Monthly Archives: October 2015

The secrecy of circumcision mortality

As intactivists protested during the AAP convention 2015 in Washington DC, and less than two months after the Canadian Pediatric Society (CPS) updated their circumcision policy with a mediocre paper that provides no criteria, while apparently discouraging routine circumcision and promoting it at the same time, we learned of a sad development in Ontario. We learned that a 22-day-old baby called Ryan Heydari bled to death following a circumcision in 2013.

Ryan Heydari

Ryan Heydari

Now, why did it take so long for this story to become public? Details about the complaints against the two physicians made to the College of Physicians and Surgeons, including their identities, would have been kept secret had Ryan’s parents not sought a review by an appeals panel.

“We are so shocked that we will not have an answer to bring us some peace for our broken hearts, to prevent other cruel deaths like Ryan’s and to ensure that doctors take proper care of their patients,” mother Homa Ahmadi told the National Post.

We learned that the parents originally did not want the surgery but were convinced of it by their family physician, who referred them. Dr. Sheldon Wise performed the surgery, and when contacted later over concern that the baby was bleeding too much, advised them to take Ryan to Toronto’s North York General Hospital.

Ryan was eventually transferred to Sick Kids hospital, but died there seven days later. Pathologists said he succumbed to “hypovolemic shock” caused by bleeding from the circumcision, which emptied his body of 35 to 40 per cent of its blood.

Dr. Jordan Carr, the North York General hospital pediatrician who saw Ryan after he started bleeding, was cautioned in writing for “his failure to recognize the seriousness of the patient’s condition and to treat compensated shock.” Carr was also ordered to write a 2- to 4-page report on the possible complications of circumcision and on how to recognize and treat compensated shock.

Wise told the complaints committee he routinely performs circumcisions, and the committee expressed no concerns about his technique or equipment, according to the HPARB decision. But it did feel that he should be obtaining and documenting informed consent before doing the operation.

Ryan’s parents said in a statement: “Our family doctor convinced us though of the health benefits of this procedure, but we had no idea that the loss of Ryan’s life was one of the risks”

Details about the death of this baby are absent from both doctors’ profiles in the College of Physicians and Surgeons’ online registry, as the complaints against the doctors were made before the college changed its policies as to what information it releases to the public.

This same month, less than two weeks ago we learned of another circumcision death, one that was also not disclosed by the media when it happened. We only learned of it incidentally.

Chance Walsh

Chance Walsh

We had been following the news of the missing 9-week old infant in Florida, Chance Walsh, who was found buried in a shallow grave. Details were released of his death, after being beaten by the father, and how he was left to decompose on his crib for several days until the mother complained of the smell, at which point the body was wrapped in plastic bags and moved to the closed, and then taken 13 miles from home and buried on a shallow grave.

But news stories released also that this was not the first baby lost by this couple. On March of 2014 the mother, Bury, gave birth to Duane Jacob Walsh. Duane was found dead 22 days later, and the cause of his dead was ruled to be a kidney infection that resulted from a botched circumcision.

His dead would have remained silent, if it wasn’t because the couple had this other baby, Chance, who died after being severely beaten by the father, a baby that the mother “despised whenever she would look at him because he wasn’t Duane.”

How many more deaths are kept in silence?

The AAP, on their Technical Report on Circumcision of 2012 wrote:

“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). These rare complications include glans or penile amputation, 198–206 [...*] and death.213″

An official estimate of mortality by the American Academy of Family Practitioners (AAFP), often cited by other medical organizations, is 1 in 500,000 circumcisions. Thomas Wiswell and Brian Morris, both avid circumcision promoters, introduced a number 20 times smaller. It really doesn’t matter. Deaths happen, and when they happen, they are often ignored. There are no official lists. Parents don’t have access to this information. The AAP Task Force on circumcision can call them case reports, but truth is nobody is trying to keep real numbers, and without real numbers, parents are being deceived. Like Ryan’s parents were.

“we had no idea that the loss of Ryan’s life was one of the risks”

Circumcision promoters often accuse intactivists of exploiting these deaths to further our agenda. But what is our agenda? To try to prevent these tragedies? To promote that all children deserve to grow with intact genitalia? And what is their agenda? To keep making money out of an unnecessary surgery? To continue providing biomedical supplies (amputated foreskins) to the biomedical industry?

Which agenda benefits babies?

Is it fair to these babies to let their names be forgotten, to allow their tragedies to be ignored, and their stories to be repeated over and over?

Let me finish this post by saying:

Rest in peace, Ryan Heydari

Rest in peace, Duane and Chance Walsh

National Post: Ontario newborn bleeds to death after family doctor persuades parents to get him circumcised

The Star: Secrecy questioned about baby’s death after circumcision

Morning Ledger: Body of 9-Week-Old Infant Allegedly Found Dead; Parents Under Custody

Yahoo: Body of 9-Week-Old Was Allegedly Left to Decompose in His Crib Until His Mom Complained About the Smell

 

Has Google been hijacked by the pro-circumcision lobby?

A few days ago it had been mentioned that searching for “intactivist” on Google was displaying, before any results, a suggested 2012 text from an odious article by pro-circumcision and misandryst author Charlotte Allen.

Bad as that is, today something far worse and way more dangerous has been reported. Searching for “care of uncircumcised newborn” displays a snippet from a webmed article explaining how to retract the foreskin to clean “under” it. It is problematic, because it is missing a sentence from the beginning of the paragraph, that limits this advice to “[w]hen the foreskin is easy to retract”, and also omits the most important, initial warning: “Do not force the foreskin back over the tip of the penis. At first, a baby’s foreskin can’t be pulled back (retracted) over the head of the penis. After the first few years of life (though it may take somewhat longer), the foreskin will gradually retract more easily“.

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Naive parents may take the snippet as advice without reading the full article, resulting in pain, bleeding, possible infection and possible scarring which may require surgical care in the future.

Even then, the webmed article isn’t that great. It states that “[b]y the time a boy is 5 years old, his foreskin is usually fully retractable“, and also that “[a] boy as young as 3 can be taught to clean under his foreskin“. Both statements are wrong. It’s long been known that there is wide variation to the age of retraction, with close to 50% of the boys becoming retractable by age 10, and approximately 95% being retractable by age 17. Trying to retract the foreskin of a 3 year old boy or a 5 year old boy (when less than 30% of the boys are capable of retracting) is likely to create trauma and injuries to the child.

McGregor et al (2007, Can Fam Phys) wrote: “if one is patient and does not rush Mother Nature, most foreskins will become retractile by adulthood“. Likewise, Wright (1994, Med J. Aust) wrote “nature will not permit the assignment of a strict timetable to this process.”

Denniston and Hill (2010, Can Fam Phys) explain: “Gairdner’s bar graph [1949!] shows a steep increase in retractility from birth to age 3 years. This does not occur in nature; it is possible that these values were obtained by the use of the probe. In any event, they have been disproved by later research. In actuality, development of retractility tends to be much slower. [...]  Gairdner’s values for the development of foreskin retractility stood alone and unchallenged for decades, during which they were quoted by the authors of numerous textbooks. Unfortunately, thousands of physicians the world over have been trained with these false values.”

In fact, the advice from the webmed article seems to be using the retraction values of Gairdner (1949) and the erroneous advice of Allan F. Guttmacher (1941) who came with the idea that a baby’s foreskin needed to be retracted and cleaned daily. Both pieces of really dangerous advice.

We call on Google to become more responsible with the snippets presented when they can lead to harming babies.

For a far better article on care of the uncircumcised newborn, read this page of the Paediatric Society of New Zealand

Update: I searched some more keywords on Google. The word “uncircumcised” also brings a biased article, this one from Cosmopolitan: “Although circumcision rates are declining in America, foreskin is still a hotly debated issue“. No Cosmo, foreskin is a part of the body. Circumcision is a debated issue.

And afterwards, a downward arrow offers more related topics: the definition of cicumcision and the definition of mohel.

In the United States, the foreskin is the only part of the body that when named, is followed by the description of the procedure to remove it. Sad and ridiculous.

uncirc