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.


  1. Excellent post once again Joseph. Thank you for your ongoing commitment to clarity and truth on this issue.

  2. The key fight is Medicaid and any possible nationalized system in the future.

    Intactivists must be loud in declaring that the government has no right to force people (the taxpayers) to pay for surgery that they view as being child abuse, a breach of human rights, and genital mutilation.

  3. Great stuff Joseph. Charlatans masquerading as responsible, ethical, principled dispensers of medical knowledge is what they are. Hippocrates must be turning in his grave.

  4. Great post! The whole thing is just sickening. Reposting at Banned From Baby Showers Facebook page.

  5. What I find fascinating is that while they are recommending anesthetic should be used in circumcision, they do not quite go as far as saying that it's seriously wrong to *not* use it.

    So in other words, circumcision without anesthetic is still OK; you know, especially if you're a busy doctor without the time to wait for anesthetic to sink in.

  6. They brand men like a herd of cows. "Neonatal post-traumatic stress disorder" -- the recurrent American nightmare for boys. American men are such wimps to let their sons be subjected to this absurd surgery. If it were women tied down & cut, the Feminists would be howling all over the world. The male genitals are a cheap commodity. There is no argument too absurd for the circumcisers. They insult the appearance of the intact penis, claim that circumcision heals everything from body warts to HIV, and draw an illogical distinction between female & male genitals. Circumcision is the mark of a slave, not a free man.

    Top Ten Tortures Less Painful Than Circumcision

    10. Get waterboarded.
    9. Pull out your fingernails.
    8. Eat a pile of steaming bear crap.
    7. Skin yourself alive.
    6. Fall into a vat of molten iron.
    5. Get run over by a train.
    4. Go through a sausage grinder.
    3. Saw off your legs.
    2. Poke out your eyes.
    1. Go To Hell