Monday, August 27, 2012

The Academy of Pediatrics "Re-evaluates" Circumcision

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. 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.

The procedure is well tolerated when performed by trained professionals under sterile conditions with appropriate pain management. 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.

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. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.
Parents ultimately should decide whether circumcision is in the best interests of their male child.

Today's (August 27, 2012) New York Times includes the article "Benefits of Circumcision Are Said to Outweigh Risks" (Roni Caryn Rabin, page A3).  Above is the actual policy statement released by the American Academy of Pediatrics.

Let me begin with some "full disclosure."  I am Jewish, I am circumcised, my stepson and grandsons have undergone ritual circumcisions as have all male members of my family.  I, however, have had some ethical questions about this procedure - a procedure that is carried out on male infants only for ritual or "cosmetic" reasons.  I wonder how many of us who approve of ritual circumcisions would support the procedure if there were no religious issue.  How many physicians would consent to performing a circumcision if the reason were purely for "cosmetic" reasons?  How many of us would support infant circumcision under such circumstances?

If we support ritual circumcision for males, then it is incongruous not to support ritual female circumcision  Yet we regard this procedure as a form of genital mutilation.  Why?  Because it is generally carried out under non-sterile conditions in backward areas of developing societies, and performed without the girl's consent. Would we change our minds and support some innocuous form of female circumcision, carried out under sterile conditions, if such a procedure were implemented?

It is also extremely important that the Academy's statement be analyzed very carefully before using health as a "reason" or "excuse" for male circumcision.  Note the highlighted paragraph above.  Though the benefits outweigh the risks, they are "not great enough to recommend routine circumcision....."

Now let's discuss some statistics.  Let us assume that there are 500 infant males who are circumcised by the same person using the same technique; then compare them with 500 perfectly matched infant males who are not circumcised.  In the first group 1 boy develops a complication.  In the second group none develop complications, but 3 go on to eventually develop AIDS.  So, in fact, three times as many non-circumcised boys v. circumcised boys went on to have issues.  But.....we are still talking about an extremely low number of problems, whether circumcised or not circumcised.  Remember - of the first group of 500, 499 did well, and of the second 500, 497 did well!  In such a statistical situation, the health benefits are minimal.  And remember that AIDS is a preventable disease - and that  AIDS "prevented by male circumcision" is only the heterosexually transmitted (mostly African) form and not the homosexually (mostly American) transmitted form!

From an entirely "neutral" point of view - a person completely unaware of ritual tradition would most likely regard circumcision as a rather barbaric procedure - the painful removal of the male foreskin for no clear indication.  If a parent, for no reason other than "I want him/her to have it," insisted that a small permanent tattoo be inserted in the skin of her infant, I doubt that many of us would support her wish.

It is very important that those supporting ritual circumcision realize that the only clear reason is traditional.  One cannot rationalize one's choice by importing "health" in this decision process.  This argument (especially in a country like the United States) fails completely.

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