Friday, August 31, 2012

WASHINGTON POST: The "Great Controversy" Strikes Again

In an earlier post, I talked about how American media uses the "Great Controversy" trope to sell the American public the false perception that the issue of circumcision is one that is fought between "expert researchers and physicians" with an interest in public health, who make sound and compelling arguments in favor of the routine circumcision of healthy, non-consenting minors, and "angry laymen" who offer nothing more than charged emotion.

In a recent set of articles, journalist Janice D'Arcy set out to reaffirm this false perception of reality. This resolve to enshrine pediatricians who advocate and perform circumcisions can be seen in the title of an article in the Washington Post, which reads "Circumcision, and why pediatricians are offering more support."

Self-appointed chair of the so-called "AAP circumcision task force" Douglass Diekema is given the spotlight, and he wastes no time chide his opposition by saying:

"For individuals who have decided that circumcision is wrong, no amount or quality of data will put these questions to rest. It is always possible to find potential weaknesses in any study. What the AAP report does is provide a critical assessment of all of the studies that have been done to date. There are clearly many studies of good quality that demonstrate that circumcision has potential medical benefits.”

In other words, it's all about the "data," and no other group could give a better assessment, than the so-called "circumcision task force" at the AAP, headed by none other than himself.

Diekema further says:

"Pediatricians want to do what is best for their patients. The AAP policy and technical report on circumcision is intended to provide physicians with an assessment of the scientific knowledge we have about circumcision so that they can best counsel parents. That is more important than what certain groups might think about the report."

This is the self-serving picture that circumcision advocates want the American audience to see, and American media is an accomplice. Only "experts" such as Diekema, and only trade unions like the AAP are capable of assessment of data, and not "certain groups."

In what I can only see as a scripted question and answer handed to Janice D'Arcy by one other than Diekema himself, we see the following Q&A:

Q: Is there a concern among pediatricians that this report will alienate the anti-circumcision folks and isolate them from the medical community (as has happened with some anti-vaccine folks?)

A: Pediatricians want to do what is best for their patients. The AAP policy and technical report on circumcision is intended to provide physicians with an assessment of the scientific knowledge we have about circumcision so that they can best counsel parents. That is more important than what certain groups might think about the report.

This could have better read "Characterizing intactivists as anti-vaccine folks, alienating them and making them as incredible and far-fetched as possible, while making *us* appear to be the knowledgeable 'experts' is precisely what we want."

The sleight of hand that has happened here is that Diekema and his trade organization, along Janice D'Arcy of the Washington Post, is trying to equate the amputation of normal, healthy flesh with immunization vaccines. The assumption that circumcision acts as a vaccine has been planted in the reader's psyche without even knowing it.

Anyone against circumcision is as irrational as people who oppose vaccines, and so they shouldn't be lent any credibility. Neat huh?

Attacking another person based on an argument he never made is known as "attacking a straw man."
It must be made clear: Circumcision does not, cannot function anything like a vaccine. A vaccine can be demonstrably proven to strengthen the immune system against pathogens that cause disease. When a virus enters the body, it makes no difference whether a male is circumcised or not. Comparing circumcision to a vaccine is an insult to science and modern medicine.

Calling intactivists anti-vaxers is a straw-man argument, and here we see the Washinton Post and Douglass Diekema using it to dismiss intactivists.

Some people who oppose circumcision may also happen to be against vaccinations, but that is not true of all intactivists.

D'Arcy Fires Back

Scathed by the remarks left on her AAP plug piece, Janice D'Arcy set out to publish yet ANOTHER piece to praise the "experts" at the AAP, and dismiss intactivists as "angry laymen," this time titled "‘Intactivists’ furious at new AAP circumcision policy."

She seems intent on separating what intactivists have to say from "expert advice," and this can be seen in the following remark:

"So angry are opponents to the procedure, sometimes called “intactivists,” that their response may be remembered as much as the pediatricians’ advice."

And we hope people might actually analyze and look beyond this "advice" from people who wish to profit at the expense of their children.

D'Arcy continues: 

"The attempt to respect both sides fell more than flat among critics, including many readers of previous posts here this week on the statement."

It never ceases to amaze me how people try to talk about this issue as if it could be "fair and balanced." Since when do we consider and respect "both sides" of female circumcision?

She continues: 

"Few addressed the issue of religious freedom or that faith is central to many parents who chose to circumcise."

That's funny, "religious freedom" doesn't seem to be an issue when condemning female circumcision, not that faith is central to the parents who have "chosen" to circumcise. While "religious freedom" and "parental choice" can be used to legitimize male circumcision, when talking about female circumcision, these arguments go out the window.

But more to the point, what does the fact that some people see circumcision as a religious requirement have to do with standard of care doctors use for treating children who don't even come from a religious background?

Since when does the AAP concern itself with appeasing a parent's faith over the health and well-being of children?

In my opinion, not much further than that members of the AAP can capitalize. Let us not forget that not too long ago, the AAP tried endorsing a "ritual nick" for girls.

For this second piece, D'Arcy reiterate's Diekema:

“For individuals who have decided that circumcision is wrong, no amount or quality of data will put these questions to rest…”

Diekema and D'Arcy want to pretend like it’s all about “research” and “benefits.”

Readers, ponder this for a moment; at least ostensibly, the ethics of cutting off normal, healthy tissue from a healthy, non-consenting minor was decided on a “cost-benefit” analysis that, supposedly, erred in favor it.

The unspoken and disconcerting implication seems to be that the forced genital cutting of female minors could one day be legitimized, if enough “research” and “quality data” said that it was “harmless,” even “beneficial, when performed by a trained professional member of the AAP/ACOG.”

This is a textbook case of sexist special pleading; there will never be enough “quality data” that would ever justify the smallest “ritual nick,” as the AAP found out not too long ago.

And yet, Diekema has the nerve to dismiss advocates of male genital integrity using a sound bite that may as well apply to himself, and D'Arcy has the nerve to reiterate it.

Projection much?

D'Arcy is intent on reaffirming the false reality of which she want to convince her readers:

"It remains to be seen if rates will continue to decline and which will have more sway among new parents: the pediatricians group or the fierce reaction to their new advice."

Pitting "expert professionals" against "the angry mob" is a disingenuous misrepresentation of reality. Absent from these smear pieces is the fact that the AAP is stepping out of line of Western medicine.

The fact of the matter is, the trend of opinion on routine male circumcision is overwhelmingly negative in industrialized nations. The most respected medical board in the world all have access to the same data as the AAP, and yet there is not a single one that recommends circumcision for infants, not even in the name of HIV prevention. They must all point to the risks, and they must all state that there is no convincing evidence that the benefits outweigh these risks. To do otherwise would be to take an unfounded position against the best medical authorities of the West, as the AAP has done in their latest "statement."

It would be more honest of D'Arcy to paint the whole picture, not just the angle that favors the AAP, and quite possibly her own bias.

These articles follow the AAP press script closely, giving canned answers to scripted questions. Either D'Arcy is in the pockets of the AAP and she rehearsed her lines well, or she really is that out of touch with reality.

Leave it to American reporters to investigate an issue to the fullest.

Read what this expert is saying; he is an ethicist and does a much better job than Diekema. The AAP ought to consider him for their "task force." (Something tells me they're not letting people who can actually debate the issue in...)

Wednesday, August 29, 2012

LEAKED: AAP Press Script

Three things cannot be long hidden; the sun, the moon, and the truth. ~Buddha

Been wondering why the latest news reports on the latest AAP statement all sound similar to each other?

This is because the AAP planned a mass circumcision ad campaign in advance. The event was carefully synchronized with members of other American medical associations which harbor perpetrators of infant circumcision, such as ACOG, as well as circumcision "researchers," such as Aaron Tobian, who both helped write the new statement, as well as the "economical analysis" released a few days prior.

Well, judging from a leaked document, it looks like the media fallout in the wake of the release of their new statement was also carefully planned. It looks like AAP members who were to meet with reporters were given their lines to rehearse, so nothing is any kind of real answer, just canned propaganda party lines and scripted answers to scripted questions. We read in the AAP script only the questions which are to be asked and the answers which are to be given, it's almost Orwellian.

I'm going to post the script here all italics, adding my own commentary.

Circumcision Speaking Points

American Academy of Pediatrics


August 2012

This information is intended to help AAP members prepare for media interviews. It is not for reproduction or distribution. (You should have been more careful.)

The AAP published the policy statement and technical report on male circumcision in the September 2012 issue of Pediatrics (published online Aug. 27). The report updates the previous recommendations made in 1999.


1. Based on the Academy’s systematic and critical review of the scientific evidence (actually, carefully selected), male circumcision has been shown (by our own review) to have significant health benefits that outweigh the risks of the procedure. The (alleged) health benefits include:

a. lower risk of acquiring HIV, syphilis, human papillomavirus, and genital herpes (not all studies show this)

b. lower risk of cervical cancer in sexual partners, (based on select studies that show a correlation between intact partners and a "higher rate of HPV"; other research shows little to no difference, if not a trend in the OPPOSITE direction; HPV has been shown by some studies to be transmitted more easily by circumcised males.)

c. lower risk of penile cancer over a lifetime, (which, even if the research can be trusted [and it in and of itself is dubious], is already vanishingly rare; in America, according to the ACS, one in six men will develop prostate cancer; a man is more likely to get prostate cancer than penile cancer, yet there are no talks of excising the prostate in children)

What the American Cancer Society has to say about penile cancer:

In the past, circumcision has been suggested as a way to prevent penile cancer. This was based on studies that reported much lower penile cancer rates among circumcised men than among uncircumcised men. But in many of those studies, the protective effect of circumcision was no longer seen after factors like smegma and phimosis were taken into account. 
Most public health researchers believe that the risk of penile cancer is low among uncircumcised men without known risk factors living in the United States. Men who wish to lower their risk of penile cancer can do so by avoiding HPV infection and not smoking. Those who aren't circumcised can also lower their risk of penile cancer by practicing good hygiene. Most experts agree that circumcision should not be recommended solely as a way to prevent penile cancer.

d. lower risk of urinary tract infection in the first year of life. (the evidence for this has been shown to be methodologically flawed; even if it could be relied upon, UTIs are already quite rare in boys anyway, when compared to girls, and they're easily treatable with antibiotics; it makes no sense to be prescribing surgery to prevent an already rare and easily treatable condition)

*Note, other medical organizations in the world have evaluated the same evidence and have not come to the same conclusion as the AAP. The AAP is daring to defy the best medical authorities in the West, putting its credibility in jeopardy

2. Although the health benefits are not great enough to recommend routine circumcision for all newborn males, the benefits are enough to warrant access to the procedure for those families choosing it. It should be covered by insurance.

(Wow, all in the same breath. I want readers to consider this for a moment; while even the AAP admits the health benefits are not enough to recommend infant circumcision, it should still be an option for parents, and public coffers should pay for it. It raises the question; is it sound medical logic to be performing radical amputative surgery in healthy, non-consenting individuals on the basis of "potential medical benefits" instead of actual medical indication?)

3. Parents must ultimately decide whether newborn male circumcision is in the best interests of their child's health. Parents should discuss the risks and benefits with their pediatrician. They will need to weigh medical information in the context of their own religious, ethical and cultural beliefs. (As opposed to actual medical necessity? What other surgery works this way, in which religious and cultural beliefs take the place of medicine? What ethics are pediatricians who are more worried about appeasing parents, as opposed to the health and well-being of the child exercising?)

Without medical or clinical indication, can a doctor even be performing surgery on healthy, non-consenting individuals, let alone be soliciting the so-called "benefits" of it to parents and eliciting any kind of "decision?" Does not profiting from the performing of non-medical surgery on healthy, non-consenting individual constitute medical fraud?

The AAP appears to be trying to deliberately sanction blatant charlatanism.

Frequently Asked Questions

Q: What does the new policy recommend and how does it differ from the previous one?

A: The new policy is based on a thorough review of the available scientific evidence, which has shown clearer health benefits than had previously been understood. (FALSE: The new policy is based on selective "research," and not all the evidence was considered. The "health benefits" are not so clear, and the AAP is alone in considering them to "outweigh the risks." The AAP continues to maintain that they are not enough to endorse the practice of circumcision.) The most significant changes since 1999 are new studies that demonstrate a protective effect of circumcision against the acquisition of several sexually transmitted diseases, including HIV, genital herpes, human papilloma virus (the virus causing genital warts, cancer of the penis and cancer of the cervix) and syphilis. ( promiscuous men in high-risk areas in Africa, and the so-called "studies" are of questionable value.)

The new policy states that the strength of the data is sufficient that the Academy advocates the procedure be covered by insurance. (...but not enough to recommend... Conflicting much?) The 1999 statement did not include such a recommendation. (This much is true.)

The new policy states that the scientific evidence indicates that the health benefits of newborn male circumcision outweigh the risks. (True. It does say that.) This is a stronger statement regarding the medical benefits of circumcision than was included in the 1999 statement, reflecting the scientific evidence that has emerged since then. (No, reflecting select data from three flawed "studies," and reflecting the financial and religious interests of its members.)

The recommendation that the final decision rests with the parents is the same as in the 1999 policy statement. (IE, the AAP continues to evade any responsibility for making a direct and forthright statement and placing it on naive parents who should consider the same "evidence" they could not use to endorse the procedure.) The new policy states that parents are entitled to factually correct and non-biased information about circumcision and must be allowed to weigh the health benefits and risks in light of their own cultural, religious, and personal preferences. (Cultural, religious, and, this time PERSONAL preference. As opposed to actual medical and/or clinical necessity? What other surgical procedure works in such a way? Without a medical or clinical condition that requires surgery, how is it parents should even be consulted on the matter? The only answer seems to be solicitation of a sales pitch. Again, the AAP appears to be advocating charlatanism.)

Finally, the new policy and technical report recommend the procedure should be performed by trained and competent providers, using sterile techniques and effective pain management. (A ridiculous red herring; all other surgical procedures performed on children should be performed by amateurs with rusty box cutters then?) The 1999 policy recommended analgesia, but the new policy includes greater detail regarding the need for sterile techniques and well-trained providers. (At the same time, we are supposed to believe circumcision is "a simple snip.")

Q: What led the AAP to revisit its policy on newborn male circumcision?

(Can we trust the following answer?)

A: It is standard practice for the AAP to revisit all of its policies on a regular basis. The previous policy statement on newborn male circumcision was first approved in 1999. It was revisited in 2005, but the depth and breadth of the HIV and STI studies at that time were not strong enough to warrant a revision, so the existing policy was reaffirmed. Since that time, new scientific knowledge has accumulated about the medical benefits of newborn circumcision. In order to maintain a current policy, it was important the scientific literature be reviewed and the policy updated. (Yes, I'm sure members at the AAP, ACOG etc. didn't all have the bejesus scared out of them by the recent developments in Cologne, Germany. Yes, I'm sure AAP members are all genuinely interested in preventing HIV in children who cannot even conceptualize sex. Yes, I'm sure there is simply no better way to prevent disease than by a procedure that happens to be a hefty stipend for AAP and ACOG members.)

Q: What has changed since the 1999 policy on newborn male circumcision was issued?

A: The primary known medical benefits of newborn circumcision in 1999 included a lower risk of urinary tract infection during the first year of life and a lower risk of penile cancer later in life. (The 1999 Task Force found that the bulk of the UTI studies were so methodologically flawed—by failing to control for confounding factors-such as breastfeeding—that no meaningful conclusions could be drawn from them. The 1999 AAP Task Force on Circumcision could not, therefore, recommend circumcision to reduce incidence of UTI [or any other disease].) The most significant changes since 1999 are new scientific studies that demonstrate a protective effect of circumcision against the acquisition of several sexually transmitted diseases, including HIV, genital herpes, human papilloma virus (the virus causing genital warts, cancer of the penis and cancer of the cervix) and syphilis. ( promiscuous men in high-risk areas in Africa... And, again, a few select "studies" show this. Other medical organizations in Western medicine have evaluated the same "evidence" and found it lacking. The AAP, however, most members who profit from infant circumcision, is going tell them otherwise.)

Q. Is it true that rates of newborn circumcision have been decreasing and if so, why is that?

A: We don't know the true rate of newborn male circumcision in the U.S., but rates appear to have fallen slightly in the past 20 years. A growing number of state Medicaid programs have stopped paying for circumcision, thereby reducing access to the service. Some families may decide against the procedure because they are unable to pay out-of-pocket. More families may be choosing not to have a circumcision because of a sense that it is not medically necessary or due to their own religious, ethnic, cultural or esthetic beliefs.

Here is where it starts getting interesting; while the new AAP statement continues to say the "benefits aren't enough to recommend circumcision," it concerns itself with how many families are choosing to circumcise, which ones are not, why, and how to badger them with these benefits and force them to make "the right decision." Are they interested in mere disease prevention? Or in securing a customer base? There are other, more effective, less invasive ways to prevent every disease mentioned in their report. Are those not going to be talked about? Or is not circumcising simply not an option?

The data sources available are based on newborns who were circumcised in the hospital, and often do not reflect those who are circumcised in their communities by a religious practitioner (like a Mohel) or in a doctor's office. Because babies are discharged from the hospital sooner after birth than in the past, more circumcisions are probably performed in the clinic, and not reflected in hospital-based data.

You know what else we don't know from hospital data? The number of botches, revisions and complications that happen. Hospitals are not required to release that data, nor are mohels or other charlatans. The AAP does not seem to be interested in finding out either, and would rather believe the reported low numbers given by the CDC, another corrupt organization.

Q: What are the primary benefits of circumcision?


• Lower risk of acquiring HIV, syphilis, human papillomavirus, and genital herpes

• Lower risk of cervical cancer in sexual partners

• Lower risk of penile cancer over a lifetime

• Lower risk of urinary tract infection in the first year of life

(All repeated from the top, all expected to be believed at face value.)

Q: How significant are these health benefits? (If asked for specific data. You can also refer reporters to the technical report to see the specific studies cited.)

Yes, only the "studies" that the AAP cites should be relied on. And, reporters too, will look beyond it to make sure the AAP did their homework.

HIV: The CDC estimates that 1.2 million people in the U.S. are living with HIV; about 50,000 Americans are newly infected with HIV each year. (How many of which are circumcised males? Any info on that?) The AAP technical report on circumcision cites 14 studies that found evidence circumcision is protective against heterosexually acquired HIV infection in men. (Did they look at studies that found little to no difference, if not a trend in the other direction? Here are some studies and reports that disagree with the "evidence" the AAP has reviewed...)

Genital Herpes: Approximately 16.2 percent of U.S. individuals aged 14 to 49 have herpes simplex virus type 2 (HSV2). Two large randomized trials in Africa found the incidence of HSV2 was 28% and 34% lower in circumcised men, and one study showed male circumcision protects female partners against HSV2 infection. (Did they look at other data? Let's analyze what we have here; the inverse is that HSV2 was still 72% and 66% in circumcised men. That's not too impressive. How do condoms and safe sex practices measure up?)

Human papillomavirus: HPV is among the most commonly occurring STIs in the U.S. and can lead to the development of cancers including cervical cancer. Two studies show a 30% to 40% reduction in risk of HPV infection among circumcised males. (Other studies show little to no difference, if not that HPV was easier transmitted by CIRCUMCISED men.)

Cervical cancer: Up to 12,000 new cases of cervical cancer are diagnosed in the U.S. annually. A study found a lower incidence of HPV infection in circumcised men (5.5%) compared to uncircumcised men (19.6%). In women whose partner had more than six lifetime sexual partners, male circumcision lowered her odds of cervical cancer significantly. (Conjecture upon conjecture; this is in conjunction with the assumption that intact men are transmitters of HPV; some studies show little to no difference, if not that HPV was more easily transmitted by circumcised males. At any rate, actual vaccines already exist for HPV, rendering circumcision a moot point.)

Penile cancer: Penile cancer is rare (0.58 cases per 100,000 individuals in 1993-2002) and rates appear to be declining in nations with both high and low circumcision rates. However, studies show an association between circumcision and a decreased likelihood of invasive penile cancer. (Come again? So evidence that shows no difference is ignored in lieu of the evidence that shows an "association," however flimsy it may be? Scroll up to read what the ACS has to say on penile cancer and circumcision.)

Syphilis: The total number of cases of syphilis reported to the CDC in 2010 was 45,834. The balance of evidence from several studies suggests male circumcision is protective against syphilis. (The bottom of the barrel gets thinner and thinner... Again, a "suggestion" obtained from selected evidence... Yes, so compelling... So a circumcised man can't get syphilis? How about a man wearing a condom?)

Urinary tract infection: The majority of UTIs in males occur in the first year of life. In children, UTIs usually necessitate a physician visit and may involve the possibility of an invasive procedure and hospitalization. (When and if they do happen. What is the incidence of UTIs in boys and girls? Are they fatal, or are they easily treated?) Infant boys who are circumcised have a lower risk of UTIs, with various studies showing a three-fold to a 10-fold reduction in risk. It is estimated that 7-14 out of 1,000 uncircumcised male infants will develop a UTI during the first year of life, compared with 1-2 infants among 1,000 circumcised male infants. (Based on WHAT evidence? And is circumcision really warranted in preventing an already rare, already easily treatable condition?)

Q: What are the risks of circumcision?

A: The risks of an adverse event during circumcision are very low when performed by an experienced practitioner using sterile technique. (Note the clarifier... Again, a red herring; surgery is always best when performed by a trained practitioner. The question is IS IT NECESSARY?) The most common (according to us) complications are minor and include bleeding, which responds to pressure, and minor skin infections. (Other common complications that are not included here are botched circumcisions which require correction later on, and meatal stenosis. Botches are so common that there are doctors that specialize in this field.) The best evidence (what we've selected) shows an incidence of circumcision-related complications of less than 1 percent, which is very low for a surgical procedure. (Too low.) More serious complications, like the removal of too much tissue or partial amputation of the penis are very, very rare, to the point that there were no good analytic studies in this area for the task force to review. (Absence of evidence is not evidence of absence. There have been an increasing number of lawsuits raised against mohels and physicians that have amputated more than just the foreskin of the penis. Here, we see one of the greatest problems with the new AAP statement; they claim "the benefits outweigh the risks," having no actual evidence to make this claim.) Circumcision can also cause pain, but this is easily addressed with the use of appropriate pain control methods during and after the procedure. (No news here; pain can be controlled in most any surgery. Most surgery is medically indicated, however...) The risks are much higher when the procedure is performed in older patients. (This is true of any surgery. Again, necessity and the ethic of performing non-necessary amputative surgery on a healthy, non-consenting individual is evaded...)

Q. What about the recent deaths of infants after ritual circumcision?

A. Isolated cases of morbidity and mortality after ritual circumcision have been reported in the U.S., and have been related to circumcisions that were not performed under sterile conditions. These cases and the practices that led to them have been limited to a specific group. (Circumcision doesn't kill... If you ignore all the deaths...) The AAP is clear: Any circumcision is an operative procedure that must be done under sterile conditions and with adequate pain control. These isolated cases are dwarfed by the number of circumcisions performed each year in this country under sterile conditions, and with a proven track record of safety. (Not discussed here: Deaths at the hands of professionals who performed the procedure under the most pristine conditions. Does the AAP have any data on this? What does the AAP know of deaths at hospitals? FACT: Hospitals are not required to release this information, and deaths due to circumcision are often covered up, or attributed to other causes, such as "hemorrhaging" or "septic shock." The AAP and it's members have a vested interest in helping suppress this data.)

Q: Isn't it true that the African studies that looked at the effect of circumcision on the acquisition of HIV can’t easily be generalized to the United States?

A: Africa has a higher prevalence of HIV, and more cases are attributable to heterosexual intercourse than in the U.S. (Not to mention the studies looked at promiscuous men where the custom is to have multiple sex partners in high risk areas in Africa.) Nevertheless, circumcision decreases the risk of heterosexual HIV by more than one-half. (The absolute reduction observed in these "studies" was 1.37%.) That still amounts to less than half as many new HIV cases due to heterosexual sex among circumcised men when compared to uncircumcised men, (promiscuous men in high risk areas in Africa) which is (might be) still beneficial for an incurable, life-threatening infection. A recent CDC study deemed that newborn male circumcision was an ultimately cost- saving HIV prevention intervention in the U.S. for all males, and of especial benefit to black and Hispanic males. (With absolutely no evidence to substantiate this claim, just pure extrapolation of the faulty African "research.")

Is the AAP prepared to explain, why HIV transmission is more prevalent in the US, where 80% of all males were circumcised from birth, and lower in Europe where circumcision is rare? Is it prepared to explain why HIV was found to be more prevalent in 10 out of 18 countries, according to USAID? More places where circumcision fails to prevent HIV here.

Q: It seems like the primary benefits of circumcision are related to the prevention of sexually transmitted diseases, so why perform the procedure on newborns, and why not wait until the male is of age and can decide for himself?

A: Behavioral health surveys show that most young males become sexually active before the age of majority, so by delaying circumcision until males reach the age of majority, they therefore would lose some of the protective benefit of circumcision. (In other words, we know what's best for all boys and men. All boys grow up to be promiscuous men, and they don't get a say in how they wish to protect themselves, nevermind that, even if the "evidence" were correct, condoms would still outperform circumcision.) According to the CDC, almost 40% of 9th grade males in 2011 reported already having had sexual intercourse. (Did it say how many were using condoms responsibly?) Also, they would not benefit from circumcision’s demonstrated protection against urinary tract infections during the first year of life. (A "benefit" they may not ever even need not want, considering the alternatives...) Just as importantly, circumcision in an older patient is more difficult and the complication rate is considerably higher. (Most surgery is; an older patient may never need to get circumcised, nor may he feel the "benefits" are important to him. NOTE: Earlier they said they didn't have any evidence.) The safest time to perform circumcision is during the newborn period. (Remember, they didn't evaluate any actual evidence to substantiate this claim, just assumed there wasn't any...)

Q. Is it ethical for parents to make this decision for their newborn son?

More importantly, without medical or clinical indication, can a doctor even be performing surgery in a healthy, non-consenting individual, much less be eliciting any kind of a "decision" from parents?

A. It is the responsibility of parents to make many important decisions for their children every day, including where they will live, what they will eat, how they will be educated, and decisions about health care. Male circumcision is one of those decisions. (I reiterate, without medical or clinical indication, can a doctor even be performing surgery in a healthy, non-consenting individual, much less be eliciting any kind of a "decision" from parents?) Parents, in consultation with their child’s pediatrician, need to consider the scientific evidence about the risks and benefits of the procedure (evidence that the AAP itself could not use to endorse the procedure?), and then need to weigh this with their own ethical and religious beliefs to make this decision. (How is it ethical to be cutting off part of the genitals of a perfectly healthy child? And what other surgery is based on religious beliefs and not medical or clinical indication? HINT: Circumcision is the only item on that list.)

Q. If the medical benefits outweigh the risks, why doesn’t the AAP recommend all newborn males be circumcised?

A: Families will bring their own religious, cultural and personal preferences into consideration in making this decision. (And doctors will oblige to perform surgery based on religious, cultural and personal preferences, as opposed to actual medical need...) Parents need to weigh the health benefits (which were not great enough for the AAP to recommend the practice?) and risks (which the AAP does not know of) in light of these considerations; the medical benefits alone may not outweigh other considerations for individual families. The data (we do not have) show that the procedure is best-tolerated during the newborn period, and accrues the most lifetime health benefits if done at this time. These benefits justify access to the procedure for those families that choose it and warrant third-party reimbursement of the procedure. (But not our recommendation? Really?) The Academy maintains that the cost of the procedure should not be a barrier. (To a procedure you cannot bring yourselves to recommend?)

Q: How does the AAP policy compare to the positions of other medical societies?

A: The American College of Obstetricians and Gynecologists (Note: WOMEN DOCTORS) has endorsed the 2012 AAP policy statement on circumcision. (WHY is the endorsement of a trade organization for WOMEN DOCTORS important to the AAP? Answer: Because they profit the most from the circumcision of children, who are not even in the purview of those professions.) The American Urological Association has recommendations very similar to those of the AAP. (They would; they too profit from the procedure.) The World Health Organization recommends circumcision as part of a comprehensive global HIV prevention strategy. (FALSE: The WHO recommends circumcision in promiscuous MEN in high risk areas in Africa. There is no global move to recommend circumcision anywhere else.)

Many of the medical society statements that have been characterized as opposing newborn circumcision do not really oppose newborn circumcision. They have concluded that the evidence does not justify a recommendation to routinely circumcise all newborn males. In reality, these statements do not differ significantly from the AAP policy. For example, the Royal Australasian College of Physicians has concluded that the evidence regarding the preventive effects of circumcision is not sufficient to recommend routine infant male circumcision, but that it is reasonable for parents to weigh the benefits and risks of the procedure and make a decision on behalf of their children. The Canadian Pediatric Society takes a similar stance. The British Medical Association recognizes significant disagreement with regard to the risks and benefits of circumcision and concludes that parents should be permitted to make a decision to circumcise as long both parents consent and have been provided with up-to-date written information about the risks of the procedure and the lack of consensus (???) in the medical profession regarding the procedure.

Almost, but not quite. Note the blatant self-contradiction; No respected medical board in the world recommends circumcision for infants, not even in the name of HIV prevention. They must all point to the risks, and they must all state that there is no convincing evidence that the benefits outweigh these risks. To do otherwise would be to take an unfounded position against the best medical authorities of the West, as it appears the AAP is doing now.

All respected medical boards say that there is not enough evidence to endorse the practice, even though they conclude that parents should "decide" based on this same "evidence." That is not "lack of consensus," that is actually quite consistent across the board. The AAP wants to paint a false picture of other medical organizations in the world.

The following paragraph is infuriating, because it is a blatant and deliberate lie.

On the other hand, the Royal Dutch Medical Association issued a statement in 2010 concluding that in light of the lack of convincing medical benefits, non-therapeutic circumcision of male minors conflicted with the child’s right to autonomy and physical integrity and that physicians should inform parents and caregivers seeking circumcision about the medical and psychological risks and the lack of convincing medical benefits. While this conclusion differs from the conclusions of the new AAP statement, it is important to recognize that the Dutch Medical Association statement does not include a comprehensive, systematic review of the scientific literature. (The author of these talking points means to say "like the AAP's.")

EXCUSE me? Just what are their conclusions based off of? Thin air?

The Dutch Medical Association is currently being notified by intactivists of what has been said here.

Q. Is circumcision child abuse? Recently a German court declared circumcision illegal. Does that ruling contradict the AAP’s policy?

Better phrased, "Is the forced circumcision of healthy, non-consenting minors, child abuse?"

A: Circumcision is a procedure with few risks and considerable health benefits. (Maybe. IS IT CHILD ABUSE to perform it in healthy, non-consenting minors.) Parents who make the decision in the best interests of their child’s health are within their child custody rights. (Without medical or clinical indication, can a doctor even be performing surgery in healthy, non-consenting individuals, much less be stoking a parent's bloated sense of entitlement?)

The German decision required medical necessity in order to legally circumcise a child. Doing so does not take the evidence of health benefits from the procedure into account. (The Germans have access to the same "evidence" the AAP does. When an act is an act of abuse, it doesn't matter that there may or may not be "health benefits." When a man rapes a woman, there is no assessment of the "medical benefits" of rape. The rights of the woman are violated regardless. For most other medical procedures, actually, medical necessity is required. Performing non-medical surgery on healthy, non-consenting individuals constitutes medical fraud. In children, it constitutes abuse, and the violation of basic human rights.) The Academy’s position is based on a comprehensive (no, selective) review of the scientific evidence. It is also important to remember that this was the opinion of one court responding to a single case of a boy who suffered heavy bleeding following a circumcision. The court ruling was effectively negated when Germany's lower house of parliament passed a resolution to protect the religious circumcision of infant boys. (UTTERLY FALSE: The resolution does not affect the court ruling, and there is actually now a case involving a rabbi there.)

Q. Why does the AAP support male circumcision but oppose female genital cutting?

A: The two procedures are not analogous. (Evidence for this is...?) Female genital cutting is mutilation. (Point blank. No female genital cutting "taskforce" ever came to this conclusion.) Female genital cutting is not circumcision. (Maybe a "ritual nick" is then?) The scientific evidence of female genital cutting indicates only harms and no health benefits. (What "taskforce" came to this conclusion? Is there a periodic "statement" released every so often? I'd like to see it. Actually, there is some evidence that female circumcision might actually be "beneficial." Not that the AAP wants to get involved in that again... Remember the Ritual Nick, Diekema.)

In male circumcision, the anatomy is different, and the procedure is different. (Again, what evidence was evaluated? What forms of female circumcision compared? The anatomy may be different, the procedure may be different, the principle violated THE SAME.) Male circumcision has been shown scientifically to provide benefits to the person being circumcised, and has a proven track record for safety. (Would the AAP endorse female circumcision would that the "evidence" were provided? Would that it could be performed "safely?" Is it really about "benefits" and "safety?" Because I can provide evidence for BOTH.)

Q: Does circumcision alter the sensation of the penis and decrease sexual pleasure?

A: This is a very difficult thing to study, but the data that exist do not suggest that circumcision alters sexual function or pleasure. (Well. At least the one's the AAP has considered anyway.) In studies done in Africa of adult males undergoing circumcision, a small number of men reported a diminished sexual experience, a small number reported an improved sexual experience, and most reported no change. (Are you going to tell us about the Sorrells' study? A study recently conducted in Denmark? Yes? No?)

Q: What questions should a parent ask of their doctor when discussing newborn circumcision?

A: Parents should ask: What is the benefit of circumcision and what is the risk? (How about "What are the alternatives to circumcision? What other ways exist of achieving the same "benefits?" Is there an STD circumcision prevents that a condom can't? What options exist for me if I don't want to mutilate my child's genitals?" Are AAP members prepared to answere these questions? Or is circumcision supposed to be the only option?) How do I select someone to perform a circumcision?  Parents should make sure that the procedure is performed by trained personnel under sterile conditions with adequate pain control measures during the procedure. (All other procedures, it's OK if an amateur does it...) Parents should think about their views about circumcision during the pregnancy, including finding out whether there is insurance coverage, in order to avoid a rushed decision after the baby is born. (WHY should parents think about their views about circumcision at all? Is the child going to be born sick? WHY should parents consider a procedure whose "benefits" the AAP could not use to endorse? Without any medical or clinical indication, can a doctor perform surgery on a healthy, non-consenting individual? Much less be eliciting any kind of a "decision" from parents? If he can't then why does "what his parents think" even matter? And why should insurance pay for non-medical surgery?)

Q: Is the AAP taking this stance simply because it allows members to make money from the procedure?

A: This issue is about access to health care, not profits. (I'm sure it's not about the money. It's not about self-serving agenda to legitimize a religious ritual for some of the AAP "taskforce" members either, what with the Cologne ruling and all...) The AAP recommends that insurance plans cover circumcision. Otherwise, some families who would choose circumcision would not be able to afford it. (Without medical or clinical indication, can doctors be performing surgery in healthy, non-consenting individuals, much less be giving parents any kind of a "choice?" Much less expect to be reimbursed by the public's coffers?)

The costs of a circumcision are paid by private insurance and Medicaid, with a small percentage funded by individuals. Rough estimates for the procedure average $165 out of pocket (within a range of $100 to $250.) However, these costs do not take into account hospital fees, supplies, and anesthesia. In the end, total costs can be upward of $1,750. (Multiply that by about 1.3 million a year. No, it's not about the money at all. Truly, it's just about healthcare and "access" to a non-medical surgical procedure you can't even bring yourselves to recommend.) It’s important to consider that choosing a circumcision later in life costs more and the procedure and anesthesia carries a greater health risk. (It is also important to remember that most surgery is the same way. It is important to remember that 80% of the world's men have intact organs, the overwhelming majority of males circumcised in the world are so because they were forcibly circumcised as infants for religious or cultural reasons; very few men in the world ever need circumcision, or ever choose it out of their own volition.)

Q. Who performs most circumcisions?

A: It depends on what part of the country one is in. It can be and it often is performed by obstetricians, pediatricians or family practitioners but could be done by nurse practitioners or nurse midwives. (A more straight and direct answer; the majority of circumcisions are performed by OB/GYNs who are members of ACOG, the trade union that gave the AAP their blessing. The rest are done by pediatricians, members of the AAP. Only a very tiny minority of circumcisions are performed by religious practitioners.)

I'm at a loss for words.

The AAP is morally and ethically bankrupt in more ways than one, not to mention outright self-serving and dishonest. The AAP couldn't be any less interested in the health and well-being of children.

Sunday, August 26, 2012

AAP: Call Them Out

The impending release of the new AAP position statement has been leaked, and it is already causing outrage among those who understand the issues.

Although the new position statement is basically the same as the last one, ignoring the ethical issue, overblowing the so-called "benefits," minimizing the risks and harms of circumcision and never actually coming to a reasonable conclusion, this one relies myopically on select "studies," namely the so-called "research" in Africa, and leans the furthest toward an actual recommendation, never actually making one.

Basically, pro-circumcision bias dominates the AAP, and the so-called "circumcision task force" has decided to release a self-serving position that tries to, but stops short of, making infant circumcision a medical indication. As in their last statement, they conclude, quite correctly, that even the latest "evidence" is not enough to recommend infant circumcision. However, they continue to say that parents, most of whom have never been to medical school, should weigh the same evidence and come up with their own conclusion.

Worse than this, the statement goes on to talk about how best to brainwash parents about the "benefits of circumcision" so that they can make the "right decision." Using select "research" as a pretext, certain racial groups are targeted and profiled as being disease prone (essentially non-circumcising groups, surprise, surprise), and focus a great deal on how they can increase circumcision rates in these ethnic groups. In other words, the AAP, with the endorsement of other medical trade unions with circumcising members are openly discussing the market and how the market share should be divided.

Essentially, stating that "the evidence is not enough to recommend circumcision" is pure lip service, followed by an entire sales pitch which has been backed by other medical trade unions with circumcising physicians with money to lose.

This seems to be the only instance in medicine where doctors, with their years of training and important-sounding credentials, are suddenly too stupid to know whether or not a surgical procedure is warranted in a healthy, non-consenting child. This seems to be the only instance in medicine where ethicists, who are supposed to be experts in their field, are suddenly dumbfounded.

The new AAP statement is complete hogwash, and the so-called "circumcision taskforce" has chosen in favor of protecting AAP members' financial interests and reputation; they self-servingly focus on just the "research" that favors their view, while ignoring evidence that is devastating practitioners of male infant circumcision. The AAP circumcision "task force" members are corrupt and couldn't care less about the health and well-being of children.

Furthermore, the AAP embarrasses itself by publishing conclusions that are inconsistent with the rest of Western medicine. In doing so, they not only embarrass themselves, but also American medicine as a whole.

Although the AAP does not recommend circumcision, and it is still true that no national medical association in the world does, their new position makes the claim that "the benefits outweigh the harms," based on flawed research, and it tries to justify physicians who profit from performing non-medical surgical procedures on healthy, non-consenting individuals.

Furthermore, based on this self-serving claim, they go on to say that public coffers should reimburse their members, and circumcising members of other, non-related physician trade organizations, such as ACOG, where doctors whose profession is the care of women, are operating on male children.

The new AAP statement was written not with the interest of child health and well-being, but with the interests of its circumcising members, and circumcising physicians in other medical fields. Basically, circumcising doctors in other medical fields, as well as circumcision advocates, have conspired with the AAP to write a document that grants physicians that circumcise healthy, non-consenting children, immunity, the health, well-being and basic human rights of children be damned.

TAKE ACTION: Call the AAP out!!!
There are currently efforts to call the AAP out on their new statement. A petition can be signed here, and Facebook users can learn about a letter-writing campaign here. See if there is a protest being organized in your area.


Rebuttal to the new statement
I don't have time to go through the entire AAP 2012 statement, and I feel it's mostly bullshit I cover on my blog anyway. (IE, the whole HIV/circumcision farce, cancer etc.) It's all basically the same old worn "benefits" circumcision advocates try to re-hash. Others, however, have taken the liberty to taker a shot at the AAP statement in its entirety. A good critique of the new AAP statement can be seen here.

PS - New "Connect" Page
I find that I have increasingly less time to cover the issue of circumcision. I do have a job and a life, and recently those have taken up most of my time. Luckily, though, the intactivist movement has grown exponentially since I've been an intactivist, and, perhaps more than ever, this issue is being given a lot more attention. The subject is no longer the taboo "non-issue" circumcision advocates wish it would continue to be.

I will of course keep tackling this issue as much as I can, but I will not always be able to. For this reason I have taken the liberty of compiling a list of resources, such as circumcision news sources, my favorite blogs, organizations etc., and putting them on a page on my blog. You will notice a bar of links; to access my links page, click on "Connect." I will be updating this page as I find more stuff, so check back regularly.

Thursday, August 23, 2012

AAP: Around the Bush and Closer to Nowhere

The eminent AAP position statement on circumcision had been much hyped by the media and circumcision enthusiasts. The new statement has been leaked, and I've read it, but it leaves a lot to be desired. More than a clear and direct statement, the statement creates more confusion than clarity.

Actually, there is one thing clear; the new statement was carefully drafted by rabid circumcision advocates wanting to keep waters muddy.

Actually, there have been two PDFs that have are bouncing about on the internet; an abridged summary, and a much longer version which often reads like a broken record, repeating the same thing over and over like a mantra. Additionally, the longer version leaves a few key points out that appear in the summary. They're essentially the same, though, continuing to ignore the crux of the argument, going on and on about questions nobody asked, and appealing to endorsement from non-related medical organizations.

I repeat again; what I criticize here is an abridged summary; this isn't the detailed statement released in its entirety. There is so much bullshit I already tackle on my blog.

From the released summary:

The Abstract
"Male circumcision is a common procedure, generally performed during the newborn period in the United States. In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academy’s 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement."

We must know what "recent/current evidence" means. Did they evaluate all of it, or just the evidence that attempts to justify this pathetic update? Notice we hear alleged "benefits," but so far, we don't hear about a single risk. And notice the part in red; this will be important later. (The "benefits," are discussed in the more detailed statement. Readers will be able to see for themselves exactly what data they used; the same old crap.)

It must be asked, what in the world does the American College of Obstetricians and Gynecologists (ACOG) matter in any of this? The American Academy of Pediatrics (AAP) is concerned, at least ostensibly, with the health and well-being of children. ACOG is concerned with the health and well-being of WOMEN. Why does it matter that ACOG approves of this statement or not, when the circumcision of infant MALES should not even be in their purview?

The answer: It is because the majority of circumcisions in the US are carried by OB/GYNs, and a negative statement by the AAP would affect their business, that's why.

A little hint; ACOG isn't the only organization that has blessed this statement; other organizations are mentioned in the more detailed statement, and understandably so, as there would be physicians in other trade unions who perform circumcisions, but ACOG is key, because OB/GYNs are the ones who have a bigger slice of the pie.

Let's move on.

The Policy Statement
"Systematic evaluation of English-language peer-reviewed literature from 1995 through 2010 indicates that preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure."

What is the literature that was evaluated? Was it a comprehensive analysis? Or was it cherry-picked data? Was the data obtained from experiments and research conducted in adult males, or children? What is the reason that no other medical organization in the world has come to this conclusion using this same "data?"

Readers will be able to read what "research" was used in the creation of this document once it is released in its entirety.

"Benefits include significant reductions in the risk of urinary tract infection in the first year of life and, subsequently, in the risk of heterosexual acquisition of HIV and the transmission of other sexually transmitted infections."

What data was used to come to this conclusion? Were other methods of prevention considered? And, again, why have other medical organizations in the world come to this conclusion?

I have read the entire thing, and I can already tell readers, it focuses myopically on how to necessitate circumcision. Not a word on alternatives. Worse than that, it fearmongers by insisting over and over again that parents should be encouraged to circumcise in infancy "because it is when they can benefit more from it." (Nevermind countries that do well without it.) They also skim over the fact that older men would be less than likely to buy this crap and refuse to undergo circumcision in adulthood, but instead of respecting older men's decisions, trampling over their basic human rights to choice over their own bodies seems to be a REASON to recommend circumcision in children, and it is ignored as the very crux of the ethical debate. Basically, a blatant endorsement of abuse, where I define it as taking advantage of those smaller, and weaker and unable to fend for themselves.

"The procedure is well tolerated when performed by trained professionals under sterile conditions with appropriate pain management."

This isn't news; most surgery is "well tolerated when performed by trained professionals under sterile conditions with appropriate pain management." The question is, is it necessary in healthy newborns? What are the risks, and it is it conscionable to cause a healthy, non-consenting child to undergo them? Are the "benefits" not obtainable using less invasive modes of prevention? What are they? Or is circumcision supposed to be the only option?

The full article rambles on about "the best way to perform the surgery."  Basically, it hopes readers will look past the important question of medical or clinical need of surgery in a healthy, non-consenting infant, and the validity of the so-called "benefits."

"Complications are infrequent; most are minor, and severe complications are rare. Male circumcision performed during the newborn period has considerably lower complication rates than when performed later in life."

What complications exist, "minor" and "severe?" In children and adult males?

Not mentioned here; MRSA infection, infection with herpes, the development of gangrene, a botched procedure resulting in unpleasant cosmetic results, partial or complete ablation of the glans, hemorrhaging, and even death.

These are actually mentioned in the more detailed article, albeit heavily minimized and not given their deserved attention. They choose only to look at, of course, only the evidence that suits them.

They actually go into other important issues like sensitivity and sexuality, but, again, only quoting the "evidence" they choose, predictably, the so-called "trials" in Africa. They even admit that the data is rather shoddy and poorly obtained but consider this the best they've got. Not included in here was the Sorrells sensitivity study. Nor the Danish study. Nor other studies that show adverse effects. (And they wouldn't because it would jeopardize the position of members who profit from circumcision; who wants to cause adverse effects to their children as grown adults?)

"Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns."

Note here, and this is important, we see nothing more than a repetition of the doublethink in their last position statement, which they were hesitant to update.

Here is where the AAP shirks its professional responsibility, and pawns it off on naive parents, most of whom are not versed in, nor interested in, medical literature. (The red part is what ACOG likes, because it absolves OB/GYNs from profiting from procedures which aren't even in their purview.)

Note here the self-contradiction in this statement. What was said earlier in the abstract? Here it is again:

"...the health benefits of newborn male circumcision outweigh the risks..."

But then, here is:

"... not great enough to recommend routine circumcision for all male newborns..."

And again:

"...sufficient to justify access to this procedure for families choosing it..."

If the so-called "benefits" weren't enough for what has been up until now, a well-respected health organization, to recommend circumcision, why would naive parents be expected to weigh the same exact evidence and reach a favorable conclusion?
In short, the weasel words are "yes, no, but maybe."

The statement concludes:
"It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner."

And we can trust a clinician who sees a price tag at the end of every foreskin to do just that, right?

"Parents ultimately should decide whether circumcision is in the best interests of their male child."

Medical necessity and the ethics of cutting off part of the genitals of a healthy, non-consenting child be damned...

"They will need to weigh medical information in the context of their own religious, ethical, and
cultural beliefs and practices." (As opposed to medical need?)

Once again, the self-same "medical information" that this piss-poor excuse for a health organization could not use to clearly come out and endorse this practice. And once again, the onus of responsibility is pawned off on parents and whatever crazy beliefs they might have. This is the one instance in medicine where "religious, cultural beliefs and practices" trump medical or clinical need. I intentionally leave out the word "ethical" from the quotes because the ethics of performing amputative surgery on a healthy, non-consenting child is being completely thrown out the window.

"The medical benefits alone may not outweigh these other considerations for individual families."

But they already said they weren't "great enough to recommend routine circumcision for all male newborns." Why should should it even be a "consideration" for families in the first place?

Maybe I'm blind?
As Michael Brady was quoted saying, the AAP statement does indeed say  "...the health benefits of newborn male circumcision outweigh the risks." This is actually a key element in this "statement." It is repeated numerous times like the hook in a really crappy pop-song. You know the kind, those silly pop-songs where it's the same song over and over again with only slightly changed lyrics and they expect you to believe it's a new release.

But this part, the important part, is only found in the summary:

"... not great enough to recommend routine circumcision for all male newborns..."

I couldn't find this anywhere in the large article. Did they forget to put it in? Maybe they hoped no one noticed?

I guess "...the health benefits of newborn male circumcision outweigh the risks..." and "...sufficient to justify access to this procedure for families choosing it..." were the more important take-home messages for charlatans who profit from this procedure, and the naive parents they give themselves permission to take advantage of.

But again, perhaps maybe I read this new piece of fiction in a hurry and I may have missed it.

I want to pray that this isn't so, and that sometime in the near future someone will correct me on it.

Medicaid, PAY for it...
Another key point in this new statement, which is only very lightly touched upon in this summary, but well expanded in the full version, is the encouragement of public funding for the procedure. Spoken like the money-driven charlatans they are. In the summary, it is found in the clause that reads "[T]he benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns."

Translated, this statement reads that (again, keeping in mind they said earlier that  the "benefits" were "not great enough to recommend routine circumcision for all male newborns...") that, while they can't come out and endorse the practice (which actually, this is what they are trying to get away with doing), funding should still be provided for it. (Because otherwise families couldn't pay for them, and the charlatans lose out.) It's what this "access" is referring to, and the detailed article goes into much further detail than it does here.

There is now no doubt in my mind the release of this statement was carefully orchestrated with the circumcision liberation brigade at Johns Hopkins and others who have been raving at state medicaid programs that have dropped coverage. The AAP has been hijacked by the likes of Tobian, Leibowitz, Gray and Wawer who, if they don't have cultural or religious convictions to defend circumcision, at the very least are trying to make themselves necessary by insisting medical organizations use the data and only their data to shape public health policy. Remember; if their work is worthless, then so are the millions in grants and funding they receive.

What is it about these "researchers" and their obsession with male genital mutilation? What drives their knives?

Is it cognitive dissonance? Sour grapes? Is it a hidden agenda to preserve what is a cherished and heavily defended religious blood ritual? (No conflicts of interest are declared, but look to their religious affiliations. Keep in mind the recent ruling in Cologne, Germany.) Is it the drive to keep their meal ticket from grants and the prestige of Johns Hopkins? Or is it all of the above?

To close:
I'm not sure what would be worse; if the AAP actually came straight out and said all US males should be forcibly circumcised, or wishy-washy weasel words like these aimed to preserve confusion and continue to allow charlatans taking advantage of parental naivete off the hook.

In short, the statement is just what I predicted it would be, parading around all the "benefits," minimizing or ignoring the risks, and again (at least in their summarized version of the statement), never coming to a direct conclusion. Regardless of the conclusion they fail to arrive, it is more important that circumcision is publicly funded, and the medical value judgement be made by naive parents, not doctors who supposedly went to school for 10 years.

All I can say is, this is nothing but a one-sided statement carefully concocted by people who couldn't be  less interested in the health and well-being of children. This is a piece of work that has had 6 years in the making, beginning with the so-called "trials" in Africa. This was the goal of those who wrote the work. This is the culmination. The ultimate goal was to vindicate what has been a historically problematic religious procedure for Jews and Muslims. The ultimate goal was to emancipate the countless mutilators who hide behind the title of "physician" to profit from infant genital mutilation. The ultimate goal was to clothe a cherished belief, money-maker and violation of basic human rights in science.

But calling a dog's tail a leg doesn't make it one:
It is mistaken, idea that the right amount of “science” can be used to legitimize the deliberate violation of basic human rights.

There would never be enough "research" or "benefits," no matter how "compelling," that would ever convince us to endorse female genital cutting of any kind. Not even a "ritual nick." Not even if it were performed "the right way."

Genital mutilation, whether it be wrapped in culture, religion or “research” is still genital mutilation.

It will be interesting how all of this is going to play out.

How will other health organizations across the globe who have not reached the same conclusion as the AAP react? How is the AAP going to be viewed after basically going against the overwhelmingly negative trend of opinion on routine male circumcision in industrialized nations? Will it be business as usual, or will there be statements from other medical organizations calling the AAP and its accomplices on their bullshit?

You can read my last post on the upcoming AAP policy statement here.

 The views I express in this blog are my own individual opinion, and they do not necessarily reflect the views of all intactivists. I am but an individual with one opinion, and I do not pretend to speak for the intactivist movement as a whole, thank you.

Tuesday, August 21, 2012

AAP: New Statement Over-Hyped by US Media?

We've all seen it all before. Media outlets wave about the so-called "latest research" from Africa, and they keep insinuating that the AAP is "about to recommend" circumcision. The hype would actually not be based in fiction, as leaders from the AAP and CDC have been saying they're working on new position statements on circumcision.

Well, according to the Washington Post, it looks like the AAP is finally getting ready to release a new policy statement sometime by the end of this month, and some commentary by one Michael Brady has intactivists worried. According to Brady:
"While details are not yet available, the new position concludes that the health benefits of circumcision outweigh the risks, said Michael Brady, a pediatric expert at Nationwide Children’s Hospital in Columbus, Ohio, and a member of the AAP’s task force on circumcision." 
If Brady is right, the AAP will be the first medical organization in the world to actually make the claim that the "health benefits of circumcision outweigh the risks."

There is already a letter-writing campaign and a petition. (If you're on Facebook, you can see a page devoted to writing to the AAP here.) But before they jump to conclusions, intactivists need to remember that the AAP and CDC have been leading on that they're "about to release new position statements on circumcision" for a few years now. They keep saying their statements are about to come out "this spring," or "by the end of the year," or "at the beginning of next year," and yet their "new statements" don't seem forthcoming. That is, until now...

The number of times the eminent AAP position statement has been postponed raises the question; what's been taking them so long?

In this post, I will explain why intactivists need not get too worried.

Media Hype: The "Great Circumcision Controversy" Trope
Could it be that there are unseen figures spurring media outlets on to release pro-circumcision articles and reports? (What with the Cologne ruling and all?) Or is it that media outlets are suffering slumps in their ratings, and they periodically release hyped up stories on "the benefits of circumcision" because they know it generates controversy? Or is it a combination of the two?

American audiences may not be aware at first glance, but media outlets are perpetrators of what I call the "Great Circumcision Controversy" trope. That is to say, that they are taking advantage of viewer gullibility, not to mention the fact that circumcision, particularly the circumcision of healthy, non-consenting infants, is a custom that is already deeply entrenched in American culture, to create "controversy" where there is actually none.

How it works; in order to encourage the belief that male circumcision is a surgery that is carried out for medical reasons, media outlets present male circumcision as a controversial and ongoing debate between altruistic "expert" medical authorities, who are attempting to vouch for male infant circumcision as "disease prevention," and the resistance of extremist "special interest" groups. However, this portrayal of reality is not at all consistent with the view of male infant circumcision given in the position statements of world medical authorities.

While the media presents male circumcision as an "ongoing debate" going on between medical "experts" and angry activists, the trend of opinion on routine male circumcision is overwhelmingly negative in industrialized nations. No respected medical board in the world recommends circumcision for infants, not even in the name of HIV prevention. They must all point to the risks, and they must all state that there is no convincing evidence that the benefits outweigh these risks. To do otherwise would be to take an unfounded position against the best medical authorities of the West.

How Do Medical Boards In and Outside the US View Infant Circumcision?
According to the American Medical Association (AMA) Report 10 of the Council on Scientific Affairs:

"The British Medical Association has a longstanding recommendation that circumcision should be performed only for medical reasons... Recent policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns".

In their last position statement on infant circumcision, the American Academy of Pediatrics (AAP) stated that:

"...benefits are not sufficient for the American Academy of Pediatrics to recommend that all infant boys be circumcised."

In their "Position Paper on Neonatal Circumcision, the American Association of Family Physicians (AAFP) 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".

According to the College of Physicians and Surgeons of British Columbia:

"Current understanding of the benefits, risks and potential harm of this procedure no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention."

The Canadian Paediatric Society says:

"[We] do not support recommending circumcision as a routine procedure for newborns."

The British Medical Association says:

"The BMA considers that the evidence concerning health benefits from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it."

The Royal Australasian College of Physicians stated in 2010 that:

 "[The foreskin] exists to protect the glans [and that it is a] primary sensory part of the penis, containing some of the most sensitive areas of the penis."

In the Netherlands, the Royal Dutch Medical Association (KNMG) issued a statement in 2010 stating that "The official viewpoint of KNMG and other related medical/scientific organizations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity." Circumcision can cause complications, including infection and bleeding, and are asking doctors to insistently inform parents that the procedure lacks medical benefits and has a danger of complications. In addition to there not being any convincing evidence that circumcision is necessary or useful for hygiene or prevention, circumcision is not justifiable and is reasonable to put off until an age where any risk is relevant, and the boy can decide himself about possible intervention, or opt for available alternatives. They went on to say "There are good reasons for a legal prohibition of non-therapeutic circumcision of male minors, as exists for female genital mutilation."

The WHO and CDC
There are some circumcision advocates who boast that the WHO and CDC have endorsed circumcision to prevent HIV, however they will not mention the fact that these organizations have been careful to specify that they endorse adult circumcision as a way to prevent HIV in high risk locations in AFRICA. The WHO has NOT endorsed infant circumcision to prevent HIV anywhere else, and the CDC, like the rest of its counterparts in the rest of the world, says that there is insufficient evidence to endorse infant circumcision, and refrains from "recommending" it in the United States of America, "leaving it up to parents."

6 Years, and Still No Change
It has been 6 years since the WHO used some very dubious "research" to endorse male circumcision to prevent sexually transmitted HIV in Africa, and yet, with the exception of the CDC who has endorsed it on adult males in Africa, no other medical organization in the world has followed suit. Even the CDC falls short of endorsing infant circumcision in the name of HIV transmission. If the best medical authorities in the West have not endorsed infant circumcision, it is because they have reviewed all of the evidence and have found it to be insufficient.

So Why Doesn't the AAP Simply Just Come Out Against Infant Circumcision?
People have a misconception of what the AAP actually is. Most think it is this altruistic organization whose prime interest is the health and wellbeing of children. The fact of the matter is that they are nothing more than a trade union whose prime purpose is the protection of the interest of its members.

Therefore, the AAP has a delicate balancing act to preform. On the one hand, they cannot put members who profit from the procedure in a tight spot. On the other, they cannot actually jeopardize their credibility by releasing a statement that will defy the whole of modern medicine. And, as a professional medical organization that is, at least ostensibly, concerned with the well-being of children, they're expected to take a position, keeping it up to date.

The true purpose of the so-called "circumcision taskforce" is therefore not to actually "weigh the evidence," but to appear to mull the so-called "evidence" and figure out how they can keep the AAP from ever coming out against circumcision, weaseling out of addressing the ethical concerns of cutting off normal, healthy tissue from healthy, non-consenting infants, while still appearing to be professionally, ethically responsible. Basically keep their circumcising members blameless and in business, while feigning an interest in the well-being of children.

The AAP endorses FGM, backpedals shortly afterward...
This is not the first time the AAP is under fire for a questionable position statement on genital cutting; in 2010, the AAP advocated for allowing female genital mutilation in the form of a “ritual nick”, under the pretext that endorsing said "ritual nick" might dissuade parents of immigrant daughters from taking them abroad to undergo a more severe form of genital mutilation. The AAP admitted that the so-called "ritual nick" would dwarve in comparison to male infant circumcision. Not surprisingly, this position was met with a world outcry, and the AAP had to promptly withdraw their statement.

In the end...
Oh there's no doubt about it. The new AAP position statement is going to milk every so-called "benefit" for what it's worth. It's going to dance around the HIV "research" in Africa numerous times. They're going to huff and puff and blow as hard as they can. In the end, however, like pretty much the rest of the medical authorities in the West, they're going to have to conclude that there still isn't enough evidence to endorse the circumcision of healthy minors, and fall short of the much hoped-for "recommendation"circumcision advocates keep pining for, and still insist "parents must weigh the pros and cons," continuing to rid themselves of any professional responsibility. After much ado, their stance will remain comfortably "neutral," never actually having "recommended it."

I say again; unless the AAP seriously plans to jeopardize their credibility by defying the whole of modern medicine, they're going to continue sitting on the fence, as Hugh Young put it, shifting their bottoms on it every once in a while.

A passage in the Washington Post article already reads:

"The AAP’s new position falls short of a routine recommendation, Brady said, adding that parents should continue to take into account their own cultural, religious or social views."

In other words, the new statement will be nothing but more of the same.

But this little detail, as usual, will be unimportant for circumcision advocates and American media to report...

Intactivists should learn not to panic every time some news outlet releases some new blurb some pro-circ quack manages to publish. This is nothing more than a saber-rattling tactic, and seeing intactivists panic is precisely what the pro-circs want; it gives credibility to their accusations that we're just a bunch of loons.

The views I express in this blog are my own individual opinion, and they do not necessarily reflect the views of all intactivists. I am but an individual with one opinion, and I do not pretend to speak for the intactivist movement as a whole, thank you. ~Joseph4GI