Tuesday, September 8, 2015

CANADA: CPS Diverges from AAP on Infant Circumcision

In 2012, the American Academy of Pediatrics (AAP) released a controversial policy statement on circumcision.

While the statement did not culminate in a recommendation as circumcision advocates were hoping for, it was littered with the baseless mantra that "the benefits [of circumcision] outweighed the risks," and with calls for public medical programs to cover it.

The claim that "the benefits outweigh the risks" conflicts with statements that "the benefits [of male infant circumcision] aren't great enough to recommend" it, and that "the true incidence of complications after newborn circumcision are unknown," found within the same Policy Statement.

So out-of-line was the 2012 AAP report, that 38 pediatricians, urologists, epidemiologists, and professors, representing 20 medical organizations and 15 universities and hospitals in 17 countries formally rejected it.

Even so, circumcision advocates took the "benefits outweigh the risks" soundbite and ran with it.

Some go as far as actually saying the AAP has given a recommendation for circumcision, when it is clear to those who have actually read their 2012 statement that they stop short.

After the AAP released their statement, it didn't take very long for the Centers for Disease Control (CDC) to mirror them. Almost like clockwork, the CDC released a statement similar to that of the AAP, seemingly giving circumcision advocates yet more ammunition for promoting male infant circumcision. (As the AAP, the CDC shies away from a clear recommendation for male infant circumcision.)

With the Canadian Paediatric Society due for a release of their own policy statement on male infant circumcision, speculation arose as to whether or not they too would mirror the controversial AAP statement.

Circumcision advocates were hoping the CPS would get into lockstep with the AAP, and repeat the same "benefits outweigh the risk" slogan.

Much to their chagrin, however, the CPS not only failed to join the AAP and CDC in chorus, they outright reaffirmed their position against it.

Said Dr. Thierry Lacaze, chair of the CPS Fetus and Newborn Committee:
"While there may be a benefit for some boys in high risk populations and the procedure could be considered as a treatment or to reduce disease, in most cases, the benefits of circumcision do not outweigh the risks."

Thus the AAP and CPS can be witnessed going separate ways on the matter.

Is the CPS stepping out of line?

Or is it the AAP who is deviating?

The fact of the matter is that the trend of opinion on routine male circumcision is overwhelmingly negative in industrialized nations.

The AAP tried very hard to push the slogan that "the benefits [of circumcision] outweigh the risks" in their 2012 statement, but they were formally rejected by 38 pediatricians, urologists, epidemiologists, and professors, representing 20 medical organizations and 15 universities and hospitals in 17 countries.

And now, the Canadian Paediatric Society joins the number of respected medical organizations who diverge with the AAP.

Thus, it continues to be true:

No respected medical board in the world recommends male infant circumcision. All of them, including the AAP in their latest statement, state that there isn't sufficient evidence to warrant this endorsement.

To say otherwise would be to take an unfounded position against the most respected medical organizations in the West.

Good on the CPS for refusing to buy into the AAP's nonsense.

Relevant Posts:
CANADA: Canadian Paediatric Society - Monkey See, Monkey Do?

OUT OF LINE: AAP Circumcision Policy Statement Formally Rejected

USA: Centers for Disease Control to Mirror American Academy of Pediatrics

Relevant Links:


  1. Off the top of my head, my understanding is that at least 2 of the 8 doctors who were on the AAP's "Circumcision Task force" are Jews. Considering that a maximum of 2% of the U.S. population is Jewish (a huge proportion, by the way), that's a huge over-representation (25%); please correct me if I'm wrong.

    Within the intellectual community—and within the scientific community in particular—it's extremely important to list conflicts of interest; naturally, nobody in the circumcision "debate" ever lists such a conflict.

    It would be a revelation to see how many participants in this sort of decision are circumcised (or not), or who are involved with circumcised sexual partners, or who circumcised their own children, or who believe that the creator of the entire Universe desperately wants males to be circumcised.

    This is world is one giant conflict of interest; unfortunately, those interests seem to fall towards the unequivocally insane.

  2. Actually, Joseph, the CPS' policy statement is quite mediocre jumping between the two extremes.

    Good: "In the male newborn, the mucosal surfaces of the inner foreskin and glans penis adhere to one another; the foreskin is not redundant skin. The foreskin gradually separates from the glans during childhood. By six years of age, 50% of boys can retract their foreskins, although the process of separation may not be complete until puberty: 95% of boys have retractile foreskin by 17 years of age."

    Bad: "The foreskin serves to cover the glans penis and has an abundance of sensory nerves,[5] but medical studies do not support circumcision as having a negative impact on sexual function or satisfaction in males or their partners."

    Almost good: "It has been reported that some parents or older boys are not happy with the cosmetic result, but no specific data from the literature to quantify this outcome could be found."

    Good: " In cases in which medical necessity is not established or a proposed treatment is based on personal preference, interventions should be deferred until the individual concerned is able to make their own choices"

    Bad: "With newborn circumcision, medical necessity has not been clearly established. However, there are some health benefits, especially in certain populations. Furthermore, performing circumcision in older boys, who are able to provide consent, can also increase risk and costs to the individual.[39] Therefore, some parents view circumcision as being in their child’s best interest."

    Bad: 1st paragraph of conclusions.

    Wishy-washy: "Because the medical risk:benefit ratio of routine newborn male circumcision is closely balanced when current research is reviewed (Table 1), it is challenging to make definitive recommendations for the entire male newborn population in Canada. "

    Parroting the AAP: "Health care professionals should provide parents with the most up-to-date, unbiased and personalized medical information available so that they can weigh the specific risks and benefits of circumcising their son in the context of familial, religious and cultural beliefs. Having the right information will enable them to make the best decision for their boys. "

    In fact, the quote that you cited: "in most cases, the benefits of circumcision do not outweigh the risks." is one physicians interpretation of the statement. A different physician on a different article was quoted: "The main thing that has changed between now and then is there is convincing evidence that circumcision can actually prevent HIV,” (Dr. Joan Robinson).

    What I see problematic is that this statement says it can be beneficial to some boys, but gives no criteria to decide which boys. It says it's mostly a cosmetic operation, and then justifies doing it for religious, cultural and familial reasons. It ignores Sorrells, Frisch, Bronselaer, Kim & Pang (even though it references the latter). It references one of BM's brochures. It even links a WHO's paper, not from the WHO's website but from circlist!

    People reading this statement are going to be left in more confusion than they were before reading it, physicians and parents alike.

  3. The world is far more reasoned with regard to routine circumcision. We know the AAP has long attempted to muddy the circumcision waters and now they have run up against World medical opinion. It bothers them NOT and they continue to hedge and issue conflicting statements. I think they were afraid routine circumcision in the US might become a thing of history book, and this for a profession who sees dollars in everything, the foreskin is no exception.

    1. The fact is that trend of opinion on routine male circumcision is overwhelmingly negative in industrialized nations. No respected medical board in the world, not even the AAP, recommends circumcision for infants. All of them, including the AAP in their latest statement, state that there isn't sufficient evidence to warrant this endorsement, much to the chagrin of circumcision advocates.

      The problem for the AAP is that they have a balancing act that they have to perform very carefully and with precision. On the one hand, they are supposed to be, in theory at least, a respected medical organization, one who is supposed to be "at the forefront of medicine," one to whom other medical organizations look to as an example. As such, they cannot publish a statement that will make people question their credibility. Their statement must be as accurate as possible, and cannot take an unfounded position against the most respected medical authorities in the west. On the other hand, the AAP is a trade organization, and as such, they cannot take a position that will disenfranchise a good number of its members who reap profit from performing male infant circumcision, so they have to publish policy statements on circumcision that won't disagree with modern medicine, AND won't get their members into trouble.