Thursday, September 22, 2011

Intactivists Give Abigail R. Esman a Run for Her Money

In response to recent efforts by the the Royal Dutch Medical Association (KNMG) to discourage the non-theraputic circumcision of boys, Abigail R. Esman uses her blog at Forbes to go on a libelous diatribe against the organization, spouting lies and false claims.

When one reads her headline, which reads "Circumcision Makes You Crazy. So Holland Moves To Stop It.", one gets the misleading impression that the KNMG actually is actually claiming that circumcision drives men insane, and that they want to move to stop circumcision on these grounds.

At least, that's what I thought until I decided to read through her post.

The amount of outright lies and blatant misinformation was astounding. I wonder if Forbes is aware that one of their contributors is embarrassing them with horrible writing.

And, as if this weren't enough, she starts deleting voices of dissent in her comments section, ultimately just closing the comments section down. I've decided I'm going to pick apart her silly post on my blog, piece by piece.

She begins:

"Calling the practice "a violation of human rights" and a precursor to mental illness, Holland’s Royal Society of Medicine is encouraging the country’s parliament to place a ban on male circumcision."

The KNMG does indeed call the practice of non-therapeutic circumcision of healthy, non-consenting minors a violation of human rights. But where on earth do they say that circumcision will in fact lead to mental illness? Is she not even going to provide a link so that we can read what in fact the KNMG says? Or are we simply expected to take her word for it?

The KNMG's 2010 position statement on male circumcision can be accessed here.

There is absolutely nothing in there that says that circumcision "makes you crazy."

The next few sentences are interesting:

"Of course, such proposals come up regularly – there’s one out now in San Francisco, for instance – but they are usually the work of political groups; after all, the idea of banning circumcision is itself politically based."

Regularly? Where? I happen to be a Californian, and to my knowledge, in all my years as an intactivist, this is the first and only proposal in this state that I've ever heard of, quite possibly the last in a very long time.

And the idea of banning circumcision is itself politically based? One would wonder how she actually came to such a conclusion. And I wonder if she thinks this, the idea that banning circumcision is "politically based", applies to ALL circumcision, or just male circumcision.

It gets more interesting:

"That [a proposal to ban the male circumcision of minors] comes from a medical association, however, suggests something significantly more sinister, if for no other reason than the fact that the arguments they offer to support the measure fly in the face of actual science."

This she claims without giving a single example. Again, we're expected to take her word at face value.

And speaking of lies and political ends, let's talk about what Abigail R. Esman is trying to insinuate. She seems to be implying, with no proof whatsoever, that failing to circumcise males on a great scale increases the risk to public health, and that it is a direct cause of health issues. She also seems to be implying that there is already prevalence of circumcision in the Netherlands that would be threatened by the KMNG's proposal, thereby putting Dutch public health at risk of all the health issues that the foreskin causes. She is either ignorant or she hopes her readers aren't smart enough to know better.

The Netherlands is a country where circumcision is in fact rare and limited to Jews, Muslims, and to procedures that are medically necessary. STD transmissions are in fact lower in the Netherlands, where circumcision is rare, than in America, where the majority of men are circumcised at birth.

To be sure, America has the highest rates of HIV transmission in the industrialized world. 80% of American males are circumcised from birth, while in most countries in Europe, circumcision is uncommon. Despite this, our country does poorly when it comes to the transmission of STDs.

In fact, AIDS rates in some US Cities rival hot-spots in Africa. In some parts of the U.S., they're actually higher than those in sub-Saharan Africa. According to a 2010 study published in the New England Journal of Medicine, rates of HIV among adults in Washington, D.C. exceed 1 in 30; rates higher than those reported in Ethiopia, Nigeria or Rwanda. The Washington D.C. district report on HIV and AIDS reported an increase of 22% from 2006 in 2009. According to Shannon L. Hader, HIV/AIDS Administration, Washington D.C., March 15, 2009, "[Washington D.C.'s] rates are higher than West Africa... they're on par with Uganda and some parts of Kenya." (Hader once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe.)

Esman continues:

"And it’s not just the doctors. Indeed, the move, coming on the heels of a so-called “modified ban” on kosher and halal slaughter, demonstrates just how far Europe has come in its response to what it sees as a threat on Western democratic values posed by its growing Muslim population; increasingly, as I argued after the Norway massacre, Europe is at serious risk of transforming itself into a white, Christian supremacist state in its efforts to avoid becoming an Islamic one."

It's very interesting how just after accusing doctors of having some sort of racist political agenda, Esman proceeds to talk about the systematic oppression of Jews and Muslims by "White Supremacist Europe," as if the people responsible for all of the other issues she brings up were "one and the same." Have Europeans all unanimously embraced Christianity now? And incidentally, how is bringing up other issues proof that doctors at the KMNG are all politically and racially motivated? Has it not occurred to her that the KMNG may actually be motivated by human rights? What does she think of governments cracking down on female circumcision? Does she stick up for Islamic practices then? Or is that "different?"

Moving on...

"According to the Dutch medical society, for instance, circumcision — practiced by Dutch Muslims and Jews and standard procedure for almost all newborn males in the USA..."

According to recent CDC reports, the rate of infant circumcision in America has dropped to approximately 55%.

I know she lives in the Netherlands... should I give her the benefit of the doubt?

"...can result in castration (just how many times does that happen, I wonder?) or death; cause infections; create “mental anguish”; cause sexual problems (we all know about Einstein’s sexual issues, right?), and more."

Well it can.

How many times can castration happen? How many times would it be acceptable? Especially given the fact that circumcision is medically unnecessary in healthy minors? If Esman would have bothered to check, she would have found the David Reimer case. There have been other documented incidences of castration, particularly in Jewish and Islamic circumcision rituals. She would have found that there have been quite a number of lawsuits in the in the States because, mohels specifically, have severed the heads of the penises of a few infant boys. She would have found that a New York rabbi gave herpes to three babies, one of whom died, by sucking on their wounded penises, an ancient practice performed by ultra-orthodox rabbis called "metzitzah b’peh."  She would have found other documented cases of death. She would have found that MRSA infection is actually a big problem at hospitals. She will have found that, according to studies in Israel, ritual circumcision is a risk factor in UTI. She will have found that circumcision botches are so common that there are actually doctors who specialize in repairing them. And she will have found that there are studies that show that circumcision can cause sexual problems.

Obviously she really couldn't care less.

"And here’s the kicker: “no medical association anywhere in the world,” they claim, endorses male circumcision for health reasons."

And the KMNG is accurate. In particular, no medical association in the world endorses *infant* male circumcision for health reasons.

As if to try and sound matter-of-fact, she continues:

"This, of course, is an outright falsehood, and surely they know it. In fact, the California Medical Association, faced with a similar proposal, recently wrote the following statement to the Senate Judiciary Committee: “”From political to religious, there are many differing views on the practice of male circumcision. However, in the medical world, the CMA has long endorsed the concept of newborn circumcision as an effective public health measure.”"

This paragraph speaks to Esman's ignorance on the matter. As I explained in a reply that she has deleted, it is clear she merely copied and pasted this quote straight out of, which was issued by one Ruth Haskins. If Esman would have tried to verify this quote, she would have found out that Ruth Haskins either suffers from Amnesia or was outright lying. There was a resolution to endorse circumcision back in 1989, but it lapsed years ago.

Esman continues by quoting the AAP, and even here, she must admit that their policy does not endorse routine neonatal circumcision, just as the KMNG has said. In fact, in their latest position statement, they declare, much to her chagrin, that "[the] ...benefits are not sufficient for the American Academy of Pediatrics to recommend that all infant boys be circumcised."

I told her in my reply, I've said it before, and I will keep saying it, 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.

For some unexplained reason, she feels it is necessary to insert the next paragraph:

"Meantime, Holland’s wise doctors have yet to issue any formal statement about the far more serious problem of the country’s enormous infant mortality rate (among the worst in Western Europe) and high breast cancer fatality rate (the fourth highest in Europe, and rising)."

Notice how instead of writing about these other issues, which apparently are worse problems that are being neglected, she writes an entire blog post about her disdain for the KNMG's positon regarding the non-theraputic circumcision of healthy minors.

She says:

"To be sure, the KNMG... has not called for an outright ban on the procedure; they are far too politically clever for that."

I'd like to point out how in her opening sentence, Esman was alleging:

"Calling the practice “a violation of human rights “ and a precursor to mental illness, Holland’s Royal Society of Medicine is encouraging the country’s parliament to place a ban on male circumcision."

The KMNG is either calling for a ban, or they are not. So which is it?

"Claiming that such a ban would only put the practice into the hands of the unskilled, they have rather recommended a “change in mentality” among those groups which practice circumcision in the Netherlands – namely Jews and Muslims, those same minority groups which happen also to be affected by the ban on ritual slaughter."

My, yes! What a coincidence isn't it!

"Because what this is really about is not health at all, but culture."

This is quite possibly the most intelligent sentence in Esman's entire blog post. I hadn't realized it before, but Esman actually admits what her real problem with the KMNG is all about.

Esman would be disingenuous if she failed to declare to her public an important conflict of interest; she is Jewish, where the circumcision of infants is a religious requirement and central to her ethnic and cultural identity. She has reasons to defend circumcision that betray an interest in public health.

Some may say that I'm racist in pointing out that the circumcision of male infants is an important custom to Jews, but that's not any more racist in pointing out that whaling is a custom that is important to the Japanese, and that this conviction to culture betrays an interest in "science" and "research." It is not biggotted or racist to point out that female genital cutting is an important custom to Malaysians and Indonesians.

It is rather dishonest to be defending circumcision by feigning an interest in public health, when your true convictions lie elsewhere.

"As radical Muslim groups increasingly put pressure on Holland’s politicians to change policies in order to accommodate their religious preferences – from censoring art exhibitions to (speaking of medicine) requiring that female Muslims be treated only by female physicians (an effort that thankfully failed) — indigenous Dutch are responding with a stronger nationalism and a tightened grasp on their Christian roots – even to the point of mangling the truth."

Mangling the truth indeed.

It is interesting to see Esman pick and choose just what religious impositions the Dutch should and should not respond to. She seems to be thankful that the effort to require female Muslims to be treated only by female physicians has failed, but is dreading the KMNG actually wants to see to it that surgical procedures in minors are actually medically indicated.

For better or for worse, female genital cutting is also seen by many, especially some sects of Islam, to be a religious custom. I can only assume that European governments cracking down on this religious custom is something Esman is grateful for. Does Esman really care about public health? Does she really care about "culture?" Or merely just her own?

Invisible Addition
Here's something interesting:
If you try saving her blog post as a PDF using PDFMYURL, an additional paragraph appears as follows:

The following links present some of the latest studies and reports on the subject, all demonstrating the health benefits of male circumcision both in Third and First World countries. Note that the most recent reports have led to determinations by the CDC, WHO, UNAIDS and AAP to revise their positions on the issue, definitive supporting male circumcision at birth.

Abigail R. Esman gives the word "idiotic" a whole new different meaning.

The links she provides do indeed allege all the usual "health benefits of circumcision." Her claim that recent reports have led any of the organizations she mentions to endorse infant circumcision, however, is false.

The WHO/UNAIDS have definitely endorsed the use of circumcision in adult men in AFRICA, and the CDC is the American health organization that has embraced the latest studies the most, however there have been no such revisions "definitive supporting male circumcision at birth."

Once again; 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.

Abigail R. Esman is either willfully ignorant, or she is outright lying through her teeth.

Trouble in the Amen Corner
As if Esman's inflammatory post weren't enough, she continues to make a fool of herself in her comments section. It seems Esman simply had no idea what she was getting into. I don't think she was actually expecting to encounter people who actually knew what they were talking about. By the end, it was clear that she was losing and she couldn't handle all the replies that were clearly destroying everything she had to say. She resorted from deleting comments to eventually just shutting down the comments section.

She is gravely mistaken if she thinks she's just going to circumcise her comments and make herself appear to be the victim. I saved some of the most juiciest comments and am posting them here. 

The position of the KNMG seems to be motivated by a concern for human rights rather than an attack on Muslim or Jewish faiths. Personally, I think that everyone should be able to decide for themselves whether or not they have parts of their genitals cut off. It’s illegal even to make a pinprick on a girl’s genitals though some people regard that as their religious right or duty. Why don’t boys get the same protection? It’s *their* body.

The AAP doesn’t actually recommend male circumcision in their official position statement, and the CMA’s policy doesn’t seem to be publicly available, so the KNMG may have been unaware of it. The Canadian Paediatric Association has been recommending against circumcision for years btw.

“standard procedure for almost all newborn males in the USA”?

Hardly. The rate seems to be below 60% and dropping. The USA and Israel are the only two countries in the world where more than 50% of baby boys are circumcised btw.

Drops in male circumcision since 1950:
USA: from 90% to about 55%
Canada: from 48% to 17%
UK: from 35% to about 5% (about 1-2% among non-Muslims)
Australia: 90% to 12.4% (“routine” circumcision has recently been *banned* in public hospitals in all states)
New Zealand: 95% to below 3% (mostly Samoans and Tongans)
South America and Europe: never above 5% 

I agree that this article badly needs a correction. Saying that it’s standard procedure for almost all US males is an outright false statement.

Also, standing up for the right for an infant to keep all of their body parts, including from sensitive sexual areas when they can’t consent to the removal does not make someone a racist anymore than standing up against a hypothetical satanic ritual or tribal child sacrifice would also not be racist or anti-religious. It’s not the religion being attacked, it’s the damage to another human being. If your religion called for murdering another human for being impure, I’d be against that as well. It would have nothing to do with being against the religion in that case, either – only the act.

I was circumcised as an infant, and deeply regret that decision by my parents. It’s my body, and if there is no medically imminent need to have a part of it removed, that choice should be left up to me. 

Uhm, Forbes, it’s The Netherlands, not Holland – Holland is only a part of The NL – it’s like calling the USA ‘Texas’.

Second, “In other words, doctors in the Netherlands have clearly put themselves in a position of being willing to put public health at risk in order to achieve racist, political ends – and to lie in order to do so.”

Since RIC (routine infant circumcision, as practiced in the US) is non-existent in the NL anyway, they’re talking mainly about religious circumcisions here. The public health in the NL is hardly being put at risk by outlawing the approx. 10,000 religious circs that are done each year. You see, since RIC is non-existent in the NL, that means that boys have *always* been left intact. And guess what? WE (yes, we, I’m Dutch) are kicking YOUR (Forbes is American) butts with much lower HIV and other STD rates that are supposedly helped by RIC.

Also, since medicine in the NL is not for profit as it is in the US, they have no reason to lie. It seems to me drs who make a ton of money off of RIC have more reason to lie about ‘benefits’ of RIC, than drs who make what they make regardless of whether they do RICs or not, have a reason to lie about RIC being physically and mentally damaging.

And lastly – political motives? Uh, no. In the NL, drs have no influence on politics unless they’re a politician in their spare time. The NL does NOT work like the US. If you’re going to try to slam someone or something, you’d do better to have sufficient background information.

And rascism, really? You find something that’s proven physically and mentally damaging and you’re going to not try to outlaw it because muslims and jews want to practice it… THAT’s racist – not protecting babies and children because they’re jewish or muslim. Allowing them to be harmed because they’re a certain race or religion. *That’s* bad. 

Abigail R. Esman responds:
I will answer this one post only.
1. I live in the Netherlands. “Holland” and “The Netherlands” are used in that country interchangeably, which you yourself would know if you either lived in that country or spoke Dutch.

2. As a matter of fact, this effort was made by doctors in the Netherlands to encourage the Parliament to consider legislation. Just as the AMA has the ability to encourage the American government– via the Surgeon General’s office, the FDA, and other government bodies — to consider health issues, so, too, in the Netherlands.

3. I defy you to find me the studies that counter the significant body of published literature, some of which is cited in my piece, that specifically point to the substantial health advantages of circumcision in preventing fatal diseases both in men and women. These studies are cited by all of the organizations cited by Ms. Netherton, below. I am pleased to see that, despite herself, she does recognize their authority in advancing the benefits to the male and female population of circumcision.

4. This is not about maintaining a practice because Jews and Muslims want it. It is about not twisting the facts of science to suit a political agenda.

To the person below who refers to “urinary infections” – I simply wish to point out that cervical cancer, HIV, penile cancer, and human papilloma virus are not urinary tract infections. I presume that he knows this and is simply avoiding the fact, but perhaps not.

I will leave to the medical professionals the matter of pointing out the endless number of medical errors posted in various comments here. 

As for cervical cancer, HIV, penile cancer, and human papilloma virus, the Australian medical association and numerous others in Australia and New Zealand and others have answered that.

5.2 Sexually transmitted diseases (STDs)
The published evidence concerning the relationship between circumcision and STD is often conflicting(41). An Australian study from 1983(42) suggested herpes genitalis, candidiasis, gonorrhoea and syphilis were all more common in uncircumcised men. A more recent Australian study(43) , however, suggested that circumcision has no significant effect on the incidence of common STD’s. One study has suggested a higher risk of non-gonococcal urethritis among circumcised men than among uncircumcised men(44). Genital ulcer disease, on the other hand, has been reported as being more common among uncircumcised men, and those with a genital ulcer are more likely to contract HIV.

There is increasing evidence, particularly from sub-Saharan Africa, which suggests an increased risk of female to male transmission of HIV in uncircumcised men(45-48). However, how much circumcision could contribute to ameliorate the current epidemic of HIV is uncertain(49). Whatever the future direction of this debate it can not be seen as an argument in favour of universal neonatal circumcision in countries with a low prevalence of HIV.

5.3 Human papilloma virus and carcinoma of the cervix
A recent international study reported an increased risk of human papilloma virus (HPV) infection in uncircumcised men who indulged in high-risk behaviours, compared with circumcised men(50). Monogamous women whose male partners had six or more sexual partners and were circumcised had a lower risk of cervical cancer than women whose partners were uncircumcised. Public health measures aimed at early detection have been shown to decrease cervical cancer fatalities; targeting sexually promiscuous men to decrease risk taking and increase condom use may inhibit sexual transmission of HPV and prophylactic vaccination against HPV is being developed. At present there are no data to suggest advocating neonatal circumcision would be of additional benefit to these strategies(51).

5.4 Carcinoma of the penis
Carcinoma of the penis is a rare condition, with an annual incidence of approximately 1:100,000 men in developed countries, regardless of whether there is a high or a low circumcision rate(4,5). There is evidence that neonatal circumcision confers protection from carcinoma of the glans penis but not of the penis shaft(52-56). Even though the evidence suggests neonatal circumcision does reduce the risk of carcinoma 10-fold, universal circumcision is clearly not justified on these grounds(46).

Other risk factors for penile cancer include phimosis (which is limited to uncircumcised men), genital warts, increased number of sexual partners and cigarette smoking(57,58). It has been hypothesised that good penile hygiene may help prevent both phimosis and penile cancer(59). 

torell (Comment Deleted) 
Nou ja zeg. Ik zal die onzin morgen wel verder lezen, maar als jij werkelijk zoveel over Nederland weet, dan zou je voor punt 1 weten dat mensen die niet in Noord- of Zuid-Holland wonen absoluut anti ‘Holland’ zijn. Holland is alleen toegestaan voor ons als het om Oranje gaat. Jij zal inmiddels wel zo’n beetje weer wakker zijn, maar ivm het tijdsverschil verwacht je mijn antwoord maar jouw tijd morgenavond.

It’s incredibly unprofessional to suggest you don’t even believe I speak Dutch or have lived there, so I’m not even sure why I’m bothering with you.

It should be common sense not to chop off the most sensitive part of a boy’s penis.

Like I said in my Dutch reply, I’ll read your comments tomorrow, as it is now bedtime here. Thanks you so much for taking the time to read the comments and take time out of your busy day to make sure people know you are actuall smartest. (Although that remains to be seen). 

Hi Abigail,

Let me begin by stating I have never read any of your other work and am solely going by your statements above, as well as your intro and website on the right of this article. I assume you are an American living in the Netherlands. I was born and raised in the Netherlands, but have lived nearly half of my life in the United States. It seems we both have a vantage point that includes both cultures.

I find several issues with your piece, and would like to address them one by one. I am looking forward to your reply.

1. You state early on that “after all, the idea of banning circumcision is itself politically based.” That’s quite the statement, and I would like to know how you came to that conclusion. Do you believe that ALL banning of circumcision is politically motivated, or just male circumcision? How about the legal banning of female circumcision – do you believe that is politically motivated?

2. You state “…doctors in the Netherlands have clearly put themselves in a position of being willing to put public health at risk…” in reference to their proposal to ban circumcision. I would like to see some documented evidence – especially since you live in a country where historically virtually no indigenous male has been circumcised – showing that lack of circumcision on a great scale (such as in Holland) shows increased risk to public health, and more importantly, DIRECT causation of other health issues. Your piece lacks this very important information.

3. In your 3rd paragraph, you swiftly move to explain the push for a ban on circumcision (circ for short from now on) w/ Europe’s desperate desire to combat the growing ‘threat’ of Islam, and state that “Europe is at serious risk of transforming itself into a white, Christian supremacist state.” What you fail to recognize is that Europe, particularly Western Europe, and considering this article, especially Holland, is far from what could be considered a Christian state. You’d need quite the evidence and premises to suggest that a ban of circ is motivated by the “Christian whites” in Holland.

4. You state that the Dutch medical association is wrong in stating that no medical association in the world recommends routine circumcision.

Setting aside the AAP’s comments on circumcision preventing certain medical issues, the AAP does NOT recommend routine circumcision in infants (as you write as well, however you include it in your paragraph on medical organizations recommending it – misleading). In fact, on their website, which automatically redirects to another, is states: “Scientific studies show some medical benefits of circumcision. However, these benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised. Because circumcision is not essential to a child’s health, parents should choose what is best for their child by looking at the benefits and risks.”

The only medical organization you mention as recommending circ is then the CMA whose statement was recently published in order to pass a bill (AB-768) in the CA legislation preventing future proposals to ban circumcision from entering the ballot. Clearly politically motivated, which you seem to loathe (see 1.). Fact is, there is no medical organization in the world that routinely recommends male infant circumcision.

5. You state: “Meantime, Holland’s wise doctors have yet to issue any formal statement about the far more serious problem of the country’s enormous infant mortality rate (among the worst in Western Europe) and high breast cancer fatality rate (the fourth highest in Europe, and rising).” This is not only indicative of poor journalism, but of poor debating skills. Bringing up completely unrelated topics to insinuate that Holland’s doctors should focus on something else that’s more ‘attention deserving’ or that they are somehow not credible is logically incredibly fallacious.

As far as your comment above to which I am replying (I have not read the original post to which you are replying), you seem to focus on the supposed medical benefits of circumcision, and are asking for studies that debunk others, or conclude the opposite. (Again, please keep in mind that I have no read the other comments, so I apologize in advance for being repetitive).

A. HIV/STD’s: The claim that routine infant circumcision reduces the risk of HIV/STD’s has been debunked and countered in several ways:

A1. Infants do not have sex and do not catch HIV or STD’s from penile exposure to those diseases. IF there truly is reason to believe that circumcision lowers (we all know it does not prevent… only condoms or abstinence does) the infection risk, why not present this to a child that is older and can make a decision for himself as to what will happen to HIS body? There is no logical or ethical reason to remove a healthy body part on our infant males because in the future it might possibly allow them to catch an STD. The very suggestion of that seems preposterous.

A2. It should be noted that the country where the vast majority of sexually active males are circumcised (United States) has one of the highest STD/HIV infection rates of any industrialized country in the world, and surely more so than Holland. While correlation is not causation, it is clear that circumcising male neonates does not decrease HIV/STD prevalence when compared to countries where circ is not routinely performed.

A3. There have been quite a few studies that show there is no correlation between circumcision and lower prevalence of HIV. One of those was published by BBC/The Lancet on July 7, 2009. The article reported on a Ugandan HIV circumcision study ending early because it showed that circumcising men who already have HIV does not protect their female partners from the virus. The research, from the Lancet, has shown no benefit in men who already had the virus and was stopped early because of the continued risk to women.

An intensive study by the USAID also showed that circumcision does not lower the risk/prevalence of HIV. Published here:

I will post a separate posts containing several studies that show no correlation or in fact an increased risk (circ = increased risk of HIV contraction).

This Reuters article states that circumcision does not affect HIV status in US men:

The MOST interesting thing about any of these studies is that the participants were all sexually active adults. Infants are not sexually active.

A4. There are only three proven and undisputed ways of lowering HIV prevalence and contraction: Condom use, abstinence, and monogamous relationships for life.

B. Penile/Cervical cancer

B1. Penile cancer is incredibly rare. In fact, it occurs less often than male breast cancer does. Even the studies (which have also been debunked) that suggest it is more common in uncirced men show we’re dealing with a miniscule difference, we again would have to ask ourselves whether routinely removing a healthy body part from infant males (among whom penile cancer is non-existent) is worth the risks of circumcision side effect that even you mention and that occur far more often than penile cancer does.

B2. Suggesting we should routinely remove a healthy part (foreskin) from newborn males because it potentially decreases the already miniscule risk of them getting penile cancer later in life is a serious ethical issue. Nowhere in the medical world is healthy tissue removed from infants to prevent illness of such low prevalence. For the same reason we do not remove healthy breast tissue from newborn males (and, breast cancer in men is more common than penile cancer in men), we should not remove penile cancer from newborn males.

C. In your article, you suggest, basically summarize, than a push for a ban on infant male circumcision is rooted in antisemitism, and/or a push by ‘white supremacist Christians’ to regain control of their culture in the face of ‘intruding Islam.” It is disappointing to me, that as an award-winning journalist, is has (presumably) not occurred to you that the push for such might not have anything to do with religion or politics but simply with human rights.

“We” have lawfully banned circumcision (from the tiniest pinprick, to full removal of female genetalia) on females, whether that is done out of cultural reasons OR religious reasons (by the way, it’s eery how arguments pro male circumcision mimic those of pro female circumcision). We do not allow parents to scar their children’s faces with burning hot iron as is common cultural and religious practice among certain African tribes. We do not allow foot-binding as still practiced in certain parts of China, nor do we allow anything else that physically alters our children’s bodies for LIFE without a medical need.

We HAVE TO acknowledge that we prevent male infant boys from having the SAME genital rights by law as female infants do and ask ourselves if our reasons are truly strong enough and morally and ethically justifiable. 

As promised, the studies…

(PS: despite many typo’s that are easy to figure out, I feel the need to correct myself in B2. last sentence, should be “should not remove healthy penile tissue”)

The following studies either show no relationship with circumcision status or a higher risk in circumcised men.

No relationship to circumcision status (13 studies):

1. Hira SK, Kamanga J< Mcuacua R, et al. Genital ulcers and male circumcision as risk factors for acquiring HIV-1 in Zambia. J Infect Dis 1990;161:584-5.

2. Pépin J, Quigley M, Todd J, et al. Association between HIV-2 Infection and genital ulcer diseases among male sexually transmitted disease patients in The Gambia. AIDS 1992;6:489-93.

3. Bollinger RC, Brookmeyer RS, Mehendale SM,l et al. Risk factors and clinical presentation of acute primary HIV infection in India. JAMA 1997; 278:2085-9.

4. Chiasson M, Stoneburner RL, Hildebrandt DS, et al. Heterosexual transmission of HIV-1 associated with use of smokable freebase cocaine (crack). AIDS 1991;5:1121.

5. Carael M, Van De Perre, PH, Lepage PH, et al. Human immunodeficiency virus transmission among heterosexual couples in Africa. AIDS 1988;2:201-5.

6. Moss GB, Clemerson D, D'Costa L, et al. Association of cervical ectopy with heterosexual transmission of human immunodeficency virus: results of a study of couples in Nairobi, Kenya. J Infect Dis 1991;164:588-91.

7. Allen S, Lindan C, Serufilira A, et al. Human immunodeficiency virus infection in urban Rwanda: demographic and behavioral correlate in a representative sample of childbearing women. JAMA 1991; 266:1657-63.

8. Seidlin M, Vogler M, Lee E, et al. Heterosexual transmission of HIV in a cohort of couples in New York City. AIDS 1993;7:1247-54.

9. Konde-Lule JK. Bergley SF, Downing R. Knowledge attitudes and practices concerning AIDS in Ugandans. AIDS 1989;3:513-18.

10. Van de Perre P, Clumeck N, Steens M, et al. Seroepidemiological study on sexully transmitted diseases and hepatitis B in African promiscuous heterosexuals in relation to HTLV-III infection. Eur J Epidemiol 1987;3:14-8.

11. Quigley M, Munguti K, Grosskurth H, et al. Sexual behavior patterns and other risk factors for HIV infection in rural Tanzania: a case control study. AIDS 1997;11:237-48.

12. Hudson CP, Hennis AJM, Kataaha P, et al. Risk factors for the spead of AIDS in rural Africa, hepatitis B and syphilis in southwestern Uganda AIDS 1988; 2: 255-60.

13. Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA 1997;277:1052-7.

A higher risk in circumcised men (4 studies):

1. Barongo LR, Borgdorff W, Mosha FF, et al. The epidemiology of HIV-1 infection in rural areas, roadside settlements and rural villages in Mwanza Region, Tanzania. AIDS 1992;6:1521-8.

2. Grosskurth H, Mosha F, Todd J, et al. A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results. AIDS 1995;9:927-34

3. Chao A, Bulterys M, Musanganire F, et al.Risk factors associated with prevalent HIV-1 infection among pregnant women in Rwanda. National University of Rwanda-Johns Hopkins University AIDS Research Team. Int J Epidemiol 1994;23:371-380.

4. Urassa M, Todd J, Boerra JT, et al. Male circumcision and susceptibility to HIV infection among men in Tanzania. AIDS 1997;11:73-80. [study 1]

Int J Epidemiol. 2004 Mar 24 [Epub ahead of print]

Trends in antenatal human immunodeficiency virus prevalence in Western Kenya and Eastern Uganda: evidence of differences in health policies?

Moore DM, Hogg RS.

Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada.

OBJECTIVE: To observe recent trends in human immunodeficiency virus (HIV) prevalence in antenatal clinic attendees to determine if previously noted falls in HIV prevalence are occurring on both sides of the Kenyan-Ugandan border. Design An ecologic study was conducted at the district level comparing HIV prevalence rates over time using data available through reports published by the Kenyan and Ugandan Ministries of Health and UNAIDS.

METHODS: Sentinel sites were compared with respect to population, ethnicity, language group, and the prevalence of circumcision practice. The prevalence of HIV found at each sentinel site was recorded for the years 1990-2000 and analysed visually and by conducting bivariate correlations.

RESULTS: Ethnographic analysis revealed a wide mix of ethnic and language groups and circumcision rates on both sides of the border. All sentinel surveillance sites in Uganda showed trends towards decreasing HIV prevalence, with three of five sites showing statistically significant declines (r = -0.87, -0.85, -0.86, P < 0.05). In contrast, all of the surveillance sites in Kenya showed trends toward increasing HIV prevalence, with two of the five sites showing statistically significant increases (r = 0.62, 0.84, P < 0.05).

CONCLUSIONS: The declines in HIV prevalence occurring in Uganda are not being seen in geographically proximal districts of Kenya. No obvious differences in ethnic groupings or their associated prevalence of circumcision appeared to explain these differences. This suggests that decreasing HIV prevalence in Uganda is not due to the natural course of the epidemic but reflects real success in terms of HIV control policies.

PMID: 15044420 [PubMed - as supplied by publisher] 

Joseph4GI (Myself; this comment was deleted.) 
You will reply as many times as you see fit to counter your dissenters. (And I was right) 

Realize that you are writing in English. Most English speakers do not live in the Netherlands or speak Dutch. If your writing is aimed towards residents of Holland who speak Dutch, then write in Dutch.

You can cite all of the “studies” you want. The fact remains that every single medical organization you name has stated that there is not enough evidence to endorse infant circumcision. They must all point to the risks, and they must all say that there is not enough “benefit” to warrant them.

I defy the author to deny the fact that while circumcision is limited in her own country, it fares better in all the so-called benefits she sites than countries where circumcision is prevalent. In the US, Approx. 80% of all males are circumcised, and yet STD transmissions, even HIV, are the highest there. The US has higher HIV transmission rates than even Africa. Deny that, Abby, deny that.

Deny the fact that you are Jewish and that the only reason you’re interested in any “medical benefits” and “research” is because you know that arguments of “religious freedom” and “parental rights” don’t get you anywhere.

Thank you for pointing out that cervical cancer, HIV, penile cancer and HPV are not urinary tract infections. I’m not exactly sure why you feel you must point this put. Do you think demonstrating your ability to differentiate between these gives you any credibility?

It sounds like you’re trying to insinuate that infant circumcision actually makes a difference and that the world’s medical organizations back you up.

I defy YOU, Abigail Esman, to furnish a single study that has proven there is any connection between infant circumcision and the prevention of any of these diseases. I defy you to produce a single statement from a well respected medical organization that endorses infant circumcision to reduce the likelihood of these diseases. I defy you to deny the fact that despite a high prevalence of circumcision, the US does poorly when compared to it’s European counterparts, including the Netherlands.

It would be better for you to leave making value judgements regarding circumcision to medical professionals, rather than embarrassing yourself further. 

cyndavaz (Comment Deleted) 
“This is not about maintaining a practice because Jews and Muslims want it.”

Of course it is.

BTW – are Muslims allowed to cut the genitals of their little girls where you live? Doubtful.

But for some reason, certain religious groups cling to the notion that subjecting boys to this barbarism is perfectly acceptable. Double standards much? 

barefootintactivist (Comment Deleted) 
1. Who cares what you call the country. The problem is your misinformed article promoting the genital cutting of infants.

2. First of all, you’re wrong: the doctors have explicitly and repeatedly said that they don’t think legislation is a good idea, because the procedure would go underground. Second of all — where were you writing articles when the USA banned female genital mutilation (down to the slightest pinprick), withOUT religious exception, in 1997?

You are aware that female circumcision is considered a religious mandate for hundreds of millions of people in Africa, the Middle East, and Southeast Asia?

You are aware that up until recently, some girls were being circumcised in America as a “cure for masturbation,” the same reason that it became popularized in the US?

3. Sorrells et al, 2006 found that circumcision involves amputating the 5 most sensitive parts of the penis, confirming Taylor et al’s earlier studies showing that the foreskin of the penis contains the most highly innervated part of the entire male genitalia, the “Ridged Band” of nerve endings.

USAID found in 2009 that in 10 of 18 countries with data available, circumcised men were MORE likely to have HIV. All of the rest of your “medical” claims have not only been de-bunked time & time again (many Western countries where circumcision is virtually non-existent have less problem with infections, STD’s, and HIV than the US), but perhaps MORE IMPORTANTLY — children don’t have sex! Why the hell do they need protection from sexually transmitted diseases when they are BABIES? If they are dumb enough to believe all of the de-bunked myths that cutting off half the skin on their penises will offer protection from STD’s, they can have it done to THEMSELVES as consenting adults.

4. Look in the mirror and ask yourself who is twisting the facts to fit a personal political agenda. 85% of the world’s men are intact. Girls in the US are protected from the slightest pinprick. Male genital mutilation rates are plummeting even in this country. Yet you continue to promote it as a “public health measure,” and anybody who disagrees with you is a “racist” who is pushing “ethnic cleansing for the 21st century.”

Apparently you will leave it to the medical professionals to decide on this — except when they disagree with you. KNMG represents over 40,000 Dutch doctors and tens of thousands more health professionals. They are taking a brave stance against the harmful & unnecessary genital mutilation of children in the face of unfounded criticism from ignorant people such as yourself. ADULTS are free to do whatever they want to their OWN genitals.

Speaking of which, feel free to go have yourself circumcised next time you think it’s a bright idea to trivialize genital mutilation. Then see you how much you like it. Just don’t force it on children.

~Barefoot Intactivist 

This article is ignorant and misleading.

First, the Dutch medical association’s report is the most detailed report by any national medical association on the topic and is backed by 7 other national medical associations in the Netherlands.

Second, the British, Australian and South African medical associations made similar, though not as detailed or hard-hitting, findings. For example, the British Columbia College of Physicians and Surgeons’ 9/09 report did not suggesting banning infant male circumcision but it declared:

“There is no evidence to support routine circumcision of newborn and infant males.”

“There is evidence that circumcision does result in memory of painful experiences, and is not quite as simple and low risk as your report suggests.”

“The stated benefits of protection against urinary tract infection are marginal, and do not justify mass circumcision. Our changing understanding of the relationship between urinary tract infection and chronic renal disease further weakens the case for routine circumcision.”

The South African Medical Association denounced infant male circumcision as unethical and illegal and expressed “serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information.”

Not a single national medical association recommends routine infant male circumcision. The California Medical Association, cited in this article, made a quick one-liner about prior beliefs without analyzing the more recent evidence discussed by the British, Dutch and other medical associations. And the quote from the American Academy of Pediatrics (AAP) had to do with the studies on HIV reduction in Africa and was not conclusive at all as to anything except that the AAP needs to re-examine it’s prior position. At this point there is still no national medical association that supports routine infant circumcision.

The author is also oblivious to the double standard that the Dutch medical association points out. Even the slightest ceremonial incision on a girl’s vagina is illegal and considered a human rights violation. But male circumcision is allowed even though it’s gynecologically equivalent to removing the clitoral foreskin (or, “hood”), one of several forms of female circumcision all of which are illegal and which also have some of the same or similar purported (but false) medical “benefits.”

It’s a complete double standard to argue that parents should have a “right” to mutilate their baby boys’ genitals while baby girls’ genitals are fiercely protected from any such mutulation.

Male circumcision removes the most sensitive part of the penis, which has over 20,000 erogenous nerve endings and acts as a natural buffer and lubrican during sex. 

Studies based on self-reports are mixed. But the ones showing now loss in sensitivity were done either on men who were cut as adults for medical purposes, or on men in African who came straight from the clinics that financially benefit from the circumcisions. By contrast, a study of Korean men who were cut as adults out of mere tradition (introduced by U.S. military) found about half of the men reported significant losses of pleasure in masturbation, and 20% reported significant losses in pleasure during sex.

Regardless, removing a girl’s clitoral hood is illegal irrespective of whether it removes sensitivity. Boys should have the same protection. and readers should look at what the national medical associations have recently been saying about infant circumcision before believing the usual prevalent myths. 

Esman is true to her Jewish roots and is faithfully spouting the usual defense of an antique practice that violates the human rights of children.

The most important statement on human rights is the United Nations Covenant on Civil and Political Rights (1966). That covenant guarantees a right to security of the person – a right which is violated by involuntary circumcision of children.

One might think that Jews have a right to circumcise their children because it is part of their religion, however that is not the case.

The above mentioned covenant gives parents the right “to ensure the religious and moral education of their children in conformity with their own convictions.”

The foreskin is a healthy functional body part. Parents are not empowered to amputate or to consent to the amputation of the foreskin by circumcision. That is beyond their rights under international human rights law.

Children are entitled to having their human right to the security of their person protected.

That is what the Royal Dutch Medical Association is saying.

One is surprised that a magazine of Forbes’ sterling quality would stoop to printing such garbage. 

I wonder if the author would consider these Jews as rasicsts?

Can you be racist against your own race? And just because a race of people mainly follow one religion, does disagreeing with one practice of that religion then make you a racist? 

Back in the 1970s, Brazilian psychoanalyst Moisés Tractenberg wrote about the mental side effects of circumcision. He, a jew, found circumcision to be destructive to the human psyche and morally indefensible. 

listen i am a jewish man. i am so glad i escaped having this done to me. my jewish mpther protected me from a world who would have thought it strengthened their identity to remove part of my dick.

for men AND WOMEN: if you are uncircumcised you have a foreskin, and smegma. if it said so in the koran (which i am sure you would be quick to point out that it does not) then it would be okay for your own clitoral hood to have been removed at birth; altered in your most personal area by an elderly person/razor? how would it be to live with the knowledge of erogenous tissue having been removed?

before Israel was created many arabs had the clitoral hood removed at birth, whether they were Jewish or Muslim or Christian, and they did it at that bar/bat mitvah instead instead of eight days.

It is a removal of erogenous tissue, it is worse than rape it is mutilation. i said “no” many times and was spared, but their are men like me who had it done to them anyway. Loss of part of their dick with no socio-cultural support to explain the abuse except made-up diseases.

please stop supporting this horrible treatment of children. 

This article is absurd. I’m saddened to think that anyone would actually BELIEVE that the idea that circumcision should be discontinued from a medical perspective comes from racism or hate. Foreskin is a normal body part, and amputation of a healthy organ is NOT medicine. If you have no diagnosis, then it is completely invalid to remove a body part. This is standard worldwide accepted medical ethics. That this sentiment comes from Doctors is highly appropriate (though it’s also appropriate for it to come from those human rights campaigners who say that men deserve to refuse amputation of their healthy genitals, ‘cause they do). It is upon them to serve the rights of their patient, and not go lopping healthy parts off just because parents have religious reasons, or ideas about what problems might occur with those parts in the future. The reason that this SINGLE exception is made in the face of such an otherwise obvious incongruence with ethics comes from cultural blindness, which the author obviously suffers from.

It is NOT true that “almost all newborn males in the USA” are circumcised. The CDC has shown the hospital rate of 2009 to be slightly over 32%, so we can imagine that the overall rate is less than 40%.

I can’t speak to the other belligerent accusations of racism, but I will say that the people responsible for all of these other issues are not even the same people, (and if you think being Dutch qualifies as being the same people, you’re being bigoted yourself) and it doesn’t serve anything but misdirection on THIS issue to bring them up as if they were proof.

As to the mounds and mounds of ‘evidence’ of circumcision’s health benefits I say: consider the source. Remember that cultural blindness? There are a few VERY active people trying to prove a medically valid reason for infant circumcision and if you pay attention, you will see the same names on most of the work. Even if it were so, popular opinion does not negate a man’s right to his own body. Even Muslim and Jewish babies have rights Ms. Esman. 

“3. I defy you to find me the studies that counter the significant body of published literature, some of which is cited in my piece, that specifically point to the substantial health advantages of circumcision in preventing fatal diseases both in men and women. These studies are cited by all of the organizations cited by Ms. Netherton, below. I am pleased to see that, despite herself, she does recognize their authority in advancing the benefits to the male and female population of circumcision.”

If we’re going to speak of fatality risk, the risk should be discussed in context. What is the risk of death from these diseases? How are the diseases acquired? What is the absolute risk of each, which we need if the numbers cited in the original post are to mean anything in context? Relative risk isn’t enough.

More importantly, where is the discussion of ethics? The ability to achieve a potential benefit does not grant it an ethical exemption. The decision is not cost-free. It takes more than just saying “science” to justify imposing surgery on a non-consenting individual. The health (i.e. lack of medical need) of the individual at the time of the proposed surgery is also science. Absent this consideration, almost any intervention can be justified with the incomplete logic offered by Ms. Esman. Making a one-sided claim is incomplete and merely begs the question one wants to answer.

Ms. Esman implies that the complications cited aren’t common. If we grant that, the question remains: how many complications are too many? Is a recipient of a complication wrong for objecting simply because Ms. Esman, his parents, and/or the CMA approve of non-therapeutic circumcision, regardless of his preferences for what should or should not be imposed on him? What about the unavoidable harm caused in every case, since even the most according-to-plan circumcision involves physical harm?

Also, it’s factually incorrect to state that circumcision is “standard procedure for almost all newborn males in the USA” under any interpretation of statistics or consideration of the reality of (problematic) proxy consent. 

Abigail R. Esman Speaks:
Note to commenters:

It was said by one member of this discussion that I will answer as often as I need to to defend my position. I believe that my position is defended clearly enough by medical experts and the substantive evidence I’ve provided in the piece. However, I will add several points, some of which relate to the piece directly, and others which refer to the behavior of those commenting on this post. 

(Right. ;-))

1. I have deleted some comments and will continue to do so when they are either (a) defamatory and abusive; (b) racist or imply an anti-Semitic tone; (c) involve a personal attack on me or on another commenter. The rules of conduct for participation on this site are clear.

(Readers, you be the judge.) 

2. As with right-to-life issues, there are many false reports and emotionally-hamstrung propaganda sources that will happily distort the truth for those who seek it. Nonetheless, I stand by my reporting.

(By using false reports and emotionally-hamstrung propaganda sources that will happily distort the truth for those who seek it! X-D)

Several resources (which ones?) continue to show that the majority of ma[l]es born in the USA are circumcised at birth ( though it is intriguing (and not surprising) to note that those with lower levels of education are less likely to have their sons circumcised. Estimates run as high as 91 percent. 

(Case in point: *I* provided a recent link to the latest CDC reports. She, instead, insists on a website run by I a known circumcision zealot! X-D)

3. In reviewing the literature, it is important to distinguish between emotionally-charged re-interpretations of objective statements and the actual science involved. 

(LOL! And then she spews the following gem:)

The scientific evidence is abundantly clear: circumcision reduces the rate of diseases in men — and consequently in their partners. That medical associations have refused to call it mandatory simply shows that it is not a medical necessity. And indeed, it isn’t – not, say, the way that removing an inflamed appendix is, or removing a cancerous tumor. But medically advisable? Yes. Like vaccinations, for instance. And that is the point that the medical associations have made. 

(Medical associations have made no such point. Far from simply "refusing to call it mandatory," or saying that it is "not a medical necessity," medical associations ALL say that there is not enough evidence to endorse the procedure. 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.)

4. Please note, once again, that comments that do not constructively add to the discussion, are in any way racist, defamatory, involve personal attacks, or in other ways violate the rules of conduct for this site, will continue to be removed. 

Circumcision does NOT provide you immunity to diseases. Why is this concept so hard for people to understand? U.S. has one of the highest rates of circ’d men and also one of the highest rates of STD’s. If the scientific evidence were so great, you’d think we wouldn’t have so many STD’s. But, wait, EVERY world health organization believes that the “science” you speak of isn’t convincing enough to recommend infant circumcision. Use a condom. Don’t amputate healthy, functioning and vitally important sexual organs. (which goes against all medical bio-ethics of a non-theraputical surgery of a minor)

You got your statistics from circinfo!?!? LOL is all I have to say to that.

Try going to the CDC or a more reputable site lol.

My first comment didn’t go through, So i’ll say it again.

Not only is circumcision of all kinds against basic human rights, it’s immoral and unethical by personal and medical standards. Any *potential* benefit you cite, has already been thoroughly reviewed by ALL world health medical organizations and they have ALL concluded that ANY *potential* medical benefit is NOT worth the risk of infant circumcision. This is abundantly clear.

Also, you completely took a citation from the AAP out of context. Go on and continue to read their statement which says that the evidence you cited is NOT enough to recommend infant circumcision.

Just for arguments sake, even if they did recommend it (which of course they do not), does that justify chopping off a healthy body part of a non-consenting minor? Absolutely not. Amputations of body parts is NOT a form of modern, preventative medicine. 

I truly can’t believe this article, but I’m reluctant to be too critical in fear that I’ll be accused of supporting ethnic cleansing. We ridicule those who object to male circumcision, but not those who object to female circumcision. Those who object to female circumcision are hailed as human rights’ heros, while those who object to male circumcision are snubbed as liberal wack-jobs. Female circumcision is a mutilation, while male circumcision is a parent’s right. We can preach science and studies until we are blue in the face, but in the end it shouldn’t matter. Ethics should trump science.

I’m a labor and delivery nurse, and see parents attempt to make decisions about circumcisions all the time. In an attempt to be arbitrary and impartial, doctors now tend to totally stay out of the decision making. They assume that parents have done their due diligence. The result is that parents make their decision in ignorance, based on hearsay, speculation, and fear. That’s not good medicine, and wouldn’t be tolerated as ethical practice in any other medical procedure. Why with this one? 

The bias of author Esman is quite transparent. Holland’s published policy on male circumcision is quite rational and does not ignore science. It is 17 well-footnoted pages. It even includes WHO findings the WHO itself is choosing to ignore, like Wawer/Gray 2009 (Cut Ugandan men 50% more likely to infect partners with deadly HIV) and Bailey 2010 (cut Kenyan men no less likely to have HIV).

What Holland’s statement does that other policies don’t is acknowledge the human rights of male infants. Any evidence regarding STIs is interesting to adults but irrelevant to infants, WHO DON’T HAVE SEX. The decision about how to weigh the evidence and whether to amputate can be made by the OWNER of the genitals at a rational age. 

It’s interesting that a man claiming to represent the California Medical Association suddenly says the CMA has long supported forced genital cutting. There is ZERO evidence of such a policy at the CMA web site or in any CMA publication, and in fact the state of California de-funded routine circumcision from Medicaid in 1982.

Circumcision is not a medical procedure when there is no diagnosis of defect or disease, nor any record of other less destructive remedies tried before falling back to the to last-resort step of amputation. By any rational standard amputating healthy normal body parts is malpractice, mayhem, wounding, battery – illegal. The lack of enforcement to punish this crime is a cultural loophole like letting people drive 5 miles an hour over the limit.

We protect every other body part of every other gender at every other age. Let’s just protect male infants too. 

There have been many that have noted that HIV reduction from male circumcision is not observed in the real world and that the AFRICA studies have many flaws. The other side of this is that if male circumcision lowers HIV risk (the allegation is a risk change of about 3.2% down to 1.78%) then the same benefit would be provided by female circumcision — same type of tissue and cells and similar moist places issues. Two studies say they female circumsiion shows the same benefits. So why is that not mentioned much? Stallings et al. (2009) reported that, in Tanzanian women, the risk of HIV among women who had undergone Female Circumcision was roughly half that of women who had not; the association remained significant after adjusting for region, household wealth, age, lifetime partners, and union status. Female circumcision and HIV infection in Tanzania: for better or for worse? (3rd IAS conference on HIV pathogenesis and treatment) International AIDS Society. Kanki et al. reported that, in Senegalese prostitutes, women who had undergone Female Circumcision had a significantly decreased risk of HIV-2 infection when compared to those who had not. Kanki P, M’Boup S, Marlink R, et al. “Prevalence and risk determinants of human immunodeficiency virus type 2 (HIV-2) and human immunodeficiency virus type 1 (HIV-1) in west African female prostitutes Am. J. Epidemiol. 136 (7): 895-907. PMID

The reason not to do this in either case, even if this small risk reduction can be detected in the real world, is that both forms of circumcision deprive the owner of the genitals of a source of pleasure for life. That is not really mentioned in the piece above. Somehow those that have bought into male circumsiion miss the point of taking away main male pleasure zones!

We would never cut off genital parts of girls and harm their sensor system, so why would we do this to boys?

BTW, Why was my previous post taken down? 

Abigail R. Esman:
Posts will be removed if they violate the terms noted above, if they plagiarize, or otherwise violate terms for use of the site. Several posts seem to have gotten caught in spam because of length or a poster posted too frequently or too quickly.

However, the repeated harangues by a few here have gone far enough, and I will shut down comments completely unless new ideas and real contributions to the discussion begin soon. 

Abigail, I would still love for you to engage my post, as I am desiring a genuine discussion. Simply stating that those who challenge you (on your points that circumcision should be advised because of it’s potential benefits as indicated by certain studies), are wrong without taking into account the many studies they (myself included) have included to show you otherwise is not much of a discussion and comes across as narrow-minded.

I’d also like to read your thoughts on the ethical implications of suggesting the routine removal of healthy tissue to prevent (going by your statements) miniscule potential risk increase of cancer, in light of the fact that we do not routinely remove any other healthy tissue from newborns, even when studies indicate removal would significantly (vs. miniscule) reduce risk of cancer (such as breast tissue removal) in their future.

Would you not agree that logically, removing any body part, or PART of a body part would reduce the occurrance in said body part? You suggest in one of your comments that the KNMR and any other medical organization should advice circumcision because it reduces risk of cancer occurrance and UTI’s – am I correctly rephrasing you? —> Would you not agree that if medical associations begin to advice the surgical removal of healthy body parts because leaving them ‘as is’ slightly increases infection risk, they would have to recommend surgical removal of nearly every other healthy body part on newborns? Do you perhaps now understand why no medical organization in the world DOES advocate for circumcision, EVEN if they would go by certain studies (assuming they are correct in their conclusions)?

By the way, not that this contributes anything to the discussion, but since I don’t want you to feel like this is ‘personal’: I am an evangelical Christian (and with that a minority voice on circ w/in my circles) who lives in the US, who has a BA in Theology, a Masters in Apologetics. I am what most would consider very Pro-Israel, and abhor anti-semitism. One of my favorite college classes (on the Holocaust and the problem of evil) was taught by a Messianic Jew whom I dearly love. I’ve read numerous articles and have sat under several speakers on the topic of Sharia Law and Jihad. I am both Dutch and American, and a mother of a little boy who was about to be circumcised (afterall, we do live in the US, in one of the states where the circ rates are still very, very high), until I spent hours upon hours reading up on the ethical implications, the function of the foreskin, and the fallacious logic used in advocating for the procedure.

I’m not out to ‘get you’, but I AM passionate about truth. When I see a piece or journalism like yours, that makes several statements containing logical fallacies (see my first reply), statements that do not cite their sources (you have yet to provide the studies, even though others have, which you have blown off instead of engaging)/research, it needs to be called out.

I understand this an opinion piece, but when you write one of those, you have to realize you will be called out on those premises you use to draw your conclusion that are false or invalid. In turn, you should be ready to defend them, and to engage counter arguments without blatantly ignoring them (the reason posters repeat the same over and over) and mainly stating that you’re ‘sticking to your statements’. 

Esman's "final word" post reads:
"As the result of incessant spamming, personal attacks and other violations of the rules of conduct by one particular member of this discussion, comments are now closed."

Could she have been refering to me?

At any rate, this entry was poorly written, full of misinformation if not outright lies, Abigail R. Esman is an insult to medicine, and Forbes should re-consider having her on as a contributor.


  1. Quelle coincidence. The title of my blog post today was "Ignorance."

    Misinformation is a Powerful Force in the Universe. We're fighting the same misconceptions and falsehoods that Ed Wallerstein tried to smack down thirty years ago. I'm heartened that circumcision rates are trending downward in the US, but my heart goes out to those 55 percent whose parents didn't get the message.

  2. My Comment to Abigail Esman (23-09-11)

    As a Canadian Physician, I find your views regarding the non-therapeutic amputation of healthy genital tissue from powerless children uneducated, immoral and sadly ignorant of the sexual and physiologic function of the male prepuce. The prepuce is richly innervated erogenous tissue, containing over 20,000 highly specialized sensory receptors such as Meissner’s corpuscles and Ruffini endings. The prepuce is the most heavily innervated part of the male body and it also provides the primary gliding mechanism during sexual intercourse. This unique structure has evolved over millions of years and it should not be amputated without medical urgency or unless the benefit SIGNIFICANTLY outweighs the potential for harm. The spurious medical benefits you quote in your article have ALL been disproved, and even if they were valid, they would not meet the ethical test of medical proportionality. For instance, intact males are more likely to die from breast cancer than penile cancer. With regards to HIV prophylaxis, ask yourself how morally bankrupt it is for Western circumcision proponents to export this brutal practice to the world’s poorest and least educated people who are dealing with a terrible epidemic. The USA (circumcision rate 70%) has the highest rate of HIV infection among all industrial nations. In fact, the HIV infection rate in the USA is 6 times higher than Sweden (circumcision rate 1.2%) and 11 times higher than in Finland (circumcision rate <1%). The circumcision experiment has been running for decades in the USA and it has failed miserably. Circumcision is a fundamental failure in human compassion, devised as a tribal genital mutilation. It was only medicalized during the Victorian era as a misguided attempt to curb masturbation. It violates the most sacred principles of medical ethics: autonomy, justice, proportionality and primum non nocere. It is time for this barbaric practice to end. Bronze age religious blood rituals should never trump rational scientific judgment, contemporary medical ethics and the universal right to bodily integrity. It’s time for physicians to put down the scalpels, stop the cultural transference and properly educate the public. Most physicians in Canada do not share your views with regards to circumcision. The boy is the patient, not the parents. His body, his choice.