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circumcism rates dramtically falling

post #1 of 48
Thread Starter 
One of my friends just shared on facebook that cirumcism rates fell from 56%in 2006 to 33% in 2009. Keep spreading the word because it is working. A majority of boys are now intact. I was so happy to hear this I shared it on facebook. I usally stay away from topics like that but I am so so stoked. I thought we were stubbornly clinging to the practice but this gives hope that it will hopefully becaome a thing of the past. Link is below

http://www.mdconsult.com/das/news/bo.../220621/1.html
post #2 of 48
The link is broken. Can you share search terms/headline or a corrected link?
post #3 of 48
Thread Starter 
Hmm. The link was working on other sites. Google US newborn male circumcision rate dropped sharply in from 2006 to 2009 and you should find it.
post #4 of 48
post #5 of 48
Has anybody seen the whole article and not just the preview? The preview says the article's from Viena and that's where the AIDS conference Brant31 attended, so I'm worried the full article actually talks about how worried they are about he HIV infection rates rising as the circ rates drop.
post #6 of 48
Unfortunately, I'm not quite sure I believe it. I did some quick research on the stats and every other site I can find says the rates are hovering around 80%+ in the north and 60%+ in the south US, with whites having the highest rate and minorities having the lowest rates, but still well over 50%...
post #7 of 48
Quote:
Originally Posted by AllyRae View Post
Unfortunately, I'm not quite sure I believe it. I did some quick research on the stats and every other site I can find says the rates are hovering around 80%+ in the north and 60%+ in the south US, with whites having the highest rate and minorities having the lowest rates, but still well over 50%...
How recent were those stats? Which year?
post #8 of 48
Quote:
Originally Posted by Anastasiya View Post
How recent were those stats? Which year?
Ooops, sorry, nevermind--the article I was reading was *from* 2009, so that obviously didn't have the right stats.

Apparently though, one of the big reasons for the drop was the fact that some states don't allow it to be covered by state aid (medicaid) and because of the recession, people didn't want to have to pay for it out of pocket, so they just didn't get it done.

It would be interesting to see if circ rates fluctuate with the state of the economy.

It's also nice that the arguement of "well, almost every other boy is circed" no longer holds water.
post #9 of 48
Thread Starter 
Quote:
By Mitchel L. Zoler
Elsevier Global Medical News
http://www.imng.com

Breaking News


VIENNA (EGMN) – Circumcision rates for newborn boys in the United States dropped steadily and markedly over the past 4 years, based on the largest review of U.S. rates ever done.

Circumcision rates fell from 56% in 2006 to 33% in 2009.

The review, which included more than 6.5 million U.S. newborn boys during the period, also showed that adverse event rates following newborn male circumcision were “extremely low,” and that the most common adverse events were “mild and easily corrected,” Charbel El Bcheraoui, Ph.D., said at the 18th International AIDS Conference.

“Severe male circumcision-related adverse events are extremely rare,” said Dr. El Bcheraoui, an epidemic intelligence service officer in the division of HIV/AIDS prevention at the Centers for Disease Control and Prevention.

The dramatic decline in circumcision rates during 2006-2009 continued a trend that began in the United States earlier in the decade, although the fall appeared to accelerate recently, he said. He attributed the drop to a 1999 statement by the American Academy of Pediatrics that said existing data were not sufficient to recommend routine newborn male circumcision (Pediatrics 1999;103:686-93).

Another factor may be that following the AAP statement, several states withdrew Medicaid coverage of newborn male circumcision, Dr. El Bcheraoui said. An earlier report by him and his CDC associates documented that during 1979-2006, the U.S. newborn male circumcision rate was relatively stable, with an average rate of 61%.

The recent fall in U.S. circumcision rates coincided with reports from three African-based randomized controlled trials in 2005-2007 that showed circumcised men had a 50%-70% reduced risk for acquiring HIV infection, compared with uncircumcised men. These findings led the World Health Organization and the Joint United Nations Programme on HIV/AIDS to recommend male circumcision as an important intervention to reduce the risk for heterosexually acquired HIV infection in 2007. The CDC and AAP are now independently interpreting the application of these recent findings on HIV transmission to the United States based on U.S. prevalence rates of HIV and circumcision, he said.

The new study also analyzed 90-day outcome data on 258,189 boys and men aged 1 or older who underwent circumcision during 2006-2009, and found that adverse events occurred much more frequently in this age group, “an important new finding,” Dr. El Bcheraoui said.

His study used data from the largest U.S. consolidator of electronic health care reimbursement claims, which included data on 117 million unique U.S. patients annually undergoing short hospital stays, and data from more than 800,000 unique U.S. health care providers. In this database, 6,571,500 newborn boys underwent circumcision during 2006-2009. To estimate the incidence of circumcision-associated adverse events, the researchers tallied the rate of any of 41 different ICD-9 and CPT codes that could be such events during the 90 days following circumcision. They also compared these rates in 18,330 infants circumcised within the first month of life with a matched set of uncircumcised infants.

The data showed that the rates for a range of adverse events, such as mishaps, correctional procedures, and infections were substantially lower in boys less than 1 year old, compared with boys aged 1-9 years, and with boys and men aged 10 years or older. For example, mishaps occurred in none of the boys aged less than 1 year or aged 1-9 years, but in 158/100,000 boys and men aged 10 years or older. The rate of correctional procedures was 58/100,000; 2,544/100,000; and 1,709/100,000 in the three age groups, respectively. Infections occurred at a rate of 154/100,000; 5,664/100,000; and 4,527/100,000 in the three age groups.

The case-control analysis identified only two types of adverse events that were more common in circumcised newborn boys, compared with matched uncircumcised infants: repair for incomplete circumcision, and lysis or excision of penile adhesions. All other adverse events tallied either similar rates among the cases and controls, or were significantly more common among the controls.

“This is the largest study to examine the incidence of male circumcision adverse events to date. It is highly representative [for the United States], with a large data set” and with a large number of potential adverse events tracked, Dr. El Bcheraoui said. One of the strengths of the study was its longitudinal design, which followed subjects for 90 days following circumcision.

Dr. El Bcheraoui and his associates said they had no disclosures.
I found more on it
http://www.acep.org/MobileArticle.as...5&parentid=742

It is saying there is no adverse affects on newborns and I believe they are using this to get rates up again due to Aids.

I think the CDC has reported 43% for 2009. I am not sure what is more accurate. Hopefully there will be more soon on the recent stats. It is clear that they are dropping quite sharply and that it is no longer the majority.
post #10 of 48
And of course, no mention of meatal stenosis - something that is quite common in circ'd boys and pretty much unheard of in intact boys. If they reported that they could never say that adverse events were rare.
post #11 of 48
Quote: "One of the strengths of the study was its longitudinal design, which followed subjects for 90 days following circumcision. "

I really struggle when 90 days is considered long enough.
post #12 of 48
I am deeply conflicted about this report. Offhand, I don't believe the figures. Thus, I am disinclined to use them myself for any reason. I also doubted the WHO's figure of 30% circumcision a couple of years ago when every other reliable source was quoting from 15% to 25%. They inflate or deflate the numbers to suit whatever agenda they have.

I met with Dr. El Bcheraoui in Vienna, along with his colleague. He is a nice guy, a young doctor, who totally believes in the tremendous health benefits of circumcision. He says that he has no conflicts, which may be true in a professional sense; but he was circumcised at the age of 4 and says that he is eternally grateful to his parents for making a decision that improved his health for life. I spent more than half an hour talking to them both, and it was apparent that the CDC is on an irreversible trajectory to pronounce on the myriad health benefits and minimal risks of neonatal circumcision.

At the conference, the CDC was tossing around a figure of 43% current neonatal circumcision rate in the US. This report now uses a 33% figure. I doubted the higher number, and I really doubt the lower number. There is no question that the CDC is tremendously alarmed about the 16 states that do not fund routine infant circumcision through Medicaid. The CDC sees this as a public health emergency, compelling it to act. After they issue their recommendation, the CDC will lobby Congress and the CMS (Centers for Medicaid and Medicare Services). [They stressed this will not be a recommendation to circumcise, only a recommendation that: circumcision has important health benefits and few risks; should be affirmatively discussed with and offered to all parents of newborn boys; and should be equally available to all Americans by a level playing field of HMO coverage, health insurance coverage, and Medicaid coverage.] If the 16 renegade states do not act on their own to reinstate automatic infant circumcision on their own, the CDC may have to lobby Congress and HHS to attach a rider to federal Medicaid funding, stating that unless a state offers universal infant circumcision coverage to all Medicaid recipients, it will lose the rest of its federal Medicaid funding. I don't know how they plan to threaten the private plans, but all have enough federal ties that there must be some leverage there.

The CDC officials I spoke with said that circumcision proponents had been bombarding the CDC with exhortations to act for the past 2 years. The division that is gathering input and will issue a recommendation is the HIV/AIDS division. This is particularly ironic, because Robert Bailey, the lead researcher on one of the 3 African RCTs, told me just 2 weeks ago that it would be absurd to circumcise an American infant for HIV concerns.

Unfortunately, the division in question is solidly pro-circumcision. The CDC head is Thomas Frieden, the former NYC health commissioner, who repeatedly refers to "circumcised men" and "males who lack circumcision". The HIV/AIDS head is Peter Kilmarx, who has frequently mentioned the effectiveness of neonatal male circumcision. And below Kilmarx is Dr. Jason Reed, who spoke glowingly in Vienna of the excitement building as they ramp up to circumcise 38 million African adults & teens and all the neonates. He is one of the project directors.

Trust me, I did my best in Vienna. I cited chapter and verse the Dr. John Taylor published studies, the Sorrells sensitivity study, all of the research on complications (major and minor), the pain studies, and the overwhelming evidence about Europe's STI health vs. the United States. I carefully deconstructed the African RCTs and highlighted their weak points. I emphasized what a colossal waste of money mass circumcision programs are, when funding is urgently needed for cancer, Alzheimers, diabetes, HIV, etc. I cited several polls where intact men were overall happier to be intact than circumcised men were to be circumcised. And most profoundly, I drove home the point that NO studies have EVER demonstrated a measurable health benefits to the United States from its 100-year experiment with infant circumcision. It is a fad, a human rights violation and an egregious waste of precious healthcare dollars. And we all pay for it through taxes (to fund Medicaid) and higher insurance premiums.

All I got in response was, "We're going with the handful of studies we have." One CDC officer said that circumcision has been the topic of intense debate within his own family (as it is in many American families, but almost none in Europe or S. America), so he appreciated that there is controversy. But at the end of the day the CDC is science-driven, and apparently science favors circumcised penises -- or so they're prepared to say.

Bottom line: I think the 33% figure is bogus, though to some extent it reflects the undeniable US trend to rush mama and baby out of the hospital and schedule circumcision for a later date, sometimes out-of-pocket. Since traditionally our data sources come from hospital data, we may never know the real figures under current conditions. My guess is it's 60-70%.

And the CDC's ulterior motive for promulgating 33% is to sound an alarm.
post #13 of 48
Well, there is a big difference between 33% and 43%. I think it's best to hold judgement until the actual study paper is published, and the real figures can be analyzed more closely. A lot of press releases tend to be inaccurate, and the numbers in this case don't add up. For instance, were there 6.5 million infant boys in total or were 6.5 million circumcised in 4 years? If it's the latter, than I have no idea how you get 33%. How reliable is the original source? This is very important to consider. Accurate circumcision statistics are difficult to come by, even with hospital discharge surveys. Yes, some people get it done outside of the hospital, but primarily it's still performed by OB/GYNs within the first two to three days of life. Furthermore, insurance codes don't necessarily reflect whether a child was circumcised or not. For example, a hospital could swallow the cost of the procedure or say that a child underwent a circumcision (no matter whether that's true or not) if everything is put under one bill. With all the information about circumcision available these days, I would venture to say that it's a solid 50/50 for the USA and far, far lower for Canada.

With regard to the CDC, it's hard to surmise what they will say on the issue, if anything at all. What's certain is that for the past several years any position statement of theirs has been continuously delayed (the RCTs came out between 2005 and 2007). If they had solid evidence for the pro-side, they would have published it by now, aside from their very inconclusive fact sheet, which can be spun to promote the amputation of any body part. If I had a guess, I would say they and the AAP will stick to the latter's 1999 position, which basically says "not necessary" in a lot of words that nobody ever reads. I really have a hard time imagining anything else, especially since their Australian, Canadian, and most recently Dutch colleagues have come out with very anti-circumcision statements in the past two years. In fact, the Dutch have taken the position that non-thereputic neonatal circumcision is pretty much illegal under their constitution, calling for increased dialogue with religious groups on the issue.
In summary, no news from the AAP and CDC is good news, and a sign that the anti-circ message is gaining traction.

As for medicaid, it seems to me that there is universal consensus on the fact that a lot of other procedures are far more important for health, but are not covered by the program or are being dropped. Ultimately, budget constraints will decide the fate of medicaid circumcision and honestly, it's far more likely that states will continue to drop coverage in the current economic environment.
post #14 of 48
Quote:
Originally Posted by brant31 View Post
Bottom line: I think the 33% figure is bogus, though to some extent it reflects the undeniable US trend to rush mama and baby out of the hospital and schedule circumcision for a later date, sometimes out-of-pocket. Since traditionally our data sources come from hospital data, we may never know the real figures under current conditions. My guess is it's 60-70%.

And the CDC's ulterior motive for promulgating 33% is to sound an alarm.
Unfortunately, I feel the same way. How can it only be 33%? I've never heard someone say that circumcised was the minority in their area unless they live on the west coast or outside of the USA. Literally almost all babies are circumcised in the midwest, and people in the northeast and deep south have told me the same thing. I do believe that percentages are decreasing, but not nearly that quickly.
post #15 of 48
Isn't it sad that the removal of 1/3 to 1/2 of the skin of the penis is not considered an adverse effect in and of itself?
post #16 of 48
Quote:
Circumcision rates fell from 56% in 2006 to 33% in 2009.
Sounds good, right? But wait ...

Quote:
The review ... showed that adverse event rates following newborn male circumcision were “extremely low,” and that the most common adverse events were “mild and easily corrected.”
Interpretation: Circumcision is safe.

Quote:
Another factor may be that following the AAP statement, several states withdrew Medicaid coverage of newborn male circumcision, Dr. El Bcheraoui said.
Interpretation: States deny parents the option of circumcision when they remove funding.

Quote:
The recent fall in U.S. circumcision rates coincided with reports from three African-based randomized controlled trials in 2005-2007 that showed circumcised men had a 50%-70% reduced risk for acquiring HIV infection, compared with uncircumcised men.
Interpretation: Not circumcising is a public health risk.

Quote:
The new study ... found that adverse events occurred much more frequently in this age group, “an important new finding.”
Interpretation: RIC is a safer medical decision than waiting until a child is older or can choose for himself.

Summary: US rates are falling, partly because of funding problems within the states. This is a public health risk. Circumcision is needed to keep boys healthy. We need to circumcise boys here and around the world during infancy, when it is safest to do the procedure.
post #17 of 48
Thread Starter 
Is it the CDC that is sounding alarms or people who are lobbying the CDC. I heard the AAP might change the stance too but I been researching lately and recently they stood up for the bogus penile cancer stuff and the UTI risk and they did deem it medically unnessacary. I hope they won't change it back but I'm not so sure they will. Is the intactivism as strong as the pro circ stuff.

I know it hard to know what numbers to trust but I think it is clear numbers are dropping right now. A lot of it is medicaid funding but in my area I noticed a surge in all things crunchy since 2006 so I think there is more awareness. With the rates around 50% at least it will start being normal in there generation to know what an intact penis is.

It is very dischearting to see more on the article and see that it is a push to sound alarms and get funding again and they use more bogus info on not doing any harm to newborns. No shit the most harm comes later in life when boys become sexually active.
post #18 of 48
I doubt those numbers too. All the article is saying is how circs are down due to no funding and that's bad for public health. I cannot understand this stuff at all, really. Nobody back home in their right mind would ever circumcise a child unless for religious reasons. What's the crazy obsession with cutting off foreskins?! It used to be to curb lust, then it was hygiene, now it is Aids, what's the next thing they come up with?!
post #19 of 48
Quote:
The data showed that the rates for a range of adverse events, such as mishaps, correctional procedures, and infections were substantially lower in boys less than 1 year old, compared with boys aged 1-9 years, and with boys and men aged 10 years or older. For example, mishaps occurred in none of the boys aged less than 1 year or aged 1-9 years, but in 158/100,000 boys and men aged 10 years or older. The rate of correctional procedures was 58/100,000; 2,544/100,000; and 1,709/100,000 in the three age groups, respectively. Infections occurred at a rate of 154/100,000; 5,664/100,000; and 4,527/100,000 in the three age groups.
I don't understand how this could be the case. I guess the question is what did they define as a "mishap". I'm surprised that more of the older males had to have correctional procedures and that they suffered from more infections. I would think the procedure would be easier with adults because the foreskin is already detached and there is no fear of taking too much off. Also, there should be less infection when the open wound is not exposed to diaper contents.
post #20 of 48
Wow, 33%? Some areas of the country must be darn near zero, because the hospital where I work has a 95% plus circ rate. I've worked here for 6 mos, and have only seen a whopping ONE family that chose not to circ their baby boy, out of over 100 boy babies that I've cared for. ONE!

The high circ rate surprises me, considering how progressive this hospital is about things like vbac and breastfeeding. And also considering that one of our pediatricians openly tells parents that there is no medical reason to circ, and the other does not even do circs. The parents are so set on it that they just ask their ob to circ if the ped won't do it.

I'm in the midwest.
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