Friday, April 18, 2014

"Infant circumcision is becoming less common in the US, but why?" comments regarding Brian Morris' latest piece on Mayo Clinic Proceedings

A couple of weeks ago, intactivists gathered in Washington D.C. for Genital Integrity Awareness Week. Upon their return home, some of them found that a reporter for a news outlet had contacted them asking some questions regarding the upcoming publication of an article by Brian Morris on Mayo Clinic Proceedings. Unfortunately the coincidence of these two events meant that the intactivists lost their chance to provide input to a genuinely interested journalist.

I had the chance to discuss with one such intactivist the journalist's message, hoping to provide a late answer to the questions. I will reserve the name of the news outlet and journalist, but will include here parts of the email and some thoughts around it:

The Journalist's message

Hello there, I’m the **** of the **** website, and we’re running a new article on the latest piece of research by Brian Morris that will be published tomorrow in association with Mayo Clinic Proceedings. 
As the findings could be considered controversial, we are interesting in including some alternative viewpoints. I happened across the Whole Network and anti-Brian Morris Facebook pages and I’ll love to include your perspective in the piece. 
I’m on a fairly tight deadline, but if you are able to provide me with responses by ***  then I will be able to include your answers in my piece, along with links to the sites. 
1) Dr Morris has carried out a risk-benefit analysis suggesting that risks from not circumcising add up to a 1 in 2 risk of a medical condition caused by retention of the foreskin. He lists these conditions as: UTI, kidney damage (infancy), candidiasis, prostate cancer, penile cancer, balantitis, phimosis, paraphimosis, oncogenic HPV, genital herpes, genital ulcer disease, Trichomanas vaginalis, Mycoplasma genitalum, chancroid, syphilis, and HIV. He also lists the following conditions that foreskin retention can result in for female partners: cervical cancer, Chlamidya trachomatis, genital herpes, Trichomanas vaginalis, bacterial vaginosis.
The risk figure of 1 in 2 seems alarming, and he also claims the benefits exceed the risks by over 100 to 1. Do you understand why people - including medical professionals and organizations such as the Mayo Clinic - therefore find Dr. Morris and the pro-circumcision argument convincing? What counter-argument would you provide that could change people’s minds? 
2) Dr. Morris claims that circumcision has zero adverse effect on sexual function, sensitivity or pleasure. Do you believe this will ease the public’s concerns over circumcision? A large part of the public’s reticence towards it as a procedure seems to stem from the Victorian belief that circumcision could be used to prevent masturbation. 
3) Prevalence of circumcision in adult men in the US has risen to 81% in the last decade, but fallen to 77% in infants and boys - why do you think this is? 
4) Accompanying the new study, Brian Morris makes this statement: “It would be unethical for a male not to be circumcised owing to the fact that it would increase his risk of an adverse medical condition and the fact that circumcision is such a safe procedure. Effectively, it’s akin to vaccination.” What would your response be?

So, here are some thoughts about it

First, Brian Morris is not a medical doctor. He is a molecular biologist who for some reason has been strongly inclined to promote circumcision since 1995. His publications are usually not original research, but meta-analysis and other reviews of existing literature, generally grading with low quality those studies that do not support his views. In fact since the Royal Australasian College of Physicians rejected his views on circumcision, he joined a small number of circumcising physicians to create the "Circumcision Foundation of Australia" with the purpose of presenting a Policy Statement on circumcision that would present a more affirmative position than the one by the RCPA. Of course the CFA is not a recognized medical organization.

The risk figure of 1 in 2 seems alarming, but it is also a very generic number, considering that this would include everything from a mild infection, a mild irritation, an inflammation, to more serious conditions such as real phimosis during adulthood. It is likely that he is also including STDs as conditions resulting from foreskin retention, which would certainly be a stretch.

Very few conditions actually warrant a "medically necessary" circumcision. Edward Wallerstein (an American circumcised Jewish man, author of "circumcision: an American health fallacy", 1980) showed that men in Finland had to undergo medically necessary circumcisions at a rate of 1 in 16,667. Many conditions traditionally treated with circumcision in our countries, respond well to conservative treatments without loss of tissue.

The benefits/risks ratio of 1 to 100 is a claim that he has often repeated without proper quantification. The AAP, in stating that "the benefits outweigh the risks", did not quantify the benefits nor the risks, recognizing that the real rate of complications is unknown, especially because many complications may not be even detected until many years later.When you say that medical organizations find the pro-circumcision argument convincing, this may be truth in places where circumcision as a cultural custom is already established (the U.S., Israel, many Islamic countries and some parts of Africa), but it is not the case for the rest of the world. Last year, Pediatrics published a letter by 38 European and Canadian physicians, heads of real medical organizations, criticizing the AAP's Policy Statement on Circumcision as being culturally biased and lacking solid science. Many European medical associations moved during 2013 to call for a ban on circumcision of minors. It is only in the American media and American medical organizations, where we see this tendency to support circumcision, and it is likely the result of cultural bias - an established custom, and the fact that most American doctors were circumcised at birth themselves, so they lack personal experience of the foreskin.

Also consider the fact that the American biomedical industry uses discarded foreskins from neonatal circumcisions for research and manufacturing processes, such as stem cell research, culturing skin to test makeup products as a "humane" (or human) alternative to animal testing, obtention of byproducts of cell culturing (growth factors) for anti-wrinkle creams, hair growth, etc., and the collected fees from 1.2 million yearly neonatal circumcisions, and you have a good financial incentive to maintain the practice of neonatal circumcision.

Professor Morris previously published a meta-analysis to "prove" that circumcision has no adverse sexual effects. In his study, he rated as "poor quality" those studies that actually show adverse sexual effects (Sorrells 2007, Kim 2007, Frisch 2011, Bronselaer 2013) while rating as high quality those that didn't show such effects, in spite of sampling bias and methodological flaws. His co-author in this study was Krieger, author of one of those studies. No conflict of interest was declared, in spite of Krieger's own study being reviewed and graded as "high quality". Brian Morris reduces the problem of sensibility and sexual satisfaction to statistics, ignoring the observable functions of the foreskin, something that may fool a mostly circumcised population but not the rest of the world. I would recommend you to read about the triple whammy of circumcision - this is the part of the issue that Brian Morris will never discuss since there is no way to refute it..

There are several factors to account for the reduction in circumcision rates. More available information through the internet and social media. Circumcised males expressing their dissatisfaction with their circumcision status. Awareness of the practice of foreskin restoration by circumcised males who wish to approximate what the original foreskin would have been. Activism, as a grassroots movement by normal people, circumcised and uncircumcised males, parents who regret circumcising their babies, physicians, lawyers, etc. Growing awareness of cases of severe complications, such as the baby from Memphis and the baby from Pittsburgh who had their penis amputated last year, one in a clinic and one in a religious ceremony.Circumcision cannot be considered a vaccine. It does not change the immunological system of the individual. All the infectious conditions that can affect an uncircumcised male can also affect a circumcised male. Even the touted 60% risk reduction of HIV during heterosexual relations is barely significant in the Western context.

Furthermore, circumcision is a permanent alteration of the form and function of the penis. The complication rate is high, with many low impact complications and some high impact complications. Many males are not even aware that their "normal" experience is the result of circumcision complications (skin bridges, painful erections, ripped skin, having to use lubricants for sexual activity).

Brian Morris would like us to see the foreskin as a birth defect. This is simply not supported based on observations of countries where circumcision is not performed - most of Latin America, Europe and Asia. When it comes to removing normal healthy tissue from another person's body, it doesn't matter if the doctor or the parents believe that the tissue has no value; what matters is the opinion, the informed opinion of the person whose body will be altered. Removing normal healthy tissue from the genitals of a minor is a violation of human rights and the children's right to physical integrity.

No comments:

Post a Comment