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232 thoughts on “Circumcision: What Does Science Say?

  1. Harriet Hall says:

    I do wish Harriet would just address studies that people believe prove their anti-circumcision position and say why she doesn’t think so since this blog is theoretically about the science

    There are a lot of studies out there, and they contradict each other. I’m not about to get into a study-citing pissing contest. The point is that no one study nor selected group of studies can “prove” the anti-circumcision position. One needs to look at the entire body of published studies and see where the weight of evidence lies. I tried to do that, and numerous medical organizations like the AAP have also tried to do that. We all reached similar conclusions.

    We may all be wrong, and if we are, the scientific process will continue to work and the weight of evidence will shift and our provisional conclusions will change. Meanwhile I stand by my assessment of the current state of the evidence.

  2. Fifi says:

    Dr Hall, I am not asking you to change your opinion. I was just hoping you’d actually say why you think particular studies aren’t valid so I (and others who may be interested) could understand why you feel they’re invalid from a scientific standpoint. Particularly because you link to a pro-circumcision site as your source of information, and then simply ridiculed people who are anti-circumcision, which doesn’t really seem to be weighing the evidence but rather making fun of people (even if their suffering is merely a manifestation of neurosis that hardly seems very kind).

    I do understand that you feel that the AAP backs up your opinion on the matter but it does seem that medical and pediatric boards in other countries like Canada and Australia have taken a less neutral stance. This appeal to authority certainly gives me pause, not because I have any disrespect for you, your experience or knowledge, but because I have a greater respect for medical associations in countries where medical practices aren’t tied to profit in the same way and public sexual health issues are dealt with as health issues not ways to impose religious morality on people (which is not to deny that political considerations can come into play, as they can anywhere).

  3. Consult says:

    “There are a lot of studies out there, and they contradict each other. I’m not about to get into a study-citing pissing contest. The point is that no one study nor selected group of studies can “prove” the anti-circumcision position. One needs to look at the entire body of published studies and see where the weight of evidence lies. I tried to do that, and numerous medical organizations like the AAP have also tried to do that. We all reached similar conclusions.”

    So, you seem to believe that studies need not be subjected to a scientifically-credible analysis to determine scientific validity–in essence, science should not enter into the process of evaluation? That science should be discarded simply beause there exist conflicting studies? And that the requirement for fulfillment of predicition is unnecessary?

    Since you like to cite the OPINION of the AAP. perhaps you can provide scientific evidence to support their OPINION? So far I have seen NONE!
    And they certainly have not- since they must fall back on non-medical excuses like religion and culture to try to justify it.
    This in itself is interesting since they are a MEDICAL body and not a religious nor a cultuural body and have NO authority to make such pronouncements.

    “We may all be wrong, and if we are, the scientific process will continue to work and the weight of evidence will shift and our provisional conclusions will change. Meanwhile I stand by my assessment of the current state of the evidence.”

    Sorry, but the circumcision benefit hypothesis cannot fulfill it’s predicitions,yet you continue to believe that your (uncritical) assessment) carries more weight than the scientific process? An interesting take on the scientific process-to say the least!

  4. Consult says:

    Today is one for those days where I am in a reflective mood. I went back and looked at Harriet Hall’s original article. She claims to be neutral.
    It may be my imagination, but it seemed to me that her assertions were almost all pro-circumcision. There were no anti-circumcision assertions. The closest she got to any was to present some allegations which she proceded to trivialize, minimize, or just dismiss outright or deride.

    If I am mistaken, perhaps Harriet Hall can point out where she presents a single anti-circ assertion which she has not trivialized, minimized, dismissed, or derided.

    Things don’t seem to be going too well for her position, so, as per a trend I have seen in the past, I expect that shortly this forum will be closed. Anyone wish to offer odds on this?

  5. Joe1 says:

    I do understand that you feel that the AAP backs up your opinion on the matter but it does seem that medical and pediatric boards in other countries like Canada and Australia have taken a less neutral stance.

    This is true and, in fact, medical communities and organizations in countries where circumcision is essentially unheard of have even more scathing opinions, when they bother to even discuss it. The Central Union for Child Welfare (Lastensuojelun Keskusliitto) fore example has issued a strong statement saying:

    The Central Union for Child Welfare considers that circumcision of boys that violates the personal integrity of the boys is not acceptable unless it is done for medical reasons to treat an illness. The basis for the measures of a society must be an unconditional respect for the bodily integrity of an under-aged person.

    Circumcision intervenes in the sexual integrity of a male child causing a permanent change in organisms and has consequences pertaining to both health and quality of life.

    The circumcision of girls is rightly considered as inhuman mutilation of the genitals and is punished abuse. Also boys must be guaranteed a similar protection by law.

    According to the opinion of the Central Union for Child Welfare in Finland nobody has the right, on behalf of the child, to consent to operation, violating the bodily integrity of the child, if it is not done to treat an illness.

    Circumcision can only be allowed to independent major persons, both women and men, after it has been ascertained that the person in question wants it of his or her own free will and he or she has not been subjected to pressure.

    Helsinki 25.8.2003

    Hell, the Australians are even looking at a ban on circumcision.

    The better question is how can a Dr. ethically justify an invasive procedure that is not therapeutic in a proxy consent situation. Where then are the boundaries? If an immigrant family came to a Dr. saying, “In our culture it is customary to cut off the bottom part of a babies ear lobes.” Would the Dr. do it? And if so, what might happen to the Dr. when some independent person notices that disfigurement. I suspect CPS would be quickly involved even if this was a cultural or religious requirement. Circumcision is essentially the same thing and if we imagine a world where it was previously unheard of, had no ties to someones culture or religion, no one would entertain the ridiculous notion to perform it on an infant or child.

  6. Harriet Hall says:

    I’m not saying any study is invalid. I’m saying that when studies contradict each other, we have to look at the weight of evidence on both sides. That is part of the scientific process, not (as Consult seems to think) a rejection of science.

    Your statement that I depended on an anti-circumcision site for my information is inaccurate and unfair. I took advantage of its handy compilation of 660 references in one place, but I also cited other sources including original articles, meta-analyses, and the American Cancer Society.

    I’m sorry you think I was ridiculing sick people by telling men to stop obsessing over something that can’t be changed. I can certainly feel sorry for those people, but it does them no good to keep ruminating over their lost foreskins. A little tough love is in order. I would say “get over it” just as readily to a woman who had had a hysterectomy and was making her life miserable by obsessing over her loss. I would not “just” say get over it: I would offer understanding, positive suggestions, and counselling.

    The organizations that are anti-circumcision are anti- on ethical grounds, not strictly medical ones.

    There is one very good argument against neonatal circumcision: it involves an elective procedure without the consent of the patient. If people would stick to that argument instead of cherry-picking the scientific evidence, they would be more credible. It is possible to admit that there is a small health benefit and still say the benefit is so small that it doesn’t outweigh the risks and the ethical considerations.

  7. Consult says:

    “I’m not saying any study is invalid. I’m saying that when studies contradict each other, we have to look at the weight of evidence on both sides. That is part of the scientific process, not (as Consult seems to think) a rejection of science.”

    IF you did a critical analysis, then you could say that such and such study is invalid, but it seems this beyond either your ability or comprehension.

    The weight of the evidence depends SOLELY on the validity of that information–not OPINIONS nor consensus. When there is a contradiction, one should only cite that information that is scientifically credible. Not to follow this is really the rejection of science. You seem to be confusing medicine with science. Science has rigid requirement, medicine only requires OPINIONS and beliefs.

    Did you even bother to read that piece on scientific requirements–the one about the necessity for fulfillment of predicition? Are you now prepared to present a alleged benefit that IS able to fullfill this requirement?

    “Your statement that I depended on an anti-circumcision site for my information is inaccurate and unfair. I took advantage of its handy compilation of 660 references in one place, but I also cited other sources including original articles, meta-analyses, and the American Cancer Society.”

    Really, then why did you not include those studies that debunk your conclusions…(you have been given many) Prove me wrong by providing ONE SINGLE purely negative piece of information in your article.
    And if the ACS has stated that circumcision has no bearing on penile cancer, why did you bring it up?
    A meta-anlysis is only valid when the original information is critically analyzed. Collecting and doing a metanalysis of invalid information is less than useless.

    “I’m sorry you think I was ridiculing sick people by telling men to stop obsessing over something that can’t be changed. I can certainly feel sorry for those people, but it does them no good to keep ruminating over their lost foreskins. A little tough love is in order. I would say “get over it” just as readily to a woman who had had a hysterectomy and was making her life miserable by obsessing over her loss. I would not “just” say get over it: I would offer understanding, positive suggestions, and counselling.

    Oh give me a break, would your sympathy also apply if the women had a unnecessary and cosmetic hysterectomy?

    And now men who regret losing the most sensitive part of their genitals are “sick”?? This is nothing more than the tired old “blame the victim” mentality. I believe that the sickness of needing to amputate normal, healthy, functioning foreskins shows a greater sickness.

    “The organizations that are anti-circumcision are anti- on ethical grounds, not strictly medical ones.”

    Gee another assertion that will likely be put forqward with no substantaiating evidence–something you seem to delight in.

    “There is one very good argument against neonatal circumcision: it involves an elective procedure without the consent of the patient. If people would stick to that argument instead of cherry-picking the scientific evidence, they would be more credible. It is possible to admit that there is a small health benefit and still say the benefit is so small that it doesn’t outweigh the risks and the ethical considerations.”

    This concept of cherry-picking coming from you is humorous since all you have provided seems to be cherry-picked. Can you show a single circumcision negative piece of information in your article? These exist in abundance.

    ANYTHING is possible, but since you have not provided any PROVEN benefit, I think it would be wiser to think of probabilities. It is POSSIBLE that a meteor will hit NYC in the next ten minutes, but the probability is so small as to seem ridiculous. IF these are possible, please show from actual stats that ANY of these exist in the real world, or have ever existed.

    BTW, when can we expect you to comment on the REAL risks for circumcision?

  8. Consult says:

    “I’m not saying any study is invalid. ”

    Why not? What did you fail to understand about this BASIC scientific requirement:

    Any conclusion based on known flawed data cannot be considered valid.

    Or do you choose to believe against all evidence that your studies have no known flaws?

  9. Harriet Hall says:

    I didn’t go into details about the risks of circumcision in my article. I’ll elaborate here. I’m not going to try to list all the studies, but you can go to PubMed and look for yourself and make up your own mind.

    You can find any rate of complications you want, from 0 to 55%. The most common reported rates are in the 2% or less range. In one study of circumcisions done in the home by non-doctors in a developing country, the complication rate was 2.3%, mostly consisting of infections that were easily controlled by local wound care. A systematic review of studies in South Africa showed complication rates from 0% to 50.1% – the 50.1% was in a series of patients with hemophilia! Minor complications are reported in 2.4% of circumcisions done with the Plastibell device.

    When “complications” are listed, it’s important to understand how complications are defined. In one study over half the reported complications consisted of “redundant foreskin” – in other words, the circumciser didn’t do a thorough enough job. In another study over half the complications consisted of bleeding during the procedure, bleeding that was easily controlled with pressure. I must say it’s practically impossible for bleeding to occur if proper technique is used with the Plastibell procedure.

    It is easy to find reports of devastating complications of circumcision including amputation of the penis and even death, but these are extremely rare with good technique. The most famous was the case of John Money’s patient who was raised as a girl – in that case it was due to an accident with an electrocautery device; there is no reason to use such a device.

    Meatal stenosis and meatal ulcers can be late complications of circumcision that may not be considered in some of these studies. Careful hygiene (prompt diaper changes, etc.) would probably prevent at least some of these cases. The incidence of meatal stenosis in circumcised males has been variously estimated at anywhere from 0.9% to 11%, but it also occurs in uncircumcised males. In a recent UK study of home dilation as an alternative to surgical treatment, 17 out of the 18 cases of meatal stenosis were due to causes other than circumcision. It is easily treated by surgery if dilation is ineffective.

    This study from 2000 looks like a reasonably fair assessment of early complications: http://www.sciencedaily.com/releases/2000/01/000111074855.htm The authors concluded that one in 500 circumcised children may suffer a complication, and one in 100 children may derive a benefit. 230 out of the 285 complications consisted of intraoperative bleeding which was easily controlled.

    I don’t know why I bother, because those of you who are biased against circumcision will choose your own studies and find reasons to reject everything I say.

    After all this, I still don’t know what I would choose to do if I had a boy baby. If that doesn’t qualify me as neutral, I guess nothing could.

  10. Joe1 says:

    I must say it’s practically impossible for bleeding to occur if proper technique is used with the Plastibell procedure.

    It is easy to find reports of devastating complications of circumcision including amputation of the penis and even death, but these are extremely rare with good technique.

    Ah yes, if the job is done right, “proper technique” little consolation especially to the boy who suffers one of those more serious consequences, isn’t it? Especially for a procedure which has no significant benefit and is not medically therapeutic. In fact, the boy you speak of, Money’s little project, eventually committed suicide about five years ago if I recall.

  11. Consult says:

    One can play games by choosing what one wishes to call a complication.

    But the comprehensive definition is:
    A complication is ANY adverse outcome. And since circumcision is an unnecessary procedure, ANY complication is uncalled for–whether operator error or other causes.
    This includes the loss of the penile nerves and the resulting loss of sensation and sensitivity and the rate of that is 100%.

    “I must say it’s practically impossible for bleeding to occur if proper technique is used with the Plastibell procedure.”

    Impossible? so why does it occur so often?–operator error is no excuse since one cannot eliminate operator error in any procedure–s*** happens!

    So bleeding is the ONLY complication for the plastibel? I don’t think so..

    http://www.medscape.com/content/2004/00/48/41/484130/484130_fig.html

    Figure 3. (A) Petechiae. Infant with an infected plastibell circumcision; the responsible organism was Group B streptococcus. Note the scattered petechiae surrounding the penis and extending upward to the periumbilical area. Photo courtesy of Dr. William Edwards, the Children’s Hospital at Dartmouth. (B) Purpura. Note the area of small hemorrhages on the right leg of this infant compared to the petechiae (minute, pinpoint-sized hemorrhages) in Figure 3A. Purpura is often associated with decreased platelet counts.

    &

    http://www.cirp.org/library/complications/woodside2/

    &

    http://www.cirp.org/library/complications/bliss/

    “This study from 2000 looks like a reasonably fair assessment of early complications: http://www.sciencedaily.com/releases/2000/01/000111074855.htm The authors concluded that one in 500 circumcised children may suffer a complication, and one in 100 children may derive a benefit. 230 out of the 285 complications consisted of intraoperative bleeding which was easily controlled.”

    THIS is a study you believe is valid? Let’s look at thsi study it’s origins and it’s methodology and conclusion.

    Reason for the study (author’s own words):

    “Christakis said the study was prompted by the influential American Academy of Pediatrics’ announcement last year that it no longer recommended routine circumcision because of questionable benefits and medical and anecdotal evidence that circumcised men have less penile sensitivity.”
    BUT he never addressed the issue of penile sensitivity–then jumped off onto alleged reasons for circumcsision.

    Methodology:

    This is nothing more than a retrospective examination of hospital records. No babies were actually examined, no parents were interviewed.

    Babies usually are discharged within a few hours of their circumcision, so such a study cannot identify the complications that arise later. Meatitis, meatal ulceration, and meatal stenosis are common complaints of circumcised boys who have lost the protection of their prepuce. Other complaints common in circumcised boys are adhesions, skin bridges and skin tags. Later in life such complications as painful erections, sexual difficulties, psychological problems emerge. So the reality has to be much worse than this report.

    The number of complications experienced by circumcised boys was 20 times greater than that experienced by intact boys.

    The report states:

    “Results. Of 354 297 male infants born during the study period, 130 475 (37%) were circumcised during their newborn stay.
    Overall 287 (.2%) of circumcised children and 33 (.01%) of uncircumcised children had complications potentially associated with circumcision coded as a discharge diagnosis.”

    Conclusions:
    the risk rate is ~ 1 in 500
    BUT in the suthors own words

    The authors claim a benefit, where do the authors offer any scientifically-credible evidence of any benefit

    “The research team reported in a supplement to Tuesday’s Pediatrics that 287 of the boys, or one in every 476, had complications related to the procedure. The most common complications were bleeding during the operation and damage to the penis requiring further treatment. The team’s estimate is very conservative, Christakis said, because **** it does not include common complications, such as infections, that develop after children leave the hospital.”***

    In other words, fatally flawed! And we know that a conclusion based on flawed data cannot be considered valid!

    “I don’t know why I bother, because those of you who are biased against circumcision will choose your own studies and find reasons to reject everything I say.”

    You should bother because you brought up the subject in a forum that is supposed to be science-based, and you need to scientifically support it–or admit that there is no acceptable medical reason for doing it…the choice is up to you.

    And please don’t confuse refuting with rejecting. It is YOU that rejects my studies but fails to refute them.

    BTW, are you just going to ignore these rates? if so, WHY?

    1. iatrogenic Phimosis 2.9%

    2. Adhesions 71%

    3. Meatal ulcers 31%

    3. Meatal stenosis 8%

    4. infection up to 10%

    5. Bleeding <35%

    ALL of these are adverse and unnecessary.

    Now we can go on and discuss catastrophic complications if you wish, but we have to keep in mind that ALL of them were due to an unnecessary procedure..then we have to ask–would these be acceptable for any other unnecessary procedure forced onto an infant?

  12. Harriet Hall says:

    I was asked what I thought was a legitimate scientific question about the true rate of complications but there was no point in my answering it because the anti-circumcision people won’t accept “any” risk and they won’t admit that there could possibly be “any” benefit. And they expect me to accept the studies they cite but they won’t accept “any” evidence that I find.

    As I said before, you would be a lot more credible if you acknowledged the evidence for a small benefit and stuck to the very valid ethical arguments. I gave my evaluation of the existing evidence in my article and I stand by it. I’ll leave the emotion and the ethical battles to the rest of you. Signing off…

  13. Skeptic says:

    I’ll say it once more: the evidence shows a small benefit and a small risk from circumcision. It is not medically indicated but it is not medically contraindicated either.

    I believe you are still dodging the question of whether circumcision meets the ordinary standard of care for pediatrics, as cited by BDwyer:

    The standard of care used for all other pediatric surgery requires the medical benefits of the surgery to far outweigh the risks and harms of the surgery or for the surgery to correct a congenital abnormality.

    I have yet to see anyone demonstrate that circumcision meets this standard. If we remove the cultural bias from the equation, clearly the non-indicated surgical mutilation of children is not acceptable. We wouldn’t consider it ethical to surgically remove other body parts or tissue without medical indication, so it can’t be objectively said that circumcision is ethical by the ordinary standard of care for pediatrics.

    While you have repeatedly claimed not to be “pro circumcision” your spurious analogies to the non-analgous practice of infant ear piercing seem to suggest otherwise.

  14. yeahsurewhatever says:

    To remove gender bias, take any arguments you read for or against foreskin amputation and parse them as if they were about clitoral hood amputation. For (very nearly) all arguments on either side where it would make a difference, discard them.

    In reference to the ethical question of performing medically unnecessary surgery on an infant who can’t consent to it: would you give an infant cosmetic rhinoplasty if the parents asked for it and the infant was not deformed in appearance? Are infants generally acceptable recipients of cosmetic surgery based on the whims of the parents? Under what circumstances does it become child abuse?

  15. Consult says:

    “I was asked what I thought was a legitimate scientific question about the true rate of complications but there was no point in my answering it because the anti-circumcision people won’t accept “any” risk”

    You forgot the word “unnecessary”..that posits the fundamental question IS ANY risk from an unnecessary procedure acceptable?

    ” and they won’t admit that there could possibly be “any” benefit. And they expect me to accept the studies they cite but they won’t accept “any” evidence that I find. ”

    I don’t accept something without proof–”possible” without being probable hardly justifies a harmful and unnecessary procedure forced onto infants. All evidence you have posted have been refuted?

    “As I said before, you would be a lot more credible if you acknowledged the evidence for a small benefit and stuck to the very valid ethical arguments.”

    Glady IF you would present us scientifically-credible evidence for them–but you have not. And if YOU presented any ethical arguments instead of ignoring the ethical questions asked of you many times by skeptic and others. Evasion is hardly credible.

    ” I gave my evaluation of the existing evidence in my article and I stand by it. I’ll leave the emotion and the ethical battles to the rest of you. Signing off…”

    You stand by something you cannot support by science and then claim OTHERS are emotional? How interesting.

    This discussion is not about what you choose to believe–it is about science-based medicine. It is not about merely posting cherry-picked information from a rabidly procirc site and then trying to claim neutrality.

    Not to worry, those remaining will likely continue to discuss the science (or the lack thereof) behind circumcision –to see IF circumcision can be ethically justified.

  16. Fifi says:

    Personally I don’t see anyone here actually backing up their position and opinion with science (or really offering more than an opinion – be that myself, Dr Hall or those who seem to be quite dedicated anti-circumcision activists who are on this blog specifically because there was a post about circumcision). I see everyone claiming that their position is validated by science but so far no one has used the evidence to prove it through debate and weighing the evidence – apart from going through the motions but cherry picking the studies that support their personal beliefs mixed in with appeals to larger authorities that share their opinions. (I make no exception for myself – however I’m not claiming I have no bias and am going purely by the science, child welfare is always an issue of ethics for me.)

    Dr Hall – You say you’ll change your opinion when the scientific evidence is overwhelming but isn’t that a bit hard to do if we only give weight to the evidence that supports one’s position? Or if we refuse to ackowledge that we tend to have a bias due to having personally engaged in an activity (once again, there aren’t many people who don’t have some sort of bias or personal connection to either cut or uncut penises). There seems to be a pretty large consensus from medical organizations in other nations of European origin that seems quite different than in the US. This could well be due to political or social considerations as well as being evidence based decisions, but the country where religion as politics has the biggest influence over medicine of all these nations is the US so it seems odd to me to assume every other medical organization is being influenced by politics/religion but the US isn’t!

  17. KristinMH says:

    I’ve always wondered why this was such a hot-button issue – here’s my theory:

    http://ihasahotdog.com/2008/06/21/funny-dog-pictures-you-are-infatuated-with-your-weiner/

    IMO, I don’t think you can make the argument that circumcision is just like FGM. Clitoridectomy DESTROYS sexual response; some people think male circumcision slightly impairs sexual response. Equating the two is just shows how obssessed some men are with their genitals.

    I’m with Harriet; acknowledge the real but slight medical benefits, and make the real and significant ethical argument.

  18. Joe1 says:

    IMO, I don’t think you can make the argument that circumcision is just like FGM. Clitoridectomy DESTROYS sexual response; some people think male circumcision slightly impairs sexual response. Equating the two is just shows how obssessed some men are with their genitals.

    I disagree. I think this is only the case if, when thinking about FGM, you only consider the worst situations. FGM in fact covers a rage of procedures some less damaging some more damaging. So when FGM is bounded half the types are either less than or equal to circumcision yet we outlaw all types of FGM and that is hypocritical.

  19. Consult says:

    “IMO, I don’t think you can make the argument that circumcision is just like FGM. Clitoridectomy DESTROYS sexual response; some people think male circumcision slightly impairs sexual response. Equating the two is just shows how obssessed some men are with their genitals. ”

    Really? Perhaps you didn’t see the posting above that circumcised women are not adversely affected sexually.

    Or how about this one:

    Female circumcision does not reduce sexual activity 12:30 24 September 02
    NewScientist.com news service

    Circumcised women experience sexual arousal and orgasm as frequently as uncircumcised women, according to a study in Nigeria.

    The researchers also found no difference in the frequency of intercourse or age of first sexual experience between the two groups of women. These findings remove key arguments used to defend the practice, they say.

    Friday Okonofua and colleagues at the Women’s Health and Action Research Centre in Benin City studied 1836 women, 45 per cent of whom had been circumcised.

    During the operation, all or part of the clitoris and the labia are removed. Proponents of female circumcision claim it makes virginity at marriage and marital fidelity more likely. Opponents condemn it as dangerous and painful.

    The women filled in questionnaires, asking about their sexual history. The results show “female genital cutting cannot be justified by arguments that suggest it reduces sexual activity in women,” write the team in BJOG: An International Journal of Obstetrics and Gynaecology.

    “Slightly impairs male sexual response”? Is the loss of 3/4 of the sensation and sensitivivity a “slight impairment?

    BTW, perhaps you did not know there are many kinds and degree of FGM –just as there are for MGM–and for every kind of FGM, there is a more severe and harmful kind of MGM?

    Since you agree with Harriet, perhaps YOU can provide scientific evidence of “benefit” since she has so far failed to provide any?

  20. Fifi says:

    KristinMH – You are, of course, entitled to your opinion…as are we all (it’s just none of our opinions, whether we’re in agreement or not, are anything more than opinions). Just to be clear, my personal opinion is it’s an ethically and medically questionable activity to be modifiying a male OR female baby’s genitals based on the aesthetic or religious desires of the parents. (And the issue of the genital modification of intersex babies is an even more complex issue involving cultural expectations, bodily integrity, nature vs culture and personal choice/individual rights.)

    No medical association (including even in the US) actually recommends male circumcision as a health measure – they used to so clearly the cost/benefit ratio as determined on the evidence continues to contain increasing potential cost next to decreasing potential benefit. This means that circumcisions are no long routine or standard medical procedure where they once used to be recommended. (This indicates that as the scientific understanding evolves and new evidence comes in we’re moving further and further away from considering male circumcision to be ethical in light of the evidence, the US seems to be quite far behind nations that don’t mix up religion in their sexual health policies.)

    Of course a clitorectomy destroys clitoral sexual response, removing the clitoral hood would change sexual responsiveness too but not destroy it. Just like there are a number of different types of male genital modification/mutilation, there are different types of female genital modification/mutilation. Even women who’ve had their clitoris removed still have vaginal sexual response available so it doesn’t destroy all potential for sexual gratification (not that this in any way justifies the practice). Would you be okay with the removal of the clitoral hood or labia minora but just not the whole clitoris? Do you think you may experience a change in clitoral sensitivity if the protective hood and inner labia were removed?

    As a woman, I certainly have more of an sympathetic and visceral response to the idea of a girl’s genitals being modified than I do a boys. I can extend that to having emotional empathy for a man but my sympathetic physical response, my visceral response, is related to the experience of my own body. Historically women’s concerns about our bodies and health have more often than not been dismissed by male doctors who just didn’t think female sexual pleasure is important and often ignored self reporting by women – dismissing it as being hysterical and emotional. I see the same thing happening here to men who aren’t conforming to the cultural expectations of both some women and some other men. I don’t actually see any real discussion of science or evidence – from any quarter – that isn’t just an affirmation of a pre-existing bias. I’m clear of what my personal bias happens to be and why but that doesn’t mean I hold a black/white position on the matter (quite the opposite, I think the complexity needs to be addressed and there’s lots of variables and gray areas).

  21. Fifi says:

    Consult wrote – “Women filled in questionnaires, asking about their sexual history. The results show “female genital cutting cannot be justified by arguments that suggest it reduces sexual activity in women,” write the team in BJOG: An International Journal of Obstetrics and Gynaecology.”

    This is a misrepresentation of what is being said in the study. Sexual ACTIVITY is not the same as sexual PLEASURE. One can be very sexually active and derive no sexual pleasure from the activity at all.

    One of the justifications for FGM is that it stops women from desiring and having extra marital affairs, it stops them from “straying”. Essentially, in some ways, the idea is not unlike that of making men eunichs to guard harems – if one removes the capacity for sexual enjoyment then the impetus to have sex for enjoyment is removed. (Of course, people have sex and romantic affairs for reasons other than just genital stimulation and pleasure.)

    I’m sorry but misrepresenting this study does nothing to support your argument.

  22. Consult says:

    “This is a misrepresentation of what is being said in the study. Sexual ACTIVITY is not the same as sexual PLEASURE. One can be very sexually active and derive no sexual pleasure from the activity at all.”

    Fifi, what does this statement say to you as far as sexual pleasure? ARE arousal and orgasms divorced sexual pleasure?

    ” Circumcised women experience sexual arousal and orgasm as frequently as uncircumcised women, according to a study in Nigeria.”

  23. Fifi says:

    Consult – I’d suggest you consider that New Scientist actually has more articles that consider FGM to be dangerous and that Dr Okonofua has also conducted and contributed to studies that those articles are based upon which talk about the increased dangers women who’ve been genetically modified go through during childbirth (which, of course, are horribly confounded by giving birth in rural areas where medical treatment for complications in childbirth is not available).

    http://www.emmabonino.it/press/world/4134

    Here is the link to the article you refer to in New Scientist though it’s hard to know what the study really found since it’s not detailed so it’s hard to know just how valid and free from inbuilt bias it is (since Dr Okonofua seems to be trying to refute a justification FOR FGM. (And obviously the same argument can be made about not knowing what one is missing thereby making reports anecdotal and necessarily biased, pleasure is like pain in that it is very subjectively measured and there are also cultural aspects to the experience….as much as seemingly everyone would like this to be a simple issue all about hard facts and just dismiss the complexity of the cultural dimensions of pleasure, pain, gender and sex in all our, ahem, cultures…none of us exist within a cultural vaccuum and neither does medicine).

    http://www.newscientist.com/article/dn2837-female-circumcision-does-not-reduce-sexual-activity.html

  24. Fifi says:

    From the site you may or may not have gotten the New Scientist info from since you didn’t link to the source…
    “GM (like MGM) is a human rights outrage regardless of its effect on sex, if any.
    When FGM seems to have no effect on sexual response, this is seen as an argument not to do it, yet the self-same “fact” in the case of the male is used in the US as an argument for doing it. In fact, however, this result (like that of such work as has been done on the effect of MGM) is probably just an artifact of using too crude a measure of sexual response, ability to have intercourse and reach orgasm.
    Someone responded to the above article that a woman circumcised before puberty learns her erotic response with whatever erogenous tissue she is left, such as her nipples. (In the same way, paraplegics gain an inordinate sensitivity in the parts of their bodies still wired to their brains.) So it would be quite wrong to say that her sexual response was unchanged.
    While the quantity of women’s arousal and orgasm may be undiminished by FGM, the loss of erotic tissue inevitably degrades its quality.
    It may be true that most sexual activity happens in the brain, but the response of the brain depends on the quality of the stimulation it receives. All music appreciation happens in the brain too, but the quality of the music depends on the quality of the instruments as well as the performance.
    The same is true for circumcised men.”

    The link to the site for anyone who may want to check the context of where the information above comes from (it is from an anti-circumcision site).
    http://www.circumstitions.com/FGM-sex.html

  25. Consult says:

    There is a glaring double standard here.It is automatically assumed ((without any scientific evidence) by western cultures who do not perform it, that FGM diminishes female sexual sensation and pleasure.

    Yet, western cultures that circumcise demand concrete evidence of the same sexual sensation and pleasure loss for males. And even when this evidence is presented, they merely dismiss it offhand.

    This provides a striking example that unfounded propaganda can be so successful in spite of the lack of scientifically credible evidence.

    “Of course a clitorectomy destroys clitoral sexual response, removing the clitoral hood would change sexual responsiveness too but not destroy it.”

    And removal of the foreskin destroys the foreskin sexual response and changes sexual responsiveness, but not destroy ALL sexual response..now what should one assume other forms of MGM affects, changes/and or destroys certain sexual responses?

    “When FGM seems to have no effect on sexual response, this is seen as an argument not to do it, yet the self-same “fact” in the case of the male is used in the US as an argument for doing it. In fact, however, this result (like that of such work as has been done on the effect of MGM) is probably just an artifact of using too crude a measure of sexual response, ability to have intercourse and reach orgasm.”

    Too crude? Not for MGM

    http://www.cirp.org/library/anatomy/taylor/

    http://www.nocirc.org/touch-test/bju_6685.pdf

    And opposing this for FGM are OPINIONS..

    “While the quantity of women’s arousal and orgasm may be undiminished by FGM, the loss of erotic tissue inevitably degrades its quality.”

    An assumption we should also then apply to MGM?

  26. Fifi says:

    Consult – As someone who IS of the opinion that both male and female circumcision of babies is not in the babies’ best interests (and who HASN’T been dismissing loss of penile sensitivity in males), you’re starting to make me want to move to the other side of the argument just not to associated with the way you’re pretending to be motivated and interested in the actual science part of this discussion when it’s clear you also have an ideological bias that you refuse to acknowledge. People who can’t even acknowledge their subjectivity certainly aren’t in any position to be accusing others of being subjective or cherry picking their evidence to suit their beliefs. You keep claiming your position is objective, as does Dr Hall. From where I sit (a subjective perspective, of course), neither of you is actually being objective in the ways you’re claiming.

    And, with that, I too will leave this discussion since I can’t see it being particularly interesting or constructive continuing to talk with you and unfortunately Dr Hall didn’t want to do an analysis or respond to issues regarding how the evidence has been interpreted by medical associations in countries other than the US.

  27. Consult says:

    Fifi,
    You and Harriet Hall seem to believe that bias, culture, and/or religion can alter or even negate science. I disagree and think that I have refuted every aspect of that concept.
    Regardless of all the verbiage used to try to alter it, no one has provided any scientifically-credible evidence (using it’s basic and fundamental tenets) to support circumcision.

    And I have posited, that if there is none, then circumcision cannot be rationally justified. This is what lies at the root of the circumcision dilemma and this discussion…can it scientifically, and rationally be justified? I think not.

  28. Fifi says:

    Consult – No, that’s not what I believe and I’m getting a bit sick of you trying to mount me on your hobbyhorse. What I have said is that cultural bias (yours included) plays a role in people’s beliefs and what is considered acceptable or not. I’ve also said that personal bias plays a role in people’s opinions and beliefs regarding this issue. Additionally, I’ve been saying that what is and isn’t considered ethical or moral – what we can accept and rationalize or cannot accept nor rationalize – has a social and cultural aspect (in fact, ahem, studies show that even personal ethics is contigent upon context).

    Despite all your verbiage you haven’t provided conclusive evidence either. Despite all your accusations of bias you have yet to have the integrity to acknowledge your own bias or that of your sources. This failure to acknowledge or understand how your own biases (and those of your sources) influence your reading of the evidence is why all your claims to hold the scientific highground fall flat and are entirely unbelievable (since you clearly wouldn’t change your opinion based upon evidence). It’s quite telling that your beliefs are so black and white that you lump all people who disagree with you together as holding the opposite beliefs – even though in this instance Dr Hall and I disagree on many (if not all) aspects of this issue and hold quite different opinions. People who see the world in black and white are generally ideologues – this is particularly evident when someone argues their position without even bothering to discover where their “enemy” actually stands.

  29. Consult says:

    I love it when one reaches a conclusion based on the credible scientific evidence and defends that conclusion with the same evidence and then is accused of a bias..

    How can a scientific conclusion have a bias?

    As for evidence not being provided–what did you not understand about this CONCRETE scientific evidence?

    http://www.cirp.org/library/anatomy/taylor/

    http://www.nocirc.org/touch-test/bju_6685.pdf

    Can it be scientifically refuted?
    I doubt –and if it cannot, then how can any claim of bias, culture, or religion justify this unnecessary and harmful procedure? This is still the fundamental question that has not been answered let alone adequately addressed.

  30. Fifi says:

    Consult – All the evidence you present is directly from anti-circumcision sites so clearly that’s where you get all your info from. Your claims to have evaluated all the evidence when you’re simply reposting from a biased site are, once again, as hollow as your other claims that you’re not biased. It’s very clear you reject studies that don’t support your ideological belief and embrace ones that do – this is a clear indication of bias and attempt at an authoritarian use of science for ideological purposes. (Though I suspect that in your mind’s eye you see yourself as a radical freedom fighter who is the saint/martyr to what you consider Dr Hall’s evil authoritarian misuses of science for ideological reasons and because in her heart of hearts she really wants to destroy babies.)

    As I’ve already said, your inability to acknowledge your own bias and constant attempts to make science serve your ideology make attempting to discuss any aspect of this issue with you futile since you’re not actually open to discussion or weighing evidence but “proving” your own emotional and ideological perspective (which you won’t acknowledge is a perspective) on the matter.

  31. Fifi says:

    If you don’t understand how “scientific conclusions” can have bias (or can be proven to be entirely inaccurate at a later point) you clearly don’t understand much about science or why the scientific method was developed.

  32. Joe1 says:

    Fifi – To be fair although the articles linked by Consult are hosted by an ‘anti-circumcision’ site, both articles were published in the BJU and not simply random commentary. Though I don’t think that is what you’re implying I think it is important to make that point. From what I understand about the Taylor work, British Journal of Urology, Volume 77, Pages 291-295, February 1996, it was one of the first close examinations of the structure and possible functions of the foreskin. If that is true, it is quite a surprise that such an easily accessible structure was not studied closely until a little over 10 years ago. Indeed even today most American anatomy books make no mention of the foreskin. And if they do they simply say this is the part removed during circumcision. No discussion about it’s structures or possible functions. Now that’s biased.

    Similarly, Sorrells et al. is also a published work the link provided just happens to be hosted at an anti-circumcision site but that doesn’t change the work itself. I will also add that the funding for the research discussed in Sorrells et al was provide by NOCIRC and yes there is clear intent in the work to demonstrate that the foreskin is not simply redundant useless tissue. As I see it Sorrells does at least two things that haven’t been previously attempted (to my knowledge). First, they did try to objectively quantify the sensitivity of the penis in both circumcised and intact men. Second, unlike work before, and at least one subsequently, they actually included the foreskin as part of the measurement. The question then becomes how do you map their findings to people? I would say that greater sensitivity to fine touch proabably leads to a closer more intimate experience but then we are getting into the realm of subjectivity.

    Are there problems with those pieces? Possibly. I haven’t read the whole Taylor article yet and it would have been nicer to see a larger sample size in the Sorrells article. I guess my point is that just because they are hosted where they are doesn’t mean they should be dismissed out of hand. Plus I think that whether or not there is a loss is not entirely relevant as non-therapeutic circumcision of minors is just simply wrong ethically.

  33. Consult says:

    “If you don’t understand how “scientific conclusions” can have bias (or can be proven to be entirely inaccurate at a later point) you clearly don’t understand much about science or why the scientific method was developed.

    Ok, then try to find the bias in those slides in Taylor’s specimen box. No one has refuted his study and can never refute it..The empirical evidence is there for all to see. And empirical evidence is the strongest evidence in science.

    As for the Sorrel’s study, it was a blind study much like an audiometer hearing test..and objective. So instead of just trotting out the claim of bias, why not just actually read it and try to show where bias could be.

  34. Consult says:

    “Consult – All the evidence you present is directly from anti-circumcision sites so clearly that’s where you get all your info from.”

    And now all you need to show is that the site itself somehow has introduced bias into the studies themselves…Have they somehow altered the PUBLISHED and information?

  35. Fifi says:

    Consult – As noted before, the fact that you can’t even recognize their own potential bias makes your accusations that others are biased nothing more than a projection of your own unacknowledged bias. You clearly don’t understand what objective and subjective mean vis a vis science (or even in general apparently) if you’re claiming objectivity for yourself or a study.

    No scientific study is “objective” – studies merely try to control parameters and minimize variables. This is why context – such as who funded a study, double blind or not, where the results fit into the larger picture, etc – are so very important to MINIMIZE bias. This is why we rely upon accummulated bodies of evidence and not one study.

    The site’s bias comes from uncritically promoting and/or funding studies that support the site’s bias. The same goes from studies pulled from pro-circumcision sites. You only take your info from one source and disregard the other, that’s your bias in action.

    This is my last post to you since, at this point, I’m pretty sure you’re just trying to bang everyone over the head with your ideology for personal, emotional reasons. I’ve already said I’m against modifying babies’ genitals (I have no problem recognizing and owning my biases or being honest) yet you continue to try to convert me to your ideological position. It’s very clear that your aim is merely to use science to promote an ideology, so I see no point or reason to give legitimacy to farcical claims of objectivity and respect for evidence.

  36. Consult says:

    Fif, I am sorry that you cannot understand that it takes more than making a claim of bias to discredit or dismiss a study. In science, one needs to do a critical analysis of each study individually. If the study is found to survive this analysis and meet the basic requirements of science, then and only then can it be deemed valid–if not, then it is invalid–and no amount of empty claims of bias will alter that conclusion.

    Speaking of ideology, what prompts you to repeatedly try to dismiss studies under the pretext that objective evidence cannot exist without bias?

    Unless you can prove that who funded or posted a study has had an effect on the results of the study, your claims can hardly be deemed credible…merely making this claim of bias is insufficient.

    Please show that MY so-called bias in any way alters the scientific evidence? You make this claim over and over and still fail to address this fundamental question.

    My aim is, and always has been to try to help people to understand that science is logical process and when done properly is not subject to bias–you seem to believe that science cannot exist outside of subjective thought–yet that is precisely what science was created to do.

  37. Fifi says:

    I can now see why Dr Hall didn’t both interacting with Consult.

    Science is just a body of knowledge, some accurate and now some proven inaccurate. The scientific METHOD was developed after science as a body of knowldge and discipline had existed for quite a long time already. It was developed to MINIMIZE bias and to give as objective a measure as possible. Even when scientists are pretty damn sure something is correct, they never claim absolute knowledge.

    You’re very far off the mark of your stated aim, as shown by the fact that you repeatedly dismiss your own subjectivity and ideological bias, that you only link to studies presented on a pro-circumcision site (at least Dr Hall was open about the bias of her source).

    The fact that you think “science was created” rather than it being something that evolved shows just how little you understand science and the history of science. It’s like some ID version of the history of science!

  38. Fifi says:

    Joe1 – No, what site hosts a study doesn’t mean that a study is innately biased (though the bias of a site will lead them to not only cherry pick studies but to misrepresent the actual findings). The site Consult links to uses studies as propaganda – though the site doesn’t hide its bias or agenda so I don’t take issue with that. What I take issue with are Consult’s claims that he’s backed up by some form of omniscient infallable science and that his beliefs are evidence based not ideological beliefs. The very fact that he treats science as a religion shows that he greatly misunderstands both the process and discipline of science. Dr Hall, at least, said she may possibly be proven wrong at some point. Consult is trying to prop up his emotional position by appealing to and assuming for himself the authority of science. Science is a very useful tool to inform decision making but, as I’m sure you’ll know if you’re up on the science regarding human decision making, you’d be aware that decisions made on purely rational/logical grounds can be very inhumane and ethically unacceptable (and actually, if they’re entirely rational, put aside the rights and feelings of the individual for the survival of our species).

    My point is that Consult is clearly only getting his info from a site with a bias and claiming that the studies he presents are objective while those on a site that doesn’t support his ideological position are biased. It makes it pretty pointless to even start discussing science with him if he doesn’t understand the basics of bias and can’t acknowledge his own.

  39. Consult says:

    So,
    Lili, you cannot scientifically refute the study, so you fall back on repeating un unsupported claim of bias. You cannot show any impact by this bias, yet you keep repeating it as if it was a magic mantra to dimiss it.

    Could you prove that decisions made on rational grounds are inhumane.?. how is not deliberately causing unnecessary harm and damage to another person be inhumane? How would preventing a person from unnecessarily removing a normal, healthy, functioning, and very sensitive body part be INHUMANE. I thought it would be the opposite.

    Again, please show how MY bias has altered the scientifically-credible evidence.

    It all boils down to–can you prove any effect your alleged bias has affected the results of the two studies. if not, then why are repeating them without anything to support them? Does repetition make them any more credible?

  40. Consult says:

    “Science is just a body of knowledge, some accurate and now some proven inaccurate. The scientific METHOD was developed after science as a body of knowldge and discipline had existed for quite a long time already. It was developed to MINIMIZE bias and to give as objective a measure as possible. Even when scientists are pretty damn sure something is correct, they never claim absolute knowledge. ”

    Wrong, science is a PROCESS that enables us to gain knowledge–I don’t know how many times this must be repeated before it is understood…it is NOT the knowledge that derives from it., but the process itself.

    And yes, you are right, there is not absolute positive or negative proof–but there sure is a process to separate valid from invalid information–just use the basic tenets and requirements inherent in the process.

    Science is a process that was created, it evolved into a formalized structure by EFFORTS of those creating it–this did not occur without the efforts of it’s creators.

  41. Fifi says:

    Dude, you can keep huffing and puffing as much as you like but you’re clearly not interested in science but rather in making science subservient to your ideology. This makes discussing studies with you pointless. While I may hold a different position on this issue than Dr Hall, I can entirely understand why she’s been ignoring you.

  42. Fifi says:

    Science wasn’t “created”, it evolved out of a hodge-podge of things that included all kinds of things we now consider antithetical to science. In fact, a lot of pseudoscience is basically just discredited scientific ideas or medical practices that someone couldn’t let go.

    Seriously, you need to educate yourself about the neurobiology and psychology of decision making, as well as educate yourself about the history of medicine and science. If you did, you wouldn’t be making the kinds of claims you are about absolute knowledge and absolute objectivity and pretending they apply to science because you’d know exactly what that leads to….

  43. BDwyer says:

    Fifi,

    In my opinion you are making this more difficult than it needs to be.

    As a medical procedure, non-therapeutic circumcision of boys is a clear violation of the standard of care that is used for all other pediatric surgery.

    The standard of care for pediatric surgery requires the medical benefits of the surgery to far outweigh the risks and harms or for the surgery to correct a congenital abnormality.

    Dr. Hall could not cite any other surgery that doctors will perform on children that does not meet that standard of care. The only procedure she could cite was another form of permanent body modification, ear piercing.

    It would be easier for me to respect doctors who circumcise healthy boys if non-therapeutic circumcision were one of several surgical procedures that do not meet the standard of care for pediatric surgery. But non-therapeutic circumcision is not one of several exceptions. It is not even one of a few exceptions. It is the only exception to the standard of care that doctors use for all other pediatric surgery.

    The standard of care requires the medical benefits to far outweigh the risks and harms of the procedure. All of the professional medical organizations say the potential benefits of infant circumcision are about equal to the risks and harms.

    Thankfully younger doctors recognize the ethical problems with making a unique exception to the standard of care for pediatric surgery in order to accommodate form of permanent body modification motivated by culture and religion.

    Circumcision by Muslim and Jewish parents is a more difficult ethical issue. However Muslim and Jewish religious circumcision should not be used as a justification by doctors to violate the standard of care for pediatric surgery for non-Muslim and non-Jewish boys.

  44. Fifi says:

    BD Dwyer – Clearly it’s not as simple an issue as you and Consult would like to make it out to be. People motivated by ideology often try to dismiss complexity and make issues black/white to serve their desire to make the world suit their personal ideology. I find it strange that you align yourself with Consult yet you consider circumcision a different issue in cultures that have religious reasons and ones that don’t – it seems that your ethics are quite contingent and influenced by cultural context and NOT based in science.

  45. Harriet Hall says:

    I’ve bowed out of this discussion, but readers might be interested in what one of my co-bloggers had to say at http://scienceblogs.com/denialism/2008/11/why_male_circumcision_and_fema.php

  46. Joe1 says:

    Fifi – I appreciate your frustration. I am curious if you could elaborate on the point you made to BDDwyer. How is it not as simple as he describes? I see it in terms very much has he/she defined which can be summed up as, without a clear medically therapeutic need it should not be performed on a non-consenting individual.

    For the record, I don’t have the same reservations with regard to the religious significants. I also noticed, I think, that you are basically opposed to the procedure on ethical grounds too, is that right?

  47. BDwyer says:

    Fifi – I don’t think you are doing it, but in my opinion some people motivated ideology try to make this issue more complex than it really is to serve their personal cultural or religious agenda.

    For the record I don’t align myself with Consult. We agree that infant circumcision is not medically necessary, but I do not agree with all of Consult’s arguments, nor his or her style of debate.

    I believe that all children, both boys and girls, have a basic right to decide what permanent body modifications are done to their own body. In my opinion there needs to be a compelling reason to override an individual’s right to genital autonomy. Clearly there is no compelling medical reason to circumcise healthy boys. I do not find the cultural reasons in support of circumcision given by non-Muslim and non-Jewish parents to be compelling.

    However I acknowledge that many Muslim and Jewish parents feel that their religious beliefs are a compelling reason to circumcise their sons. I am willing to listen to their reasons why they think their religious beliefs as adults should take priority over their son’s right to genital autonomy. To date I have not found their arguments to be persuasive, but I am willing to consider their point of view.

  48. Consult says:

    “I’ve bowed out of this discussion, but readers might be interested in what one of my co-bloggers had to say at”

    Before I waste some more time, could you tell me if they post any scientifically credible evidence or is it merely more unsubstanatiated opinions and speculation?

  49. Consult says:

    “Seriously, you need to educate yourself about the neurobiology and psychology of decision making, as well as educate yourself about the history of medicine and science. If you did, you wouldn’t be making the kinds of claims you are about absolute knowledge and absolute objectivity and pretending they apply to science because you’d know exactly what that leads to….”

    Oh, so now there is a science behind decision making? Sorry I have had courses in neurophysiology and while we understand how neurons work, we have no credible idea (just speculation)how the brain works for even memory let alone decision-making.

    It seems you fail to read what I have stated–repeatedly–remember the terms scientifically-credible evidence? How did you manage to read “absolute” in that statement?

  50. Consult says:

    “BD Dwyer – Clearly it’s not as simple an issue as you and Consult would like to make it out to be. People motivated by ideology often try to dismiss complexity and make issues black/white to serve their desire to make the world suit their personal ideology. I find it strange that you align yourself with Consult yet you consider circumcision a different issue in cultures that have religious reasons and ones that don’t – it seems that your ethics are quite contingent and influenced by cultural context and NOT based in science.”

    Sorry, but irrational desires can hardly justify DOCTORS doing a harmful procedure–it IS as simple as that–doctors should be doing MEDICINE!
    But as you stated, rational thinking and actions can be harmful?

  51. ml66uk says:

    Since we’re talking about science-based medicine, it’s worth remembering that we wouldn’t even be having this discussion if it weren’t for the fact that 19th century doctors thought that :
    a) masturbation caused various physical and mental problems (including epilepsy, convulsions, paralysis, tuberculosis etc), and
    b) circumcision stopped masturbation.

    Both of those sound ridiculous today I know, but if you don’t believe me, then check out this link:
    http://www.noharmm.org/docswords.htm
    (A Short History of Circumcision in North America In the Physicians’ Own Words)

    Over a hundred years later, circumcised men keep looking for new ways to defend the practice.

    You might also want to check out the following:

    Canadian Paediatric Society
    http://www.cps.ca/english/statements/fn/fn96-01.htm
    “Recommendation: Circumcision of newborns should not be routinely performed.”

    http://www.caringforkids.cps.ca/pregnancy&babies/circumcision.htm
    “Circumcision is a non-therapeutic” procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social or cultural reasons. To help make the decision about circumcision, parents should have information about risks and benefits. It is helpful to speak with your baby’s doctor.

    After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.”

    Royal Australasian College of Physicians
    http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527
    “After extensive review of the literature the Royal Australasian College of Physicians reaffirms that there is no medical indication for routine neonatal circumcision.”
    (those last nine words are in bold on their website, and almost all the men responsible for this statement will be circumcised themselves, as the male circumcision in Australia in 1950 was about 90%. “Routine” circumcision is now *banned* in public hospitals in Australia in all states except one.)

    British Medical Association
    http://www.bma.org.uk/ap.nsf/Content/malecircumcision2006?OpenDocument&Highlight=2,circumcision#Circumcisionformedicalpurposes
    “to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.”

    National Health Service (UK)
    http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=649
    ”Many people have strong views about whether circumcision should be carried out or not. It is not routinely performed in the UK because there is no clear clinical evidence to suggest that it is has any medical benefit.”

  52. Fifi says:

    “Since we’re talking about science-based medicine, it’s worth remembering that we wouldn’t even be having this discussion if it weren’t for the fact that 19th century doctors thought that :
    a) masturbation caused various physical and mental problems (including epilepsy, convulsions, paralysis, tuberculosis etc), and
    b) circumcision stopped masturbation.”

    Yes it is worth remembering, which is one of the things that I’ve been saying repeatedly and one of the reasons why it’s not nearly as simple an issue as people with ideological positions they’d like to impose one way or the other would like to make it out to be. It’s also worth remembering that it’s science-based medicine that has shown that masturbation is actually a healthy, natural activity (it’s actually good for us not harmful) and that the decision to circumcise was based in a moral/ethical consideration that then used medicine to enact that morality/ethos. So, what happened historically was that medical practice was influenced by cultural concerns. (Most SCAM is a lingering reminder of this now discarded concept since it equates health with morality – “good energy” or “connection with the divine” or past life wrongdoing or whatever.) Medicine isn’t practiced in a vaccuum, as is clear by the differences in how medicine is practiced in different countries today (looking back over a century to compare with today is obviously even more problematic!!!)

  53. Consult says:

    “Yes it is worth remembering, which is one of the things that I’ve been saying repeatedly and one of the reasons why it’s not nearly as simple an issue as people with ideological positions they’d like to impose one way or the other would like to make it out to be.”

    It IS simple if you confine it to science–and not try to excuse it with cultural or religious excuses…complications only occur when one tries to introduce tangential excuses.

  54. Mark Crislip says:

    From Medscape fyi

    Nerve-Sparing Circumcision in Adults Maximizes
    Protection Against HIV
    By Karla Gale
    NEW YORK (Reuters Health) Nov 12 – A
    modified approach to circumcision in adult
    men developed by surgeons at Robert Wood
    Johnson Medical School should substantially
    increase resistance to HIV infection while
    preserving sensory nerves.
    “Conventional circumcisions offer protection against AIDS because the mucosa on the
    uncircumcised foreskin is not keratinized and permits viral attachment, and immune cells called
    Langerhans cells that attract the AIDS virus are numerous under the mucosa,” Dr. Joel Marmar said
    in an interview with Reuters Health.
    Dr. Marmar presented details of the revised technique and operative results at the annual meeting of
    the American Society for Reproductive Medicine in San Francisco.
    “This procedure is intended for adults in an at-risk population for AIDS who are interested in a
    circumcision that offers nerve preservation,” he noted.
    “With conventional circumcision, one simply pulls the foreskin down over the glans and amputates it,
    not really minimizing the amount of undersurface, just whacking off nerves and vessels and
    everything else,” the surgeon said. “I wanted to preserve the outer skin as much as possible but
    minimize the undersurface.”
    In the modified circumcision, he explained, a “sleeve of foreskin” overlying and extending beyond the
    glans is incised, followed by injection of normal saline beneath the penile skin and mucosa for hydro-
    dissection.
    “I then simply remove as thin a layer of skin as possible, leaving behind most of the blood vessels
    and nerves,” he continued. The skin and mucosa are then re-approximated.

    Dr. Marmar and his associates in Camden, New Jersey, found that the seven men who underwent
    the nerve-sparing procedure required fewer postoperative pain pills than five men who underwent
    conventional circumcision (12 vs 26, p = 0.001), and they returned to intercourse earlier (mean 59 vs
    88 days, p<0.001).
    The mean mucosal border in uncircumcised patients at their clinic was 4.5 cm. The remaining
    mucosal border was substantially smaller following the revised surgery (mean 0.5 cm) than after
    conventional surgery (3.2 cm, p < 0.001). However, the nerve count in the removed skin was
    significantly less following the modified technique.
    Dr. Marmar expects, based on the more extensive removal of mucosa, that the revised circumcision
    will offer better protection against infection. “The number of Langerhans cells that appear in a square
    centimeter of mucosal tissue is phenomenal,” he added.

  55. Consult says:

    What a lot of utter nonsense–on two fronts..

    First the bogus concept of circumcision reducing HIV. Pure specualtion on causation..and already disproven by the CDC!

    Secondly, this moron has apparently not even bothered to read Taylor, just assumed that nonsense that removing mucuosa retains nerves–forgetting about the ridged band. And totally forgetting the mucuosa also has specialized nerves–a cute bit of cognitive dissonance at best. The retained outer skin has almost NO nerves!

    Guess some are such circumfanatics, they grasp at any straw to get to circumcise men.

  56. Jim_T says:

    “There’s no good evidence that circumcised men get less pleasure from sex.”

    Most men would like to believe this but I don’t think it is true. If you were to examine the studies that led you to that conclusion, you would find they were flawed in some way. What about the thousands of men who have restored their foreskins, just send an e-mail to the people at NORM-UK: http://www.norm-uk.org/index.html
    ,and ask them if there is any difference.

    One of the reasons used in favour of circumcision is reduced risk of contracting HIV during penile-vaginal sex. The reason for this, so they say, is because of keratinization of the glans. Then they say that circumcision doesn’t reduce sensitivity. So how can the glans be both keratinized and not lose sensitivity?
    Have you actually looked at a comparison between a glans that has been covered and protected by the foreskin, and a glans that has been left to dry out a rub against clothes?
    Here is one site that gives you that comparison:
    http://www.noharmm.org/IDcirc.htm
    ———————————————
    “most [circumcised] men will tell you that if their genitalia were any more sensitive, it would cry during Meryl Streep movies.”

    Good tactic – keep the tone light,cheery and informal – let us not get too serious about this – it is only genital mutilation without consent.
    ———————————————
    “If some men are psychologically damaged by circumcision and mourn their lost foreskin, their mental health must be pathologically fragile. Get over it, guys!”

    Hmm. I thought you were a doctor? Guess you skipped Ethics and Psychology lectures – must have been sick that day?
    ———————————————

    “I don’t think there is any evidence that babies are capable of remembering the pain of circumcision or for that matter the birth experience.”

    Maybe, maybe not – it is not really that important in the whole realm of this discussion. He still has a reminder in the circumcision scar. And one of his first experiences will be pain. This could affect his behavior and this in turn could affect his behavior with his mother. And this in turn could effect his personality. So not as simple as you make out. and certainly shouldn’t be dismissed so easily.
    ———————————————–
    “The risks are minimal…”

    Define risk. Quantify minimal. Would it be better to use the word complication?
    ————————————————-

    “I used to do assembly-line circumcisions where we’d strap several babies to molded plastic restraining boards; they didn’t like being restrained, but by the time the last baby was restrained, the first one would usually have stopped crying and would often remain calm throughout the actual procedure”

    You sound like you are trying to justify putting the baby through this pain. Is this why you became a doctor? If there is any doubt in your mind that this isn’t for the good of the patient then it shouldn’t be done. Primum non nocere. Particularly when you know that it isn’t done in Europe and they have no problems whatsoever.

    ————————————————–

  57. Jim says:

    Langerhans cells in the foreskin have recently been shown to destroy HIV. This is being ignored by circumcision proponents.
    http://www.medicinenet.com/script/main/art.asp?articlekey=79688
    Demographic data from sub Saharan Africa, which show no overall protective effect against HIV from circumcision, are also being ignored. http://www.ingentaconnect.com/content/nisc/ajar/2008/00000007/00000001/art00001 (abstract and full text). HIV prevalence in the United States, where 75% of adult men are circumcised, is 3 to 7.6 times that in many European countries, where circumcision is rare. http://www.who.int/whosis/database/core/core_select.cfm Only abstinence, monogamy, or the consistent use of condoms reliably prevents HIV or other sexually transmitted diseases. Circumcision does not!

  58. Consult says:

    Also ignored by those pushing circumcision to reduce HIV is the study by the CDC that destroys their assertion by showing that the undamaged epithelia (unkeratinized and with Langerhan cells) does NOT transmit the virus:

    http://www.cirp.org/library/disease/HIV/dezzutti/

    Dr. Marmer above has believed a lot of unfounded assertions and then went on to concoct a procedure that then ignores the anatomical evidence and claims to have improved the process..

    Forest Gump–”stupid is as stupid does”.

  59. Jim_T says:

    Now on to the pro-arguments, although i think you already started early in the “against” section. You begin with a few tired cliched assumptions:

    “Some of the arguments for circumcision are unavoidably intertwined with a separate issue: hygiene. The warm, moist space under the foreskin is a prime breeding ground for bacteria, it can harbor sexually transmitted disease organisms, and it produces a cheese-like, foul-smelling substance called smegma. It is plausible that this could contribute to infections in the man and his partner, and even to cancer. Many studies support that idea, others don’t. There doesn’t seem to be any good evidence comparing circumcised men to uncircumcised men who practice meticulous hygiene. It’s difficult to sort out whether it is the circumcision itself or just improved hygiene that makes the difference. Circumcision undoubtedly facilitates hygiene, but is that a reason to operate?”

    This sounds like someone from a circumcision activist site. How do we trust your definition of hygiene when you already hold the incorrect belief that smegma is a bad thing? You do know that women produce more smegma than men, right? Why not go at the vagina with a knife to reduce any crevices? We don’t want a perfectly natural substance hiding in there, do we? Smegma is a natural oily substance, it contains anti-bacterial enzymes. It helps lubricate the gliding action of the foreskin. Remember the consequence of no smegma – a dried out penis. Here are a few studies:
    http://www.cirp.org/library/disease/STD/fleiss3/
    http://www.cirp.org/library/disease/cancer/vanhowe2006/

    ——————————————————

    AIDS – I think this section is better than the others, although you should have been a bit more critical. You could have also said that circumcision has had no effect on reducing HIV infection in the USA despite a 90% circumcision rate at one point. Circumcision is also highest among African-Americans yet these have the highest rate of STI’s. Outside the USA, in places where they do not circumcise, like Britain and Scandinavia, the rates are a lot lower than the USA’s. That goes for all STI’s – not just HIV. Also keep in mind that the chances of getting HIV through penile-vaginal sex is rare. Even if you sleep with a HIV infected woman the chances of you getting it are about 1 in 500. Some say it is as little as 1 in a 1000. Condoms have been shown to be 95 times more effective than circumcision.

    Let us turn our attention to the subject of cherry-picking studies because i agree with you that there are studies on both sides of the argument. So it is important that the studies are analyzed in detail. I have deliberately refrained from saying that there is evidence on both sides of the argument for exactly this reason.
    One of the most reliable studies is supposed to be a longitudinal cohort study. According to Van Howe only 2 have been done on STI’s. Let us take Fergusson’s one in Christchurch, New Zealand:
    http://pediatrics.aappublications.org/cgi/content/abstract/118/5/1971

    Now you can do 2 things here, you can read the abstract and just go to the conclusions and then use it as an argument to promote circumcision,
    OR you can click on full text and look at the whole study and analyze it for yourself. After that, you can read the responses from other authorities on circumcision, to the study:
    http://pediatrics.aappublications.org/cgi/eletters/118/5/1971

    By doing this you see that the study has flaws. You also see that it is in contrast to cross-sectional studies showing no difference and that these studies had a larger number of participants.

    Robert Van Howe provides some good criticisms. He also mentions the other longitudinal study, done by Dickson also in New Zealand:

    http://www.cirp.org/library/disease/STD/dickson2008/

    as you can see it showed the opposite result.

    ———————————————————-
    On to the other “advantages”. First, I’d like to say, I can’t tell whether you are listing arguments that pro-circ people use (true or not) or you are actually listing the advantages as if you actually believe them to be true yourself?

    To rebut your case for lack of circumcision reducing your risk of Cancer, I’ll quote from one survey:

    “It has been suggested that circumcision prevents cancer of the penis and of the uterine cervix. Both kinds of cancer are associated with genital infection with specific types of human papillamoviruses. It has been alleged that cancer of the penis is virtually unknown among men circumcised in infancy. However penile carcinomas have in fact been reported among circumcised men. The incidence of cancer of the penis in the United States, where most men have been circumcised at birth, is reported to be between 0 and 2.1 per 100,000, representing less than 1 percent of all cancers in men. This incidence of penile cancer is similar to the rates in Denmark (1.1 per 100,0000 and Japan (0.3 per 100,0000 where neonatal circumcision is not routinely performed.

    One study, reporting contradictory data, claimed that the lifetime risk in American men is 1 in 600. This estimate was extrapolated from a study of the incidence of male circumcision and depended on three incorrect assumptions: that all penile carcinomas occur in men who are not circumcised at birth, that the circumcision rate between 1890 and 1905 was the same as that in 1959, and that men presenting at a cancer detection center in Los Angeles, 40 percent of whom were classified as professionals or managers, were representative of the U.S. male population. Thus the lifetime risk of cancer reported in this study is probably incorrect. The evidence that penile cancer has a viral cause and the disease’s similar incidence rates in countries with very different rates of circumcision cast doubt on the proposition that circumcision is the most effective way to prevent cancer of the penis.”
    Source: http://www.cirp.org/library/general/poland/

    -See what I mean about cherry-picking studies. you must analyze them first before you take them as true.
    —————————————————————-
    “Reduction of the incidence of various sexually transmitted diseases in men and in their female partners. Reduction of cervical cancer and maybe even breast cancer in women. Again, these are likely more related to hygiene than to surgery.”

    Again what do you mean by hygiene? It is more to do with not contracting the HPV virus – this is safe sex, not hygiene. There is now a vaccine for the HPV virus. And condoms are much more effective. So would you still categorize it as one of your advantage points?

    ————————————————————–

    “About 10% of uncircumcised infants will require circumcision later in life”

    Huh? where did you pluck that figure from? So 1 in 10 men in Britain gets a circumcision later in life? Erm, no he doesn’t. Stupid doctors in the USA can’t tell the difference between normal developmental non-retractability of the foreskin and phimosis. The average age of retractability of the foreskin is 10 years of age and by age 18 most boys have retractable foreskins. Whenever he gets an infection, they put it down to him being circumcised. It is probably more to do with parents pulling the foreskin back and creating tears. Also by trying to clean inside you do more harm than good – you just introduce infections and disturb the natural flora of the penis. It is the same reason why women are told not to clean out their vagina. Phimosis is very rare, misdiagnosed a lot in the USA, and usually caused by unusual masturbation habits:
    http://www.cirp.org/library/treatment/phimosis/beauge/
    —————————————————————–
    “Reduced risk of urinary tract infection”

    You don’t mention that these are easily treated with anti-biotics. So again, not really an advantage of circumcision at all.
    ————————————————————————-

    Brian morris who runs circinfo.net is a rabid circumfetishist. I don’t know why you chose to get all your info from his site. You can read a rebuttal to his arguments here:
    http://www.circumstitions.com/Morris.html
    —————————————————————————-

  60. Jurjen S. says:

    For what it’s worth at this late stage in the game, I am a vehement opponent of circumcision (I’m a European-born, uncircumcised male), and yet I had few problems with Dr. Hall’s post. I’m willing to accept that the scientific evidence supporting both positions is pretty much a wash, and that the benefits are either negligible or achieved with greater effect by other means (particularly hygiene and HIV protection), but that the drawbacks aren’t that major a cause of concern either, medically speaking.

    That said, the ethical question remains that Dr. Hall herself acknowledges: absent a compelling medical need, can one justify removing part of the body of an individual who is incapable of giving consent? In my opinion, the answer is an unqualified no, and that alone is sufficient reason to oppose FGM, circumcision and yes, neonatal ear piercing.

    I really don’t have a lot of patience for people who claim that “you can’t compare” those procedures. In the strictest sense, such a statement is paradoxical, because it cannot be made without having, in fact, compared them to each other. Of course, what such people mean is that they are not equivalent, and there I would agree, but only to the extent that the degree of severity differs. The underlying principle, in all three cases, is precisely the same: the unnecessary alteration of the body of a person incapable of giving consent for the sole purpose of making that individual conform more closely with some cultural norm.

    I’ll admit that I’m a little perturbed by Dr. Hall’s acknowledgment that there is a strong ethical argument against circumcision, combined with her description of having carried out multiple circumcisions on more than one occasion. I suppose I would have hoped for a little more introspection regarding the justifiability of her past actions. But as she has asserted, she has attempted to take up a neutral stance in this post, and I think she has succeeded in doing so. Perhaps the problem that those who claim she has not have is they have trouble accepting that anyone can, or would want to, remain neutral about an issue that evokes such strong emotions. I admit that, to my own mind, failing to condemn the practice is, in effect, condoning it, and such an effort to remain neutral does come off as rather suspect when the person involved is someone who has herself performed circumcisions. But that is an emotional response on my part, and to claim that Dr. Hall’s post is not neutral because her own behavior has not been neutral with regard to this issue would be a perfect example of an argumentum ad hominem (or, more correctly, ad mulierem).

  61. Consult says:

    I think Harriet”s attempts to scientitifically justify circumcision and hence ethically and morally justify her having performed this procedure without the patient’s consent fall far short.. cherry-picking questionable studies and inserting facile and silly “reasons” AND ignoring the proven harms and risks is hardly neutral –regardless of her claims that they are.

    And this is hardly an ad hominem argument–merely one analyzing her claims.

  62. weing says:

    Speaking as an uncircumcised man, all I can say is “Ouch! Ouch! Ouch” I think I’ll stay in my monogamous relationship instead.

  63. Harriet Hall says:

    Jurjen S,

    I wasn’t going to respond to this thread any more, but I can’t resist applauding you for reading what I actually wrote and not reading more into it, for being able to separate the science from the emotion, and for providing a sterling example of critical thinking. Thank you.

    Your comment stands in stark contrast to the following comment by Consult that misinterprets what I wrote.

  64. Consult says:

    “Your comment stands in stark contrast to the following comment by Consult that misinterprets what I wrote”

    Gee, now I am confused, HOW and WHAT have I misinterpreted that you wrote?

    “I think Harriet”s attempts to scientitifically justify circumcision and hence ethically and morally justify her having performed this procedure without the patient’s consent fall far short.. cherry-picking questionable studies and inserting facile and silly “reasons” AND ignoring the proven harms and risks is hardly neutral –regardless of her claims that they are.”

    Once again, you are confusing “cutting you a break” with doing a critical analysis–so far the only critical analysis iI have seen here are those on the studies you have provided..

    AGAIN, I ask you,–where is this SCIENCE that you allege you have provided? Do you understand what the scientific process is?

  65. Harriet Hall says:

    Anyone who reads what I wrote and thinks I was trying to scientifically justify circumcision, that I was trying to ethically or morally justify it, that I was cherry-picking studies, or that I ignored the proven harms and risks obviously can’t read.

    It’s really sad when intelligent people are so overwhelmed by their prejudices that it interferes with their ability to understand plain English.

  66. Consult says:

    “Anyone who reads what I wrote and thinks I was trying to scientifically justify circumcision, that I was trying to ethically or morally justify it, that I was cherry-picking studies, or that I ignored the proven harms and risks obviously can’t read. ”

    The title of the site is science-based medicine. You posted cherry-picked pro-circumcision studies from BM’s site exclusively..not a single anti-circumcision study. You posted a lot of non-medical anecdotes and “reasons” for circumcision–from locker-room laughter to zipper injuries. You even resorted to trivializing and ridiculing the reactions of men to their forced circumcision. You gave us your skewed opinion to the procedure and how it was so harmless, and you pertsonally have done many with no adverse affects (those you have dismissed or ignored). Lastly after all of this, you threw in the superstition justification..and with this HUGE imbalance, you then asked If it was justified.

    “It’s really sad when intelligent people are so overwhelmed by their prejudices that it interferes with their ability to understand plain English

    Intelligent people are able to perceive patterns formed from those plain english words.

    Even more sad, is when people go to the lengths you have to try to justify the procedure and their participation in it–and are even then unable to see what is obvious to all objective people.

    Are you still going to ignore the risks and harms that I posted, and pretend that your claim for that small number you posted are correct and credible?Prove me wrong or show me that you are willing to accept evidence against circumcision.

  67. Joe1 says:

    First JurjenS, Excellent post.

    Second, Go Denmark!

    http://politiken.dk/newsinenglish/article598875.ece

    Male circumcision should be cut

    While there are laws preventing female genital mutilation in Denmark, there are none preventing male genital mutilation. Demands for action.

    The Children’s Council and the Chair of the Ethical Council say it is objectionable and ethically indefensible that while there is a law preventing female genital mutilation, no such law exists for males.

    Both the Jewish, Muslim and other traditions call for the circumcision of males. In Denmark, the Chief Rabbi Bent Lexner carries out the circumcision of Jewish boys. Muslim circumcisions are often carried out in clinics or hospitals.

    Religious links
    The Children’s Council Chair Charlotte Guldberg says the practice should be stopped.

    “There is a deep problem here. Society is in no doubt that the genital mutilation of girls is unacceptable – but we accept it with boys and have tolerated it for many years because it is linked to religion. It is gender discrimination from birth that we make a distinction between boys and girls,” says Gulberg, who adds that circumscision should be banned for boys under 15 years of age. According to tradition, young Jewish boys are circumcised at the age of eight days.

    Voice
    The Ethical Council does not have a general view of circumcision, although Chairman Peder Agger does not immediately reject the notion of legislation.

    “There is an ethical problem. I would prefer people to wait until the child is 15, thus respecting his right to choose and so that he knows what is going on. I believe that one should not undertake physical procedures that leave lasting scars or have lasting effect until a child is 15. And there should be some discussion as to whether the procedure should be ritualised in another way. In Denmark we have also stopped putting a child’s head completely under water during baptism,” says Agger.

    Symbolic
    In the United States there is an increasing tendency to carry out symbolic male circumcision by simply pricking the foreskin to draw blood. But in Denmark, as in many other countries, boys have the entire foreskin removed.

    Covenant
    In the religious tradition, circumcision is part of the covenant reported between God and Abraham. The relevant passage regarding Abraham is found in Genesis 17: 9-14 and reads:

    “Then God said to Abraham, “As for you, you must keep my covenant, you and your descendants after you for the generations to come. This is my covenant with you and your descendants after you, the covenant you are to keep: Every male among you shall be circumcised. You are to undergo circumcision, and it will be the sign of the covenant between me and you. For the generations to come every male among you who is eight days old must be circumcised, including those born in your household or bought with money from a foreigner–those who are not your offspring. Whether born in your household or bought with your money, they must be circumcised. My covenant in your flesh is to be an everlasting covenant. Any uncircumcised male, who has not been circumcised in the flesh, will be cut off from his people; he has broken my covenant.”

    Violation
    Nonetheless, religions cannot set themselves outside norms and violate a child’s physical integrity according to Kirsten Ketscher, Professor of Social Law at Copenhagen University. She tells Kristeligt Dagblad that the procedure should wait until a child is old enough to decide itself.

    Reject
    Chief Rabbi Bent Lexner, who has received special training in the procedure, rejects both the idea of a legal ban and the introduction of symbolic circumcision.

    “Jews have been fighting for many years to maintain the tradition, as it is a sign of Jewish identity. Even among Jewish families who do not live according to Jewish practice there are only very few who do not have their children circumcised. If you want to be part of the Jewish people, you have to fulfill precisely that rule. Getting rid of circumcision would be the same as removing baptism from the Christian faith,” says Chief Rabbi Lexner.

    Imam Abdul Wahid Pedersen says that parents exert their decisions on children in many other issues also.

    “They decide what clothes children have to wear so they aren’t bullied. And if children are to be able to decide, why shouldn’t they be able to decide themselves whether to be baptised,” the Imam tells Kristeligt Dagblad.

    There are some Christian directions and sects who practice circumcision. These are predominantly the Coptic, Ethiopian and Eritrean Orthodox churches.

    Edited by Julian Isherwood

  68. Consult says:

    Notice the non-rational (excuses)

    The Jewish one of requirement from god–however research has shown that this circumcision nonsense was inveneted by priests circa 550BCE

    “They decide what clothes children have to wear so they aren’t bullied. And if children are to be able to decide, why shouldn’t they be able to decide themselves whether to be baptised,” the Imam tells Kristeligt Dagblad.”

    None of these parental dec isions are permanemtly harmful to children–logic is lacking in this excuse.

  69. JackNOknife says:

    I guess a point here is that the author is not really able to:
    “stand back and look at the scientific evidence objectively. What are the medical benefits and risks of circumcision?”

    I read this and I can only think that deep down the Author is pro circumcision. I know as a professional that if I havd been doing something for years and it was shown to not be helpfual and instead hamrful I could want to defend myself. I sense that here. Why else would there be no mention that this surgery removes the most sensitive part of the male genitals. I cannot overtate this as this part of the body feels SO SO good to the owner. If you don’t have these touch sensitive parts, you should at least heavily investigarte before giving an opinion of the sceintific reasons to saty natural and not cut off thepart. It is an active promotion of the amputation to NOT mention the lost nerves and lost touch sensitivity.

    The points that were included make the point(s) absent more significant. This is clearly a persuasion piece.

    JUST silly to include:
    Zipper injuries to the foreskin can’t occur if you don’t have a foreskin. True, but trivial
    I have never had this problem and I have never heard of this. Possibly the author does note really know what this part of the anatomy is all about. This rediculous and non existant issue was worth mentioning over: the fact that the foreskin contains about 20,000 nerve endings which are extremely touch sensitive (like the female clitoris). These touch-sensitive nerves are called “Meissner’s Corpuscles and Circumcision cuts off ‘more than 3 feet of veins, arteries and capillaries, 240 feet of nerves, and 20,000 nerve endings”

    The silly point was the homosexual docking practice. This is important to very few people and again becomes a silly point to include. Why not include the basic human practice of pulling forward the foreskin upon entry into the vagina to provide smooth insertion and enjoyable coitius. This slip in practice is a human interaction that goes away with the cut. Coitus is a big issue with humans and this part of the anatomy is very helpful for enjoyment.

    This part of the body feels so good to the owner. Please start paying attention to that instead of theoretical zipper injuries.

  70. Jurjen S. says:

    Jack, it’s not theoretical. I’ve known a guy who managed to get his foreskin caught in his fly zipper, and mangled it so badly (he was seriously inebriated at the time, and his movements were rather uncontrolled) that his doctor advised him to have it removed entirely. I cannot begin to imagine the pain he must have been in.

    That said, however, my reaction at the time was “good thing he had a foreskin” because what would have happened if he’d done that to his glans? So you can turn that around and make it an argument against circumcision, because at least that way there is something to prevent zipper injury to the glans itself (at least once).

  71. Jurjen S. says:

    Consult, are you reading the same piece I am? Dr. Hall explicitly says:

    “What all this really boils down to is that there are no compelling scientific arguments for or against neonatal circumcision.”

    Italics mine. How does that translate to “attempt[ing] to scientifically justify” the procedure? She literally says there are no compelling scientific arguments for neonatal circumcision.

  72. Consult says:

    “Consult, are you reading the same piece I am? Dr. Hall explicitly says:

    “What all this really boils down to is that there are no compelling scientific arguments for or against neonatal circumcision.”

    Italics mine. How does that translate to “attempt[ing] to scientifically justify” the procedure? She literally says there are no compelling scientific arguments for neonatal circumcision.”

    You are confusing her claims there ARE scientifically-credible benefits with the fact that there are NO scientifically-credible ones. …Presenting ALLEGED ones IS trying to justify it.

    And to further my point, there IS compelling scientific evidence against circumcision which she has, and continues to ginore.

  73. Jurjen S. says:

    Consult, not to put too fine a point on it, you’re peddling horseshit. Dr. Hall literally says “there are no compelling scientific arguments for [...] neonatal circumcision” and yet you persist in claiming that she asserts that there are. Are you delusional? Are you so insecure about the correctness of your stance on neonatal circumcision that you absolutely have to have a safety blanket of science-based arguments to fall back on? Isn’t the simple ethical argument–that it’s unacceptable to perform a permanent and medically unnecessary procedure on a newborn incapable of giving any kind of consent, let alone informed consent–sufficient?

  74. Jurjen S. says:

    Consult, I can only repeat my previous question:
    Dr. Hall literally says that “there are no compelling scientific arguments for [...] neonatal circumcision.” How can this possibly translate to claiming that there are?

    (And to be a “grammar Nazi” for a moment: when you put an adverb before an adjective, you don’t need a hyphen. It’s “scientifically credible,” not “scientifically-credible.”)

  75. Consult says:

    THIS is what she stated..

    “What all this really boils down to is that there are no compelling scientific arguments for or against neonatal circumcision.”

    Agreed, there is no credible scientific evidence FOR circumcision-none at all. Yet, there is credible and compelling evidence AGAINST circumcision.

    In the main part of her article, she quoted alleged benefits from BM’s site with NO critical analyses.
    And then she proceded to pretend these benefits actually existed–and deliberately ignored the proven harm from circumcision.

    This pretense of there being ANY science behind the advocation of circumcision (in a so-called science-based article) is what I consider to be the real “horseshit peddling”.

    So where is this “horseshit peddling?

  76. Ira says:

    Oh boy… My apologies to Drs. Hall, Gorski et al. I did NOT mean to start a war on the anniversary post. I just fealt that since there are over 170 comments by now, and most of us don’t have time to read through all of them, it means that not all arguments have been counted and completely supported or refuted.

    My starting point: I’m an Atheist Israeli. I feel myself part of the Jewish people but I’m not too happy with many archaic bits of the Jewish Religion, that’s why personally circumcision was an interesting subject for me. I was generally anti circumcision and most of the post confirmed that and then this piece of data came up: “About 10% of uncircumcised infants will require circumcision later in life for medical reasons.”

    10% is not a number to gloss over. I wanted to get more info on where that information came from, if it was reliable, is it for Africa, the USA or Europe, etc. I saw there was a little discussion about it later in the comments, but I could not find Dr. Hall’s exact opinion about that, links to data and what the final verdict was. if 10% is a correct, unbiased number, unrelated to hygiene and other parameters, this could be a reason to reconsider my stand on the matter. I’d vaccinate kids against much smaller odds of other health issues, so the argument at least about this item needs a bottom line.

  77. Harriet Hall says:

    Ira,

    I did a lot of research for this post, and I didn’t take the time to document every source. I can’t locate the 10% citation at the moment, but as I remember it was from a credible primary source (a paper by a urologist?) and a US population. It would be comforting to think some of the 10% could have been avoided by optimal hygiene, but there’s no evidence to support that.

    A typical example: a pediatrician friend of mine chose not to have either of her boys circumcised at birth, and ” the older one at about age 12 had phimosis bad enough that I could hear him having trouble initating urination. He had an in office circ and did fine with it. ”

    She didn’t have a crystal ball, but I bet if she could have known this was going to happen she would have preferred neonatal circumcision (safer and less emotionally traumatic to the child).

    As I said, I never decided whether I would want my own son circumcised if I had one. My dilemma boiled down to this: I didn’t like the idea of doing an elective procedure on an infant who couldn’t give consent, but if my child were one of those who was going to need circumcision later on, or who was going to develop penile carcinoma, I could save him a lot of grief by having it done when it was safer, simpler, and would not even be remembered. In my mind, these two arguments pro and con were of comparable weight. So much so that I would have been glad to leave the decision to my husband and would have happily accepted whichever path he chose.

    The whole circumcision question is a tempest in a teapot: a “big issue over a little tissue.” People who are emotionally invested in it will continue to argue forever and will continue to misinterpret whatever I write. The fact remains: there is evidence that circumcision provides a small health benefit and has only a small risk. It is neither medically indicated nor medically contraindicated. That’s the conclusion I reached from reviewing the medical literature, and it is also the consensus reached by many medical organizations. Nothing in the comments made me question that consensus.

  78. Ira says:

    Ok then… I guess I’ll take the middle road as you (and the AAP recommendation) do: leave it to the parents. I wonder what it says now about the supposedly unbalanced organizations like the CDC and WHO, both recommended circ. in the past year.

    As always, I’ll be following these subjects, the “too close to call” ones are always the most fascinating of course :)

    Happy New Year,
    Ira.

  79. storkdok says:

    I’ve read a lot of circ debates on the mom websites. I’ve also read a lot of the evidence, although not as many articles as I think Harriet did in writing this post. I think Harriet did a very good job of looking at the larger body of evidence and boiling it down. I think she was neutral in presenting the evidence.

    Looking at what has been said here, it is evident that Consult is arguing from a fixed conclusion, not from an unbiased reading of the entire body of evidence. But of course, those who make this mistake, will rarely admit they have already reached a conclusion and acknowledge that they have biases. They then try to fit the evidence to their conclusion.

    Brava to you, Harriet, for taking on the subject!

  80. Harriet, I did the exact same thing as you decided– let my husband decide whether to circ our son. :)

    Brava to you, Harriet, for taking on the subject!” I second storkdok’s brava. It takes a Klingon to tackle this issue!

  81. Consult says:

    ““About 10% of uncircumcised infants will require circumcision later in life for medical reasons.”

    Actually this is nonsense promulgated by Dr schoen..

    the real numbers from countries that don’t mistreat the normal penis is:

    First of all, for a man who was not circumcised as an infant the chances of him having to get circumcised as a adult are extremely rare. In fact it’s only 6 in 100,000. (0.006%)

    Health officials of each Scandanavian country were queried about adult circumcision.. None of the health officials could provide precise data, because the numbers were so small that they weren’t worth compiling. Each official stressed that foreskin problems were present but said they were largely treated medically-surgical solutions were extremly rare.

    “in Oslo, Norway, over a 26-year period in which 20,000 male babies were cared for, 3 circumcisions were performed-a frequency rate of 0.02%.

    In Denmark. 1968 children up to the age of 17 were examined over a period of several years. In this group, 3 circumcisions were performed-a frequency of 0.15%. In this study, in retrospect, the physicians believed that all three operations might have been avoided. Both of these studies related to the infrequency of circumcision and puberty, they did not deal with the issue in adulthood.

    Wallerstein, Edward, Circumcision: An American Health Fallacy. pg 128

  82. Consult says:

    “I did a lot of research for this post, and I didn’t take the time to document every source. I can’t locate the 10% citation at the moment, but as I remember it was from a credible primary source (a paper by a urologist?) and a US population. It would be comforting to think some of the 10% could have been avoided by optimal hygiene, but there’s no evidence to support that.”

    From what I have read of your posts–nearly ALL of your “research” consisted of copying and pasting info from BM’s site–without doing any critical analysis of his information. and as posted, this nonsense came from Schoen–a fanatic promoter of circumcision–and a proven liar–even in his articles (proof upon request).

    “A typical example: a pediatrician friend of mine chose not to have either of her boys circumcised at birth, and ” the older one at about age 12 had phimosis bad enough that I could hear him having trouble initating urination. He had an in office circ and did fine with it. ”

    And likely due to mistreatment of the foreskin.. the real rates of it occurring when left alone is:

    The Finnish National Board of Health provided national case records for the year 1970 for both phimosis and paraphimosis. A total of 409 cases was reported for males 15 years and older,which represents only 2/100ths of 1% (0.023%) of the total male population in that age group. This means thaat 99.97% did NOT develop a problem. Moreover, according to Finnish authorities, only a fraction of the reported cases required surgery– a number too small to reliably estimate.

    Wallerstein, Edward, CIIRCUMCISION: AN AMERICAN HEALTH FALLACY p.128

    But thanks for the anecdote–so much more credible than actual research–NOT!

    “She didn’t have a crystal ball, but I bet if she could have known this was going to happen she would have preferred neonatal circumcision (safer and less emotionally traumatic to the child).”

    yes, neo-natal circumcision is so much better than as an older child? How so?

    “As I said, I never decided whether I would want my own son circumcised if I had one. My dilemma boiled down to this: I didn’t like the idea of doing an elective procedure on an infant who couldn’t give consent, but if my child were one of those who was going to need circumcision later on, or who was going to develop penile carcinoma, I could save him a lot of grief by having it done when it was safer, simpler, and would not even be remembered. In my mind, these two arguments pro and con were of comparable weight. So much so that I would have been glad to leave the decision to my husband and would have happily accepted whichever path he chose.”

    Ah, the old fear-mongering rationale for neo-natal circumcision.. too bad you didn’t do enough research and critical thinking to realize that these fears are mostly unfounded. the rationale of “IF”. Do you apply this “logic’ to other possible problematic body parts?

    Safer? HOW? there are documented deaths from neonatal circumcision, yet not ONE from later circumcisions.

    So, leaving it to your husband? WHY? Is he more educated on the subject than yourself? What qualifies HIS decision-making ability better than yours?

    “The whole circumcision question is a tempest in a teapot: a “big issue over a little tissue.” People who are emotionally invested in it will continue to argue forever and will continue to misinterpret whatever I write.”

    Interestingly you still are trying to call this a “little tissue” in spite of the large amount of scientifically credible evidence to the contrary–WHY and HOW is this still your perception?

    “The fact remains: there is evidence that circumcision provides a small health benefit and has only a small risk. It is neither medically indicated nor medically contraindicated. That’s the conclusion I reached from reviewing the medical literature, and it is also the consensus reached by many medical organizations. Nothing in the comments made me question that consensus.

    Still clinging to This OPINION when you have been given credible evidence proving there really are no proven benefits and many proven risks and harm? A whole lot of denial seems to be in play here. Research? from one-radically pro-circ site. Science is NOT a consensus procedure. Before re posting your OPINION and conclusions, I suggest you DO some research and critical analysis..this repetition of unsupported opinions hardly presents you in a good light.

    1A. Any study, conclusion, or opinion predicated on flawed or invalid data is inherently flawed and invalid.

    1B. Any conclusion or opinion predicated on any number of flawed studies with invalid data is inherently flawed and invalid..

    2. ALL conclusions from all data must be consistent and agree with all other conclusions very time, or it is considered flawed.

    3. Any theory or hypothesis that is unable to fulfill it’s prediction EVERY time is inherently flawed and invalid.

    But hey, don’t let science get in the way of your opinion.

  83. Consult says:

    “Ok then… I guess I’ll take the middle road as you (and the AAP recommendation) do: leave it to the parents. I wonder what it says now about the supposedly unbalanced organizations like the CDC and WHO, both recommended circ. in the past year.”

    This is the old “appeal to authority” default position. If you are of that mentality, why not follow all advice of all of the rest of the world’s medical organizations–do not circumcise.

    At least their position is not predicated on lies like that of the AAP, both lies of omission and lies of commission.

  84. Consult says:

    “I’ve read a lot of circ debates on the mom websites. I’ve also read a lot of the evidence, although not as many articles as I think Harriet did in writing this post. I think Harriet did a very good job of looking at the larger body of evidence and boiling it down. I think she was neutral in presenting the evidence.”

    Looking at BM’s site and copying and pasting the info with no critical analysis is a “good job”? HOW?

    “Looking at what has been said here, it is evident that Consult is arguing from a fixed conclusion, not from an unbiased reading of the entire body of evidence. But of course, those who make this mistake, will rarely admit they have already reached a conclusion and acknowledge that they have biases. They then try to fit the evidence to their conclusion.”

    Sorry, but I am coming from science–the conclusion is predicated on that process–NOT questionable evidence, anecdotes, and opinions. The mistake is accepting evidence based on those, and not a critical analysis.

  85. Consult says:

    “Harriet, I did the exact same thing as you decided– let my husband decide whether to circ our son. :)”

    WHY? what credible scientific evidence does he bring to the decision that warrants his decision valid?

  86. Fifi says:

    Harriet – “And that an intact foreskin is an absolute requirement for a mutual masturbation practice amongst homosexual men known as “docking,” in which the penis is placed under the foreskin of the male partner. I didn’t need to know that. You probably didn’t want to know that either, but now it’s too late.”

    What’s the big deal about talking about a sexual practice? Why “didn’t you need to know that”? What makes this so particularly icky to you? It’s just sex and people enjoying each other’s bodies.

    Harriet – “I don’t think there is any evidence that babies are capable of remembering the pain of circumcision or for that matter the birth experience. There have been studies suggesting that infant circumcision alters pain response later in life, but they are contradictory and unconvincing.”

    There’s no proof either way yet you choose to think/believe one thing over the other (and equate circumcision with being born, which seems very odd to me since clearly they’re entirely different contexts vis a vis pain!). This seems to be the promotion of a non-evidence based belief – naturally a preferable one for someone who has done circumcisions. I know pain isn’t your speciality (and I’m not claiming to be a pain specialist myself!) but it’s not so incredibly far fetched that early pain experiences would have a lasting effect – whether they’re medical or due to abuse. It’s a rather old fashioned belief that what a child can’t remember didn’t effect them and certainly not based in evidence of any kind!

    Harriet – “If some men are psychologically damaged by circumcision and mourn their lost foreskin, their mental health must be pathologically fragile. Get over it, guys!”

    This belittling of a person – in a way that would be considered unacceptable if we were talking about a woman’s genitals due to a hell of a lot of consciousness raising in both general society and medicine by women – really was the clincher for me in revealing Harriet’s bias. While I suspect she was just trying to keep the blog post light and entertaining – not only does it seem unnecessarily provocative but it refuses to even consider the topic seriously since Harriet has decided that it’s not a big deal (even though she doesn’t have a penis). The whole stoic man-up and get over it kind of attitude Harriet reveals here probably comes more from working in the military than being a doctor but it really is far from neutral and reveals a fundamental sexism where male vulnerability is mocked.

    Harriet, of course, is human and I don’t expect her to be bias free and I respect that her intention was to present the subject in a humorous and what she considered neutral way. I am, however, disappionted she couldn’t see or own her own bias in this case – not that admitting a bias changes the facts or makes anti-circumcision people somehow “right”. Sadly, Harriet’s personal asides and beliefs do make an appearance on this blog in a way that disempoweres any claims to being neutral or presenting the evidence in a neutral fashion.

  87. Mark Crislip says:

    2. ALL conclusions from all data must be consistent and agree with all other conclusions very time, or it is considered flawed.

    3. Any theory or hypothesis that is unable to fulfill it’s prediction EVERY time is inherently flawed and invalid.

    The medical literature rarely meets these two criteria.
    You have to decide what the bulk of data suggests combined with biologic plausibilty.

    Off topic, but in my own field, should you treat MRSA with two drugs, one being rifampin? Got me. I have to make clinical decisions on treatments when 2 and 3 certainly do apply and the data is flawed. If I had to wait for 2 and 3 to be true before I treated a patient, I would rarely treat a patient.

    “Science is NOT a consensus procedure”

    Medical science is, and the consensus changes with time.

  88. Consult says:

    “Science is NOT a consensus procedure”

    “Medical science is, and the consensus changes with time.”

    The problem still exists when “medical science” is contradicted b
    actual science–should one still depend on consensus? Should OPINIONS supersede scientifically credible evidence which exists as it does concerning circumcision?

    I see it that consensus can apply IF and UNTIL credible evidence exists; after that the credible evidence should apply.

  89. Consult says:

    “You have to decide what the bulk of data suggests combined with biologic plausibilty.”

    So, anything “plausible” that someone can dream up is sufficient to perform a procedure?–should not that “plausibility” be proven to even exist?

    What happens when that plausibility is proven not to be true or to exist? What then?

  90. weing says:

    “So, anything “plausible” that someone can dream up is sufficient to perform a procedure?–should not that “plausibility” be proven to even exist?

    What happens when that plausibility is proven not to be true or to exist? What then?”

    Here is an example of what happens. Back in the early 1980s people with palpitations would have a Holter monitor placed and found to have many PVCs. It seemed plausible that they would be at greater risk of sudden death. These patients were therefore treated with antiarrhythmics. Studies came out that convicingly showed that patients thus treated were dying at a higher rate than those not treated. What did we do? We stopped using antiarrhythmics to treat PVCs.

  91. Consult says:

    “What happens when that plausibility is proven not to be true or to exist? What then?”

    Here is an example of what happens. Back in the early 1980s people with palpitations would have a Holter monitor placed and found to have many PVCs. It seemed plausible that they would be at greater risk of sudden death. These patients were therefore treated with antiarrhythmics. Studies came out that convicingly showed that patients thus treated were dying at a higher rate than those not treated. What did we do? We stopped using antiarrhythmics to treat PVCs.”

    If this is the case, then we should do the same with circumcision. The convincing and EMPIRICAL evidence shows there are no medical benefits for circumcision and there are unnecessary risks and harm from doing it– instead we get the “cultural and religion” rationales. Why has the American medical industry not stopped doing it? Or does circumcision exist in a special category that need not follow the usual criteria.

  92. @Consult:

    “Or does circumcision exist in a special category that need not follow the usual criteria[?]”

    Yes, it most certainly does, like it or not. This is the first thing you’ve written that we can probably all agree on. In her post, Harriet tacitly granted that fact and addressed the question of whether science—not ethics, not religion, not culture—has anything to add to it. Her (correct) answer: little to none. This is exactly what anti-circ crusaders should want to hear. Armed with that, take your battle to the relevant fields: ethics, culture, religion. You’re barking up the wrong tree here.

  93. Consult says:

    “Yes, it most certainly does, like it or not. This is the first thing you’ve written that we can probably all agree on. In her post, Harriet tacitly granted that fact and addressed the question of whether science—not ethics, not religion, not culture—has anything to add to it. Her (correct) answer: little to none. This is exactly what anti-circ crusaders should want to hear. Armed with that, take your battle to the relevant fields: ethics, culture, religion. You’re barking up the wrong tree here.”

    Since circumcision has no valid scientific foundation I have to wonder why Harriet posted all the pseudo-scientific rationales for circumcision in a forum called “science based medicine”.

    Perhaps she should have shortened her posts by stating simply that there is no scientific basis for it, and said that therefore the medical industry violates it’s ethical and moral code everyday by doing them while promoting it to parents and then telling parents that the industry cannot do them without the PARENTS’ consent.

    This begs the question is WHY is the foreskin the only body part that is amputated with no medical indication–or even a logical reason.

  94. pmoran says:

    Consult: “The Finnish National Board of Health provided national case records for the year 1970 for both phimosis and paraphimosis. A total of 409 cases was reported for males 15 years and older,which represents only 2/100ths of 1% (0.023%) of the total male population in that age group. This means thaat 99.97% did NOT develop a problem. ”

    That gives the rate of the events in one year only. It also ignores the children who may need later circumcision. 30,000 would be a more accurate figure over a male uncircumcised lifetime. A lot of other men will be simply putting up with penile problems, and others will be afflicted by penile warts, cancer, greater risks of venereal disease, and increasing similar risks for their women.

    Not as trivial as you wish to make out. How can you say elsewhere that there is NO reason and NO evidence in favor of circumcision?

    Nevertheless, I don’t know of a single doctor or surgeon who is currently “promoting” neonatal circumcision, as you allege. . There is still some difference of opinion as to its wisdom, but there is a strong swing away from it in most countries where it was previously almost routine.

    The main stumbling block to the complete abandonment of neonatal cirfcumcision is not medical avarice but considerable inertia in social mores. When I gave up performing neonatal circumcisions I was put under intense pressure to resume, and decades later I was getting regular inquiries as to where parents could get it done.. It is usually grandma or the circumcised father who insists on it in the face of any argument.

  95. Skeptic says:

    “# Harriet Hallon 03 Jan 2009 at 1:27 pm

    Ira,

    I did a lot of research for this post, and I didn’t take the time to document every source. I can’t locate the 10% citation at the moment, but as I remember it was from a credible primary source (a paper by a urologist?) and a US population. It would be comforting to think some of the 10% could have been avoided by optimal hygiene, but there’s no evidence to support that.”

    I’m sorry. That, IMO, simply isn’t good enough. The 10% citation is one of the most compelling arguments you make, but only if it is actually true. While I trust that your impression of the source being a seemingly reliable one to be an honest statement, that is not a good basis to use the 10% claim as a fundamental point in your article. The figure may well be true, or their may be serious flaws in the methodology. But we can’t easily check for ourselves since you don’t even know where the figure came from.

  96. Harriet Hall says:

    What if I had said “many patients” rather than quoting a number? How many would justify a pro-circumcision argument? 9%, 8. 7%? One percent? If even an occasional person requires circumcision later in life, some would still opt for circumcision thinking that that occasional person might just happen to be their son. Whatever the real number, you are playing the odds. Even if the 10% figure is accurate, or even if it were 20%, that does not constitute a clear and compelling medical indication for circumcision, and the decision is still based on non-medical grounds.

    I’m quite willing to question the 10% figure, so if anyone has better information about the rate in the US, please let us know. I don’t think it’s appropriate to use far lower figures from another society where circumcision is not as acceptable and people may go to greater lengths to avoid surgical resolution of penile problems.

  97. Consult says:

    “That gives the rate of the events in one year only. It also ignores the children who may need later circumcision. 30,000 would be a more accurate figure over a male uncircumcised lifetime. A lot of other men will be simply putting up with penile problems, and others will be afflicted by penile warts, cancer, greater risks of venereal disease, and increasing similar risks for their women.”

    I am sorry, but your assumptions (speculations) are not contradicted by the EMPIRICAL evidence.

    First of all, for a man who was not circumcised as an infant the chances of him having to get circumcised as a adult are extremely rare. In fact it’s only 6 in 100,000. (0.006%)

    Health officials of each Scandanavian country were queried about adult circumcision.. None of the health officials could provide precise data, because the numbers were so small that they weren’t worth compiling. Each official stressed that foreskin problems were present but said they were largely treated medically-surgical solutions were extremly rare.

    “in Oslo, Norway, over a 26-year period in which 20,000 male babies were cared for, 3 circumcisions were performed-a frequency rate of 0.02%.

    In Denmark. 1968 children up to the age of 17 were examined over a period of several years. In this group, 3 circumcisions were performed-a frequency of 0.15%. In this study, in retrospect, the physicians believed that all three operations might have been avoided. Both of these studies related to the infrequency of circumcision and puberty, they did not deal with the issue in adulthood.

    Wallerstein, Edward, Circumcision: An American Health Fallacy. pg 128

    Also, if you took the trouble to find the actual rates of the other problems in the US and Europe, you would also find they are lower (or the same).

    “Not as trivial as you wish to make out. How can you say elsewhere that there is NO reason and NO evidence in favor of circumcision?”

    You forgot the phrases “scientifically credible evidence” and “non-therapeutic” —THEREIN are the critical points.

  98. Consult says:

    “Nevertheless, I don’t know of a single doctor or surgeon who is currently “promoting” neonatal circumcision, as you allege. . There is still some difference of opinion as to its wisdom, but there is a strong swing away from it in most countries where it was previously almost routine.”

    By quoting questionable scientifically evidence in favor of RIC, one IS promoting it.

    Now matter how you phrase it, the American medical industry promotes medical RIC and no other. Other countries that have pretty much dropped circumcision because thay have based their position on circumcision by the valid evidence and not by the profit margin.

    “The main stumbling block to the complete abandonment of neonatal cirfcumcision is not medical avarice but considerable inertia in social mores. When I gave up performing neonatal circumcisions I was put under intense pressure to resume, and decades later I was getting regular inquiries as to where parents could get it done.. It is usually grandma or the circumcised father who insists on it in the face of any argument.”

    Sorry, but this is called passing the buck–all it takes is telling parents that circumcision is not medically justified and refuse to do it. You cannot be responsible for the morals and ethics of others–only for your own.

    YOU (pl) created the circumcision craziness in this country–and now you are trying to blame the parents for the efficacy of your propaganda?– sorry, you can’t have it both ways.

  99. Consult says:

    “I’m quite willing to question the 10% figure, so if anyone has better information about the rate in the US, please let us know. I don’t think it’s appropriate to use far lower figures from another society where circumcision is not as acceptable and people may go to greater lengths to avoid surgical resolution of penile problems.”

    Sorry, Harriet, but this dodge is not adequate–the EMPIRICAL evidence exists that actual the necessity for later circumcision with NO mistreatment can be applicable if American professionals like yourself would just educate yourselves and your patients.

    The ignorance of the medical industry is hardly an excuse to cling to a number that inflates reality.

    This is an ARTIFICIAL problem created and maintained by your profession… more commonly called an iatrogenic problem!

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