Monthly Archives: December 2014

Doug Diekema, ethical excellence?

It has come to our attention that during the AAP meeting in last October, Dr. Douglas Diekema received the Bartholome Award for ethical excellence.



Dr. Douglas DiekemaDoug Diekema is member of the 2012 AAP Task Force on circumcision. On an interview in 2012, prior to the release of the Policy Statement, Diekema dismissed bodily autonomy in a statement to the Broward Palm Beach New Times: “[Circumcision] does carry some risk and does involve the loss of the foreskin, which some men are angry about. But it does have medical benefit. Not everyone would trade that foreskin for that medical benefit. Parents ought to be the decisionmakers here. They should be fully informed.

Even more, a year after the release of the Policy Statement, during a debate with Steven Svoboda from Attorneys for the Rights of the Child, Diekema and fellow task force member Dr. Brady failed to describe any functions of the foreskin (Brady said “I don’t think anybody knows the function of the foreskin, nobody knows the function of the foreskin” – see page 8 of PDF file at the link), only to have the answer from a layman who has a foreskin. Of course their arrogance prevented them from listening to the young intact (“uncircumcised”) man.

But male cutting is not enough for Diekema, who in fact supported the failed 2010 AAP policy statement on “ritual genital cutting of female minors“. Diekema defended the “ritual nick” telling the Sydney Morning Herald that “[It] would remove no tissue, would not touch any significant organ but, rather [it] would be a small nick of the clitoral hood which is the equivalent of the male foreskin – nothing that would scar, nothing that would do damage

But external genitalia seems to be not enough for Mr. Diekema, who was part of the committee that gave clearance to the “Ashley treatment” in 2004, a treatment to stunt the growth of a severely disabled girl, remove her breast buds (so she wouldn’t grow breasts), remove her reproductive organs (hysterectomy, so she wouldn’t have menstruation) and removed her appendix (since they had her open already, why not?).  The Ashley treatment was later deemed to be illegal without a court order, but nobody was made responsible for it. Diekema’s partner in the committee, Daniel Gunther, committed suicide shortly afterwards for unknown reasons.

But apparently genitals of males and females are not enough. Diekema was a witness in support of an Oregon city couple whose adolescent son Neil died of renal disease without medical treatment, partially because they were part of a congregation that favors faith healing over medical treatment. Diekema said: “Neil had a faith, and his faith was important to him, I don’t know if it determined his decision.”

And perhaps this is part of the key to understanding Diekema. Religion. As Diekema himself said in an interview: “one of the skills I’ve had to learn is that if I do arrive at a decision about what I think is the right thing to do and my reasons for believing that are related to my religious beliefs, I have to be able to craft secular arguments to support that view. The real art of bioethics is convincing other people why something is right or something is wrong and why something shouldn’t be done or should be done“.

Is this really a man whose ethical values should be celebrated? Is this a man who speaks for children, who protects children? Is he dedicated “to the health of all children“, as the motto of the AAP says? We believe this man to be dangerous and an embarrassment to modern medicine, someone who belongs in the 19th Century, not in the 21st Century.

More data on CircLeaks

Dr Diekema (in blue shirt) lowers his eyes after seeing the “bloodstained” protesters outside the Orlando convention center in October of 2013. This happened just a few weeks after his embarrassing defeat in the debate against Steven Svoboda and the Attorneys for the Rights of the Child.

Baby dies after circumcision – Social networks

We mentioned a while ago that “Activists monitoring social networks often encounter individual cases of complications that usually go unreported“.

A new tragic case will likely be recorded as death caused by ex-sanguination (loss of blood) or systemic failure, while failing to mention that the blood was lost through an intentional wound on the body (circumcision).

The activist who shared the screenshots below, wrote: “On December 14th, 2014, a mother gave birth to her son via emergency c-section. From what I was told the mother and baby were doing fine after the delivery. On December 17th, 2014, the child was circumcised. I do not know the reasoning for the circumcision but I do know they were first time parents. A few hours later the child was pronounced dead. The parents were told the baby suffered massive blood loss but that an autopsy must be performed before the cause of death would be official“.

Rest in peace sweet baby. The names were blacked out by the activist who shared this, in order to protect the privacy of the family.

As it always happens, some people gets heated about these senseless tragedies, and some people criticize those who share these kinds of information during times of loss for the families, for what they perceive as bashing the families. But if this information was not shared, how would you know? Would you expect to hear this from the AAP? From the CDC? They won’t tell you.

The AAP in the Technical Report on circumcision, August 27 to 2012, “The majority of severe or even catastrophic injuries are so infrequent as to be reported as case reports (and were therefore excluded from this literature review).” (see page 20 of Technical Report)

It’s not the families’ fault. Yes, they signed a consent form, but quite often they were pressured by doctors, nurses, family, society, they were kept ignorant of the risks, they were told that “the benefits outweigh the risks“, most likely the dads are circumcised, who can think that anything can go wrong during a circumcision?

So sad that lives of babies can be “excluded” for being just “case reports”.

Doug Diekema, Susan Blank, Michael Brady, Ellen Buerk, Waldemar Carlo, Andrew Freeman, Lynne Maxwell, Steven Wegner, this is the truth that you withhold from the American public. Your hands are tainted with babies’ blood. The American public will remember you.


The Guardian censors the discussion of circumcision

As reported by inside Man, the Guardian, in an article about FGM, warned that comments about male circumcision would be removed by moderators because “although the two issues are superficially related the effects and cultural practices/significance are very, very different”.

An individual mention in the article says, of the female activist: “She is giving a voice to those who would otherwise be silenced“. The Guardian, however, will silence those who speak for the rights of male children.

The article states: “Religious dogma is one of the toughest challenges campaigners face in the Gambia.” From our experience, religious dogma is also one of the toughest challenges in the fight against genital mutilation… of boys. See the reaction of the Anti Defamation League when San Francisco was looking to vote to age restrict circumcision in the city, or the reaction of even the highest leaders of Israel when the Parliamentary Assembly of the Council of Europe defined circumcision as a procedure that violates the rights of children to physical integrity.

The Guardian may like to see these topics remain separate debates, but they are not. They are not about males or females, they are about children’s rights. When adults raise the blade, children are powerless to defend themselves.

Shame on those who would silence those who dare speak against damaging traditions and rituals affecting the health, well-being and happiness of children.


Moderator warning commenters that comments regarding male circumcision would be deleted

Mary Jane Minkin, MD, FACOG, stigmatizes men and pathologizes a normal body part

In an interview in 2Dun’s Spread, Dr. Mary Jane Minkin, MD, FACOG, clinical professor of obstetrics and gynecology at Yale School of Medicine and staff member at Obstetrics Gynecology & Menopause Physicians, violates the ethical principle of justice by stigmatizing 70% of the males in the world, those who are not circumcised, and by pathologizing a normal body part, the foreskin, in what only can be interpreted as blatant cultural prejudice.

This starts with the media circus around the CDC proposed guidelines, of which we spoke on our previous post. The Background document by the CDC also warned (page 40):

“Furthermore, recommendations to increase rates of male circumcision in the U.S. to reduce male acquisition of heterosexually acquired HIV infection may result in stigmatization of uncircumcised men or groups of men who are not routinely circumcised should they choose to not undergo circumcision.” ~ CDC

And Dr. Minkin gives us a clear example of what that meant.

Asked by 2Dun whether “doing the deed with an uncircumcised man puts you at a higher risk for contracting an STI?“, Dr. Minkin replies: ”To be exact, yes, if uncircumcised men are more likely to get infected with [an STD], then they’d be more likely to transmit“.

Dr. Mary Jane Minkin, M.D., FACOG, stigmatizes normal men

Dr. Mary Jane Minkin, M.D., FACOG, stigmatizes normal men

Dr. Minkin tells us two lies in this statement, first, that the mere presence of foreskin makes a man more likely to get infected, and second that the mere presence of foreskin makes a man more likely to transmit an infection.

But some readers will say, “the science is sound”. What the readers are forgetting, what the AAP and the CDC often would like people to forget, is that adult individuals can make lifestyle choices. Humans have a capability to make rational decisions, we are not bound by uncontrollable instincts, we can make decisions about whether to have sex or not, whether to engage in safe sex or not, whether to have multiple sex partners or follow a more monogamous lifestyle, and all those decisions are not reflected in the presence or absence of a normal part of the body.

A high risk male has a larger chance of contracting STIs than a low risk individual, regardless of their circumcision status. The risk attitude has far more priority on the chance of contracting sexually transmitted diseases than submission to circumcision.

If the presence of foreskin immediately implied a higher prevalence of HIV and STIs, how can we explain that most countries in Latin America and Europe, where circumcision is uncommon, have a lower prevalence of HIV than U.S., where circumcision rates are prevalent?

Dr. Minkin’s second implication, that uncircumcised males would be more likely to transmit an STI, is again fallacious and stigmatizing. Infected males will transmit infection no matter what, as the virus pollutes the sperm. The presence or absence of foreskin does not alter the composition and presence or absence of virus in sperm.

Dr. Minkin then re-states her lie: “The data is certainly suggestive that circumcised males are at less risk of acquiring—and then transmitting—certain STDs” and then says the only fully true statement:”but not to the point of saying it’s okay to not use a condom.”

All sexually active adolescent and adult males should continue to use other proven HIV and STI risk-reduction strategies such as reducing the number of partners, and correct and consistent use of male latex condoms, and HIV preexposure or postexposure prophylaxis among others. ” – Recommendation #2 in the proposed CDC guidelines

It is sad and corrupt when doctors and university professors, particularly in such a prestigious university, abuse their positions to pass cultural prejudice and false beliefs as science, stigmatizing in the process the vast majority of males in the world and demonizing a normal part of the body. It is simply shameful.

We recommend that Dr. Minkin takes the time to read the full Background document and review those good old ethical principles.

P.D., would it be a surprise that Dr. Minkin is originally from New Jersey, an area with high prevalence of circumcision? And why is a doctor who is “interested in all aspects of women’s health, she has a special interest in menopause” speaking about men’s health? Does she teach her students based on her beliefs on circumcision – or in real science?

Dr. Minkin, you had a chance to educate the public on the importance of safe sex and risk management, but you wasted it to promote a social surgery. We are so disappointed.

CDC, circumcision and misleading headlines

For anyone following the issue of genital cutting of minors in the United States, yesterday brought a plethora of new and misleading headlines:

The Verge: Benefits of circumcision outweigh the risks, US CDC says

NPR: CDC Considers Counseling Males Of All Ages On Circumcision

webmed: CDC Endorses Circumcision for Health Reasons – WebMD

Salon:  CDC: Circumcision is a very good idea –

The Raw Story: CDC to parents: Consider circumcising your sons, because

UPI:  CDC recommends circumcision procedure, says benefits

NYTimes (blog):  Circumcision Guidelines Target Teenagers –

But are these guidelines really such endorsement?

Or is it that the media is hungry to present benefits and call for a universal endorsement, something that really hasn’t happened?

It is our opinion that these headlines are nothing but a feeble attempt to manipulate the public opinion, under the assumption that everybody is too lazy to go to the source materials.

Anyone wishing to produce objective reporting on the CDC guidelines should start by fully reading and understanding the 8 pages draft document and the 60 pages technical report. It is unlikely that any of the reporters lending their names to the apparently carefully scripted articles, read any of the documents.

But we did, so let’s share our interpretation.

The CDC guidelines refer to counseling. Counseling does not mean immediate and universal endorsement. Counseling means aiding a person through a decision-making process, and that is what the guidelines attempt to do, to counsel patients or parents through a decision-making process.

In this decision making process, the CDC considered 3 main categories of individuals based on the age range: neonates and children, adolescents, and adults.

The CDC also considered the sexual orientation and lifestyle choices as factors to be weighted during this decision making process. And for those willing to go deep enough (as deep as page 39 of the technical report), the CDC also gave consideration to the fact that parents deciding for a newborn raise concerns about autonomy, including the argument that “a man with a foreskin can elect to be circumcised but if circumcised as a newborn, cannot easily reverse the decision“. The PHEC  (Public Health Ethics Committee) subcommittee is, however, of the opinion that “both a decision to circumcise and a decision to not circumcise are legitimate decisions“.  This is one opinion that genital integrity promoters and people for the rights of the child would oppose though.

For those saying that the CDC is fully recommending circumcision, they probably need to read in detail where the technical report indicates that “There are advantages and disadvantages to performing male circumcision at various stages of life” and one of the listed disadvantages of neonatal circumcision is that “the newborn has no ability to participate in the decision“.

The guidelines recognize that in the case of adolescents, both the adolescent and his parents should be involved in the decision-making process.

Let’s make one thing clear. One of the main reasons for the CDC’s discussion of circumcision has to do with the African trials on circumcision and HIV, considered to be evidence that circumcision could help reduce the risk of heterosexual transmission of HIV from infected females to males. The role of the CDC is not to discuss each one of those studies and their validity, strengths and flaws, but to make their recommendations based on currently accepted medical practices and standards. So of course an important premise of these guidelines is the so-mentioned potential benefit of reducing the risk of heterosexual transmission of HIV from infected females to males. As such, it is not within our current scope to discuss the African trials, something that has been already done by others in detail, but to discuss how the CDC interpreted those trials in reference to the U.S. conditions.

When discussing adult circumcision, the CDC recognizes both the documented benefits and limitations of circumcision as part of the prevention of HIV, that is:

  • that circumcision does not replace the need for condoms and safe sex,
  • that circumcision does not reduce the risk of male to female transmission
  • that circumcision does not reduce the risk or male to male transmission,
  • that circumcision does not reduce the risk of transmission through anal or oral sex, or for intravenous drug users.

In other words, that circumcision would only curb the transmission of HIV from females to males during vaginal penetration.

So, with those premises, the guidelines recommend a discussion of the person’s HIV risk behavior, HIV status, sexual preferences and gender of the sexual partner, in order to provide proper guidance depending on individual circumstances.

The PHEC subcommittee concluded that the disadvantages associated with delaying male circumcision would be ethically compensated to some extent by the respect for the integrity and autonomy of the individual.

And what are those “disadvantages”? A slightly increased risk of UTIs during the first year of life (risk of UTIs is low and they are generally easily treatable) and the possibility of the adolescent having a sexual debut prior to counseling and assessment of risks, which could potentially expose the adolescent to the risk of heterosexually transmitted HIV from infected female partners.

The CDC then states that:

The prevalence of HIV infection in the United States is not as high as in sub-Saharan
Africa, and most men do not acquire HIV through penile-vaginal sex. Targeting
recommendations for adult male circumcision to men at elevated risk for heterosexually
acquired HIV infection would be more cost effective than offering routine adult male
circumcision. Men may be targeted according to sexual practices or an elevated
prevalence of HIV within a geographic region or race/ethnicity group.

Also, regarding sexually active individuals:

“All sexually active adolescent and adult males should continue to use other proven HIV and STI risk-reduction strategies such as reducing the number of partners, and correct and consistent use of male latex condoms, and HIV preexposure or postexposure prophylaxis among others.”

So, are these guidelines an immediate and universal recommendation for circumcision? No, as much as biased media and individuals would like it to be, it is not.

The CDC gave slight consideration to sexual effects of circumcision. Again, we need to consider that they are reviewing existing medical standards, practices and publications (and it is noteworthy that proper discussion of the male foreskin is so absent from American health books that even pictorial representations of the foreskin are missing most of the times except in the context of its removal through circumcision). So, the guidelines devote the full length of a single paragraph to the discussion of sexual effects from circumcision:

The foreskin is a highly innervated structure and some authors have expressed concern
that its removal may compromise sexual sensation or function. However, in one survey
of 123 men following medical circumcision in the United States, men reported no change
in sexual activity and improved sexual satisfaction, despite decreased erectile function
and penile sensation. Furthermore, a small survey conducted among 15 men before and
after circumcision found no statistically significant difference in sexual function or sexual
satisfaction. Other studies conducted among men after adult circumcision have found
that relatively few men report that there is a decline in sexual functioning after
circumcision; most report either improvement or no change.”

This paragraph acknowledges the histological studies of John Taylor and Sorrells’ study on fine touch pressure thresholds, but not the European surveys of Bronselaer in Belgium and Frisch in Denmark (both of which showed sexual difficulties among circumcised males), preferring instead to refer to Krieger‘s Kenyan study (which does not show the same difficulties). This begs the question of why African studies are more relevant to the sexual function and satisfaction of American citizens than European studies, but we will leave such discussion for the readers to make their own conclusions.

Finally, missing from the guidelines is any discussion of the role and functioning of the foreskin, something that could be accomplished by simple observational studies of the sexual behavior of uncircumcised males. But one could argue that the role of the CDC is to counsel on control and prevention of diseases, and not on sexuality.

I can’t avoid, however, citing this quote from the late Dr. Paul Fleiss, from his 2002 book:

“Accurate information about the foreskin itself is almost always missing from discussions about circumcision. How can parents make a rational decision about circumcision when they are told nothing about the part that will be cut off?” Fleiss. What your doctor may not tell you about circumcision

Our conclusion is that the CDC draft is far from being the universal recommendation for circumcision that biased media, organizations and individuals may wish for, it is actually more balanced on its ethical aspects than the AAP’s Policy Statement, however it is not unbiased as it still gives more relevance to African studies than European, in spite of the American circumstances being more comparable to those of Europe than to Sub Saharan Africa. The media however latches to key phrases like “benefits from circumcision” ignoring the harms and collateral effects and autonomy concerns, thus distorting the message and manipulating the public opinion.