The prestigious BMJ ran an article this week on the growing schism in world medical association opinions about the efficacy and justifications of male infant circumcision. It is entitled "Circumcision: Divided We Fall".
Sophie Arie, a freelance journalist, wrote the piece that was published in the 17 August 2010 "This Week in BMJ".
The author lists an email address for feedback.
A few interesting observations include the fact that "circumcision is considered hygienic by those who accept it for cultural or religious reasons," implying that those who don't, still harbor doubts. We've known this for decades: circumcision begets circumcisers. Otherwise we would see intact men advocating for circumcision solely on its compelling health bases. They don't. It is chiefly those already invested in circumcision who see it through rosy glasses.
Arie points out the divide in stark terms. In May 2010 the Royal Dutch Medical Association was the first such body to declare that infant circumcision was both medically unnecessary and a human rights violation, at least under the Dutch constitution. Middle-ground is the British Medical Association, which does not denounce circumcision but still maintains that any evidence of health benefits on its own is an insufficient basis to elect or perform infant circumcision. Nevertheless, the BMA feels that parents should remain entitled to make choices about the best interests of their children as they see fit. At the other end of the spectrum is the US, which apparently is poised to come out with statements endorsing, but stopping just short of recommending universal, infant circumcision.
Doug Diekema, a medical ethicist from Seattle who has advised the AAP, says that the evidence for circumcision has only grown since 1999, the last time the AAP came out with a statement. But there is no evidence that risks have grown, so "although the benefits of circumcision in preventing the spread of HIV may be smaller in the US [than in sub-Saharan Africa], any degree of risk reduction is a good thing" and apparently grounds to suggest that circumcision is desirable for American baby boys.
Experts at Johns Hopkins University and the NIH have argued in favor of neonatal circumcision for health reasons and concluded it is time for the AAP's stance to reflect the latest data of the last 10 years [from Africa and elsewhere]. A 2007 CDC consultation on male circumcision for the prevention of HIV infection concluded that financial barriers to accessing circumcision should be removed, presumably a reference to pressuring all states to cover routine infant circumcision under Medicaid and to lobby private insurance plans and HMOs to fully cover elective infant circumcision, as they once did.
The article says "pressure has been growing on the [AAP] to take a stronger position in favor of the health benefits circumcision may offer" at the same time that countries like the Netherlands and the Scandinavian countries are taking a stronger stance that the "evidence" thus far in no way justifies or compels infant circumcision -- which increasingly looks like a clear human rights violation. Gert van Dijk, a medical ethicist at the Royal Dutch Medical Association, says the US has overstated the implications of the 3 African RCTs and overlooked several African studies that reached the opposite conclusion. "There is no convincing evidence on this", as well as no convincing or credible data on complications, says van Dijk. "It could be as high as 20%. We say this is a medically futile operation so not one complication can be justified."
In Africa, more than a dozen countries are actively promoting circumcision with radio, television and billboard campaigns. Arie notes that "circumcision has become fashionable among men in these African countries" in part because many believe the reduced sensation will make them perform better during intercourse. In many African countries, the surgery is moving faster into maternity wards, presumably because of lower cost, complications and resistance. Botswana, which has a 45% HIV rate, aims to circumcise all newborns in 2012 and even Rwanda, with only a 3% HIV prevalence, "is assessing the cost effectiveness of circumcising all newborn boys to prevent the spread of HIV." A recent study there concluded that infant male circumcision can be integrated into existing health services more easily than voluntary programs targeting adult men and adolescents "to achieve the very high coverage of the population required."
The article states that with the rise of the world wide web, partisans on both sides have been able to raise their voices in the debate. In the past 10 years, the number of foreskin restoration clinics catering to those who regret their parents' decision have increased [I have no clue what she is talking about] and circumcision in developed countries is generally waning rapidly. Only the United States appears poised to fight the trend and will likely praise the practice on newborns for health reasons. However, "most medical bodies in Western countries agree that although there may be health benefits, there is no medical justification for routine circumcision in neonates or children."
.
Sophie Arie, a freelance journalist, wrote the piece that was published in the 17 August 2010 "This Week in BMJ".
The author lists an email address for feedback.
A few interesting observations include the fact that "circumcision is considered hygienic by those who accept it for cultural or religious reasons," implying that those who don't, still harbor doubts. We've known this for decades: circumcision begets circumcisers. Otherwise we would see intact men advocating for circumcision solely on its compelling health bases. They don't. It is chiefly those already invested in circumcision who see it through rosy glasses.
Arie points out the divide in stark terms. In May 2010 the Royal Dutch Medical Association was the first such body to declare that infant circumcision was both medically unnecessary and a human rights violation, at least under the Dutch constitution. Middle-ground is the British Medical Association, which does not denounce circumcision but still maintains that any evidence of health benefits on its own is an insufficient basis to elect or perform infant circumcision. Nevertheless, the BMA feels that parents should remain entitled to make choices about the best interests of their children as they see fit. At the other end of the spectrum is the US, which apparently is poised to come out with statements endorsing, but stopping just short of recommending universal, infant circumcision.
Doug Diekema, a medical ethicist from Seattle who has advised the AAP, says that the evidence for circumcision has only grown since 1999, the last time the AAP came out with a statement. But there is no evidence that risks have grown, so "although the benefits of circumcision in preventing the spread of HIV may be smaller in the US [than in sub-Saharan Africa], any degree of risk reduction is a good thing" and apparently grounds to suggest that circumcision is desirable for American baby boys.
Experts at Johns Hopkins University and the NIH have argued in favor of neonatal circumcision for health reasons and concluded it is time for the AAP's stance to reflect the latest data of the last 10 years [from Africa and elsewhere]. A 2007 CDC consultation on male circumcision for the prevention of HIV infection concluded that financial barriers to accessing circumcision should be removed, presumably a reference to pressuring all states to cover routine infant circumcision under Medicaid and to lobby private insurance plans and HMOs to fully cover elective infant circumcision, as they once did.
The article says "pressure has been growing on the [AAP] to take a stronger position in favor of the health benefits circumcision may offer" at the same time that countries like the Netherlands and the Scandinavian countries are taking a stronger stance that the "evidence" thus far in no way justifies or compels infant circumcision -- which increasingly looks like a clear human rights violation. Gert van Dijk, a medical ethicist at the Royal Dutch Medical Association, says the US has overstated the implications of the 3 African RCTs and overlooked several African studies that reached the opposite conclusion. "There is no convincing evidence on this", as well as no convincing or credible data on complications, says van Dijk. "It could be as high as 20%. We say this is a medically futile operation so not one complication can be justified."
In Africa, more than a dozen countries are actively promoting circumcision with radio, television and billboard campaigns. Arie notes that "circumcision has become fashionable among men in these African countries" in part because many believe the reduced sensation will make them perform better during intercourse. In many African countries, the surgery is moving faster into maternity wards, presumably because of lower cost, complications and resistance. Botswana, which has a 45% HIV rate, aims to circumcise all newborns in 2012 and even Rwanda, with only a 3% HIV prevalence, "is assessing the cost effectiveness of circumcising all newborn boys to prevent the spread of HIV." A recent study there concluded that infant male circumcision can be integrated into existing health services more easily than voluntary programs targeting adult men and adolescents "to achieve the very high coverage of the population required."
The article states that with the rise of the world wide web, partisans on both sides have been able to raise their voices in the debate. In the past 10 years, the number of foreskin restoration clinics catering to those who regret their parents' decision have increased [I have no clue what she is talking about] and circumcision in developed countries is generally waning rapidly. Only the United States appears poised to fight the trend and will likely praise the practice on newborns for health reasons. However, "most medical bodies in Western countries agree that although there may be health benefits, there is no medical justification for routine circumcision in neonates or children."
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