The AAP report on circumcision: Bad science + bad ethics = bad medicine
For the first time in over a decade, the American Academy of Pediatrics (AAP) has revised its policy position on infant male circumcision. They now say that the probabilistic health benefits conferred by the procedure just slightly outweigh the known risks and harms. Not enough to come right out and positively recommend circumcision (as some media outlets are erroneously reporting), but just enough to suggest that whenever it is performed—for cultural or religious reasons, or sheer parental preference, as the case may be—it should be covered by government health insurance.
That turns out to be a very fine line to dance on. But fear not: the AAP policy committee comes equipped with tap shoes tightly-laced, and its self-appointed members have shown themselves to be hoofers of the nimblest kind. Their position statement is full of equivocations, hedging, and uncertainty; and the longer report upon which it is based is replete with non-sequiturs, self-contradiction, and blatant cherry-picking of essential evidence. Both documents shine as clear examples of a “lowest common denominator” mélange birthed by a divided committee, some of whose members must be well aware that United States is embarrassingly out of tune with world opinion on this issue.
On a global scale, medical experts are steadfastly divided on the question of whether the circumcision of male minors confers any – let alone significant – health benefits. Indeed, child health experts in Britain, Germany, Scandinavia, Australia, New Zealand, and Canada are firmly of the view that non-therapeutic circumcision (NTC) confers no meaningful benefits, and that it should be neither recommended to parents nor funded by health insurance systems.
In view of this empirical uncertainty on the medical question, it is problematic to assert, as the AAP does in its new report, that a person does not retain the right to decide whether he wishes to keep his own healthy foreskin–and preserve his genitals in their natural form–and that the right belongs instead to his parents.
Parents can of course give proxy consent for needful therapeutic procedures aimed at treating a known pathology–if the pathology presents a grave threat to the child, and if the intervention cannot be delayed until the child understands what is at stake, and if there are not safer, more reliable, more effective alternative treatments. A healthy foreskin, however, is not a pathology. It needs no treatment at all. To remove it, therefore, on grounds of “proxy consent” is to misunderstand–quite dangerously–the ethical limits of parental authority.
A more reasonable conclusion than the AAP’s, then, is that the person whose penis it is should be allowed to consider, for himself, the available evidence (in all its chaotic murkiness) when he is mentally competent to do so—and make a personal decision about what is, after all, a functional bit of his own sexual anatomy and one enjoyed without issue by the vast majority of the world’s males.
According to the Seattle-based physicians group Doctors Opposing Circumcision, there is neither a medical nor an ethical case for removing healthy genital tissue from baby boys. They can’t consent to the procedure in the first place, and the bulk of the claimed—yet heavily disputed—health benefits don’t even apply to them: babies are not sexually active, yet circumcision is supposed to protect chiefly against sexually-transmitted infections and related diseases. In any case, these are afflictions whose prevention is much more soundly assured by the use of a condom in adulthood than by genital surgery in infancy. And before you bring up urinary tract infections in early childhood, remember these are profoundly rare for boys, and can be easily treated with antibiotics if and when they do occur—no surgery required. So how did the AAP reach its much-hyped, yet ultimately fallacious, and certainly medically unjustified conclusion? …
Flawed Studies Used to Claim Circumcision Reduces HIV Infection
An article in the December Journal of Law and Medicine cites numerous flaws in three African studies that claim male circumcision reduces transmission of HIV. (see: the article here)
According to the article, the studies, which are being used to promote the circumcision of up to 38 million men in Africa, had selection bias, inadequate blinding, problematic randomization, experimenter bias, lead time bias, supportive bias, participant expectation bias, time-out discrepancy, and lack of investigating of non-sexual HIV transmission among other confounding factors and problems.
The absolute reduction in HIV transmission associated with male circumcision for the three studies was only about 1.3%. The African studies had cited the relative reduction in HIV transmission, a misleading figure. Reports in the popular press have been even more misleading. Furthermore, there are at least 17 observational studies that have not found any benefit from male circumcision in reducing HIV transmission. Since condom use after male circumcision is essential to prevent sexual transmission of HIV, circumcision does not have any additional value.
Ronald Goldman, Ph.D, executive director of the Circumcision Resouce Center and author of Circumcision: The Hidden Trauma, stated, “This article is another serious, critical analysis of flawed research that is being used to promote circumcision. We have seen such claims about the ‘preventive benefits’ of circumcision for over 100 years. They have all been refuted. No other normal, healthy body part is cut off for supposed ‘preventive benefits.’ From our psychological work, we know that there is a compulsion on the part of some circumcised men to have others circumcised.
Unfortunately, it appears that this compulsion continues to drive some professionals and authorities to promote circumcision without proper critical analysis. They also ignore the serious sexual and psychological harm caused by circumcision.”
Here’s what the AAP is actually promoting. This is taken from http://www.drmomma.org/2011/01/neonatal-circumcision-video-for.html. There’s a name for all this insanity: sadopedophilia. At least the pedophiles in the catholic church didn’t torture the kids.