and make a personal decision about what is, after all, a functional bit of his own sexual anatomy and one enjoyed without issue by the vast majority of the world’s males.
...

You may be surprised to learn that the word “condom” does not appear even once in the 28 page AAP report.

In making their risk/benefit calculations, then, the AAP simply leaves out a critical bulk of factors relevant to the equation, including the existence of a range of proven healthcare tools like condoms, vaccines (including an effective HPV vaccine), and antibiotics. If they had bothered to consider human rights and bodily integrity issues, the function of the foreskin, its value to the individual, and his possible wishes in later life, as well, their computations would quite plainly yield a very different answer.
...
Critics have also pointed out that the “60%” figure that is typically sold as the relationship between circumcision and reduction of HIV infections is the misleading output of a statistical sleight-of-hand: the absolute reduction between the circumcised and intact groups in these flawed studies was a mere 1.3%.
...
But let’s put all that to the side. For even if it were true that circumcision offered some minor protective effect against HIV/AIDS or other STDs such as HPV (for which, as I stated before, there is an effective vaccine)—despite the best evidence to the contrary, and against all the points I have just laid out—it would still not follow that the procedure could be ethically performed on infants. This is crucial. Given that there is a cheaper, more effective, less invasive, less coercive alternative—namely condom-use in adulthood—it cannot be considered even remotely consistent with biomedical ethics to endorse the risky genital cutting of a pre-verbal child toward the same ostensible end.
...
It took the AAP circumcision “task force” several years to choreograph its latest tap-dance routine. Why it has produced a document so far out of line with both world opinion and the most basic of bioethical principles is a fascinating—and disturbing—question, but one which I cannot hope to answer in a single blog post. Whatever the reason, however, one can be sure that it has far more to do with culture than with science. As medical historians and cultural analysts have meticulously documented, circumcision as a birth ritual remains deeply, and uniquely, embedded in American medical culture and in the na├»ve expectations of doctors and parents alike. This sets the U.S. apart from everywhere else in the developed world—certainly outside of religious communities for whom the ritual is still self-consciously sacramental, and by whom it is performed without needing the rationalization of “health benefits.” Like any ritual, American proponents of circumcision are loath to give it up, for dread of the unknown consequences.


And this other blog entry: When bad science kills, or how to spread AIDS

The worst part about all of this is not just that the science behind “the circumcision solution” is so shaky, but that the actual implementation of these recommendations—so vociferously pushed-for by the circumcision advocates doing this research — would very likely lead to more HIV infections, not less. The big idea here is “risk compensation” 
...

In Uganda, as Boyle and Hill uncovered, the Kampala Monitor reported men as saying, “I have heard that if you get circumcised, you cannot catch HIV/AIDS. I don’t have to use a condom.” Commenting on this problem, a Brazilian Health Ministry official stated: “[T]he WHO [World Health Organization] and UN HIV/AIDS program … gives a message of false protection because men might think that being circumcised means that they can have sex without condoms without any risk, which is untrue.”

Van Howe and Storms spell this all out:

How rational is it to tell men that they must be circumcised to prevent HIV, but after circumcision they still need to use a condom to be protected from sexually transmitted HIV? Condoms provide near complete protection, so why would additional protection be needed? It is not hard to see that circumcision is either inadequate (otherwise there would be no need for the continued use of condoms) or redundant (as condoms provide nearly complete protection).
...
The studies we’ve looked at, claiming to show a benefit of circumcision in reducing transmission of HIV, are paragons of bad design and poor execution; and any real-world roll-out of their procedures would be very difficult to achieve safely and effectively. The likeliest outcome is that HIV infections would actually increase—both through the circumcision surgeries themselves performed in unsanitary conditions, and through the mechanism of risk compensation and other complicating factors of real life. The “circumcision solution” is no solution at all. It is a waste of resources and a potentially fatal threat to public health.






4 big voids in the AAP's 2012 Policy on Circumcision

As I read the Technical Report, I see 4 big voids that seem were logical to explore as we are talking of amputative surgery:

a) What are the functions and anatomy of the part being amputated? Seems just logical to study them. In fact, the technical report gives BAD advice as it seems to suggest that by the time the baby is 4 months old the foreskin should be retractable.

b) What are the benefits of not getting circumcised? If you "can elect" to loose a body part (or elect to have a body part removed from another person, which is the next point), what benefits would it have to keep that body part? I never saw a discussion of that in the Technical Report. If you think that there is no benefit, you should still state so, not just leave the blank, especially when you are talking of unbiased information.

c) Given that the surgery is irreversible and that the individual being operated does not have the ability to consent, is it ethical to do it? What makes it a parental right to decide to remove a body part from a baby? If it was ANY other healthy body part (a phalanx of a finger, the tip of the nose, an ear lobe, a clitoral hood) the doctor would turn down the parents' request, even if that part can become unhealthy in the future. So what makes the foreskin so different that it is seen as disposable by proxy?

d) There are a large number of adults who were circumcised as babies and are unhappy, angry or depressed about it -you wouldn't see protests otherwise, it's not like people routinely protest against brain surgeries right? So, doesn't that deserve a little bit of study as well? I didn't see any mention of that in the technical report. If those adults were your "patients" (by parental consent) 20 and 30 and 40 years ago and they are so unhappy and feel abused, there was something that obviously didn't work out that well, but you are basically selling the same product, just changing the selling speech. But what is it that didn't work for them, in spite of parental consent and such?

Wednesday, August 29, 2012

Someone reacted to my circumcision story

My story: http://circumcisiondiaries.blogspot.com/2012/06/getting-personal-my-own-circumcision.html 

In a circumcision debate I had said:

I am and I never wanted to be. I was done at 5 years and I begged the doctor not to cut. He didn't even went to my parents, he just sedated me and proceeded. To me, that was aggravated assault.

She says:

You almost got a little sympathy from me til I remembered another little boy begging the dr's not to cut thanks to an idiot that thought he should be told exactly what they were gonna do to him right before surgery. That was my son, right before surgery to repair a damaged aorta. If I or the dr's had listened to him he'd be dead now. No, it's not the same, but there are a few points you're missing here. Have you ever seen a toddler with frequent infections down there and listened to them scream in agony? I have and it ain't pretty. Some boys just tend to get infections a lot no matter how well you take care of it and this can be the best option for them. If you have so much trauma from it so many years later, maybe you should spend more time advocating that children not be told all the gory details before ANY procedure and that if parents want circumcisions on their kids, it should be done while they're babies instead of fully functioning, vocal, and capable of remembering it for life instead of whining about something that happened to you and can't be changed. FYI ... After seeing his friend get injured down there which caused the kid to be circumcised at 17, my son was extremely grateful that his was done as a babe and it was a nightmare he'd never have the slightest chance of enduring as an adult and a process he'd never remember going through. And the extra steps involved in cleaning it properly? Yeah right! Have you seen how lazy these kids are now? To each his own, but respect others choices whether you like them or not as others are trying to respect yours.

My response:

I do understand your point, but you don't seem to understand mine. Circumcision is an ELECTIVE surgery. Most of the times it's not treating a life threatening situation. Most of the times you can leave the child intact and he won't need it.

Circumcision should be used with therapeutic reasons. I have not seen a toddler do what you said (and I grew up where circumcision was not prevalent, and I also have an intact son), but there are SOME cases where it is therapeutically needed, and if that's what the toddler needed, well, then that's the moment to treat him. When he needs it.

Same with the kid at 17. He got injured, he got treated. Too bad he got injured in the first place. Most people don't get injured.

But to say that we should circumcise all children because some will need it and because some will get injured is just uncalled for. That's like performing routinary heart surgeries on all babies because some will grow to need a heart surgery, so better to do it while they can't remember? No, it doesn't work like that.

And you make me think of something. If anything about my own operation, I'm grateful I learned what was going to happen before it did. I'm glad I was just not sedated and cut and later have to find out what was done to me. Because for one moment, it made me aware of my own body and how I loved my own body the way it was. Because it gave me the strength to speak up 35 years later. Because I know that I asked to be left intact, and my voice was not heard. That is empowering to me. I'm glad I just didn't grow up not knowing that I had had a body part that got removed. I prefer knowing, because knowing gives power.

No, I don't wish it had been done at birth. That would be like wishing I had been raped while I was passed out. No, that would have been totally wrong.

Thank you for giving me something to think about. Most people don't do that.

Tuesday, August 28, 2012

The perils of engaging in circumcision debates

It's hard, emotionally and physically. It's exhausting. You get called so many things. You end up saying things that you don't want.

It's hard to keep it cool when the subject is an emotional trigger for you. But among everything, the stubbornness of some people and the personal triggers, that's what I dislike the most.

I know that the person defending circumcision at the other side of the internet is not going to change his views. But quite often they will ask one thing, and when you give facts to substantiate your point, they will just jump to a different "benefit" or "cultural" or "religious" thing and dismiss what you just said.

And other times you will explain that a study is not all that everybody wants to make out of it because (all the reasons), only to have them quote the same study as conclusive (ignoring in the process all the reasons you just gave them).

Sometimes people say that we come off as a group of bullies. If you saw someone beating a child at a park, wouldn't you be outraged? Wouldn't you want to stop the beaters right away? Well, that's how we see circumcision of infants. Something that the child cannot defend himself of. Something that the child is subjected to by those who should protect him. But how do we reason with them, especially when they don't want to reason, when they are stuck and defensive?

But there are situations that are especially complicated. Every now and then you have the "I was circumcised and I'm okay" guy. I normally told them that I'm glad for them, but there are others who were not as lucky. But sometimes I end up arguing about all the things that will come with age that they might not have noticed yet, or how what they feel could be better. But that's bad, I don't need to do that. I know that I was mutilated ("mutilation" is an inflammatory word according to the AAP - yet apparently mutilating babies is okay), he was mutilated, but how much do I need to prove to somebody that he was mutilated if he can't see it? Do I really need? And my whole point is not so much for him, but for his possible children. How do you teach someone to not do something harmful to his children, if it was done to him and he doesn't believe he was harmed?

And what's worse, when parents come and tell you that they circumcised their children and they would do it again. It hits low, because on a personal level, I wish the doctor had stopped when I begged him, and had gone to my mom and told her "we have another option, your son is agitated, there's something else we can do", but no, he didn't. And I remember when my friend brought his two sons home and I realize that they were circumcised when he changed their diapers, and I was like why would such a young baby be circumcised - I was not aware of the high rate of circumcision in the U.S. yet, for me it was something that was done on a need-to basis, so I was sad that such a young baby had gone through that. So how do you keep from telling something hateful to someone who is so blind in their ways that he or she would do it again? And why even engage?

My only hope with these debates is that someone else might read them and wonder what's that all about and maybe do some research.

One of the issues of going against something that the AAP or Johns Hopkins Medical say is that you come out as saying something against science. I know its not that. I know that the AAP is making too much of the African studies while dismissing other studies, I know that they haven't bothered to study men who are not happy with their circumcisions, they see us as an anomaly, collateral damage, case studies that don't deserve studying. I see the whole thing as a puzzle from which inconvenient pieces have been left aside. But people see some words and they believe, after all it wouldn't be in the media if it wasn't true right? So it's hard to get through, to show the fallacies. If you give too much information they end up thinking that you are just twisting the information.

What gets me is that the AAP says that there is no change to sexual function or satisfaction, quotes a couple of studies, and suddenly everyone just believes it's true. But I tell them that how can the AAP say that if they didn't even stop to consider the functions and anatomy of the foreskin, and they will just keep repeating the same mantra.

Children see the truth. I just read from a fellow intactivist that her 4 years old daughter heard about circumcision and said "cutting babies is not nice". Another intactivist's child said that those who cut babies should go to jail for ever. Another one said that if the doctors had cut his penis, he would have probably bled  all over until he died. One of two brothers, the older one (circumcised) with a younger (intact) brother, asked his mom if it would grow again - she had to go cry in the other room after talking with him.

Why is it that people become so callous later on? How can they not see it? Something so basic. If you use the word mutilation, they call you dramatic, but if you use the word amputation they still think you are dramatic. Since when an amputation is not an amputation? And why do men do not deserve empathy when they denounce that they have been hurt?


Washing our Hands Clean of the AAP!





Photo Album: https://www.facebook.com/media/set/?set=a.445849575459661.105253.121502171227738&type=3

Saturday, August 25, 2012

My quick opinion on the new 2012 AAP policy on routine circumcision of infants


I found troubling this: “The majority of severe or even catastrophic injuries are so infrequent as to be reported as case reports (and were therefore excluded from this
literature review). These rare complications include glans or penile amputation,
198–206 transmission of herpes simplex after mouth-to-penis contact by a mohel (Jewish ritual circumcisers) after circumcision,207–209 methicillinresistant
Staphylococcus aureus infection, 210 urethral cutaneous fistula,211 glans ischemia,212 and death.213″
They absolutely IGNORED any information on the more severe complications of circumcision because they are just “case reports”. Hmm, how many cases of impurity is needed in a medication before it’s recalled, how many incidents are needed with any product that can affect a child before it’s recalled. But to deny analyzing this issue just because it’s reduced to case studies…
When they refer to the African studies linking HIV and “lack of circumcision”, of course at the same time they ignore any study that did not match that result, like the one from Puerto Rico that found more prevalence of HIV among circumcised males, or the one from the NAVY that found no correlation between circumcision and HIV among people in the NAVY, or any analysis of the difference with Europe. Perhaps the methodology is different as those were not experiments.
One question that they never seem to ask is: are there benefits to not being circumcised? Because, when weighing the potential benefits and the possible risks, what are the benefits of not performing the intervention? This question alone would completely change the balance of the ethic dilemma in my opinion.
And what follows from there is the lack of analysis as to why some (or so many) men are unhappy about being circumcised. Those men are the children that the AAP should have protected 20 and 30 and 40 years ago. Today, thanks to the internet, they are speaking out and stating that they wish this had not been done to them. Isn’t that information essential to debate the future of the procedure? Or do they reduce the foreskin to a price tag and completely dismiss the person who had it?
The policy also states that “parents are granted wide latitude in terms of the decisions they make on behalf of their children, and the law has respected those decisions except where they are clearly contrary to the best interests of the child or place the child’s health, well-being, or life at significant risk of serious harm” Well, what if circumcision does place the child’s health, well-being and life at significant risk of serious harm? How do they define “significant”? Because the severe risks were ignored because they were case studies, so they must be insignificant, right?
It also says that If the US is a “pluralistic society of the United States, where parents
are afforded wide authority for determining what constitutes appropriate child-rearing and child welfare”, but why is it that the only healthy tissue that can be legally removed for non-therapeutic reasons, whether by a doctor or religious practicioner is the foreskin? Why is the foreskin not granted the same protection as, say, the tip of the nose, the lips, the skin of the fingers, the clitoral hood? Is it really just a matter of having a health benefit to justify it when the individual does not have the ability to consent? Or is this “pluralistic” adjective a hint to come back in a couple of years an recommend the ritual nick on infant girls as an alternative to female genital mutilation, like they did in 2010?
What they never discuss is if an imposed circumcision can the violate human rights of the baby, and I think that was the most important question. In lack of that answer, potential health benefits and minimized risks are just a distraction. Candy coating the issue. It will give us something to talk about. We can discuss benefits and risks all day long, and in doing it we forget that we are talking about a human rights issue, about an unneeded and irreversible amputation performed on a vulnerable individual who is incapable to voice his consent or lack of. Which is evidenced in this malicious statement: “Newborn males who are not circumcised at birth are much less likely to elect circumcision in adolescence or early adulthood.” Not only that states that most men would not elect to get circumcised if given the chance, but they use it to leverage it against the baby by pressing the parents: “do it to him now while you have the chance because he won’t want it done later”.
Oh and on this: “The Task Force advises against the practice of mouth-to-penis contact during circumcision” – They make it sound like they don’t recommend it JUST during circumcision, which is to say that at any other time it would be just fine right? Or do we just need to type a big “duh” after the statement. Or should they extend it to say “during circumcision – and at any other time”.

The point of this new AAP Policy on circumcision is to rub in our noses the 3 African studies (while ignoring anything that doesn't match them - or why the conditions are different in the U.S.), to further pressure parents into circumcising their babies before they grow up and have the right to decline, to press Medicaid into restoring funding for circumcisions in those states where they have dropped it (as an unnecessary intervention), and of course to open the door for institutions like Johns Hopkins Medicine for further solicitation of funds from the likes of Bill and Melinda Gates for additional self-serving studies.
These guys are a joke.

Intact America, Doctors Opposing Circumcision, and Attorneys for the Rights of the Child Release Statements in Response to the American Academy of Pediatrics' Expected Circumcision Policy Statement


Intact America states:
Georganne Chapin, Executive Director of Intact America, stated today, “From the AAP Circumcision Task Force’s pre-publication comments, it is clear that the group has chosen to feature only literature (almost exclusively focused on adult men in Africa) that supports its predisposition toward circumcising boys; the Task Force has failed to consider the large body of evidence from the developed world that shows no medical benefits for the practice, and has given short shrift, if not dismissed out of hand, the serious ethical problems inherent in doctors removing healthy body parts from children who cannot consent.”
Doctors Opposing Circumcision believes that circumcision of children violates numerous legal rights of the child and is highly unethical, if not unlawful. We believe that genital integrity provides the highest level of health and well being for the child. We do not know what the AAP is going to say in their new statement, but we are circumcision experts and we are convinced that non-circumcision is best for children. We reaffirm our Genital Integrity Policy Statement of 2008, which advocates genital integrity for boys.
The AAP statement demonstrates its ignorance of the fact that European men don’t circumcise and yet enjoy better health outcomes including in the areas the statement cites as improved after circumcision. Moreover, medical organizations and politicians in Finland, Sweden, Norway, the Netherlands, Germany, Switzerland, Austria, and other countries are calling for the practice to stop. Even in the US, the American Medical Association (AMA) agrees that there is insufficient justification for performing the procedure on newborns absent specific medical indications.

Doctors Opposing Circumcision - Public Notice


Public Notice

AAP Announces Intent to Release its Sixth Major Circumcision Policy
Doctors Opposing Circumcision reaffirms its Genital Integrity Policy
Source: http://www.doctorsopposingcircumcision.org/pdf/2012-08-22_PublicNotice.pdf

The American Academy of Pediatrics (AAP) revealed that it intends to publish its sixth
major circumcision policy on Monday, August 27, 2012 and in the September 2012 issue of
Pediatrics, its house journal. This will be its sixth position statement on male circumcision,
as it has previously published position statements in 1971, 1975, 1983, 1989, and 1999.

The new AAP policy has been five years in the making. The intent to publish a new
statement was announced in 2007, however internal disagreement on its content has
prevented publication. The new statement likely will be a compromise between positions.
The AAP, despite its high-sounding academic name, actually is a trade association of
pediatric doctors. Its primary duty is to advance the business and professional interests of
its 60,000 members who are called “fellows”.  The interests of its child-patients are a
distant second to their primary interest.

There is a severe and intractable conflict of interest between the financial interests of its
fellows and the best interests of the child-patient. Most of its fellows perform nontherapeutic circumcisions on children and profit thereby. These members do not want
anything to interfere or disrupt their steady income stream. The AAP will not publish a
statement that would harm that income stream. The AAP ensures the outcome of its
circumcision statements by appointing doctors who are known to have a pro-circumcision
position. The current task force, like previous task forces on circumcision, is stuffed with
pro-circumcision doctors, including its chairwoman. Obstetricians and family doctors also
profit by doing unnecessary circumcisions. The presence on the task force of a
representative from the American College of Obstetricians and Gynecologists (ACOG) and
the American Academy of Family Doctors (AAFP), as well as Dr. Stephen Wegner, MD, JD,
representing the AAP Health Care Financing Committee, highlight the business and
financial nature of the forthcoming circumcision policy statement. We anticipate a very
self-serving statement that protects doctors’ incomes.

Previous AAP circumcision statements have exaggerated the alleged, but unproved
prophylactic benefits of non-therapeutic circumcision while minimizing the risks,
complications, drawbacks, permanent irreversible physical, sexual, and emotional injury of
male circumcision. We expect that this one will use prevention of HIV sexual transmission
as a reason to circumcise boys, even though the African studies that indicate circumcision
prevents HIV infection in adult males have been shown to be trash and,1 2 in any event, not
applicable to infant boys in North America.


In recent years, 46 percent of boys born in the United States have left the birth facility with
intact foreskins. There is not a shred of evidence that these boys are less healthy than the
54 percent of boys who were circumcised.

Doctors who perform circumcisions have had their income stream curtailed by the
decision of eighteen state Medicaid agencies to terminate payments for medically
unnecessary non-therapeutic circumcision of children. The AAP is expected to call for
restoration of those taxpayer-funded Government payments to doctors, so as to restore
the income of their fellows.

The AAP, thus far, has consistently refused to recognize that children are human beings,
who have legal rights to bodily integrity and the security of their person under both
American law and international human rights law, which are trampled by the unnecessary
amputation of the functional body part called the foreskin. The AAP has consistently
misapplied legal rules regarding surrogate consent for therapeutic operations on children
to non-therapeutic circumcision. By so doing, it has tried to protect the alleged parental
right to cut body parts from boys at will for religious/cultural reasons or no reason at all.
As noted above, the AAP is simply a trade association, which advances the perceived
interests of its fellows. Its position statements are not legal or medical imperatives and do
not have the force of law or public policy. This statement on circumcision is going to be all
about money, not about child health or welfare.

The Royal Dutch Medical Association has called male circumcision a human rights
violation and an unethical practice.  The AAP’s forthcoming pro-circumcision policy is not
supported by foreign medical associations.
A court in Cologne, Germany says parents may not grant consent for unnecessary
circumcision. We will see shortly whether the AAP will reform its abusive practices. We
are not hopeful.

Doctors Opposing Circumcision believes that circumcision of children violates numerous
legal rights of the child and is highly unethical, if not unlawful. We believe that genital
integrity provides the highest level of health and well- being for the child. We do not know
what the AAP is going to say in their new statement, but we are circumcision experts and
we are convinced that non-circumcision is best for children. We reaffirm our Genital
Integrity Policy Statement of 2008, which advocates genital integrity for boys.

We urge parents to ignore this latest statement from the AAP and to continue to protect
their sons’ whole and complete bodies.

George C. Denniston, MD, MPH John V. Geisheker, JD, LLM
President Executive Director & General Counsel
Wednesday, August 22, 2012.

                                                     
1 Van Howe, Storms MS. How the circumcision solution in Africa will increase HIV infections. Journal of
Public Health in Africa 2011; 2:e4 doi:10.4081/jphia.2011.e4.
2 Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV
transmission: Methodological, ethical and legal concerns. J Law Med (Melbourne) 2011;19:316-34.

Pediatric response to the new AAP policy on circumcision


Pediatric Response by Petrina Fadel


Part 1 : Dear AAP Board Members and AAP Task Force on Circumcision:
I am writing to you to request that you withdraw or rescind the newest
2012 AAP Circumcision Policy Statement. Below I have critiqued for you some of the serious problems with this new statement.
The Abstract states on page 585 that “health benefits are not great enough to recommend routine circumcision for all male newborns”, but this is not repeated even once in the long text on pages 758-785.
Other long columns favoring circumcision are repeated over and over again, on pages 761-762, 770, 775-776, and 778. The 1999 AAP Statement was 8 pages long (pages 686-693), but this diatribe against living with a foreskin goes on for 28 pages. There is almost the feeling that AAP physicians hope that if they repeat something over and over again, eventually it might become true.
The AAP concludes on page 778 that “the health benefits of newborn male circumcision outweigh the risks”, and yet on page 772 the AAP admits that “the true incidence of complications after newborn circumcision is unknown”. If one doesn’t know how often complications occur, then one can’t make the judgment that the benefits outweigh the risks! The AAP lacks the evidence it needs to make such a claim.
The 1999 Statement studied 40 years’ worth of research, and the 2012 studied only selective research since 1999. Only 1031 of 1388 studies were accepted to look at. Balance might have been found in the 357 studies that were omitted, but the AAP was not seeking balance. The AAP statement goes on ad nauseum about alleged “benefits”, to the point of fear-mongering that something will go wrong if an infant isn’t circumcised. It’s a high pressure sales pitch to try to get the American public to buy the circumcisions that AAP and ACOG doctors are selling. This is in direct contrast to Europe, where circumcision is uncommon and the health of European children equals or surpasses that of American children.
No studies on ethics were included in this statement, and it is clear that the rights of the child and how a grown man might feel about HIS foreskin being stripped from him were never given any consideration at all by the AAP. These are major issues, and even more important than many of the other minor issues the AAP discusses. Material was provided to the AAP to study this aspect of circumcision, but it was ignored. With one bioethicist on the panel, you would have thought that the AAP might at least have given the ethics of circumcision a cursory examination, considering that they were provided with many sources showing the emotional distress many men feel. Ethics and mental health, however, nowhere enter the picture for the AAP. Respect for the bodily integrity of another person were not included, and medical ethics were thrown out the window as infants were thrown under the bus.
Financing studies weren’t included in the studies, but the AAP did its best to push financing repeatedly for third-party reimbursement of non-therapeutic circumcision, at the expense of taxpayers during a time of budget crises. Those with private insurance would see premiums and medical costs rise. The cost for circumcision on page 777 ranges from
$216 to $601 per circumcision in the U.S. In 2010, the in-hospital U.S. circumcision rate was 54.7%. Thus, 45.3% of newborn males left
the hospital genitally intact. If the AAP were to convince parents of
these 45.3% to circumcise (as they are attempting to do in this 2012 statement), then there would be 45.3% of roughly 2.1 million baby boys that could be an additional income source for physicians. (Remember, don’t consider the ethics!) This would be an additional 951,300 male infants to profit from. At prices the AAP quotes, this could mean an additional $205,480,800 to $571,731,300 for doctors who circumcise.
This is no small sum, and as Thomas Wiswell, M.D. stated on June 22,
1987 in the Boston Globe, “I have some good friends who are obstetricians outside the military, and they look at a foreskin and almost see a $125 price tag on it. Each one is that much money. Heck, if you do 10 a week, that’s over $1,000 a week, and they don’t take
that much time. “(Lehman 1987) Money like that would certainly help
doctors make their mortgage payments and their car payments, pay for vacations, etc. – a “benefit” that the AAP failed to mention. Under Literature Search Overview, it is understandable why AAP physicians might consider it important to investigate “What are the trends in financing and payment for elective circumcision?”
No studies on the anatomy and functions of the foreskin were included.
This is surprising, since it would seem like common sense to consider what the functions of any healthy body part are before amputating it.
Probably since the male AAP Task Force members are all circumcised, this idea was difficult for them to grasp. Only one study on the sexual impact of circumcision was included, and this from Africa.
Other studies were ignored or discounted. “The effect of male circumcision on the sexual enjoyment of the female partner”, which appeared in BJU INTERNATIONAL, Volume 83, Supplement 1, Pages 79-84, January 1, 1999, is not mentioned. Nor is the newest Danish study that was publicized on November 14, 2011 – “Male circumcision leads to a bad sex life” – “Circumcised men have more difficulties reaching orgasm, and their female partners experience more vaginal pains and an inferior sex life, a new study shows.” See:
http://sciencenordic.com/male-circumcision-leads-bad-sex-life The AAP had time to include this study, but it was ignored. Others sent material to the AAP about CIRCUMserum, Senslip, foreskin restoration that men are undergoing to undo some of the damages of circumcision and how this improves the sexual experience for both men and women. It didn’t fit the AAP’s pro-circumcision agenda, so it was ignored. The Policy Statement is totally lacking in ethics, anatomy, and foreskin functions. Instead, the Task Force is more concerned with how to train more doctors to circumcise, and how to do so with different devices and various forms of anesthesia.
The physical and sexual harms from circumcision are minimized or dismissed outright. Deaths from circumcision and botched circumcisions are considered “case studies”, and the children horribly damaged from circumcision don’t merit the AAP’s consideration, even though the AAP’s alleged mission is that it is “Dedicated to the Health of All Children”. When cribs are faulty or car seats aren’t safe, the AAP becomes concerned and warns the public. When physicians botch circumcisions and are at fault, children don’t matter. After one botched circumcision lawsuit and a large settlement, the company that manufactured the Mogen clamp went out of business. The AAP report should have advised physicians to NOT use the Mogen clamp because of the botched circumcisions that have resulted with this device. If still in use, no doubt there will be future tragedies with the Mogen clamp, but parents will only be able to sue the doctor and hospital and not the manufacturer.
There was so much reliance on studies from Africa in this statement, that it seemed like the AAP should change its name to the African Academy of Pediatrics. In contrast to the AAP, the American Association of Family Physicians (AAFP) has stated: “…the association between having a sexually transmitted disease (STD) – excluding human immunodeficiency virus (HIV) and being circumcised are inconclusive…
most of the studies [of the effect of circumcision on HIV] …have been conducted in developing countries, particularly those in Africa.
Because of the challenges with maintaining good hygiene and access to condoms, these results are probably not generalizable to the U.S.
population”. But generalize the AAP did! In addition, the AAP listed page after page of STDs that allegedly circumcision would prevent, and wrote conflicting statements about syphilis. A recent study in Puerto Rico found that circumcised men have HIGHER rates of STDs and HIV. The 60% reduced risk of HIV following circumcision is the relative risk reduction, not the absolute risk reduction. There’s a huge difference.
Across all three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18%) became HIV-positive. Among the 5,497 controls, 137 (2.49%) became HIV-positive”, so the absolute decrease in HIV infection was only 1.31%, which is not statistically significant.”
(Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. J Law Med 2011; 19:316-34.)
Infants are not at risk of STDs or HIV through sexual contact, so this speculation about their future risk is foolhardy. Infants can also be at risk for many other diseases, but surgical amputation of healthy body parts is a foolhardy approach for prevention and treatment of disease. If an infant is at risk of an STD, then it is probably safe to say that an adult is perpetrating a crime against the child and needs to be arrested and charged.
Judaism and Islam are mentioned as religions that practice religious circumcisions. Once again, the statement ignores Christianity, which teaches that circumcision is unnecessary. Christianity is the largest religion in the U.S., but its teachings don’t even get a mention by the AAP, which is rather insulting! With an over-representation of members on the Task Force who have a religious bias favoring circumcision, this is not surprising.
The AAP promotes parents choosing medically unnecessary circumcision for their male children, completely contradicting what it said in PEDIATRICS, Volume 95 Number 2, Pages 314-317, February 1995. It said then, “Thus “proxy consent” poses serious problems for pediatric health care providers. Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. . . the pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent.”
Parents deserve factual information about circumcision, but they won’t find it in the new AAP Statement. In fact, the AAP wrongly advises parents of intact baby boys to retract the foreskin and wash it with soap and water. (page 763) Soap can alter the good bacteria under the foreskin, potentially causing infections that should then be treated with liquid acidophilus to restore the good bacteria. Water is sufficient for cleansing. Circumcised doctors with circumcised sons probably don’t know this.
On page 764, the AAP speculates that the foreskin contains a high density of Langerhans cells, “which facilitates HIV infection of host cells.” Actually, the exact opposite is true. “Langerin is a natural barrier to HIV-1 transmission by Langerhans cells” (Nature Medicine- 4 March 2007). This study states, “Langerhans cells (LCs) specifically express Langerin . . . LCs reside in the epidermis of the skin and in most mucosal epithelia, such as the ectocervix, vagina and foreskin.”
UTIs can be prevented through breastfeeding, which the AAP allegedly supports. This is nowhere mentioned under “Male Circumcision and UTIs”
on page 767. HPV can be prevented with a vaccine for both boys and girls, but it is not mentioned on that same page. A recent study reporting on the large number of re-circumcisions done following infant
circumcisions is also not even mentioned. On page 770, EMLA is
mentioned as a possible anesthetic, but EMLA is not supposed to be used on infants. The fact remains that unnecessary surgery performed with anesthesia is still unnecessary surgery.
There is so much wrong with this new statement that it should immediately be withdrawn before it is presented on Monday. The AAP should either start all over again (with new, unbiased Task Force members), or renew its 1999 statement which attempted to at least give a more balanced view of circumcision. The 1999 circumcision statement certainly had its flaws by ignoring ethics and the anatomy and functions of the foreskin, but it wasn’t as atrocious as this new statement is.
If the AAP wants to be regarded as a credible organization, it will look to the judgment of other foreign medical associations who recognize that circumcision is medically unnecessary and has serious ethical problems underlying its practice. American parents should look to these foreign medical associations for good advice, since the AAP is not providing it in its new statement.
Sincerely,
Petrina Fadel, Director
Catholics Against Circumcision
Part 2 : Sent to the AAP Board of Directors and the AAP Task Force Members on Aug 24, 2012 :
After rereading the AAP’s new Circumcision Statement, several more problems have emerged with this statement. This statement needs to be rescinded and withdrawn immediately! Others are becoming aware of this matter as well.
Under “Ethical Issues” (pages 758-759), two of the references for this opinion come from Dr. Douglas Diekema (AAP’s bioethicist), who signed his name to this statement. The rights of the child are totally ignored in this section, from an organization that claims to be concerned with the welfare of children but in this case isn’t. This is Diekema’s own personal opinion that the Task Force has bought into, based on what he wrote before. References are also taken from M.
Benatar and D. Benatar (both Jewish circumcision supporters), as well as from AR Fleishman (whom I suspect has a religious bias favoring circumcision). Under “Ethical Issues” (page 759), there’s an interesting choice of words by the AAP. “In cases, such as the decision to perform a circumcision in the newborn period, … and where the procedure is not essential to the child’s immediate well-being …” , the AAP admits here that circumcision “is not essential”. It even calls circumcision “elective” in several other places, but it then proceeds to do a massive sales pitch for this unnecessary surgery.
Under Ethics, Reference #14 comes from the British Medical Association- “The law and ethics of male circumcision: guidance for doctors: J. Med Ethics 2004. The BMA did not print a favorable piece on circumcision, but the AAP cherry-picked something from it on page 760. Medical associations in other countries, like the British Medical Association, do not promote circumcision as the AAP has so foolishly chosen to do.
On page 760, the AAP states, “The Task Force’s evidence review was supplemented by an independent, AAP-contracted physician and doctoral-level epidemiologist who was also part of the entire evidence review process.” Who was this? The AAP should reveal the name of this physician.
Several times in the report, the AAP states (page 762), “For parents to receive nonbiased information about male circumcision in time to inform their decisions…clinicians need to provide this information at least before conception, and/or early in the pregnancy, probably as a
curriculum item in childbirth classes.” There is absolutely no way
doctors can do this before conception, and “Inform their decisions” is code for brainwashing parents as early as possible. This is mind control at its worst, supported by the AAP!
The AAP on page 763 uses the term “Uncircumcised” under “Care of the Circumcised Versus Uncircumcised Penis”, and later the term “non-circumcised” when saying, “The non-circumcised penis should be washed with soap and water.” The correct terminology is intact penis, or normal or natural penis. We don’t say “uncircumcised” female or “non-circumcised” female.
The APP on page 764 states, “Mathematical modeling by the CDC shows that, taking an average efficacy of 60% from the African trials, [Note:
This is the relative risk, not absolute risk, which is 1.31%.) and assuming that protective effect of circumcision applies only to heterosexually acquired HIV" ..." The AAP states here that they are assuming, which means to "suppose to be the case, without proof."
There's a saying that if you "assume" anything, it makes an ass out of u and me. Assumptions are not evidence, and since when should the AAP be relying upon or making assumptions? "Sexual Satisfaction and Sensitivity" (page 769) never once mentions or considers how circumcision impacts the sexual experience for females. The AAP gets it totally wrong about males, while then totally ignoring females! A Danish study by Morten Frisch (whom the AAP uses as a reference in
#118) revealed late last year that circumcised men have more difficulties reaching orgasm, and their female partners experience more vaginal pains and an inferior sex life.
"Analgesia and Anesthesia for a Circumcision After the Newborn Period"
(page 771) states, "Additional concerns associated with surgical circumcision in older infants include time lost by parents and patients from work and/or school." The AAP is promoting newborn circumcision so parents don't have to miss work? Parents miss work all the time when their kids get sick as toddlers or later on as young children. Now, all of a sudden, the AAP is concerned about parents missing work, but not concerned about the rights of the child.
Under "Complications and Adverse Events" (page 772), the AAP twice mentions how circumcision risks are lower in hospitals with trained personnel than those performed by untrained practitioners in developing countries. U.S. parents don't live in a developing country, and this doesn't even belong in an AAP statement!
"The true incidence of complications after newborn circumcision is unknown ..." (page 772) "Two large US hospital-based studies with good evidence estimate the risk of significant acute circumcision complications ... " "(T)here are no adequate studies of late complications in boys undergoing circumcision in the post-newborn
period; this area requires more study." (page 773) "There are not
adequate analytic studies of late complications in boys undergoing circumcision in the post-newborn period." (page 774) Under "Stratification of Risks" the AAP says, "Based on the data reviewed, it is difficult, if not impossible, to adequately assess the total impact of complications, because the data are scant and inconsistent regarding the severity of complications." After admitting that the true incidence of complications is unknown (i.e. the risks), the AAP then has the audacity to state that "the health benefits of newborn male circumcision outweigh the risks". (page 756). Under "Task Force Recommendations" (page 775), the AAP says, "Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks ..." The AAP doesn't know the incidence of risks, so how do they expect physicians to know that?
The AAP sings its own praises under "Medical Versus Traditional Providers". "Physicians in a hospital setting generally have fewer complications than traditional providers in the community setting."
Was this the AAP saying that doctors are safer than mohels? I don't think they'll like that!
In 2009, ten years after the AAP did not recommend circumcision (and still doesn't apparently, doesn't on its words on page 585, but which one would never know after wading through this rubbish), their own survey of AAP members found that "18% responded recommending to all or most of their patients' parents that circumcision be performed." (page
776) I don't find that surprising that AAP doctors would recommend a surgery that means more money for them. On pages 777-778 the AAP wants to know about the effectiveness of their new 2012 statement to mislead parents. "The Task Force recommends additional studies to better understand ... The impact of the AAP Male Circumcision policy on newborn male circumcision practices in the United States and elsewhere." In other words, how effective are we in deceiving American parents and people in other countries?
The AAP wants to work with the ACOG, AAFP, American Society of Anesthesiologists, and American College of Nurse Midwives to develop a plan about which groups are best suited to perform newborn male circumcisions. (page 777) In other words, how is the AAP going to divvy up the money it so eagerly wants?
The AAP targets blacks and Hispanics in the U.S. for unnecessary circumcisions. "African-American and Hispanic males in the United States are disproportionately affected by HIV and other STIs, and thus would derive the greatest benefit from circumcision." (page 777) But then, under Areas for Future Research, the AAP says, "The Task Force recommends additional studies to better understand ... The impact of male circumcision on transmission of HIV and other STDS in the United States because key studies to date have been performed in African populations with HIV burdens that are epidemiologically different from HIV in the United States." The AAP just spent several pages before this promoting newborn circumcision to allegedly prevent STDs and HIV based on African studies, but now it's admitting that more studies are needed because the results could be different in the U.S. Was this put in to help with the solicitation for more funding for pro-circumcision researchers at Johns Hopkins and elsewhere, to keep them going? Maybe these researchers are tired of Africa and want to come home?
The AAP did actually say ONE good thing, but only ONE good thing in this whole statement. On page 760 the AAP says, "The Task Force advises against the practice of mouth-to-penis contact during circumcision, which is part of some religious practices, because it poses serious infectious risk to the child." If I were to guess, I'd say that perhaps Dr. Susan Blank put that in. While working for the New York City Health Department, Dr. Blank has done nothing to ban metzitah b'peh, so as not to offend the Orthodox Jews who practice it.
Babies have died of herpes from metzitzah b'peh under her watch.
This atrocious AAP Statement needs to be rescinded immediately. I suggest that the AAP use good judgment and do precisely that.
Sincerely,
Petrina Fadel, Director
Catholics Against Circumcision

Thoughts while reading the new AAP Policy

 "I swore never to be silent whenever and wherever human beings endure suffering and humiliation. We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented." Elie Wiesel






Friday, August 24, 2012

What the new AAP policy on circumcision does not address

* Adults who are unhappy that they were circumcised. I think this is a vital element. If the pediatrics are there for the well-being of the child, what happens when a recommended procedure has long lasting effects over the body and/or psyche of the adult-who-was-a-child? Has the AAP or any research group bother to approach or study those men who feel severely damaged by their infant circumcision? Dismissing them as an anomaly doesn't cut it. And they are relatively easy to find now: http://www.foreskin-restoration.net and http://www.noharm.org

* What are the benefits of not being circumcised?

* The policy barely mentions some Korean men finding less pleasure in masturbation. What about the studies on dullness syndrome, loss of sensation on the glans? You acknowledge keratination of the glans, but your studies on sensitivity don't go beyond 12 weeks after adult circumcision which you acknowledge is not enough to assess long term.

* What about the studies of the nerve endings of the foreskin? Is the anatomy of the foreskin relevant at all? What about studies that show how the sexual function is altered when the penis is altered? You must have heard about it.

* Data on the most severe risks is ignored because it's only reported as case reports. But understanding the most severe risks is important when assessing the decision, isn't it? i.e., what's the worse that can happen and what are the chances? I would ask that.

* Justifies removing healthy tissue from one person's body based on the parents' religion, culture or preferences. As long as it's just the foreskin - any other tissue would be protected, including the clitoral hood of the girls in spite of being anatomically the same tissue.

* The study of complications leaves a lot to be desired. "Financial costs of care, emotional tolls, or the need for future corrective surgery (with the attendant anesthetic risks, family stress, and expense) are unknown.". How can you advise a parent without that kind of information.

Some notes: "parents are granted
wide latitude in terms of the
decisions they make on behalf of their
children, and the law has respected
those decisions except where they are
clearly contrary to the best interests
of the child or place the child’s health,
well-being, or life at significant risk of
serious harm"  <-- What if circumcision does place the child's health, well-being and life at significant risk of serious harm? How do you define significant risk?

Is circumcision a human right issue? Can irrevocably removal of healthy tissue from a non-consenting individual regardless of any purported benefit be considered morally and ethically correct or a violation of human rights?

If the US is a "pluralistic society
of the United States, where parents
are afforded wide authority for determining
what constitutes appropriate
child-rearing and child welfare", why is it that the only healthy tissue that can be legally removed by a doctor or religious practicioner is the foreskin? Why is the foreskin not granted the same protection as, say, the tip of the nose, the lips, the skin of the fingers, the clitoral hood? Is it really just a matter of having a health benefit to justify it when the individual does not have the ability to consent?


Circumcision and HIV

As an intactivist, I have a bias. I already consider that routine infant circumcision is wrong and a violation of human rights. I feel that way because of my own experience, not because of something I read or something I told me. I've felt this way since my doctor lifted a scalpel against my penis.

However, when speaking about science, health benefits and risks, I have to keep things in check. I don't want to advocate based on bad science, and if there is bad science on either side of the equation I want to denounce it and point it. Understanding the issues around circumcision require rationality, but also require a degree of humanity, empathy and compassion.

Intactivists are often accused of being a cult-like organization. However, pro-cutters have never discussed publicly why we exists, why we speak. They say we have something wrong in our psyche, but they can't acknowledge that they messed with our psyche when they cut us. If there's something wrong with us, it started when someone used their rationale to amputate a healthy part of our body without our permission to do so, and no level of rationality is going to change how we feel about it.

However, I want to discuss here how some studies are presented as an absolute truth and used to promote circumcision of infants, while other studies are ignored and dismissed because they show different results. What I want to show here is that the public statements voluntarily omit information in order to sell an idea, that circumcision prevents HIV and so it is a good thing, which most people will accept as a truth after reading it in the newspapers - without delving deeper into the issue and seeing the other side of the coin.


As circumcision programs are embraced in Africa as a preventive measure to curb down the epidemic of HIV based on 3 trials (experiments) ran in 3 different countries, the poorly understood HIV prevention mechanism is promoted by the pro-circumcision institutions as a reason why people should be embracing circumcision of neonates and infants elsewhere. These 3 studies are rumored to be the base for the new AAP statement on infant male circumcision to be released next week.

Johns Hopkins Medical in particular came out with a simulation (which they called a "study") showing how the decreasing rate of circumcision in the U.S. would cause billions in loss due to health care, based of course in the data from the 3 African studies - which they were also participants of. This was basically a self-serving study designed to call the attention of the media by implying billions in losses, to desperately promote circumcision of infants - and to support the AAP's rumored attempt at having Medicare restore coverage for circumcision of infants in those states where it has been dropped.

The first danger here is that people are extrapolating the results of the 3 studies away from the population that generated the data. The characteristics of the epidemic in Africa are different from those in the United States, Europe, Asia, South America or the Caribbean, so what is recommended in one place is not necessary the best approach for all.

According to the WHO ""Countries with high rates of heterosexual HIV infection and low rates of male circumcision now have an additional intervention which can reduce the risk of HIV infection in heterosexual men. Scaling up male circumcision in such countries will result in immediate benefit to individuals. However, it will be a number of years before we can expect to see an impact on the epidemic from such investment."" <-- This means, this recommendation does not apply to the case of the U.S. http://www.who.int/hiv/mediacentre/news68/en/

To clarify, the U.S. has a high prevalence of circumcision and a high rate of HIV, which seems to run contrary to the hypothesis that circumcision protects from HIV. But this would have to be explained in the fine letter: circumcision appears to have a protective effect to prevent the female to male transmission of the virus through vaginal intercourse. A high percentage of AIDS in the US is attributed to homosexual relations, anal sex and intravenous transmission.

Most of Europe however has a low prevalence of circumcision and a lower rate of HIV. If the African studies could be generalized, Europe should be in a far worse position regarding HIV than it is.

So whether the 3 African studies found a correlation, they didn't find a causality, and furthermore, the correlation cannot be extrapolated, which means that there are several other factors that are not even taken into consideration in the equation. For example: "because circumcision is usually linked to culture or religion, it has been argued that the apparent protective effect of the procedure is likely to be related not to removal of the foreskin but to the behaviours prevalent in the ethnic or religious groups in which male circumcision is practised" http://www.unaids.org/en/media/unaids/contentassets/dataimport/pub/report/2000/2000_gr_en.pdf


The second danger is that the institutions that want to push circumcision for the masses are being selective on what data they consider and what studies they dismiss. For example:

There is a new study conducted in Puerto Rico that shows that "While preliminary, the data indicate that in and of itself, circumcision did not confer significant protective benefit against STI/HIV infection. Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented", in reference to the Caribbean region. http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2012.02871.x/abstract

The U.S. Navy also conducted a study among its troops, which found  that "Although known HIV risk factors were found to be associated with HIV in this military population, there was no significant association with male circumcision." http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA458066

See also where circumcision doesn't prevent HIV

Another study, presented along with the African studies, shows that female circumcision had an apparent preventive effect over HIV in Tanzania. However this study was pretty much dismissed: "The surprising and perplexing significant inverse association between reported female circumcision and HIV seropositivity has not been explained by other variables available and examined in these analyses. As no biological mechanism seems plausible, we conclude that it is due to irreducible confounding" - What this means is that they are aware that there are more variables that were not studied - which is what the 3 African trials on male circumcision should have also acknowledged. So why was this study dismissed while the others were so highly touted to push circumcision? Simply because female circumcision has fallen in disgrace in the Western world since  the 80s (even though it's still widely practiced in Africa and the Middle East), so any Western study that appears to promote what the West already recognizes as a cruel and dangerous practice would be a severe contradiction, and furthermore could lead to the question that keeps begging to be asked: Isn't male circumcision of infants also cruel, dangerous and a violation of the human rights of those who are most vulnerable?

More criticism of the African trials:

When bad science kills, or how to spread AIDS

 Circumcision and HIV - The randomized controlled trials

Doctors Opposing Circumcision - HIV statement

Methodological, ethical and legal concerns

 Confusion over circumcision leaves ‘smart men’ in the cold

Boon or boondoggle?

In the recent AIDS conference, while some African countries presented positive results, some other like the president of Uganda decreed circumcision programs as a loss of time and resources, and the results from some countries like Zimbabwe serve as a counterexample of the premises, since the rate of HIV is currently higher on circumcised men than in not circumcised.

Oh, and look, the  US is urging soldiers to circumcise to prevent HIV. Does that sound familiar? Sounds like the when "military doctors published reports proving that Blacks were responsible for the spread of venereal disease and so Blacks were targeted for circumcision." during WWI and WWI.

So where is the ethical value of these organizations? Why do they want us to walk blindfolded into their schemes, why do they perpetuate myths not unlike J.H. Kellogg did 100 years ago when he pushed male and female circumcision to prevent masturbation because it caused epilepsy, tuberculosis, paralysis and more harm that wars and diseases together.