AAP stance ... Seriously?? - Mothering Forums

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#1 of 24 Old 08-20-2010, 10:50 AM - Thread Starter
 
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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!
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#2 of 24 Old 08-20-2010, 10:57 AM
 
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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.

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#3 of 24 Old 08-20-2010, 11:14 AM
 
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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
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#4 of 24 Old 08-20-2010, 11:23 AM
 
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can i get a link?
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Unassisted birthing, atheist, poly, bi WOHM to 4 wonderful, smart homeschooling kids Wes (14) Seth (7) Pandora Moonlilly (2) and Nevermore Stargazer (11/2012)  Married to awesome SAH DH.

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#5 of 24 Old 08-20-2010, 11:24 AM
 
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Thanks, glongley! Have you heard anything about their plan to re-examine the evidence?

Now mom to a boy born January 2010. 
Cautiously expecting Dec 2014!

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#6 of 24 Old 08-20-2010, 11:57 AM
 
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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..

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#7 of 24 Old 08-20-2010, 12:05 PM
 
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This is the first I've heard that the AAP is going to change its stance on circumcision. Can someone provide a link?
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#8 of 24 Old 08-20-2010, 03:10 PM
 
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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.
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#9 of 24 Old 08-20-2010, 03:59 PM
 
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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.
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#10 of 24 Old 08-20-2010, 04:20 PM
 
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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.
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#11 of 24 Old 08-20-2010, 04:31 PM
 
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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.

Dianna environmentally educated tree hugging mom of dd 9/06 and ds 10/08 newbie dd 9/10
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#12 of 24 Old 08-20-2010, 04:32 PM
 
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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."
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#13 of 24 Old 08-20-2010, 05:05 PM
 
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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.
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#14 of 24 Old 08-20-2010, 05:29 PM
 
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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?
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#15 of 24 Old 08-20-2010, 05:53 PM
 
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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.
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#16 of 24 Old 08-20-2010, 06:27 PM
 
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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!
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#17 of 24 Old 08-20-2010, 06:48 PM
 
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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.
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#18 of 24 Old 08-20-2010, 07:13 PM
 
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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.

Single mom to the Crunchy Froglets, Keith and Carlin, twin boys born 1/30/09. Frozen for 10 years, now unleashed on the world.
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#19 of 24 Old 08-20-2010, 07:58 PM
 
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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.
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#20 of 24 Old 08-20-2010, 08:01 PM
 
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Wow. I totally missed this. Does anyone have a link?

I'm me. In love with this guy. We're bringing up two girls: Big A (8) and Little A (3)

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#21 of 24 Old 08-20-2010, 08:03 PM
 
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The CDC is filled with pro-circ fanatics as far as I can tell. They never once mention the function of the foreskin. Daniel Halperin of Harvard ( of "my granddad was a part-time mohel and I am "destined" to bring this benefit to others" fame) appears to me from correspondence placed on the internet to have communicated with Peter Kilmarx of the CDC, who sat at the Nat'l HIV conference last year here in Atlanta [along with Katherine Kretsinger of the NHS and CDC] and said nothing as Inon Schenker of Operation Abraham from Israel derided the intact male by displaying a photo of a naked male with an elephant drawn on him so that his intact member looked like the trunk with "Yes, A Circumcision Please" drawn in a white cartoon balloon. I am still awaiting an apology from Kilmarx and Kretsinger. The medical literature is now filled with pro-circ "studies" by a small group (20-30) of pro-circ advocates who seem to me to have made pushing universal circumcision their careers. Among those are Robert Bailey, Bertrand Auvert, Ronald Gray and his wife M. Wawer, Brian Morris, Malcolm Potts of PSI, Catherine Hankin of WHO/UNAIDS, Helen Weiss from London, Stephen Moses from Canada, Edgar Schoen, Thomas Wiswell, Inon Schenker, Daniel Halperin, and others. Halperin gave a lecture at UNC's medical school in May entitled "Moyels Without Borders." Just Google "Daniel Halperin UNC medical school moyels without borders." His resume is on the internet and it is very instructive. Look through it and become enlightened. Go to Morris' website www.circinfo.net and look at who reviewed the brochures he has on there. Check out the Gilgal Society's website too. And for real entertainment check out the WebMD interview with Halperin at http://www.circumcisioninformation.c..._home_new.html where he recommends circlist. You will find it by clicking on "Circumcision in the Media" and then on "General News and Interviews About Circumcision" and then on "WebMD Interview with Dr. Daniel Halperin." Circlist is mentioned in the body of the interview. Click on the circlist site there [yes, check on it there; it has since been changed and you won't find the same thing at the site now] and then peruse it. [Warning - very graphic]. Wow! Would a dispassionate individual recommend such a site?

As to the AAP, the task force is headed by an apparent circumcision advocate from NY, its urologist circumcised his own son himself, the ethicist appeared recently as an expert witness for parents who let their son die rather than get medical care, and Peter Kilmarx is the liaison with the CDC and sits on the committee. Want to bet that there is no intact male on the committee and that all of the women have circumcised husbands and sons? [BTW this has been pointed out to the AAP's outside counsel, so they must be aware we are aware of it]. Can such a committee really look at the facts objectively? No wonder Dr. Brady, also on the committee, has recently been quoted as predicting that this statement will be more positive toward circumcision than the last one.

So don't be surprised at what is going on. It looks like a very well coordinated campaign to me. Doesn't it to you?? And don't you know they are desperate now that the circumcision rate is below 50% (or so they apparently believe).
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#22 of 24 Old 08-20-2010, 08:14 PM
 
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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.
I too agree largely with what tennisduded is saying here. There will not be a recommendation; what you will probably see change is the language from "potential benefits" to "identified benefits" or something like that. They'll support that by going on and on about the HIV research in Africa.

The real question is will they present that information honestly? That is to say one can, for example, accept the possibility that there may be some reduced risk to HIV infection in circumcised men from female -> male but what does that actually mean to a man in the US? The answer, as noted by the AFAO and others, is essentially nothing. They might say something about HPV but will they add, as British docs have noted, that since we now have a vaccine any potential benefit is a pointless pursuit? My sense is that they will be blind to those, and similar, points; I'll be shocked if they're mentioned at all.


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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.
I believe this to a point but I think in a sense the cat is largely out of the bag on this one. Thanks to easily accessible information parents can be shown the the solid looking reasons folks like the AAP are pushing are as thin as a playing card turned to its edge. Information is a powerful tool and in spite of the past three years I see broadening support for our position among the general public. Many boards have pro-intact advocates (even ones that aren't parenting boards), there are always many positive blog entries, and lots of positive comments to these entries and articles. And the best part is most comments don't typically seem to come from whom I might consider the usual suspects. As the BMJ article noted, there are firmer stances from medical groups outside the US. If it hasn't been done yet I would hope that IA or NOCIRC has begun to talk with these medical groups and work with them to strengthen their statements. Get others who haven't released one to do it, such as the Norwegians. So support seems to be genuinely broadening.

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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.
I have little doubt this will happen, and for now there won't be much we can do about it. We're all going to have to rely more on the message and appealing to common sense.

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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.
Well to the first part, they already do this. I agree the second part will be more difficult but that's how it will shake out. They'll say because there are some "benefits" we must allow "access" to all.
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#23 of 24 Old 08-20-2010, 08:29 PM
 
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The AAP and the CDC have lost all credibility in my eyes. If the CDC's statistics were correct then it would seem 67.5% of the American population do not trust their judgment either. If you notice, the rates started to plummet as soon as their "Circumcise to prevent HIV/AIDS" claims made headlines. How could something so absurd NOT smell like rotten fish?

History tells us, when the rates of newborn genital surgery start to decline, the MGM lobby is the most active. They're doing whatever they can at whatever cost it takes to increase the rates of an arbitrary newborn genital surgery. Consequently, they're experiencing a serious backlash! Their propaganda backfired.


My guess is the actual rate of elective newborn genital surgery is 43% nationwide. The CDC's 32.5% is a cry to the underwriters, "Circumcision is on its way to extinction!" in hopes they'll rewrite their policy to a near-mandate stance. I truly hope I'm wrong and it really is 32.5%. That would be wonderful. Even better if it was at 0% which apparently is the rate for California Bay Area, a number noted at the Berkley Symposium earlier this summer.

The inconsistency, the illogical HIV/AIDS data, the researcher's motives to circumcise the world...

We're not stupid. As much as they'd love to dumb us down, literally: diluting education, poison in our water, over-inoculations... we can still see it for what it is & we will not be controlled. HA! This is the greatest "controlled" experiment in the history of the world! They can't scare us with their hypothetical #s conjectured by an imaginary crystal ball.


Their latest plans in the makings is to fund soccer teams for young African boys. The catch? They will not be allowed to play unless a certain number of them are circumcised. They said that they were not going to take no for an answer in the same breathing space as insisting that it would be voluntary. This is to further their fabrication for more propaganda.

Is it any wonder why many Americans lost their faith in the CDC and the AAP for the self-serving trade union that it is? The CDC says "No babies died". ummmm....

yeah, right. They need replace that statement with, "No babies have ever died from a complete set of male genitals!" Which is accurite. It doesn't suprise me at all that the CDC is trying to cover up the rate of death caused by "circumcision" an arbitrary penis reduction surgery.
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#24 of 24 Old 08-21-2010, 10:39 PM
 
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Brant31 said
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When parents have to pay out-of-pocket, by and large they skip circumcision.
There are number of possible reasons, one i think is if people see something is subsided they make a few assumptions "it must be recommended and good its covered", "its free we may as well get it". Nothing much to think about.
i.e. they take it for granted

If its not covered, people might start to think a little more 'Its not covered maybe its not necessary" or "they have stopped covering, maybe they don't think its any good any more." or "maybe we should research it"

Its very important that insurance stops covering infant circumcision.
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