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232 thoughts on “Circumcision: What Does Science Say?

  1. Mark Crislip says:

    “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.”

    We need a source for cloning neurosurgeons?

    for neurosurgeon fill in your least favorite profession:-)

  2. pmoran says:

    Consult: “By quoting questionable scientifically evidence in favor of RIC, one IS promoting it.”

    Not at all. I have been trying to persuade parents against it for years, and refusing to do it myself,

    I am merely responding to over-the-top, mindless attempts to use this issue to portray the medical profession in general in the most unfavourable light possible. We are by no means perfect, but we are not as stupid, avaricious or careless as to the interests of our patients as you want to make out. We are culpable to the extent that there are no redeeming social or medical benefits to circumcision so it suits you to pretend that there are none.

    And which of any assertions that I made about circumcision are at all “questionable”? You yourself quoted certain rates for phimosis and paraphimosis but will not allow that you did not notice that the source you were presumably quoting grossly underestimated the true rate. Be man enough to admit it.

    “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.”

    Me? Personally? I have never been to America but I know that it is another free country like mine , and that while parents determinedly seek circumcision there will be doctors who will be prepared to do it. In other countries it is dying out naturally and it will almost certainly do so do so in America at least in non-Jewish and non-Muslim communities.

  3. Fifi says:

    I think it’s important to remember context as well. Doctors are part of society, they’re people and influenced by social values. GPs and MDs generallly aren’t research scientists, and particularly historically, they tended to be heavily embedded within the community. It’s unrealistic (not to mention a bit crazy) to expect doctors to magically know things that weren’t then known, and to hold social values and concerns that are only now emerging. As in most professions, there are a variety of motivations for becoming doctors that range from incredibly noble (Medicins Sans Frontiers, as just one example) to pure greed (most cosmetic surgeons fall into this category but there are obviously obstetricians to the stars and such who do too – not surprisingly, these are the ones who can be found using their MD to sell woo since that’s flying off the shelves these days and has a high profit margin…or diet books).

    Now, it is reasonable in retrospect to critique and acknowledge some of the strange, now clearly more harm than help, kinds of practices and attitudes towards babies that emerged in hospitals. I don’t bring up things like this to disempower medicine – we all realistically know medicine exists within society and is practiced by people (or one would hope we understand this and don’t resort to cartoons and social stereotypes). Medicine was just reflecting larger social, religious norms of the time. An obvious more harm than help example being the push for women to feed their babies formula rather than breast feeding (America’s very strange attitude towards breastfeeding persists today, though I certainly don’t put the whole thing at the door of medicine, it has to do with America’s rather distorted public policies and attitudes towards the body and sex that extends beyond breast feeding).

    pmoran – No offense but as an Australian/Canadian who’s spent lots of time in the US, it’s not really the same as Canada or Australia (and Canada is more like the US than Australia, well apart from being a bilingual nation – but then it could be easily argued that’s still more similar to the US which has Spanish as an unofficial second language and residual remenants of Francophone culture). Not only is the political system quite different in the US than Commonwealth countries, so are the social systems and values. Medicine, in particulary, is a very different animal than it is in most other nations for a number of reasons. The concept of “freedom” is also very different in the US than in countries with more collective social contracts (particularly since it’s one of the main signifiers and propagandistic slogans of the American Dream/MythTM and national identity….er, under God, of course..). The US is markedly less “free” than many other nations – not only does it have an outrageously high percentage of it’s citizens in jail (mainly poor people), it’s also much less socially mobile than Canada or Australia (this has to do with the lack of educational opportunities in the US), it’s also very far behind in all kinds of civil rights issues (from Gay marriage to separation of Church and State to abortion and on the list goes, getting longer every day). Freedom is a brand in America more than it is a reality (particularly on a legal level after the Patriot Act, though we’ve all lost some ground in terms of basic human rights in the last five years). So, yes, America is a “free” country but not like Canada or Australia…and it really depends who you are and how much money you have as to how much “freedom” you can buy.

  4. weing says:

    “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.”

    To make wallets that are convertible into suitcases just by rubbing?

  5. Consult says:

    “And which of any assertions that I made about circumcision are at all “questionable”? You yourself quoted certain rates for phimosis and paraphimosis but will not allow that you did not notice that the source you were presumably quoting grossly underestimated the true rate. Be man enough to admit it.

    C’mon, these rates were the OFFICIAL rates for Finland..

    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 that 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, CIRCUMCISION: AN AMERICAN HEALTH FALLACY p.128

  6. Consult says:

    “Me? Personally? I have never been to America but I know that it is another free country like mine , and that while parents determinedly seek circumcision there will be doctors who will be prepared to do it. In other countries it is dying out naturally and it will almost certainly do so do so in America at least in non-Jewish and non-Muslim communities.”

    In all of my posts I have tried to use used the term “American medical industry”–that should have been assumed here when I used the (pl).

    “Not at all. I have been trying to persuade parents against it for years, and refusing to do it myself, ”

    Good for you–and I mean that sincerely.

    Now we have an “adopted son and DIL” who are both doctors–when I asked them separately what they were taught about circumcision in medical school they both replied pretty much the same: it cures or prevents every disease known to man and is a billable procedure.

  7. Peter Lipson says:

    Well, Harriet, if i have a son and you’re in town…

    I really think some of this anti-circ rhetoric is kinda nuts. Just sayin’.

  8. Fifi says:

    Consult – Anecdote alert here – my brother wasn’t circumcised (he was born mid-60s in Australia) and both my parents, who are doctors, made that choice. My brother did develop phimosis as an adult and had a circumcision – he doesn’t seem to consider either particularly a big deal (but then we were brought up with a very natural and non-hysterical attitude towards the body and sex). Now, clearly I’m not going to extrapolate my brother’s experience and impose it upon everyone but, I’d suggest, that both ends of the extremes regarding this debate come off as slightly hysterical about cultural issues that ultimately aren’t to do with science or medicine.

    There is a subset of the larger blame culture in the US that has developed into a sort of competitive victim culture where men continually try to position themselves as victims (I find this particularly problematic since it’s often men who are actually abusers who claim this kind of victimhood since the majority of abusive men don’t take responsibility for their actions and blame someone else – be it their parent, spouse or partner). This is not to say that there aren’t men who are abused by female partners, or male on male or female on female violence and abuse doesn’t exist, it’s just being realistic about who really is a social victim and why some people who are shunned are not victims but architects of their own loneliness and aloneness. This also doesn’t mean that people aren’t victimized and that men in the lower classes aren’t used as factory and cannon fodder – however even poor white men really aren’t and weren’t victimized in the same way as women and people of color in the same economic bracket (this is not to deny America’s class system, it’s just putting things in context).

  9. Consult says:

    “My brother did develop phimosis as an adult and had a circumcision”

    Apparently your parents did not know that there are very effective, non amputation treatments for phimosis– steroids and/or:

    http://www.cirp.org/library/treatment/phimosis/beauge/

    the information is readily available, so likely his circumcision was unnecessary–reinforcing my position about ignorance of the normal penis in countries that do or have circumcised.

    If your brother is happy without his full sensation or sensitivity–good for him since he has no other choice.

    What does the “compare the victimization game” have to do with unnecessary circumcision?

  10. Fifi says:

    Consult – Yes, my brother looked at the options and decided he wasn’t particularly emotionally attached to his foreskin so he had the operation. He was an adult capable of making his own choices (my parents chose not to circumsize him, there’s no bias towards circumcision in my famiy – if anything it’s towards leaving the body intact, which is why I still have my tonsils even though I had recurring tonsilitis as a child). He also reports no loss of sensation or sensitivity – so please don’t impose your beliefs and desires onto his experience when he’s quite happy with the outcome (and was happy and comfortable with his penis in the first place, genitals weren’t taboo in my family, they’re just part of the body…though I will confess that my brother did think his penis was pretty fab as a kid since neither me or my sister had one).

    You claim the stance of a victim, so much so that you want to impose your self identification as a victim onto my brother even though he doesn’t consider himself victimized or “missing out” (and he’d know what he’s missing out on – were you circumcised as an adult and lost sensitivity and are therefore projecting your own experience onto others or did you hold this belief because you read about it somewhere?) I suspect you think that you can manipulate people through sympathy by continually casting yourself as being victimized. You’re so attached to this concept of yourself as a victim that you want to impose your beliefs on the experiences of others!!!

  11. pmoran says:

    Consult: you have not understood the point that the Finnish statistics refer to cases reported in one year only. The true lifetime figure would be 70 times that at least.

    Also no country keeps records that would provide such population information for medical consultations. The figures would almost certainly refer to hospital visits for either circumcision or reduction of a paraphimosis i.e. non-trivial episodes. Paraphimosis may not always progress to circumcision but those who are said to not have undergone circumcision for phimosis or paraphimosis may well have had to put up with considerable ongoing discomfort and uncleanliness because of difficulty in retraction of the prepuce (which is essential for good hygiene in adults otherwise the smelly gunk that can collect is most unpleasant for all, as well as being carcinogenic.)

    No man seeks circumcsion with any enthusiasm so that such figures may even considerably underestimate the amount of preventable preputial pathology in the community. Medical science is rarely as cut and dried as you wish to find it.

    Steroid cream treatment works for some children with phimosis but not so well with adults. It is one of the reasons for being less supportive of routine circumciusion, but it is most unlikely to be permanent solution in most adults. A dorsal slit is another alternative to circumcision but many find the appearances of that unappealing, and recovery is about the same as with the full oepration.

    My last comment.

  12. Consult says:

    “Yes, my brother looked at the options and decided he wasn’t particularly emotionally attached to his foreskin so he had the operation. He was an adult capable of making his own choices (my parents chose not to circumsize him, there’s no bias towards circumcision in my famiy”

    He chose it, and therefore his anecdotes are hardly valuable in showing no sensation is lost..as the Fink study has indicated.

    “You claim the stance of a victim, so much so that you want to impose your self identification as a victim onto my brother even though he doesn’t consider himself victimized or “missing out” (and he’d know what he’s missing out on – were you circumcised as an adult and lost sensitivity and are therefore projecting your own experience onto others or did you hold this belief because you read about it somewhere?)”

    Huh?

    Do you even bother to read the evidence? Did you even see the concrete scientific evidence? If so, why would one believe the assertion of no sensation loss from someone who chose this procedure?

    Since we did not assess men’s expectations before they were circumcised, we are unable to comment on how their expectations might have affected their biases. ****Another limitation is that men may have been recalling sexual experiences before circumcision when suffering from the medical problem ****that was the indication for the procedure.**** However, if circumcision was supposed to correct the problem then we would have expected entirely favorable outcomes. Instead we found worsened erectile function and decreased penile sensitivity.****

    We found that adult circumcision appears to result in worsened erectile function, decreased penile sensitivity and improved satisfaction. ****Overall, the majority of men were satisfied that they had undergone circumcision which suggests that in this population factors in addition to sexual function affect satisfaction.***

    Note: Think cultural and/or psychological factors..

    The logic to me is inescapable–loss of the majority of penile nerves = loss of sensation.

  13. Consult says:

    “The figures would almost certainly refer to hospital visits for either circumcision or reduction of a paraphimosis i.e. non-trivial episodes.

    I consider compression, packing in sugar, or an injection of hyaluronidase to be a lot more trivial than amputation.

    “Paraphimosis may not always progress to circumcision but those who are said to not have undergone circumcision for phimosis or paraphimosis may well have had to put up with considerable ongoing discomfort and uncleanliness because of difficulty in retraction of the prepuce (which is essential for good hygiene in adults otherwise the smelly gunk that can collect is most unpleasant for all, as well as being carcinogenic.) ”

    Oh, and this pain and discomfort is worse than ripping the foreskin from an infant’s penis? How?

    Smegma collects?

    http://www.cirp.org/library/anatomy/cold-mcgrath/

    Clinically, the presence of smegma preputii is a rare finding; in a prospective examination of 4521 uncircumcised boys, only 0.5% had smegma [72]. In adult men with clinically confirmed phimosis, only 6% had smegma present on examination [73]. Smegma can also be found in up to 25% of circumcised male children [25] and can be detected in circumcised adults.

    Smegma cause cancer? An outdated notion that even the ACS has dismissed..

    A 1947 study of the carcinogenic effects of smegma resulted in the test mice living longer than the control group. They have no explanation for the outcome.

    Plaut A, Kohn-Speyer AC (1947) The carcinogenic action of smegma.
    Science 105(2728):391-392.

    “There was no significant difference in the survival rates of treated and control mice up to the 400th day of life: 85 and 88 per cent, respectively, after 200 days; 74 and 80 percent after 300 days; 65 and 57 percent after 400 days. After 500 days, 47 percent of those treated with smegma were alive as compared with 30 percent of the controls. From the 600th day on, there was a marked difference (26 and 6 percent, respectively), and on the 700th day, the survival rates were 12 and 1½ per cent.”

    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

  14. Fifi says:

    Consult – The “evidence” you keep asserting proves our point has already been critiqued, now you’re just pretending. Like I said, I was relating an anecdote not providing evidence. Though, I trust my brother who is non-hysterical about his penis and who has had the actual experience of adult circumcision (therefore experienced both) over your rather hysterical and exaggerated claims to be a victim based on a really poor study that’s already been addressed.

    The fact that you’re so evangelical even though I’m actually against routinely circumcising babies and was raised by two doctors who chose not to circumcise their boy child, just points to how this isn’t about reason or the science to you but a personal crusade and a rather desperate need to self identify as a victim (so much so that you insist others can’t have had the experiences they had because you say so!). Sighs….shakes head….walks away.

  15. Consult says:

    “Consult – The “evidence” you keep asserting proves our point has already been critiqued, now you’re just pretending. Like I said, I was relating an anecdote not providing evidence. Though, I trust my brother who is non-hysterical about his penis and who has had the actual experience of adult circumcision (therefore experienced both) over your rather hysterical and exaggerated claims to be a victim based on a really poor study that’s already been addressed.

    The problem with anecdotes is there can be found those on both sides..those who disagree with your brother’s are just as valid on the surface as his..but theirs is supported BY the evidence, his contradicted by the evidence–which is more credible?

    “The fact that you’re so evangelical even though I’m actually against routinely circumcising babies and was raised by two doctors who chose not to circumcise their boy child, just points to how this isn’t about reason or the science to you but a personal crusade and a rather desperate need to self identify as a victim (so much so that you insist others can’t have had the experiences they had because you say so!). Sighs….shakes head….walks away.”

    Thanks for the amateur psychobabble. I do love your assumption of me as a victim with nothing behind this assumption.

    You may be against circumcision, but you are willing to excuse it on nebulous things such as society, ignorance of people and doctors

  16. Fifi says:

    I don’t assume you’re a victim and don’t think you’re one. What I said is you’re trying to claim victim status for yourself, which you have been doing here quite consistently. I’m sure I’m not the only one who’s noticed and it is clear you’re blind to your own biases and the biases you’re peddling here.

    As for your assertion that I’m “willing to excuse it on nebulous things such as society, ignorance of people and doctors” that’s hardly the position I’ve taken so once again you are misrepresting what I say to try to put me on a convenient “side” in your ideological battle. I’ve called Dr Hall on what I consider to be her blind spot repeatedly (and you and other anti-circ ideologues jumped all over what I said and repeated it, so clearly you only hear and use whatever you think supports your ideological position and ignore anything that might challenge your self perception as a victim). What you don’t seem to understand – being an ideologue who wants to claim they’ve been victimized – is reality and historical context.

    I didn’t claim my anecdote was evidence. I presented it to explain why I don’t buy into the anecdotal evidence you have presented expecting it to be considered valid. Though, I must say, it’s very telling that you tried to impose victimhood and your ideology on my brother’s penis rather than respecting his personal experience – that’s ideology-based body fascism at its most basic.

  17. Consult says:

    “I don’t assume you’re a victim and don’t think you’re one. What I said is you’re trying to claim victim status for yourself, which you have been doing here quite consistently. I’m sure I’m not the only one who’s noticed and it is clear you’re blind to your own biases and the biases you’re peddling here.”

    So, someone who is the helpless victim of unnecessary pain and harm is now somehow not a victim? Like Rachel Maddow, I will need to be talked down on this. If what I post is merely bias, then you should be able to scientifically rebut them.Once again, please don’t try the emotional bit about alleged victimhood–mine or your brother’s..try sticking to the evidence.

    “I didn’t claim my anecdote was evidence. I presented it to explain why I don’t buy into the anecdotal evidence you have presented expecting it to be considered valid. Though, I must say, it’s very telling that you tried to impose victimhood and your ideology on my brother’s penis rather than respecting his personal experience – that’s ideology-based body fascism at its most basic.”

    I am not painting your brother as a victim, only one who chose the be circumcised. And pointed out the scientific evidence that he did suffer the losses.

    Interestingly you don’t seem to understand the difference between concrete evidence and anecdotes..once again, can you provide a credible rebuttal to the evidence? The anatomical slides exist showing the loss of nerves, the blind quantification study exists–prove the are anecdotes.

    Adhering to the credible evidence is hardly fascism–fascism depends on propaganda and deceit. Adherence to the evidence is also not ideology–except perhaps that of science and rational thought.

  18. Peter Lipson says:

    Smegma cause cancer?

    No, just vomiting.

  19. Fifi says:

    Peter – I find myself having the same reaction to consult and his attempts to impose his victim ideology upon my brother and his penis. It’s just the kind of body fascism that consult claims he’s personally a victim of!

  20. Consult says:

    “No, just vomiting.”

    An interesting reaction –then you must vomit constantly since your female partner(s) make and retain much more of it.

  21. Consult says:

    “I find myself having the same reaction to consult and his attempts to impose his victim ideology upon my brother and his penis. It’s just the kind of body fascism that consult claims he’s personally a victim of!”

    Time to get over yourself and your over-emotional response to facts and evidence that does not fit into your world view. Reality is what I have “imposed” upon your anecdote.

    Just what do you think your anecdotes, psychobabble, and AD Hominen” arguments contribute to a science-based discussion? Love the pejoratives, they really always seem like the last resort when one has nothing left to offer.

  22. Fifi says:

    You’ve been offered all kinds of perspectives on your ideology and the evidence has been weighed – you turned on me when I didn’t agree with you about you being a victim since it screws with your self image and the info you cherry pick to sustain your mission to view yourself as a victim. It’s hardly like you’ve been dealing with science – since the science is inconclusive and one can cherry pick to support either pro or anti circumcision stances, Harriet was being more honest than you about this DESPITE having a bias – but then maybe you just mistake your ideological stance with reality and this causes you to deny anything that contradicts it.

    The accusation of being overly emotional is funny coming from someone who is clearly hysterical about their penis and blaming being circumcised for all their life issues as an adult. I’m not only against routine circumcision but come from a medical family that didn’t practice it, I’ve been critical of what I see as Harriet’s bias and I’m equally critical of your bias. You were perfectly happy to repeat my “psychobabble” when you thought it supported your position, you just don’t like having the clearly ideological and biased position you take being analysed the same way. Once again, you expect to be treated with privilege and exception which is what seems to attract you to assuming a victim ideology.

  23. Consult says:

    You’ve been offered all kinds of perspectives on your ideology and the evidence has been weighed – you turned on me when I didn’t agree with you about you being a victim since it screws with your self image and the info you cherry pick to sustain your mission to view yourself as a victim. It’s hardly like you’ve been dealing with science – since the science is inconclusive and one can cherry pick to support either pro or anti circumcision stances, Harriet was being more honest than you about this DESPITE having a bias – but then maybe you just mistake your ideological stance with reality and this causes you to deny anything that contradicts it.

    Un-cherry- pick this if you believe if you actually believe that there is no conclusive evidence in science–it is called EMPIRICAL evidence:

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

    And in all of circumcision, it is the ONLY empirical evidence.

    AND your argument might have more wight IF you understood and did a critical analysis of the information–not all evidence is of equal value.

    It seems that instead of discussing the evidence, you prefer to discuss the person and their motivations, so let’s discuss motivations..

    Since the 11th century, physicians have known and stated that the purpose of circumcision was reduce sensation.

    In the 50′s, people started thinking of the rights of individuals and the possibility of litigation for doing this to males; suddenly the American medical industry did a complete flip-flop and tried to pretend that the impossible occurred everyday and that there was NO loss of sensation. Since their primary excuse for doing circumcisions vanished, they invented new bogus ones–and called them “medical benefits”.

    Without ready access to correct information, the American public, accepted these pronouncements from “esteemed professionals” and ate the bowl of bull crap being fed to them.
    This enabled circumcision to become a multi-billion dollar industry in America.

    The rest of the world (with not-for-profit insurance systems) has abandoned medical circumcisions, and does not recognize any “medical benefits” for RIC.

    From this history, it seems obvious to me that the primary motivation for infant circumcision in America is greed. It is going to take a lot of rational and logical arguments to talk me down of this one.

    So, how does this example of “motivations” work for you?

  24. Fifi says:

    consult – As you conveniently forget, you glommed on to MY critique of Harriet and medical bias. I AM against routine circumcision and come from a medical family where it WASN’T done. The only thing I won’t give you is acknowledgment that YOU are the victim you claim to be – clearly this is what you desire more than anything else since you’ve willing to actually drive people away from your cause to claim it for yourself!

  25. Consult says:

    “consult – As you conveniently forget, you glommed on to MY critique of Harriet and medical bias. I AM against routine circumcision and come from a medical family where it WASN’T done. The only thing I won’t give you is acknowledgment that YOU are the victim you claim to be – clearly this is what you desire more than anything else since you’ve willing to actually drive people away from your cause to claim it for yourself!”

    Still trying to deny the evidence of loss with no rebuttal?

    Whether or not YOU are against it or not, we are discussing the SCIENCE of circumcision, not your position.

    At least “I” am trying amidst all of the psychobabble you are trying to introduce..speaking of which, why are you addressing only MY imagined motivations and not addressing the motivations of circumcisers?

  26. johnbon says:

    I have no idea who this Harriet Hall is, but I’ve seldom seem such a mix of misinformation and bias in covering a topic.

    To take one example – to say that 10% of uncircumcised men will need to have it done eventually is just a TOTAL FALSEHOOD. If that were true, the 80% of males worldwide who escape this mutilation s babies would be keeping doctors so busy they would have time for little else! (pop about 6 bn: uncirc. about 4.8 bn: 10% of that 480 million – nonsense! But anyway there is actual data out there showing that the number who need it, for instance tin the Scandinavian countries where it is virtually never done, is an infinitesimal fraction of 1%. See http://www.fathermag.com/health/circ/circumcision/circumcision4.shtml

    Practically her other pro-circumcision statements – about minimal pain, no loss of sensation etc – are refuted by well-reported studies..and by natural common-sense!

    What a load of tripe.

  27. Mark Crislip says:

    In the mail today, NEJM for March 26. Pg 1298 has “Male Circumcision for the prevention of HSV 2, HPV Infections and Syphilis”

    worked for prevention of hsv and hpv.

  28. Consult says:

    “In the mail today, NEJM for March 26. Pg 1298 has “Male Circumcision for the prevention of HSV 2, HPV Infections and Syphilis”

    worked for prevention of hsv and hpv.”

    It has? Then why does circumcising USA have much higher rates of these than intact Europe?

    One needs to have some COMMON SENSE when reading articles–ESPECIALLY from NEJM..

    http://home.comcast.net/~consult2/nejm.html

    New England Journal of Medicine on Circumcision

    Medicine? —no

    Science? —-no

    Politics?——yes
    Did the New England Journal of Medicine Circumcise Medical Information?

    To the Editor:

    The New England Journal of Medicine(NEJM) printed a strongly pro-circumcision (anti-normal anatomy) editorial by Dr. Thomas Wiswell,1 but did not print the pro-normal anatomy alternative opinion (see Abstracts & Analysis). When misinformation in Wiswell’s editorial was brought to the attention of the editor, there was no attempt to correct Wiswell’s exaggerated benefit claims. Strangely enough, the NEJM printed a Sounding Board discussion of circumcision in 1990 examining the purported advantages and disadvantages of circumcision2,3.

    What has happened in the last seven years to make circumcision less controversial? Why does the NEJM only present the purported benefits of circumcision? Why did the NEJM fail to print any letters critical of this pro-circumcision agenda? Let’s recap some of the research that they overlooked.

    Circumcision is losing popularity in the United States and has been discredited by the Canadian Pediatric Society4 and the Australasian Pediatric Surgeons5 in 1996 position papers. Taylor described the unique innervation of the preputial mucosa in 1996, and its loss to circumcision6. Taddio et al. showed that circumcision with and without local anesthesia (EMLA) resulted in negative behavioral changes in a child’s’ response to pain7. Laumann has shown that circumcision causes sexual behavior changes and an apparent increased risk of many venereal diseases in adult men8. Price has questioned whether parents can ethically change their child’s genitalia9. The editorial staff at NEJM could not have missed these advances. So why did they not present another Sounding Board article, and instead choose to present only a pro-circumcision editorial by Wiswell?

    In a previous article in the NEJM, Royce et al. insinuated that the prepuce may be a risk factor for HIV infections.10 This factually inaccurate article was referenced in a letter to the editor as proof that circumcision protects an individual from HIV infections.11 Fortunately, Laumann pointed out the fallacy of this logic. “The lack of rigorous, systematic controls for co-factors relevant to the particularities of the African context, the prophylactic status of the presence or absence of the foreskin remains an open question12.” But the fact that the NEJM failed to print our letter of criticism (see Abstracts & Analysis), suggests that the NEJM only prints material that supports neonatal circumcision.

    Beyond Wiswell’s proclamation of the benefits of circumcision, the research presented by Taddio et al.13 was proclaimed as a major advance. When the limitations of this form of local anesthesia was brought to the attention of the editors, they failed to print the criticism (see Abstracts & Analysis). They failed to point out that this form of local anesthesia (EMLA) did not prevent the long term negative behavioral response to pain previously reported in the Lancet7!

    Interestingly, the lack of effects of EMLA on long term negative behavioral changes caused by circumcision was printed in a British medical journal. Presumably, Taddio is smart enough to submit negative studies to European medical journals7,14 and luke-warm studies to American medical journals13.

    Certainly, over the last seven years, the NEJM has shifted from a balanced approach, to a one-sided, pro-circumcision stance, even though the lion’s share of the medical literature would encourage a shift in the opposite direction. It is hoped that in the near future, the NEJM will have the courage to confront the ethical problems and medical complications associated with circumcision. Maybe then, it will be acceptable for a physician to tell the parents of a newborn child, “Your baby has normal anatomy, so there is no need to charge you money to surgically alter this child’s genital anatomy. If your son or daughter wants to change their genital anatomy, they are free to do so after age 18, when they can make an informed decision.” Physicians will then be able to teach parents not to fear normal anatomy.

    Normal anatomy is not as dirty and dangerous as once thought. Even if a part of the body is malformed, diseased, or carries some risk, an individual must retain the right to refuse surgery. Prophylactic removal of normal anatomy to please parents, or to produce income for the physician is unethical. I hope the NEJM can temper its pro-circumcision agenda. Circumcision of medical knowledge and information is more dangerous than amputating part of the penis from a restrained, non-consenting baby.

    Christopher J. Cold, MD
    Department of Pathology
    Marshfield Clinic

  29. bigballs5555 says:

    i don’t like the fact that she states that men who mourn their lost foreskin should get over it ( the psychological trauma) and are fragile . for those who , after the fact, grew up and decided they would have rather not of had it done, the psychological trauma can be very real.
    it is very disturbing that a doctor would state this opinionated dig at a real phenomenon.
    also didn’t mention the fact that it is a religious, cultural superstition that has persisted for thousands of years. the tribes in the Amazon cut holes in their lips, but people think that and things like it our superstition/ritual and circumcision is not
    not everyone likes the look or feel of a circumcised penis.
    and give me a break you can zip up any of your parts in your zipper no matter if circumcised or not. even your bigballs

  30. shawmutt says:

    As someone who remembers catching his pee pee in his pjs, I can add anecdotal evidence that circumcision does not preclude penis injury by zipper.

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