Intactivists Respond To The 2012 AAP Circumcision Policy Statement (AAP = No Ethics)

Intactivists Respond To The 2012 AAP Circumcision Policy Statement [Op Ed]

On Monday, the American Academy of Pediatrics (AAP) published its updated policy statement on circumcision in the most recent edition of the journal Pediatrics. In a move that shocked and angered intactivits — activists who oppose infant circumcision and support genital integrity for both males and females — throughout the country and around the world, the AAP made the claim that the benefits of circumcision outweigh the risks.

To learn more about the updated AAP circumcision policy statement and the reactions of intactivists, I recently spoke with members of The WHOLE Network and End Routine Infant Circumcision (ERIC).

1. What changes has the AAP made to its circumcision policy statement?

The WHOLE Network: On Monday, the twenty-seventh of August, the American Academy of Pediatrics released a new circumcision policy statement. In this new statement, even though they still don’t recommend routine infant circumcision, the AAP proclaimed the benefits of circumcision outweigh the risks.

2. Why are intactivists so upset about the changes to the AAP policy on circumcision?

The WHOLE NETWORK: Not only does this new statement ignore all data that refutes this claim, it also flies in the face of common sense and the Hippocratic Oath. Routine infant male circumcision is medically unnecessary and risky. Unless medically indicated, this surgery should only be performed on a consenting person.

Human rights advocates across the nation were angry. We at The WHOLE Network wanted to give them an outlet for their anger. A way for their voice to be heard.

Prior to the statement’s release we discovered the current AAP president, Dr. Bob Block, on Twitter. He is shown, palms facing outward, with “AAP ROCKS” scrawled on his hands in permanent marker. This is how the concept for “Wash Your Hands Clean of the AAP” was born. An online event was created using The WHOLE Network’s Facebook page. We encouraged people to attend by switching their profile pictures to one showing hands with the words “AAP” and “NO ETHICS” written on them. Attendance to this online event exploded. Soon we had nearly 1,500 people in attendance, with over 500 photos submitted. Using these photos, we created a YouTube video to music.

It’s been truly inspiring to see members of the intactivist movement coming together to unite against the AAP. We are glad to have been able to play a part in that. Our hope is that the world will see just how strong our movement is. We are here, we are ready to be the voice for these baby boys, and we are not going away. (Check out the video on YouTube or at the bottom of this article.)

Jeremy (ERIC): The new statement is extremely disappointing and, as expected, neglects the medical ethics of cutting a healthy body part off a non-consenting individual and the human rights aspects of bodily integrity. The AAP Task force on circumcision started with a pro-circumcision bias and cherry picked which studies to use in forming their policy, and their claims fly in the face of many other studies, real world statistics, and medical positions around the world. I hope new parents can see through the smoke screen and realize that there are ulterior motives at work here.

The changes the AAP have made to the circumcision policy, while they do not recommend circumcision, they push benefits over and over again and mention the money incentive.

I believe the AAP made these changes because circumcision rates in the US have plummeted between 2006 and 2012 and the revenue earned by its members are dropping too. Note that the ACOG endorses this policy; this is no surprise as OB-GYNs are the ones performing most circumcisions in the United States, so a drop in rates hits their revenue too.

Doctors and nurses may tell patients a one sided view of all these “benefits” but miss out that it is still not recommended.

As for around the world, doctors and human rights groups are condemning the policy. The policies conclusions contradict the findings of other major health organizations, and they have read the same studies. Remember that the AAP task force on circumcision started with a bias for circumcision then cherry picked which studies to use to back them up.

3. How will these changes affect male babies born in US hospitals?

The WHOLE NETWORK: Probably not much. The rates of circumcision in America have been dropping dramatically over the last decade, especially in the last couple years. All the while, the AAP has held a neutral stance. People are not influenced that much by the AAP anymore, especially after the 2010 incident where they endorsed a “ritual nick” circumcision for infant girls, and quickly withdrew that statement due to the backlash. They simply aren’t credible in the eyes of many people anymore.

4. Will the updated AAP circumcision policy statement, do you think, have a negative impact on circumcision policies around the world such as the current ban on circumcision in countries like Germany and Switzerland?

The WHOLE NETWORK: Not at all. We are the only country who circumcises our baby boys routinely for non-religious purposes. 80% of the men in this world are not circumcised, so they view our practices of routine infant circumcision as barbaric. This is why all other medical organizations have spoken out against infant circumcision, and countries have even taken steps to outlaw it. They realize the harm that it causes and the ethics it violates.

5. Is there anything else that you would like to state about the revisions to the AAP circumcision policy?

The WHOLE NETWORK: Citing evidence from three studies in Africa that found a reduced rate of HIV transmission to circumcised males, the AAP has irresponsibly dismissed conflicting evidence that distinctly calls the effectiveness of circumcision on HIV rates into question.[1-4] The AAP also cites a reduction in urinary tract infections, even though the circumcision procedure itself can cause life-threatening infection.[5-7] Reduced risk of penile cancer is touted, but this cancer is so rare a man is more likely to experience breast cancer[8] than cancer of the penis in his lifetime.[9] The AAP fails to acknowledge that easier, less-costly, non-invasive measures exist for all of the supposed benefits of circumcision, such as condoms, antibiotics, and proper hygiene.

Further, the AAP has turned a blind eye to mounting evidence that circumcision is a harmful practice with serious risks such as hemorrhage [10-19], accidental dismemberment,[20-36] and death,[37-45] and potential life-long physical, psychological,[46-55] and sexual consequences ranging from a personality disorder to erectile dysfunction to orgasm difficulties, with sexual side-effects also extending to his partner.[56]

It is important to remember that the task force charged with reviewing and updating the academy’s position on circumcision is not without conflict of interest. The AAP is a professional organization, which exists to represent and support the professional interests of its members. In its last position statement they acknowledged that those members stand to lose an estimated $150-270 million dollars if circumcisions were no longer performed, without including follow-up care and corrective procedures, which are quite common.[57] The new statement proclaims, “Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it, and to warrant third-party payment for circumcision of male newborns,” revealing whose interests they truly have in mind.

Last year when the AAP issued a call to allow physicians to offer a ‘ritual nick’ on the genitals of girls,[58] the immediate and intense public response led to a prompt retraction. The WHOLE Network calls upon the AAP to act quickly to retract the 2012 circumcision statement, and instead put the rights and well-being of the patient before all other interests by condemning routine infant circumcision.

Dennis Gouws (ERIC): Cutting off a child’s foreskin is a morally reprehensible act. A boy has a right to all of his healthy body, and how he experiences it should be his choice — not the choice of a parent, a religious leader, a government, a philanthropist, or a doctor.

Kim Davis (ERIC): I am deeply saddened by the new statement; however, there are contradictions within the policy. I believe they are grasping at straws to try to and bring up the circumcision rates. People have access to information now more than ever and it shows with the decline in cut rates. Doctors are about business and an elective surgery than takes them 15 minutes from start to finish is quite a profit in their pocket plus any revenue they earn from the sale of the foreskin. I honestly believe that doctors know that most men if left intact will never have a problem nor elect this surgery so they take advantage of parents lack of knowledge and cut before the boy has a choice which ensures they get paid. What really burns me about the new policy is the amount of press. Most people have no idea what the AAP said about RIC before this release (and if they did they did not listen to them then) and now the ONLY thing they will see is the headlines — “THE BENEFITS OUTWEIGH THE RISK” — which will validate their choice for cutting their son without ever considering the risk or the ethical implications.

The researchers say if the trend continues to where only 10 percent of US males are circumcised — rates similar to Europe — the country could face about $4.4 billion in health care costs, an added $407 per man. So, if each circumcision costs about $400, how is the cost any more or less? And what about those that never “have” to have a circ and never get UTIs, STDs, etc.? And what about the European countries: What exactly is their rate of UTIs and STDs?

Micheal (ERIC): This is a basic human rights issue, and no one has the right to take away a piece of a person’s functioning body. It is his body, his choice. There is nothing wrong with foreskin; it is not a birth defect. The foreskin serves a very unique purpose and removing it alters the way the male anatomy functions. This is not only morally and ethically wrong, it is illegal according to the 14th Amendment. It was a pleasure to work with Lauren Jenks and The WHOLE Network in this campaign and I hope that the video goes viral. The AAP should never had renewed its stance on circumcision, stating it is still up to the parents. This is not about a parent’s choice. when does the child get to choose his own fate, we are talking about the very core of a man’s identity here.

Speaking more about the “Wash Your Hands Clean of the AAP” event, Stacey M. Butler, LPN, CBE, Doula, of ERIC explains more about the campaign.

“As the countdown began, The WHOLE Network and Lauren Jenks came up with an idea to launch the “Wash Your Hands Clean of the AAP.” The Idea was to have as many intactivists that were upset with the upcoming new release of the circumcision policy release date (08/27/2012); all the intactivists were to write on their hands “AAP” on one hand and on the other “NO Ethics.” Well, the response was overwhelming; over 540 pics were submitted and it became an overnight sensation to the YouTube world!”

References

1. Brewer D. Scarification and male circumcision associated with HIV infection in Mozambican children and youth. Webmedcentral 2011;2(9):WMC002206.
2. Darby, R. L., Van Howe, R. S. (2011). Not a surgical vaccine: there is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia. Australian and New Zealand Journal of Public Health, 35, 459-465.
3. Green, L. et al., “Male Circumcision and HIV Prevention: Insufficient Evidence and Neglected External Validity,” American Journal of Preventive Medicine 39 (2010): 479-82.
4. Thomas AG, Bakhireva LN, Brodine SK, Shaffer RA Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. navy population. Abstract no. TuPeC4861. Presented at the XV International AIDS Conference, Bangkok, Thailand, July 11-16, 2004.
5. Bliss Jr DP. Healey PJ, Waldhausen JHT. Necrotizing fasciitis after Plastibell circumcision. J Pediatrics 1997;31:459-62.
6. Cook J, Parish JA, Shooter RA: Acquisition of Staphylococcus aureus by newborn babies in a hospital maternity department. Br Med J 1938;1:74-8.
7. Hurst V. Transmission of hospital staphylococci among newborn infants. Pediatrics 1960;25:204-14.
8. “What Are the Key Statistics about Breast Cancer in Men?” What Are the Key Statistics about Breast Cancer in Men? N.p., n.d. Web. 23 Aug. 2012. <http://www.cancer.org/Cancer/BreastCancerinMen/DetailedGuide/breast-cancer-in-men-key-statistics>.
9. “What Are the Key Statistics about Penile Cancer?” What Are the Key Statistics about Penile Cancer? N.p., n.d. Web. 23 Aug. 2012. <http://www.cancer.org/Cancer/PenileCancer/DetailedGuide/penile-cancer-key-statistics>.
10. Shulman J, Ben-hur N, Neuman Z. Surgical complications of circumcision. Am J Dis Child 1964; 107:149-54.
11. Patel H. The problem of routine infant circumcision. Can. Med. Assoc. J 95 (Sept 10, 1966): 576-581.
12. Gee WF, Ansell, NF. Neonatal circumcision: a ten year overview; with comparison of the Gomco clamp and the Plastibell device. Pediatrics 1976; 58: 824-7.
13. Kaplan GW. Complications of circumcision. Urol Clin N Amer 1983;10:543-549.
14. Griffiths DM. Atwell JD. Freeman NV. A prospective survey of the indications and morbidity of circumcision in children. European Urology 1985 11(3):184-7.
15. Williams N, Kapila L. Complications of circumcision. Br J Surg 1993; 80:1231-36.
16. Killick CJ, Barton CJ, Aslam S, Standen GR. Prenatal diagnosis in factor XIII-A deficiency. Arch Dis Child Fetal Neonatal Ed 1999;80:F238-F239.
17. Hiss J, Horowitz A, Kahana T. Fatal haemorrhage following male ritual circumcision. J Clin Forensic Med 2000;7:32-4.
18. Corbett HJ, Humphrey GME. Early complications of circumcisions performed in the community. Br J Gen Pract 2003;53(496):887-8.
19. Newell TEC. Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan. Burnaby, B.C.: British Columbia Coroner’s Service, Monday, 19 January 2004.
20. Brimhall JB. Amputation of the penis following a unique method of preventing hemorrhage after circumcision. St Paul Med J 1902; 4: 490
21. Lerner BL. Amputation of the penis as a complication of circumcision. Med Rec Ann 1952;46:229-31.
22. Levitt SB, Smith RB, Ship AG. Iatrogenic microphallus secondary to circumcision. Urology 1976; 8: 472-4.
23. Izzidien AY. Successful replantation of a traumatically amputated penis in a neonate. Journal of Pediatric Surgery April 1981,16(2):202-203.
24. Hanash KA. Plastic reconstruction of partially amputated penis at circumcision. Urology 1981; 18(3): 291-3.
25. Azmy A, Boddy SA, Ransley PG. Successful reconstruction following circumcision with diathermy. Br J Urol 1985; 57: 587-8.
26. Yilmaz AF, Sarikaya S, Yildiz S, et al. Rare complication of circumcision: penile amputation and reattachment. European Urology (Basel) 1993; 23(3): 423-424.
27. Audry G, Buis J, Vazquez MP, Gruner M. Amputation of penis after circumcision–penoplasty using expandable prosthesis. Eur J Pediatr Surg 1994; 4: 44-5.
28. Hanukoglu A, Danielli L, Katzir Z, Gorenstein A, Fried D. Serious complications of routine ritual circumcision in a neonate: hydro ureteronephrosis, amputation of glans penis, and hyponatraemia. Eur J Pediatr 1995; 154: 314-5.
29. Gluckman GR et al. Newborn Penile Glans Amputation During Circumcision and Successful Reattachment. Journal of Urology (Baltimore), vol. 153 no. 3 Part 1 March 1995 pp. 778-779.
30. Strimling BS. Partial amputation of glans penis during Mogen clamp circumcision. Pediatrics 1996; 97: 906-7.
31. Neulander E, Walfisch S. Kaneti J. Amputation of distal penile glans during neonatal ritual circumcision — a rare complication. Br J Urol 1996; 77: 924-5.
32. Sherman J, Borer JG, Horowitz M, Glassberg KI. Circumcision: successful glanular reconstruction and survival following amputation. J Urol 1996; 156: 842.
33. Van Howe RS. Re: circumcision: successful glanular reconstruction and survival following traumatic amputation (Letter). J Urol. 1997;158:550.
34. Coskunfirat OK, Sayiklkan S, Velidedeoglu H.. Glans and penile skin amputation as a complication of circumcision (letter). Ann Plast Surg 1999;43(4):457.
35. Siegel-Itzkovich J. Baby’s penis reattached after botched circumcision. BMJ 2000;321:529.
36. Park JK, Min JK, Kim HJ. Reimplantation of an amputated penis in prepubertal boys. J Urol 2001;165:586-7.
37. Holt LE. Tuberculosis acquired through ritual circumcision. JAMA 1913;LXI(2):99-102.
38. Reuben MS. Tuberculosis from ritual circumcision. Proceedings of the New York Academy of Medicine 1916; (December 15): 333-334.
39. Rosenstein JL. Wound diphtheria in the newborn infant following circumcision. J Pediatr 1941;18:657-8.
40. Gairdner D. The fate of the foreskin. A study of circumcision. BMJ 1949; 2: 1433-37.
41. Scurlock JM, Pemberton PJ. Neonatal meningitis and circumcision. Med J Aust 1977;1:332-334.
42. Cleary TG, Kohl S. Overwhelming infection with group B beta-hemolytic streptococcus associated with circumcision. Pediatrics, Vol 64, no 3, (September 1979), pp. 301-303.
43. Hiss J., Horowitz A., Kahana T. Fatal haemorrhage following male ritual circumcision. J Clin Forensic Med 2000;7:32-4.
44. Newell TEC. Judgement of inquiry into the death of McWillis, Ryleigh Roman Bryan. Burnaby, B.C.: British Columbia Coroner’s Service, Monday, 19 January 2004.
45. Paediatric Death Review Committee: Office of the Chief Coroner of Ontario. Circumcision: a minor procedure? Paediatr Child Health 2007;12(4):311-2
46. Bollinger, D. and Van Howe, R. , “Alexithymia and Circumcision Trauma: A Preliminary Investigation,” International Journal of Men’s Health (2011); 184-195.
47.Glover E. The ‘screening’ function of traumatic memories. Int J Psychoanal 1929; 10:90-93.
48. Cansever G. Psychological effects of circumcision. Br J Med Psychol 1965; 38: 321-31.
49. Flaherty, JA. Circumcision and Schizophrenia. J Clin Psychiatry 1980; 41: 96-98.
50. Kennedy H. Trauma in childhood: signs and sequelae as seen in the analysis of an adolescent. The Psychoanalytic Study of the Child 1986; 41:209-219.
51. Gunnar MR, Porter FL, Wolf CM, Rigatuso J, Larson MC. Neonatal stress reactivity: predictions to later emotional temperment. Child Dev 1995; 66: 1-13.
52. Davis M, Emory E. Sex differences in neonatal stress reactivity. Child 54. Goldman R. The psychological impact of circumcision. BJU International 1999; 83, Suppl. 1:93-102.
53. Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis Journal 1999; 29(3):215-221.
54. Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. .J Health Psychol 2002;7(3):329-43.
55. Gerharz EW, Ransley PG, Woodhouse CRJ. Urinary retention, erectile dysfunction and penile anaesthesia after circumcision: a mixed dissociative (conversion) disorder. Int Urol Nephrol 2005;37(3):525-
56.Frisch, M., Lindholm, M., and Grønbæk, M., “Male Circumcision and Sexual Function in Men and Women: A Survey-based, Cross-sectional Study in Denmark,” International Journal of Epidemiology (2011); 1-15.
57. “Circumcision Policy Statement.” Circumcision Policy Statement. N.p., n.d. Web. 26 Aug. 2012. <http://pediatrics.aappublications.org/content/103/3/686.full>.
58. Belluck, Pam. “Group Backs Ritual ‘Nick’ as Female Circumcision Option.” The New York Times. The New York Times, 07 May 2010. Web. 23 Aug. 2012.

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