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US medical positions--why?

post #1 of 20
Thread Starter 
I was thinking this morning about my sister-in-law. She had a baby boy just days before my DS #2. In making their decision about circumcision, they decided they really didn't feel strongly either way and would "do whatever the doctor recommended." Well, I'm sure you can imagine how that turned out.

It then got me thinking, if I were an undecided first-time mom, checking out the positions of the US medical associations, I probably would come away thinking that circumcision was necessary. Even the AAP, who is supposed to be "neutral," hardly seems neutral after reading their benefits vs. risks.

So my question is WHY? Why are the medical associations here in the US so quick to support circumcision (whether officially or implicitly)--does anyone know the history behind it?
post #2 of 20
I think more likely the history has been forgotten what was the cause to start circumcision to reduce sexual pleasure and possibly some other doctors which are more old school or depending on what school they went too for their teachings.

Because the schools still teach doctors/nurses to retract foreskin in children and the circing of boys no matter what age so their is still a possiblity that doctors are learning circing prevents making them believe in the myths because after all that's what their teacher is teaching to believe in .

Believe me we need to find out what books are floating around in their school area where the doctors and nurses are learning from.

Some nurses still mention they are still teaching nurses to retract while they are in school/training etc .

So I think we need to change the way the future doctors/nurses are getting taught .

Plus, with circumcision being around so long and future doctors who are males are circ'ed possibly all forgot about foreskin including the male professors who are doing the teaching proably forgot about foreskin because they never had it , they don't want to learn about it and hey figure of teaching in what they only know because they don't want to feel what was done to them was wrong or admit they are wrong in their teachings.

Once someone who has a foreskin and ends up teaching them they will learn & more likely become more pro-intact . Also a female professor who grew up in a intact family who is against circumcision would be a better teacher on the circ /foreskin truths too . Including if she was a nurse/doctor too etc

Most of those AAP are pro-circ ppl except one who I think is a gal on the chair force states she wants to put it in the against term .

Also, like as this one thing says AAP puts Warning of Choking on hotdogs is a cause of death in children actually Lesser Amount than the actual circ deaths .

I do think they need to more also focus & keep track of the circ risks and complications then put them together they would more likely find out they are causing More Harm to boys than to help them which I figure they are afraid to find out they are doing that so they just don't keep track . Because if parents knew they were causing harm and continued to cause harm that was more higher than the flawed myth non-existenting benefits you would get some high outrage .
post #3 of 20
My guess is it's because they are not patient advocacy organizations. Particularly in a very free-market country, they medical associations are established to advance and protect the interests of their members, including lobbying for self-regulation over governmental regulation. We know how well that turned out for the financial industry.

First off, these associations have small armies of lawyers. Seems to me that any change in position would set off alarms internally -- abruptly saying that circumcision doesn't provide the health benefits that previously were alleged, or has a higher rate or broader spectrum of complications than previously admitted, could open the door to a spate of lawsuits against their members. This would be particularly true if the AAP, AAFP, AMA, etc came right out and said that their previous recommendations were wrong. They would have to say that previously unavailable information has led them to adopt a new position, though probably even that statement would be tested in court.

Second, the general members and leadership members of these organizations who derive income from circumcision, and want to see circumcision perpetuated, are more vocal than those who don't like it or don't care. They certainly don't want their professional organization telling the world not to use their services, especially when it's fee-for-service. Unsurprisingly, we find that in those countries where most MDs are on salary, they rather quickly turn against doing infant circumcisions.

Remember the old adage: every American boy is born with a coupon for $300 on the end of his penis. All the doctor (OB, Ped, etc.) has to do to collect is cut it off. Free money!

And the last reason, the broadest, is that any large country or corporation naturally tends to become more conservative in its operation and heavily biased toward protecting the status quo. Circumcision has worked its way into American culture in fits and starts, sometimes slowly and occasionally in very fast run-ups - like in the 1950's, when maternity insurance became widespread, almost all births moved from the home to the hospital, and moms took Dr Benjamin Spock's word as gospel, and from 1946 right up to the Bicentennial he very plainly advocated circumcision.

Social change comes slowly in a stable society; but even there, economic change can come swiftly. That's what happened with circumcision in most of the other English-speaking countries. As Britain, New Zealand, Australia and Canada revamped their healthcare delivery systems, doctors turned from being strong advocates (or at least willing participants) in keeping the routine circumcision momentum going, to questioning and then criticizing the practice. Parents suddenly showed much less interest in circumcision.

The US hasn't experienced such a healthcare overhaul. We still subsidize infant circumcision to a shocking extent, and the beneficiaries of those subsidies -- the doctors and hospitals, not just the parents -- hold tenaciously onto their piece of the pie. It's not evil; it's merely rational economic behavior, even for a morally-questionable practice that sadly has become ingrained in the culture. So much so that very few Americans question the fact that more than a quarter million healthy baby boys a year have their foreskins surgically removed at birth on the public dime (Medicaid), and another 800,000 or so get it done through private insurance and HMOs -- their parents aren't out of pocket for the surgery, and consider it a "benefit". Who would turn down a free benefit? Unfortunately, we all pay for those million+ circs a year through our taxes and higher insurance premiums.

Medical associations are merely being rational advocates for their members when they provide "cover" in their noncommittal statements that keep the money flowing. Until the medical leadership says "Let's discourage infant circumcision", insurers will continue to include it. And until some external force steps in and breaks this symbiotic relationship, American parents and doctors will continue the robotic cutting of baby boys.
post #4 of 20
It's unconscionable that the AAP Circumcision Task force said in their statement that the complication rate was 0.2% to 0.5%, when the actual source that they quoted put it at 2.0% to 5.0%, and stressed that those were serious complications -- the general rate was much higher.

When confronted, the AAP basically said, "Oops - typo."
post #5 of 20
I firmly believe it is about the Almighty Dollar!
post #6 of 20
I consider the medical community in the US to be passive agressively promoting RIC. Why is a good question, but I have no idea. it is easy to speculate about the money motive, the lack of first hand knowledge, the lak of knowledge because the are not taught about foreskins in school, the fear mongering and the biased feelings about sex and foreskins our society has, etc.

Shrug. Probably all of these and more are at work to some degree.

Regards
post #7 of 20
and i was just wondering tonight why it's the OBs who do most of the circumcisions. was going to post that question, but seems to be largely answered here already... the reason being that they *can* get a first crack at the $300 coupon.

i guess that's why the OB (not the midwife who caught my son when he was born in the hospital) was at my bedside promptly at 7 am following our 1 am birth... to ask me in my sleepy state if i was going to circumcise my son... when i had already had the midwife mark my file "do not circumcise."

[of course i was ready for this, and woke up right away to tell him no. and baby boy was asleep right beside me in my bed and never left my sight the whole two and a half days we were in the hospital.]
post #8 of 20
Because it's culturally acceptable. And many American doctors are circumcised themselves and propagate the practice.

It's not based on medical or scientific fact. If it were, there would be similar position statements elsewhere in the world, since the same data is available to all. but only the US has the passively pro-circ position.
post #9 of 20
I think some of it goes back to the same reason that men want their sons cut and use the look like me argument.

Most US doctors are cut...if they are forced to look at the fact that cutting babies is harmful and unnecessary, they will have to accept that something horrible was done to their genitals and that would be too difficult.

"It has to be best or that means that my penis is damaged...I can't handle that, so I'll put the blinders back on and keep cutting babies. Cause it's best...right?????"


I think in Europe, they were able to stop the practice because there were still doctors and fathers who were intact when the tide started to turn back. (and it was no longer covered by insurance there). They were not so entrenched in the it has to be better thinking since intact men were still around.

There was also no longer a financial incentive for it in Europe.

Follow the money...There is a lot of money in unused foreskins in the US. $300 - $500 to cut it off...a thousand or so to sell it and then the cosmetic companies get thousands more.....
post #10 of 20
Quote:
Originally Posted by Fyrestorm View Post
I think some of it goes back to the same reason that men want their sons cut and use the look like me argument.

Most US doctors are cut...if they are forced to look at the fact that cutting babies is harmful and unnecessary, they will have to accept that something horrible was done to their genitals and that would be too difficult.

"It has to be best or that means that my penis is damaged...I can't handle that, so I'll put the blinders back on and keep cutting babies. Cause it's best...right?????"
I think that probably works the other way, too. If you've already cut the foreskins off dozens, or even hundreds, of boys, you're probably not going to want to look at evidence saying you've caused irreparable damage, yk? It's easier to stay in denial and just keep doing it than face what you've done.

I think there are many factors involved, as others have said...doctors being cut themselves, faulty education feeding the myth monster, doctors having seen the complications "of being intact" (and never realizing that almost all of those complications were caused by their flawed advice to "retract and clean"), money, denial of having done harm, cultural messages (nasty cycle there - doctors say "circ is beneficial", so most boys are done, so people think of a circ'd penis as "normal" and an intact one as "ugly", so the foreskin remains a negative, so the people and the doctors say "circ is beneficial", so most boys are circ'd, so...round and round and round), etc.
post #11 of 20
Quote:
Originally Posted by Storm Bride View Post
I think that probably works the other way, too. If you've already cut the foreskins off dozens, or even hundreds, of boys, you're probably not going to want to look at evidence saying you've caused irreparable damage, yk? It's easier to stay in denial and just keep doing it than face what you've done.
This is a really good point...I wonder if they fear all the boys they cut coming back to sue them?
post #12 of 20
Quote:
Originally Posted by Fyrestorm View Post
I think in Europe, they were able to stop the practice because there were still doctors and fathers who were intact when the tide started to turn back. (and it was no longer covered by insurance there). They were not so entrenched in the it has to be better thinking since intact men were still around.

There was also no longer a financial incentive for it in Europe.
Some newspapers in the US have unprofessionally reported that circumcision is "widely practiced in the West" or that "many in Europe are no longer choosing circumcision". Both statements are misleading, bordering on outright lies. So much for journalistic integrity.

The only country in Europe to experiment with infant circumcision was England, and they peaked at only about 35% just before WWII. The fad didn't even catch on in the other parts of Britain (Scotland, Wales) and N Ireland. As such, infant circumcision was an affectation that found favor with only certain upper social classes. The US, Canada and Australia, being much less rigidly class-stratified societies (anyone could move up or down), also adopted circumcision, but without the class barriers it spread like wildfire.

No other European country has ever had an infant circumcision rate exceeding 10%. Some Eastern European countries in the Balkans have practiced circumcision on older boys and certain areas of West Germany near US military bases thought infant circumcision was a progressive idea in the first half of the 1960s, but it certainly never exceeded the single-digit percentages. Then fell back down to zero.

Since infant circ never really got above about 1/3 in the UK, it wasn't hard to go back to being an intact country with the advent of the NHS in 1948. If only the US had copied Britain again! With all the myths about disease and circumcision, sometimes I secretly wish someone had started a rumor in the 1930's, 40's or 50's that circumcised boys were more likely to contract polio. It's an infection, after all. Man, that would have set off a panic that would have stopped circumcision cold in its tracks. Folks were terrified of polio.

Many prominent British physicians were themselves intact and spoke out or wrote about the uselessness or damage of circumcision. This helped. In the structure of today's US medical profession, they would have been quickly stifled.

Once the US crossed the 50% threshold of infant circumcision, going back became more difficult. To add to the problem, after WWII there was a "perfect storm" of US-unique events to ensure that circumcision rates did not merely continue to climb; they shot up like a rocket. First, the IRS issued a controversial tax ruling that made widespread employee private health insurance very attractive to employers. Coupled with a wage freeze imposed by the federal government, it was a perfect way to evade the law's intent and provide untaxed income. As previously mentioned, Dr Spock's book Baby and Child Care appeared in 1946, the first year of the biggest baby boom in history -- and it clearly recommended circumcision, with a threat that skipping it might mean a boy would not feel "regular". And if you were contrarian enough to skip it, then you'd have to painfully pull back your son's foreskin every day in the bath, causing even more trauma to both mother and child.

In 1970, shortly before the AAP's first statement on circumcision clarifying that it was unnecessary, Dr David Reuben published "Everything You Always Wanted to Know About Sex: But Were Afraid to Ask." This popular and titillating but ghastly book pretended to be liberating, but was actually filled with reactionary attitudes and tons of misinformation; so much so, that it was banned in the Netherlands. It made the option of noncircumcision sound extremely irresponsible and just not normal. It emphasized that cancer of the penis was exclusive to uncircumcised men and curable only by total penile amputation. (Both completely untrue.) Shortly thereafter Masters & Johnson, who had made themselves famous with their investigation into female sexual arousal, declared that circumcision did not diminish sexual sensitivity or response at all.

No other country had this constant onslaught against foreskins to contend with. It was relentless for a period of about 30 years. The few voices with a different message were completely drowned out (for example, Joseph Lewis's book "In the Name of Humanity" in 1949 - now back in print - and Air Force Capt. Noel Preston's brilliant article debunking the penile cancer myth in 1970, "Whither the Foreskin?") amid the race to make circumcision universal in the US. While it was clearly a social custom, its proponents continued to seek medical cover.

One extremely odd, but heavily documented, reason for the US's interest in circumcision was the Cold War. Living in an era long after it was gone, the US continued to believe that our "allies" -- mostly other English-speaking countries -- remain invested in infant circumcision. It was easy to catch communist spies: they had foreskins. There are literally hundreds of articles, books, films and other resources dealing with the issue of Americans being able to "out" spies by their circumcision status. Sometimes this was as simple as finding out that a Russian spy had perfected English and taken the identity of an American or Canadian who died in infancy or childhood. Medical records showed neonatal circumcision, but the spy would be intact or have an easily detectable adult circ. The Pentagon, CIA and NSA all came to believe that our practice of infant circumcision was a legitimate matter of national security. The agencies even sent recruiters to college campuses looking for intact male students (increasingly rare) to become US spies abroad.

Huge bodies of water separate the USA from the areas of the world that continued to get along just fine without infant circumcision -- Europe, South America, northern Asia. This isolationism also led Americans to believe that circumcision was commonplace and allowed the practice to thrive. I remember that high school friends of mine -- and their parents -- absolutely refused to believe that other first-world countries didn't practice RIC.

More accessible travel and now the internet have really opened a hornet's nest on the issue of circumcision. But it will take much more to change the US's profile, because no country in history has ceased circumcision on debate alone. It takes the influence of the medical profession and economic pressure.
post #13 of 20
Quote:
Originally Posted by ElliesMomma View Post
the OB (not the midwife who caught my son when he was born in the hospital) was at my bedside promptly at 7 am following our 1 am birth... to ask me in my sleepy state if i was going to circumcise my son... when i had already had the midwife mark my file "do not circumcise."
I think I would have said nothing to that OB. Instead I would have picked up the phone and asked the switchboard if there was an office of professional ethics.
post #14 of 20
Wow, Brant, you rock! I would like to save your post and investigate/use it to educate my future clients, but I would like to give you credit. I am PMing you!
post #15 of 20
Thank you Brant31! That was really interesting!
post #16 of 20
Quote:
Originally Posted by frogautumn View Post
So my question is WHY? Why are the medical associations here in the US so quick to support circumcision (whether officially or implicitly)--does anyone know the history behind it?
One on the bigger reasons I think is that they don't want to admit they were wrong all these years. I think it's that much more than even a money issue.
post #17 of 20
Brant, Wow, that all is very interesting... I'd love to see it referenced so it could be spread around.
Quote:
Originally Posted by brant31 View Post
Many prominent British physicians were themselves intact and spoke out or wrote about the uselessness or damage of circumcision. This helped. In the structure of today's US medical profession, they would have been quickly stifled.
Especially being able to show these, would be pretty helpful.

Jessica
post #18 of 20
Quote:
Originally Posted by Arduinna View Post
One on the bigger reasons I think is that they don't want to admit they were wrong all these years. I think it's that much more than even a money issue.
You think making it public common knowledge and letting 100 million men know that their equipment was needlessly modified might create 100 million angry men?

I think that'd be right. No, we probably won't get over it either. But the insanity has to stop some time. Might as well do it now and get it over with before it's 200 million angry men :-)
post #19 of 20
wow, brant, great post.

I was just wondering, from a legal standpoint, have there been any cases of sons initiating litigation against parents or doctors? If we look at the issue as surgery on a minor who cannot provide consent, then do they have grounds for it and has someone actually proceeded?
post #20 of 20
This topic is well covered by Robert darby's site
http://www.historyofcircumcision.net...d=73&Itemid=52

Quote:
If we look at the issue as surgery on a minor who cannot provide consent, then do they have grounds for it and has someone actually proceeded?
A small number have. I think it has only have been succeeded if the circ has been botched.
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