Tuesday, August 28, 2012

Circumcision the AAP and some data....

Your usual Feckblog post. The reason I am chiming in is this current development:

American Academy of Pediatrics - POLICY STATEMENT Circumcision Policy Statement - 2012

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. [...]

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

Sigh...before we continue with the above, some data on health benefits:


1. Urinary Tract Infection (UTI)

The AAP estimates that noncircumcision means a four- to ten-fold increase in risk during the first year of life. However, the actual incidence of UTI is low, even for uncircumcised boys. According to the AAP, at most approximately one percent (1 out of 100) of uncircumcised males contract UTI during their first year. Since publication of the Task Force's report, a new study reports that among uncircumcised boys, the actual incidence of UTI is 2.15 percent. But even if this new statistic is correct, less than 3 out of every 100 uncircumcised males will contract UTI, and most who do can be easily treated with antibiotics.

2. Penile Cancer

[W]hile penile cancer is serious, it is also exceedingly rare, even for uncircumcised men. [...M]ost cases of penile cancer occur in uncircumcised males, who have an incidence rate of 2.2 per 100,000.

3. HIV

The connection between HIV and circumcision has not been heavily studied in the United States. [...] The only random population study conducted in the United States found no correlation between circumcision status and the rate of HIV. What is undoubtedly true is that behavioral factors are "far more important risk factors in the acquisition of HIV infection than circumcision status." The United States itself illustrates this point: it has both the highest rate of circumcision and the highest rate of HIV infection in the Western world.

4. Other Sexually Transmitted Diseases (STDs)

If circumcision makes a difference, it is probably for reasons that are similar to why noncircumcision is a risk factor for HIV: the moist environment under the foreskin and the susceptibility of particular cells in the foreskin. In addition, the foreskin may be prone to small abrasions during intercourse, which would facilitate transmission of STDs. Importantly, as with HIV, behavioral factors are far more significant than circumcision status in determining whether a person contracts an STD. Again, the United States has both the highest rate of circumcision and the highest rate of STDs in the Western world.

5. Cervical Cancer

In sum, more research needs to be done before prevention of cervical cancer can be added to the list of circumcision's potential health benefits. But because of the issue of distributional fairness, as well as the dubiousness of the parent's ability to consent to circumcision when its purpose is to benefit adult women, we should view with caution any argument that promotes the prevention of cervical cancer as a justification for routine circumcision.

Let me summarize the health benefits of circumcision for you: It helps with 2 rare medical problems, UTIs and Penile Cancer. With HIV and STDs, behavior is far more important (the US has the highest rates of circumcision and STDs in the western world). Cervical Cancer / HPV....there is a vaccine for that:

In 2010, 49% of teenage girls in the US got the HPV vaccine, while in comparison around two-thirds of teens have gotten shots for meningitis and DPT vaccine.

Not even talking about complications here or other negative effects of circumcision. It just seems the argument for medical benefits does not have much meat. The AAP says:

It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.

This however does not really matter as circumcision in the USA is not about health benefits.

From the Waldeck paper:

If routine circumcision is not medically recommended, is painful, and carries the risk of complications, why do more than 65 percent of American parents choose to do it? While there is no simple answer to this question, the existing social science research shows that the procedure is highly path dependent: in large part, parents circumcise because their parents did it and because their peers are doing it. Indeed, surveys of parental decisionmaking reveal that the single most prominent factor is usually what researchers term "social concerns," that is, the desire for the boy to look like his peers or his father. With regard to the former, parents worry that a boy whose penis is different from others will be ridiculed by his schoolmates, or that his sex life will be negatively affected in later years. In other words, parents perceive that the presence or absence of a foreskin is a basis for what McAdams describes as esteem-based sanctions. And there is room here for Posner's signaling theory as well. With no medical reason for the procedure, the circumcision decision is wholly arbitrary and an opportunity to signal a "good type."

Another study I came across:

Factors Affecting the Circumcision Decision - Jeffrey D. Tiemstra MD - 1999

Although this study is clearly limited by the small and heterogenous sample, the findings are consistent with those from studies from 15 years ago, which showed that (1) that the circumcision decision is most often made before parents discuss the issue with their care providers, (2) that social concerns are more important than medical ones, and (3) that providers' discussions have limited impact on the decision made. Medical benefits were cited more frequently in this study than in past studies, although medical issues remain secondary to hygience and convenience. Given the limitations of this study, the minor increase in parents citing medical issues might or might not be important. The study design could have contributed to this finding as well, because the mere presence of this item on the survey could have prompted parents to choose it. [...] In summary, then, this study suggests that parents continue to have preformed decisions regarding circumcision based primarily on non-medical concerns, which are unlikely to be changed by attempting neutral discussion of the relative risks and benefits.

There was one thing that was missing from all of this and it can be said in one short sentence:

It is his body, it should be his choice.

1 comment:

  1. They brand men like a herd of cows. 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, my friends.

    Top Ten Tortures Less Painful Than Circumcision

    10. Get knocked out by Mohammed Ali.
    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