Preparing anti-circumcision response to Public Health England White Paper.

post #1 of 4

3/19/11 at 6:04am

Thread Starter

155 Posts. Joined 2/2011
Location: Australia
Select All Posts By This User

I have drafted responses to questions a. and c. on page 80 of the White Paper (http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122347.pdf)

I should have responses to the other questions drafted in the next couple of days and will post a "Call to Action" in the Activism section.

a. Role of GPs and GP practices in public health: Are there additional ways in which we can ensure that GPs and GP practices will continue to play a key role in areas for which Public Health England will take responsibility?

There has been a concerted effort in the professional literature, from a small cabal within the medical fraternity, to argue the case for reinstating non-therapeutic circumcision at the expense of the NHS, frequently using professed concern for the well-being of boys of certain ethnic or religious backgrounds receiving circumcision in non-medical settings, as a pretext [1], a call loudly echoed in sections of the mainstream media [2].

Regardless of whether it is performed in a medical or non-medical setting, a significant number of boys subjected to the practice of circumcision fulfill the DSM-IV criteria for a diagnosis of Post-Traumatic Stress Disorder [3].

The British Medical Association advises against routine male circumcision [4], and no national medical association in the world recommends that boys be forcefully circumcised for preventive health reasons.

Holland's very up-to-date policy on circumcision states that "KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications", and that there is a good case for making it illegal [5].

It is therefore imperative that Public Health England mandate that all staff, contractors, agencies, facilities and departments under it's auspices, including GPs and GP practices:

- Must not offer among their services the harmful male genital mutilation known as circumcision;
- Must not permit on their premises individuals or organisations promoting the harmful male genital mutilation known as circumcision;
- Must not be refer patients explicitly for the harmful male genital mutilation known as circumcision;
- Must not be employed or associated with any facility offering the harmful male genital mutilation known as circumcision;
- Must not allow their facilities to be used for the harmful male genital mutilation known as circumcision.; and
- Must not stock or allow on their premises literature or other material promoting the harmful male genital mutilation known as circumcision.

References/Links:

1. Paranthaman K., Bagaria, J & O'Moore, E. (2010) The need for commissioning circumcision services for non-therapeutic indications in the NHS: lessons from an incident investigation in Oxford J Public Health first published online July 14, 2010 http://jpubhealth.oxfordjournals.org/content/early/2010/07/14/pubmed.fdq053.full

2. Campbell, D. (2010) NHS urged to offer circumcisions to avoid botched operations in The Guardian Sunday 11 July 2010 http://www.guardian.co.uk/society/2010/jul/11/doctors-urge-circumcision-on-nhs

3. Samuel Ramos and Gregory J. Boyle. Ritual and Medical Circumcision among Filipino boys: Evidence of Post-traumatic Stress Disorder Humanities & Social Sciences papers (2000). Available at: http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1120&context=hss_pubs

4. British Medical Association.The law and ethics of male circumcision: guidance for doctors. London: BMA, 2006 http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp

5. KNMG (2010) Non-theraputic circumcision of male minors http://knmg.artsennet.nl/web/file?uuid=579e836d-ea83-410f-9889-feb7eda87cd5&owner=a8a9ce0e-f42b-47a5-960e-be08025b7b04&contentid=77976

c. Public health evidence: How can Public Health England address current gaps such as using the insights of behavioural science, tackling wider determinants of health, achieving cost effectiveness, and tackling inequalities?

Recently, there has been a string of mainstream media items favourable to male circumcision, which amount to nothing less than a marketing campaign to motive parents to have their sons circumcised [1-4]. Many of these articles draw upon established marketing concepts (in turn derived from insights of behavoiural science), most notably, the use of “experts”. An “expert”, in a marketing context, is an individual who, because of their occupation, or perceived experience, is uniquely placed to lend credence to the product or service that an advertisement promotes [5]. In the context of promoting circumcision to parents, such “experts” generally include medical practitioners who work at private circumcision clinics [2,4] and religious officials [3].

Following complaints from the public, the Press Complaints Commission has reached resolutions noting the inappropriate implication in media items that religious officials are qualified to offer medical advice in regard to circumcision, the minimisation of the inherent risks of circumcision as a medical procedure, and the implication that circumcision is of minimal discomfort through the impression that it is legitimate practice to conduct the procedure without anaesthesia [6,7].

Both the hospital and doctor featured in a recent episode of the Channel 4 series Embarrassing Bodies [4], are linking to the video on the Channel 4 website from their respective web-pages [8,9], effectively by-passing the General Medical Council Guidelines about how medical practitioners should promote and publish information about their services [10].

It is unsurprising that such symbiotic relationships should form between private doctors seeking to promote their practice and mainstream media outlets who want to appease advertisers by keeping such a high-profile controversial social issue alive, since advertising is the force which has historically sustained all commercial media [11].

Regardless of whether it is performed in a medical or non-medical setting, a significant number of boys subjected to the practice of circumcision fulfill the DSM-IV criteria for a diagnosis of Post-Traumatic Stress Disorder [12].

Further, circumcision removes the most sexually sensitive parts of a boy’s penis, including the foreskin, the frenulum, and the ridged band of nerves [13]. The male foreskin is also designed to protect the glans of the penis throughout a man’s life, ensuring that the internal mucosal tissue remains moist and sensitive (much the same way that a woman’s clitoral hood protects the clitoris). In addition, the foreskin acts as a natural gliding mechanism to reduce chafing and dryness during intercourse [14].

To counteract the mainstream media marketing of circumcision to parents, it is appropriate that Public Health England prepare a single document stating that circumcision will not be made available by any staff, contractors, agencies, facilities and departments under it's auspices, including GPs and GP practices, and detailing the harms of circumcision discussed above.

References/Links:

1. Campbell, D. (2010) NHS urged to offer circumcisions to avoid botched operations in The Guardian Sunday 11 July 2010 http://www.guardian.co.uk/society/2010/jul/11/doctors-urge-circumcision-on-nhs

2. Renton, A. (2010) It protects men (and women) against fatal diseases and sexual infections. So, should all boys be circumcised? in TheDaily Mail http://www.dailymail.co.uk/health/article-1199472/It-protects-men-women-fatal-diseases-sexual-infections-So-boys-circumcised.html

3. Rich, B. (2010) To snip or not to snip? in The Guardian http://www.guardian.co.uk/lifeandstyle/2010/oct/30/circumcision-jewish-son-ben-rich

4. Channel 4 (2011) Embarrassing Bodies Series 4 Episode 4 http://www.channel4.com/programmes/embarrassing-bodies/episode-guide/series-4/episode-4

5. Schiffman, L Bednell, D O’Cass, A Paladino, A Kanuk, L (2005) Consumer Behaviour 3rd Edition Pearson Education Australia, Australia: Frenchs Forest

6 Press Complaints Commission (2011) Parkes vs The Guardian http://www.pcc.org.uk/news/index.html?article=NjkxNg==

7. Press Complaints Commission (2010) Warren vs Daily Mail http://www.pcc.org.uk/news/index.html?article=NjIyNA==

8. http://www.spirehealthcare.com/Liverpool/Our-Facilities-Treatments-and-Consultants/Our-Treatments/Adult-circumcision/

9. http://www.spirehealthcare.com/Liverpool/Our-Facilities-Treatments-and-Consultants/Our-Consultants/Mr-P-Cornford/

10. General Medical Council (2011) Good Medical Practice: Providing and publishing information about your services http://www.gmc-uk.org/guidance/good_medical_practice/probity_information_about_services.asp

11. Cunningham, S & Turner, G (2002) The Media & Communications in Australia Allen & Unwin, Australia

12. Samuel Ramos and Gregory J. Boyle. Ritual and Medical Circumcision among Filipino boys: Evidence of Post-traumatic Stress Disorder Humanities & Social Sciences papers (2000). Available at: http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1120&context=hss_pubs

13. Morris L. Sorrells, James L. Snyder, Mark D. Reiss, Christopher Eden, Marilyn F. Milos, Norma Wilcox, Robert S. Van Howe Fine-touch pressure thresholds in the adult penis British Journal of Urology International, Volume 99 Issue 4 Page 864 – 869 April 2007 http://www.nocirc.org/touch-test/bju_6685.pdf

14. Taylor, J.P., A.P. Lockwood and A.J.Taylor The prepuce: Specialized mucosa of the penis and its loss to circumcision Journal of Urology (1996), 77, 291-295 http://www.cirp.org/library/anatomy/taylor/

Edited by Minuteman - 3/27/11 at 8:21am

Below are the responses to questions b., d. and e.

It's not perfect but better than nothing I suppose.

I'll leave these up for perusal and comment for 24 hours, make any last minute changes and then post a "Call to Action" in the Activism forum.

b. Public health evidence: What are the best opportunities to develop and enhance the availability, accessibility and utility of public health information and intelligence?

The White Paper states among it's objectives “Starting well, through early intervention and prevention, is a key priority for the Government, developing strong universal public health and early education with an increased focus on disadvantaged families. This approach, proportionate universalism, was advocated in the Marmot Review into health inequalities.” (p. 32).

A priority area demanding early intervention and prevention by Public Health England, is reducing the incidence of the harmful male genital mutilation known as circumcision.

There has been a concerted effort in the professional literature, from a small cabal within the medical fraternity, to argue the case for reinstating non-therapeutic circumcision at the expense of the NHS, frequently using professed concern for the well-being of boys of certain ethnic or religious backgrounds receiving circumcision in non-medical settings, as a pretext [1], a call loudly echoed in sections of the mainstream media [2].

Regardless of whether it is performed in a medical or non-medical setting, a significant number of boys subjected to the practice of circumcision fulfill the DSM-IV criteria for a diagnosis of Post-Traumatic Stress Disorder [3].

Further, circumcision removes the most sexually sensitive parts of a boy’s penis, including the foreskin, the frenulum, and the ridged band of nerves [4]. The male foreskin is also designed to protect the glans of the penis throughout a man’s life, ensuring that the internal mucosal tissue remains moist and sensitive (much the same way that a woman’s clitoral hood protects the clitoris). In addition, the foreskin acts as a natural gliding mechanism to reduce chafing and dryness during intercourse [5].

Female genital mutilation has been illegal for a number of years now [6].

There has been little incentive for the medical profession to investigate the long-term affects on men's sexual and psychological health and well-being, but the growth of groups such as NORM-UK (an organisation registered with the Charities Commissioners for England and Wales), suggests that a substantial number of men genuinely resent being circumcised [7].

To best develop and enhance the availability, accessibility and utility of public health information and intelligence regarding the harmful male genital mutilation known as circumcision, it is imperative that Public Health England establish a central information store of the harm caused by male circumcision, which will form the basis for establishing a dictate that staff, contractors, agencies, facilities and departments under it's auspices, including GPs and GP practices, will not perform nor refer patients for circumcision; and to make use of the insights of behavioural science to research and implement strategies which discourage parents from subjecting their sons to the harmful male genital mutilation known as circumcision, without lending to it's prestige by implying that it is a practice worthy of it's own policy statement or the subject of a legitimate 'debate'.

Refernces/Links:

1. Paranthaman K., Bagaria, J & O'Moore, E. (2010) The need for commissioning circumcision services for non-therapeutic indications in the NHS: lessons from an incident investigation in Oxford J Public Health first published online July 14, 2010 http://jpubhealth.oxfordjournals.org/content/early/2010/07/14/pubmed.fdq053.full

2. Campbell, D. (2010) NHS urged to offer circumcisions to avoid botched operations in The Guardian Sunday 11 July 2010 http://www.guardian.co.uk/society/2010/jul/11/doctors-urge-circumcision-on-nhs

3. Samuel Ramos and Gregory J. Boyle. Ritual and Medical Circumcision among Filipino boys: Evidence of Post-traumatic Stress Disorder Humanities & Social Sciences papers (2000). Available at: http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1120&context=hss_pubs

4. Morris L. Sorrells, James L. Snyder, Mark D. Reiss, Christopher Eden, Marilyn F. Milos, Norma Wilcox, Robert S. Van Howe Fine-touch pressure thresholds in the adult penis British Journal of Urology International, Volume 99 Issue 4 Page 864 – 869 April 2007 http://www.nocirc.org/touch-test/bju_6685.pdf

5. Taylor, J.P., A.P. Lockwood and A.J.Taylor The prepuce: Specialized mucosa of the penis and its loss to circumcision Journal of Urology (1996), 77, 291-295 http://www.cirp.org/library/anatomy/taylor/

6. LASSL (2004)4: Female Genital Mutilation Act 2003, DoH, published 27.2.2004

7. http://www.norm-uk.org/

d. Public health evidence: What can wider partners nationally and locally contribute to improving the use of evidence in public health?

A priority area demanding early intervention and utilisation of public health evidence by Public Health England, is reducing the incidence of the harmful male genital mutilation known as circumcision.

There has been a concerted effort in the professional literature, from a small cabal within the medical fraternity, to argue the case for reinstating non-therapeutic circumcision at the expense of the NHS, frequently using professed concern for the well-being of boys of certain ethnic or religious backgrounds receiving circumcision in non-medical settings, as a pretext [1], a call loudly echoed in sections of the mainstream media [2]. Recently, there has been a string of mainstream media items favourable to male circumcision, which amount to nothing less than a marketing campaign to motivate parents to have their sons circumcised [2-5]. Many of these articles draw upon established marketing concepts (in turn derived from insights of behavoiural science), most notably, the use of “experts”. An “expert”, in a marketing context, is an individual who, because of their occupation, or perceived experience, is uniquely placed to lend credence to the product or service that an advertisement promotes [6]. In the context of promoting circumcision to parents, such “experts” generally include medical practitioners who work at private circumcision clinics [3,5] and religious officials [4].

Regardless of whether it is performed in a medical or non-medical setting, a significant number of boys subjected to the practice of circumcision fulfill the DSM-IV criteria for a diagnosis of Post-Traumatic Stress Disorder [7]. Further, circumcision removes the most sexually sensitive parts of a boy’s penis, including the foreskin, the frenulum, and the ridged band of nerves [8]. The male foreskin is also designed to protect the glans of the penis throughout a man’s life, ensuring that the internal mucosal tissue remains moist and sensitive (much the same way that a woman’s clitoral hood protects the clitoris). In addition, the foreskin acts as a natural gliding mechanism to reduce chafing and dryness during intercourse [9].

A recent statement from the British Association of Paediatric Urologists on behalf of the British Association of Paediatric Surgeons and The Association of Paediatric Anaesthetists admitted that some doctor's under it's charge “have been willing to provide non therapeutic circumcision without charge rather than risk the procedure being carried out in unhygienic conditions.” [10]. In it's statement on the law and ethics of male circumcision, the British Medical Association has concluded that “it is for society to decide what limits should be imposed on parental choices.” [11].

There has been little incentive for the medical profession to investigate the long-term affects on men's sexual and psychological health and well-being, but the growth of groups such as NORM-UK (an organisation registered with the Charities Commissioners for England and Wales), suggests that a substantial number of men genuinely resent being circumcised [12].

It would therefore be appropriate to invite appropriately registered charity organisations such as NORM-UK to partner with Public Health England to contribute to compiling and improving the use of public health evidence to counteract the mainstream media marketing of circumcision to parents and discourage parents from subjecting their sons to the harmful male genital mutilation known as circumcision, without lending to it's prestige by implying that it is a practice worthy of it's own policy statement or the subject of a legitimate 'debate'.

References/Links:

1. Paranthaman K., Bagaria, J & O'Moore, E. (2010) The need for commissioning circumcision services for non-therapeutic indications in the NHS: lessons from an incident investigation in Oxford J Public Health first published online July 14, 2010 http://jpubhealth.oxfordjournals.org/content/early/2010/07/14/pubmed.fdq053.full

2. Campbell, D. (2010) NHS urged to offer circumcisions to avoid botched operations in The Guardian Sunday 11 July 2010 http://www.guardian.co.uk/society/2010/jul/11/doctors-urge-circumcision-on-nhs

3. Renton, A. (2010) It protects men (and women) against fatal diseases and sexual infections. So, should all boys be circumcised? in TheDaily Mail http://www.dailymail.co.uk/health/article-1199472/It-protects-men-women-fatal-diseases-sexual-infections-So-boys-circumcised.html

4. Rich, B. (2010) To snip or not to snip? in The Guardian http://www.guardian.co.uk/lifeandstyle/2010/oct/30/circumcision-jewish-son-ben-rich

5. Channel 4 (2011) Embarrassing Bodies Series 4 Episode 4 http://www.channel4.com/programmes/embarrassing-bodies/episode-guide/series-4/episode-4

6. Schiffman, L Bednell, D O’Cass, A Paladino, A Kanuk, L (2005) Consumer Behaviour 3rd Edition Pearson Education Australia, Australia: Frenchs Forest

7. Samuel Ramos and Gregory J. Boyle. Ritual and Medical Circumcision among Filipino boys: Evidence of Post-traumatic Stress Disorder Humanities & Social Sciences papers (2000). Available at: http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1120&context=hss_pubs

8. Morris L. Sorrells, James L. Snyder, Mark D. Reiss, Christopher Eden, Marilyn F. Milos, Norma Wilcox, Robert S. Van Howe Fine-touch pressure thresholds in the adult penis British Journal of Urology International, Volume 99 Issue 4 Page 864 – 869 April 2007 http://www.nocirc.org/touch-test/bju_6685.pdf

9. Taylor, J.P., A.P. Lockwood and A.J.Taylor The prepuce: Specialized mucosa of the penis and its loss to circumcision Journal of Urology (1996), 77, 291-295 http://www.cirp.org/library/anatomy/taylor/

10. British Association of Paediatric Urologists (2007) MANAGEMENT OF FORESKIN CONDITIONS Statement from the British Association of Paediatric Urologists on behalf of the British Association of Paediatric Surgeons and The Association of Paediatric Anaesthetists. http://www.apagbi.org.uk/sites/apagbi.org.uk/files/circumcision2007.pdf

BMA (2006) The law and ethics of male circumcision - guidance for doctors http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp

12. http://www.norm-uk.org/

e. Regulation of public health professionals: We would welcome views on Dr Gabriel Scally’s report. If we were to pursue voluntary registration, which organisation would be best suited to provide a system of voluntary regulation for public health specialists?

An area which raises questions about the professional conduct of some medical practitioners, is the continuing practice of the harmful male genital mutilation known as circumcision.

There has been a concerted effort in the professional literature, from a small cabal within the medical fraternity, to argue the case for reinstating non-therapeutic circumcision at the expense of the NHS, frequently using professed concern for the well-being of boys of certain ethnic or religious backgrounds receiving circumcision in non-medical settings, as a pretext [1], a call loudly echoed in sections of the mainstream media [2].

Recently, there has been a string of mainstream media items favourable to male circumcision, which amount to nothing less than a marketing campaign to motivate parents to have their sons circumcised [2-5]. Many of these articles draw upon established marketing concepts (in turn derived from insights of behavoiural science), most notably, the use of “experts”. An “expert”, in a marketing context, is an individual who, because of their occupation, or perceived experience, is uniquely placed to lend credence to the product or service that an advertisement promotes [6]. In the context of promoting circumcision to parents, such “experts” generally include medical practitioners who work at private circumcision clinics [3,5] and religious officials [4].

Both the hospital and doctor (who is also a Consultant Urological Surgeon at Royal Liverpool University Hospital NHS Trust) featured in a recent episode of the Channel 4 television series Embarrassing Bodies [5], are linking to the video on the Channel 4 website from their respective web-pages [7,8], effectively by-passing the General Medical Council Guidelines about how medical practitioners should promote and publish information about their services [9].

A recent statement from the British Association of Paediatric Urologists on behalf of the British Association of Paediatric Surgeons and The Association of Paediatric Anaesthetists admitted that some doctor's under it's charge “have been willing to provide non therapeutic circumcision without charge rather than risk the procedure being carried out in unhygienic conditions.” [10]. Regardless of whether it is performed in a medical or non-medical setting, a significant number of boys subjected to the practice of circumcision fulfill the DSM-IV criteria for a diagnosis of Post-Traumatic Stress Disorder [11].

Given questions raised about the professional conduct of some medical practitioners with regard to the continuing practice of male circumcision, whatever system of voluntary regulation may be implemented, it is appropriate that Public Health England mandate that staff, contractors, agencies, facilities and departments under it's auspices, including GPs, GP practices and other public health specialists, will not perform nor refer patients for the harmful male genital mutilation known as circumcision.

References/Links:

1. Paranthaman K., Bagaria, J & O'Moore, E. (2010) The need for commissioning circumcision services for non-therapeutic indications in the NHS: lessons from an incident investigation in Oxford J Public Health first published online July 14, 2010 http://jpubhealth.oxfordjournals.org/content/early/2010/07/14/pubmed.fdq053.full

2. Campbell, D. (2010) NHS urged to offer circumcisions to avoid botched operations in The Guardian Sunday 11 July 2010 http://www.guardian.co.uk/society/2010/jul/11/doctors-urge-circumcision-on-nhs

3. Renton, A. (2010) It protects men (and women) against fatal diseases and sexual infections. So, should all boys be circumcised? in TheDaily Mail http://www.dailymail.co.uk/health/article-1199472/It-protects-men-women-fatal-diseases-sexual-infections-So-boys-circumcised.html

4. Rich, B. (2010) To snip or not to snip? in The Guardian http://www.guardian.co.uk/lifeandstyle/2010/oct/30/circumcision-jewish-son-ben-rich

5. Channel 4 (2011) Embarrassing Bodies Series 4 Episode 4 http://www.channel4.com/programmes/embarrassing-bodies/episode-guide/series-4/episode-4

6. Schiffman, L Bednell, D O’Cass, A Paladino, A Kanuk, L (2005) Consumer Behaviour 3rd Edition Pearson Education Australia, Australia: Frenchs Forest

7. http://www.spirehealthcare.com/Liverpool/Our-Facilities-Treatments-and-Consultants/Our-Treatments/Adult-circumcision/

8. http://www.spirehealthcare.com/Liverpool/Our-Facilities-Treatments-and-Consultants/Our-Consultants/Mr-P-Cornford/

9. General Medical Council (2011) Good Medical Practice: Providing and publishing information about your services http://www.gmc-uk.org/guidance/good_medical_practice/probity_information_about_services.asp

10. British Association of Paediatric Urologists (2007) MANAGEMENT OF FORESKIN CONDITIONS Statement from the British Association of Paediatric Urologists on behalf of the British Association of Paediatric Surgeons and The Association of Paediatric Anaesthetists. http://www.apagbi.org.uk/sites/apagbi.org.uk/files/circumcision2007.pdf

11. Samuel Ramos and Gregory J. Boyle. Ritual and Medical Circumcision among Filipino boys: Evidence of Post-traumatic Stress Disorder Humanities & Social Sciences papers (2000). Available at: http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1120&context=hss_pubs