AAP stance ... Seriously??

[vachi73]

This is a vent, as I am just aghast that the AAP is going to recommend RIC starting next year. Seriously?? I realize that doctors get money for doing circs, but I just shudder to think what might happen to all the progress made in recent years.

Who is in charge of the AAP subcommittee on circ? That person or persons must really be biased or have an agenda to promote circ. Ugh.

Sorry for venting, just sick about it.

Thank goodness all four of our boys are intact!

[NSmomtobe]

I have heard this and also that the CPS (Canadian Pediatric Society) is "re-examining the evidence" on circumcision, in light of the new information collected from the RCTs. I want to know if there is any truth to the latter rumour and if so, who I can write to to make sure that they are not going to come to the same irrational conclusions as their American counterparts.

[glongley]

Originally Posted by NSmomtobe

I have heard this and also that the CPS (Canadian Pediatric Society) is "re-examining the evidence" on circumcision, in light of the new information collected from the RCTs. I want to know if there is any truth to the latter rumour and if so, who I can write to to make sure that they are not going to come to the same irrational conclusions as their American counterparts.

http://www.cps.ca/English/InsideCPS/contact.htm

[Sharlla]

can i get a link?
Posted via Mobile Device

[NSmomtobe]

Thanks, glongley! Have you heard anything about their plan to re-examine the evidence?

[AFWife]

I honestly don't always put stock in the AAP...mostly because I'm a non vaxer and, according to them, I'm endangering my child and those around him...

Like all of the evidence, take it with a grain of salt. There are doctors on both sides that will go on and on about how right THEIR SIDE is and how stupid the other side is..

[Pirogi]

This is the first I've heard that the AAP is going to change its stance on circumcision. Can someone provide a link?

[tennisdude23]

Originally Posted by Pirogi

This is the first I've heard that the AAP is going to change its stance on circumcision. Can someone provide a link?

Although a circumcision task force was formed a few years ago, they have not published any conclusions as of yet, which I think means that they don't have any good evidence going one way or the other. If I had to guess, the AAP's stance will not change much from their 1999 statement, meaning that they will still stress that circumcision is of no medical necessity. As to the details of the cost/benefit analysis, there is really no way to tell what they will say. It would be nice though if they would follow in the foot steps of their Dutch or Australian colleagues, whose pediatric academies recently came out very much against circumcision.

[brant31]

The new AAP policy is already written. It is now just making the rounds of various committees (legal, bioethics) for fine-tuning and compliance.

If I had to guess, I would say that the new statement will say for the first time that circumcision is beneficial (tho still not officially "recommended") and carries ridiculously low risk. They'll stress that it is a very reasonable option for parents to choose, and that more parents should be made aware of the (considerable) benefits and (tiny) risks. Nowhere will they mention the structure or function of the foreskin, or mention body autonomy. In short, the AAP will "endorse" infant circumcision for parents who, after being fully informed, feel it is in the best interests of their child and their family.

Still a cop-out, but our uniquely American cop-out. Don't expect the Canadians or Australians to be hoodwinked by this. The 2 things the AAP wants to protect are the status quo (at least that of adult males) and the professional right to do circs for money. Neither consideration carries as much weight in other countries.

The AAP has a long history of downplaying the risks of circumcision, either by selective consideration, typos, or outright deception. In one statement, they quoted a respected source as saying the risks of all complications were between 0.2 and 0.8 percent. In fact, the source had said the risks "of serious complications" were between 2.0 and 8.0 percent. When this was pointed out, the AAP said it was "just a typo". Yeah, right.

[tennisdude23]

Originally Posted by brant31

The new AAP policy is already written. It is now just making the rounds of various committees (legal, bioethics) for fine-tuning and compliance.

If I had to guess, I would say that the new statement will say for the first time that circumcision is beneficial (tho still not officially "recommended") and carries ridiculously low risk. They'll stress that it is a very reasonable option for parents to choose, and that more parents should be made aware of the (considerable) benefits and (tiny) risks. Nowhere will they mention the structure or function of the foreskin, or mention body autonomy. In short, the AAP will "endorse" infant circumcision for parents who, after being fully informed, feel it is in the best interests of their child and their family.

Still a cop-out, but our uniquely American cop-out. Don't expect the Canadians or Australians to be hoodwinked by this. The 2 things the AAP wants to protect are the status quo (at least that of adult males) and the professional right to do circs for money. Neither consideration carries as much weight in other countries.

The AAP has a long history of downplaying the risks of circumcision, either by selective consideration, typos, or outright deception. In one statement, they quoted a respected source as saying the risks of all complications were between 0.2 and 0.8 percent. In fact, the source had said the risks "of serious complications" were between 2.0 and 8.0 percent. When this was pointed out, the AAP said it was "just a typo". Yeah, right.

I have not seen anything to suggest that the policy is written already. They were supposed to have their statement out a while ago, but so far nothing, which makes me suspect that they don't really have a "smoking gun," advocating far reaching benefits. Yes, I am sure they will mention some pros, but it's doubtful their statements will deviate much from those of other institutions. Indeed, I presume that the stance will be highly open to interpretation, so as to cover their backs and not make it seem that they are going overtly in one direction or other. Whatever the end result may be, I doubt it's going to have long lasting effects either way.

[dmpmercury]

This can't be happening. This would be a huge blow. It would totally suck and perpetuate the falsehoods. I can't believe people are falling for this HIV stuff that it provides good protection and that there is no harm in circumcision. Seriously. How can we allow this practice to happen. How do medical professionals believe all these myths. I can't believe what has been taken from us and still occurs and that a few men and some bogus studies can cause us to cut off the most functional part of a sex organ and no one cares or notices and actually think it was a good thing we did.

[brant31]

Originally Posted by tennisdude23

I have not seen anything to suggest that the policy is written already. They were supposed to have their statement out a while ago, but so far nothing, which makes me suspect that they don't really have a "smoking gun," advocating far reaching benefits.

Did you even follow the link to the New York Times article from this past Tuesday?

"Officials from the pediatrics academy said its new policy would be issued by early 2011; a task force that studied the topic has completed its report, which is being reviewed by several other committees, said Dr. Michael Brady, chairman of pediatrics at Nationwide Children’s Hospital in Columbus, Ohio, who served on the task force. The academy is likely to adopt a more encouraging stance than its current neutral position and to state that the procedure has health benefits beyond H.I.V. prevention, Dr. Brady said."

[tennisdude23]

Originally Posted by brant31

Did you even follow the link to the New York Times article from this past Tuesday?

"Officials from the pediatrics academy said its new policy would be issued by early 2011; a task force that studied the topic has completed its report, which is being reviewed by several other committees, said Dr. Michael Brady, chairman of pediatrics at Nationwide Children’s Hospital in Columbus, Ohio, who served on the task force. The academy is likely to adopt a more encouraging stance than its current neutral position and to state that the procedure has health benefits beyond H.I.V. prevention, Dr. Brady said."

I skimmed through the article briefly, and I guess I missed this part. In any case, the reporting here is very vague. They seem to have conducted only a preliminary report. There is no real mention of the content. What does it mean to say that it will be "more encouraging?" Encouraging is a word that is highly open interpretation, as I suspect the entire AAP position will be. Brady, by the way, from previous interviews always touted a sort of "pro" stance. It will be interesting to hear the opinions of others in the academy, and so far, they have kept pretty quiet. As to the date of the official release, it keeps changing. Last time the NYT reported on this issue, the date was supposed to be the fall of 2009. Why the constant delays? Something tells me that they are having difficult time coming to a consensus. Perhaps, this has something to do with the recent Dutch position and the APP's gaffe on FGM. In any case, I sort of doubt that you can get much worse than the conclusions of the 1989 task force, which was led by Edgar Schoen, the creepiest circumcision promoter on the planet. Even that report, which was "more encouraging," did not really promote circumcision or had any measurable impact on circumcision rates in the USA. The AAP has already opened itself up to lots of criticism for even having this task force, and knows very well that it should be wary of overstating its case. So, I reserve final judgment until I see the new position.

[brant31]

The most recent AAP statement on circumcision, which was released in March 1999, was originally slated to be released in November 1997. This is normal for the AAP. Lots and lots of lawyers involved. This next statement also will not be a "recommendation", because the first couple that follows such a recommendation to circumcise and loses a kid (or has any other major mishap) is going to sue the AAP from here to Uranus.

To my knowledge, the AAP has never issued any "statement" on the normal intact penis and how to keep it healthy. Not a word about form, not a word about function, not a word about care, other than some vague mumblings in the circumcision report about not retracting in the first few years.

Very strange, even bizarre. Why are they afraid to calmly address a normal part of male anatomy, rather than just jump into cutting it off? Why is it not called the "AAP Statement on the Penis", with a footnote about circumcision?

[tennisdude23]

To be honest, I have come to the conclusion that it really won't matter what the AAP will or will not say. Personally, a "no recommendation" statement is good enough for me. The facts still remain the same, namely that for any possible benefit of circumcision that same benefit can be achieved though less invasive means and that the "benefits" in question do not apply to newborn infants. With the way things are going, I foresee that the rates will continue to drop and that sooner or later, the AAP will get fully in line with the rest of the world.

[Papai]

Originally Posted by tennisdude23

To be honest, I have come to the conclusion that it really won't matter what the AAP will or will not say. Personally, a "no recommendation" statement is good enough for me. The facts still remain the same, namely that for any possible benefit of circumcision that same benefit can be achieved though less invasive means and that the "benefits" in question do not apply to newborn infants. With the way things are going, I foresee that the rates will continue to drop and that sooner or later, the AAP will get fully in line with the rest of the world.

Your optimism is heart-warming. Hope you're right!

[brant31]

It is not the AAP's and CDC's forthcoming pronouncements that concern me. I agree with tennisdude23 that they'll be largely ignored by parents, or have a very small impact.

But circumcision in the United States is far more an economic issue than even a cultural or social issue, given the structure of our healthcare delivery system. When parents have to pay out-of-pocket, by and large they skip circumcision. There are exceptions, but that is the rule. In states that have dropped Medicaid coverage of infant circumcision, circ rates have dropped from 60-90% to about 10% among Medicaid births.

What concerns me is the repeated rumblings by both the AAP and the CDC about the urgent need to address the issues of "access to circumcision", "fairness of circumcision opportunity" and "public health concerns". It all sounds like code to me for lobbying to reinstate Medicaid circumcisions on-demand in the 16 states that have dropped it, and to put in place safeguards to ensure no state ever drops it again. This also impacts the private insurance market, because more private insurers and HMOs don't cover infant circumcision in those states where Medicaid has already dropped it. The goal of the AAP and the CDC is to once again get infant circumcision to a point where all a parent has to do is tick a box or sign a form, and they'll never see a bill. They know that's their best bet for universal infant circumcision, and they're couching their weird obsession in "fairness" language, as if Medicaid parents were being deprived of a very important health benefit.

Honestly, I don't see how they can come out and say "OK if you do, OK if you don't", then screech about discrimination against the poor. There are some very wealthy, well-educated families not choosing circumcision, but a newspaper article in NC during the debate to drop Medicaid circ (they ultimately did) talked about the foreskin as a locker room stigma of poverty, and suggested boys should not have to wear a scarlet letter (F?) revealing their family's penury just for the privilege of showering with the circumcised middle-class masses.

[Crunchy Frog]

brant31, I think you're right about economics being a prime motivator for the current changes. I don't think it's any coincidence that the timing of this is so close to the whole health care reform process. My guess is that they want to ensure that circumcision will be mandated to be a covered procedure under the new health care guidelines.

I wanted to say that I appreciate all the information and insight from you, and wonder if you have considered starting a blog for this information. I think it would be an incredibly valuable contribution if you would.

[brant31]

Wow, thanks! (I hope that's not a way of asking me if I've taken my Ritalin this week. ) In all seriousness, I feel fortunate that recently I have had a front-row seat at some of the important policy discussions taking place (like Vienna), and frankly this is one of the most important places I can think to share what I've been privy to. I have said many times that I am just in awe of the moms here -- you soak it all up, spread the word and change the world.

Funny you mention a blog, because I have taken a few tentative steps in that direction. The issue, of course, is commitment. It's hard to take a month off here and there from something that important, while I've gone months here without posting. It's just that a lot has been happening lately on the circ front. If I did blog, I'm afraid I wouldn't be going for "balance" as some others do; in my mind, the issue is rather clear. The foreskin is not a birth defect, and I wouldn't be very receptive to debating "both sides"... it's pretty clear what's right from the child's perspective.

If I don't do a blog, I'll write a book. I promise.

[luvmybaby333]

Wow. I totally missed this. Does anyone have a link?