-Submitted by David Drumm (Nal), Guest Blogger
The American Academy of Pediatrics (AAP – the science-based one) has recently published the results of its task force on circumcision. The AAP evaluated the recent evidence and determined 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.” We have previously discussed the ruling of a German court that parents who circumcise their sons based on religious beliefs are committing child abuse.
The specifics benefits of circumcision include
- prevention of urinary tract infections,
- penile cancer, and
- transmission of some sexually transmitted infections, including HIV.
However, the AAP notes that the health benefits are not great enough to warrant routine circumcision.
The AAP notes that the benefits warrant reimbursement via medical insurance policies. We await the Christian conservatives’ outrage, claiming that circumcision, and it accompanying reduction in sexually transmitted diseases, will increase male promiscuity.
The AAP Technical Report recommends that “circumcision should be performed by trained and competent practitioners, by using sterile techniques and effective pain management.” The Task Force notes the problems with finding competent providers.
Researchers from Johns Hopkins University have found that “twenty years of falling circumcision rates have cost the country $2 billion in preventable medical costs.” Eighteen states have dropped their Medicaid coverage of the procedure.
Those who claim that the uncircumcised penis is natural and hence, better, commit the naturalistic fallacy. The argument that circumcision violates a “right to bodily integrity” would also apply to any number of surgeries to correct birth defects like fused limbs and the removal of vestigial tails.
While circumcision for health benefits has a rational basis, circumcision to demonstrate a commitment to an imaginary being is not rational.
H/T: David Bernstein (VC), Monya Baker (Nature), The Virginian-Pilot.
Malisha, LOL!!!
HUGH7, thanks for the list and the reasoning.
Waldo, for showing his ignorance, even in handling terminology. The massive cultural embedded
circumcision practiced in the USA is no small target. But the rest of the modern nations oppose circumcision.
When does the State Department rule on which nation to attack first?
Smegma has a natural function, badly smelling as it may become if left too long. The smelly bacteria are not just a signal, but function to prevent pathological (harmful) bacteria from taking root.
We have slso had mentioned the biological functions associated with a foreskin vv the glans.
The only defense seem to be the usual illogical one:
“I got one, so should everybody else have one too.”
That someone with a medical background actually proposed “nicking” women is outrageous. Money hogs.
And here’s a kick at the boys, are you too lazy to do your own hygiene?
And to lovers of antibiotics. Our health services are giving out reminder cards to patients that overuse and repeated use does more harm than good.
MIRS and other resistant bacteria strains are a problem which is increasing. Years ago the best and permanent cure for otitis in children was a treatment by a knowledgeable D.O.
MIRS has become such a problem that those treated in foreign hospitals are screened for infestation/infection by answering a routine admission form.
And here we are discussing false facts supporting myths versus the body designed by “God”. What do the evangelists say. Nonsense as usual.
Thankful I live in Europe and see European doctors and don’t have to educate them about why a foreskin is worth having. (For my son’s sake) I personally thankful female circumcision did not take off very well many years back, as doctors/researchers would be working really hard to justify and preserve that cultural-medical habit, if it generated enough funds that they’d miss it.
Consider this Waldo. Is the ethical case for female genital cutting (which if you don’t know is an umbrella term for a wide range of procedures which can be on par or far more detrimental than male circumcision) any weaker because the majority of women who have undergone female genital cutting do not attempt restorative techniques and perpetuate the practice on their daughters and granddaughters?
My point in stating the fact that most men enjoy their foreskins and would not part with them willingly is that this tells us a great deal with regard to what the preference of the individual might be on whom an elective surgery is being considered, elective being the key word. And we must absolutely consider this since 99% of the time circumcision is not necessary. Consequently, we must weigh the individual’s preference without the surgery and try to attempt to respect his right to autonomy, which is an established right in medical ethics. From that perspective, you can’t seriously say that there is an “ethical problem to not remove the foreskin at birth.” After all, men who are not circumcised can always choose to be circumcised later in life. However, the reverse is not true and those men are screwed.
In short, I think you only are attacking a straw man. Yes, most circumcised men are happy with their state, but there is no guarantee their sons will be and in terms of elective surgery, knowing what their preference most likely will be without the operation, I think the ethics are pointing us clearly in the direction of holding off the procedure.
“Most important of all and this gets always lost in the medical conversation is that most most men do not choose to get circumcised later in life because they find their foreskins to be functional, beneficial, non-optional parts of their genitalia. Clearly, there is an ethical problem to remove this at birth if the vast majority of men later in life choose not to and many men who have been circumcised attempt foreskin restoration techniques.”
Your reasoning is poor because you are only looking at one side. I can flip your statement around and it would be just as factually true as what you wrote:
Most important of all and this gets always lost in the medical conversation is that most men who are circumcised as infants do not choose to have foreskin restoration techniques later in life because they find their circumcised penises to be functional, beneficial, and have no need or desire for a foreskin. Clearly there is an ethical problem to not remove the foreskin at birth if the vast majority of circumcised men later in life choose not to try foreskin restoration and many men who have not been circumcised choose to have the foreskin removed.
– First International Symposium on Circumcision May 3, 1989
LOVED the Penn & Teller video…. LOVE their show…..
From the Vancouver Sun: “I am reminded of Aesop’s fable of The Fox Who Had Lost His Tail, in which a fox whose tail had been cut off publicly advised all foxes to sever their own tails.The fox expounds at length on the many benefits of tailless life until interrupted by another fox who says, ‘If you had not yourself lost your tail, my friend, you would not thus counsel us.'” http://www.vancouversun.com/business/endorsement+male+circumcision+undercut/7178837/story.html#ixzz25HVJUoht
~Dick-Scalper
Nal,
You are saying that individuals have no right of self-determination over their own bodies. What is more fundamental than that?
Laws against genital modification and mutilation should apply equally to males and females.
The apologists & proponents of male circumcision defend & justify it with as much cynicism, arrogance, misinformation, and callousness as the ardent proponents of its female circumcision equivalent–the removal of the clitoral hood in many cultures. Try that in America and see how far you get. Boys? who gives a $^!t, men are dogs, stick it to ’em before they grow up. Read between the lines of many respondents and THAT is the message.
~Dick-Scalper
Preventative mastectomies offer a marginal survival benefit to some, particularly younger women. According to Nal’s reasoning, parents own the bodies of their offspring until the age of 18, and have the power to mutilate their children at will if they believe it is for the child’s health benefit. If tests can demonstrate that a preventative mastectomy of a teenaged female has a health benefit, there is a “rational basis” for parents to order it be performed. To object is to commit a naturalistic fallacy.
@bigfatmike
“It seems to me that the ones who feel most strongly about this are the ones who do not practice it and have not been through it.”
And that counts against us because…? We still have the part in question and we know its value.
“The men who have actually been through it at a young age seem to be telling us that it is not such a big deal.”
…because they don’t know what they’re missing.
“If there are any support groups for victims of male circumcision they are being pretty cagy and not that easy to find.”
Search on “foreskin restoration” First-person accounts from >200 men who resent being circumcised are at http://www.circumstitions.com/Resent.html
“I have to wonder, are there any counselors whose practice is composed mainly or significantly of men who feel they are victims of circumcision?”
I think the counselling is mainly peer-to-peer. I do know of three lawyers who are occupied just about full time on cases involving botched circumcision.
“The benefits may be small or non existent.”
So why do it?
“But, baring some tragedy, the damage also seems small.”
But you can’t bar some tragedy, up to and including death, even from a “properly performed” unnecessary circumcision. To upend Stalin, a million deaths is a statistic, but one death is a tragedy. And there are many mishaps that are unnoticed on a baby, but devastating to a man’s sexual functioning.
“This really seems to be a non issue, except in the minds of those who feel compelled to impose their view on others.”
The people who feel compelled to impose their view on others are the people who are so determined to cut parts OFF of the penises of others, who will not be children all their lives, but men with every right to decide for themselves what parts of their own genitals they want to keep.
Bodily integrity is no new fad. One of the fathers of western law, Sir William Blackstone wrote in 1765: ” “Besides those limbs and members that may be necessary to man … the rest of his person or body is also entitled by the same natural right to security from the corporal insults of menaces, assaults, beating, and wounding; though such insults amount not to destruction of life or member….” – Commentaries on the Laws of England.
You don’t have to commit the naturalistic fallacy to think that a person has a human right to all the normal, healthy, non-renewing body-parts he was born with, and that if it had been the slightest bit harmful, it would have evolved away aeons ago. (The appendix can’t do that, for obscure genetic reasons.)
The AAP policy is culturally biased and seriously flawed. It should be withdrawn.
(The policy itself is annotated at http/www.circumstitions.com/Docs/aap-12-anno.pdf to cite the faults that follow.)
It fails to consider the structure or functions of the foreskin, a normal healthy body part, only the cutting of it off. It does not, for example, cite Taylor’s groundbreaking 1996 paper, The prepuce: Specialized mucosa of the penis and its loss to circumcision. The erogenous value of the foreskin has been known for millennia, even to its enemies. Recent denial of that value is confined to those who have no experience of it.
It bases its conclusions about sexuality on two physiological studies that did not consider the foreskin, and on surveys of African adult volunteers for circumcision in the context of HIV prevention.
It treats normal intact penile features as pathological; late separation of the prepuce from the glans can take as long as 17 years but the AAP says it should separate within two months; and it associates “preputial wetness” with disease when it is normal, just like oral wetness.
It is filled with confirmation bias – finding the results the authors want.
It claims benefits of circumcising outweigh the risks without ever numerically comparing them.
It exaggerates benefits and minimizes risks and harm: For example –
It cites a study showing that “circumcision ablates [removes] the most sensitive part of the penis” and ignores that finding.
It admits the African HIV findings may not be applicable to the USA, but goes ahead and applies them.
It cites a study suggesting circumcising men increases the HIV risk to women, and ignores that finding.
It cites a study showing that a narrow foreskin (phimosis), not a normal one, is the issue in penile cancer, and ignores that finding.
It dismisses major complications and death from circumcision because it did not find any statistical studies of them.
It discusses the action of the Mogen circumcision clamp without mentioning that the clamp has caused too much of several boys’ penises to be cut off; lawsuits have driven the company out of business.
It repeats the common claim that it is safer to circumcise babies than adults, but offers no evidence for that claim.
Its discussion of the ethical question of removing genital tissue from a non-consenting person versus leaving it for him to decide assigns no value to his autonomy or his human right to bodily integrity.
It compares the costs of doing it early vs late, but not with the benefits of not doing it at all.
Its ethical consultant, Dr Douglas Diekema, has said elsewhere that circumcision is not necessary and has a risk of harm, and that a parental wish is not sufficient to justify doing any surgery, and it ignores that.
The AAP’s policy seems bent, not on considering the healthy intact penis at all, but on restoring insurance and public funding to circumcision in order to find a new market among the poor.
The AAP should withdraw its circumcision policy the way it withdrew its female genital cutting policy after a storm of outrage two years ago, when it recommended a token ritual nick to baby girls, much LESS extensive than neonatal male genital cutting.(Dr Diekema headed that committee and has never recanted from that policy.) If that was unacceptable, how can this be acceptable?
Kraaken, whatever has to do with penises is very serious.
I’m not making a joke by saying this.
Story: My kid was in the bathtub playing with his bathtub toys when he was three. He decided to stick his penis into a toy that I thought had a kind of sharp plastic edge — I think it was a boat. I said non-chalantly, “Honey don’t stick your penis into the toys, OK, you could get scratched.” He looked up innocently and asked, “then what can I stick my penis INTO?” I said, “well, nothing.” He then looked devilish and said, “I KNOW SOMETHING I can stick my penis INTO!” (He was always too smart for me and always had a fast answer, so this gave me pause, but then I asked the predictable question): “And what would that be?”
“MY PANTS!”
And this is a real problem HOW?
In the part of the world in which my daughters were born (southwest US), folks have the habit of poking holes in the ear lobes of baby girls for cosmetic purposes, sometimes within weeks if not days of bringing them home from the hospital. I’ve always considered that (1) child abuse, and (2) my daughters’ own business whether they wanted holes in their ears..
It was a big deal, a rite of passage, for my girls to get their ears pierced prior to start of 5th grade classes. And each expressed some displeasure at my not letting their ears be pierced before the age of remembering things.
This may seem like a small thing, but it was part of my attitude around my daughters: you are the person with the primary responsibility for your own health and safety, and no one does anything to you without your express consent.
I saw my 5’2″ daughter as a freshman make the popular,hotshot sr. high school quarterback cringe and back away with a vicious rebuke when he took a liberty with what had been a friendly hug. It helps me feel not so nervous as she a long ways out of my sight these days.
Oro Lee,
That is a great story….
My daughter is now 14… I tend to be of the more Rock N Roll.. Punk Rock mom….. I took my daughter to her first Punk show, a few months back…. Took her to her first heavy metal show last year….. We do EVERYTHING together… and I tend, as you may have guessed, to be rather Liberal… even in my parenting…..
THO… I made my daughter also wait, to get her ears pierced…. 12 was the magic age…. I was 12 when I had mine done…
and my daughter was 12 when she had hers done…. 🙂
Funny part of that is…. I have a sister…. she is 12 years younger than I am…. she was the responsible one… she was more, stable and conservative…. when she had her daughter, she had her ears pierced when she was just a few months old…. :-\
What is ODD…. my daughter was GLAD, I was making her wait…. and even to this day thanks me for this…. 🙂
I sometimes follow this blog and I wanted to weigh in here because I think not enough credence is given to this idea of “bodily integrity,” which I think is an emerging right in human rights law. I am not an expert on this and I am going to post here some links in a moment but we should consider that in most developed countries there are strict prohibitions against all forms of genital cutting to the point that you cannot lay a medical instrument on an infant girl’s genitals without good medical reason. This is so entrenched within out culture and reflected in our laws that even if tomorrow we found out that there might be some “potential” medical benefit to excising a portion of a girl’s labia to say prevent UTI (which are far more likely in a girl than a boy anyway) or STDs, we would still maintain that genital cutting of a baby girl is wrong or at least I hope we would! Correctly, we would point out that antibiotics, proper hygiene, and safe sex practices are far better options rather than strapping down an infant and cutting off parts of their functional genitalia in hopes of preventing some theoretical infection 20+ years down the line.
Well, the same holds true for a boy, and this seems to be the disconnect I find in these conversations. Even if the cited health benefits of circumcision exist (by the way, if you read the AAP report carefully and consider the opinions of other organizations, you will realize there is little debate regarding the general lack of applicability of the benefits to infants of the developed world), you would still have to show that there are not less invasive, cheaper, more effective, consent-respecting alternative treatments to circumcision. Since there are, circumcision creates a major ethical problem. For example, UTIs affect 1% of boys in the first year of life and can be treated with antibiotics, circumcision is almost always unnecessary. Should we still insist on cutting off every boy’s foreskin? I hope not!!! If you look at circumcision, you will find the medical case for it is very dubious, having its roots in 19th century hysteria regarding sex and masturbation. Its a cultural practice in search of a medical problem that has time and again created post ad-hoc justifications. The simple fact is that developed countries, aside only the United States, do not practice circumcision in large numbers, and they for the most past enjoy far better health outcomes. As such, on a population and public health level, circumcision has not been shown to offer any significant health benefits.
Most important of all and this gets always lost in the medical conversation is that most most men do not choose to get circumcised later in life because they find their foreskins to be functional, beneficial, non-optional parts of their genitalia. Clearly, there is an ethical problem to remove this at birth if the vast majority of men later in life choose not to and many men who have been circumcised attempt foreskin restoration techniques.
Here are the two links I promised:
http://blog.practicalethics.ox.ac.uk/2012/08/the-aap-report-on-circumcision-bad-science-bad-ethics-bad-medicine/
http://newhumanist.org.uk/2856/circumcision-time-to-cut-it-out#.UD9zabUIKCE.facebook
Whether passing a law against circumcision is a good/idea is far more complicated and I don’t have a good answer to that. I share cultural sensitivities and strongly believe in protecting the rights of the minority. However, given the direction we taking with this idea of “bodily integrity” I certainly see the reasoning for it.
http://www.drmomma.org/2012/08/aap-circumcision-policy-statement.html
A BRILLIANT Blog… with a letter to the AAP regarding this last study….
Chojnacm…. BRAVO!!!!!
The Link your provided was also brilliant in that it addresses EVERYTHING I was thinking about this study, but….
A. did not have the energy to look up and source…..
B. Could not have possibly written it as well…
Both the Practical Ethics UK blog, and the Dr. Mommy blog that I have posted above, go over this study with a fine tooth comb… and dismantle it piece by piece….
@Waldo “When it comes to circumcision, the only ones trying to use governmental power to impose their ideas and morals on others are those who oppose it”
I think I have to agree.
It seems to me that the ones who feel most strongly about this are the ones who do not practice it and have not been through it.
The men who have actually been through it at a young age seem to be telling us that it is not such a big deal.
If there are any support groups for victims of male circumcision they are being pretty cagy and not that easy to find.
I have to wonder, are there any counselors whose practice is composed mainly or significantly of men who feel they are victims of circumcision?
The benefits may be small or non existent. But, baring some tragedy, the damage also seems small. I say this despite the gruesome videos. I don’t think one can evaluate a medical procedure on the basis of the way it looks.
This really seems to be a non issue, except in the minds of those who feel compelled to impose their view on others.
PS
From the video film provided by Scalper, it would appear that there at that Student Union, the only propagators for diminishing circumcision were using information and reasoned discussion Wish more would use such techniques.
Are there any pushing for government prohibitation?
Then tell them to FO, it is mine to defend. No more prohibitions, except for Romney and Co. Couldn’t help that one kick.
Waldo,
Excuse me saying so, but my final sentence was meant as humor. Guess our tastes differ. “You” might even be in the majority on my sense of humor.
But I have only my taste to go after. I don’t write jokes for TV. That last sentence was meant as a joke too, if I must say so to be understood.
Your comments are accorded the same freedom as mine. Go to it as you desire. No pain here. Just thought you might like to know of my real intent.
“I will defend my foreskin until my death”
I’m pretty sure your foreskin is safe from harm as no one is arguing for mandatory circumcision. It reminds me of those opposed to gay marriage who seemed to think that those in support of gay marriage were going to make them marry someone of the same sex. When it comes to circumcision, the only ones trying to use governmental power to impose their ideas and morals on others are those who oppose it.