Category Archives: AAP

Edgar Schoen, MD passed away

Edgar Schoen, M.D., (August 10, 1925 – August 23, 2016) passed away peacefully in his sleep on August 23, at his home and surrounded by family.

Edgar Schoen was an American Jewish Physician and worked as a Clinical Professor in Pediatrics at the University of California, San Francisco. In 1987, Schoen was appointed head of the Task Force on Circumcision by the American Association of Pediatrics, where he pushed for routine infant circumcision, but the neonatologists on Schoen’s committee wouldn’t go for it. Under his supervision, the AAP released the Policy Statement on circumcision of 1989, which was greatly reverted by a new statement in 1999. Schoen angrily criticized the overriding statement of 1999 in a letter titled “It’s Wise to Circumcise: Time to Change Policy

As an enthusiastic circumcision promoter, Schoen shamelessly mixed medical, religious and cultural arguments. His bias was clearly obvious in some of his latest articles, such as “Circumcision is not only Jewish, it’s good for you” (JWeekly, 2013) or his 2009 book “Circumcision, Sex, God, and Science: Modern Health Benefits of an Ancient Ritual“.

We share a recently released video interview conducted by James Loewen in 2009, where Dr. Schoen expresses his views rather freely.

AAP 1984 – or how circumcision causes amnesia

As told by Steven Svoboda of Attorneys for the Rights of the Child, on October of 2013 there was a debate at the Medical University of South Carolina in Charleston, South Carolina, during which, Dr. Michael Brady MD, one of the 8 members of the American Academy of Pediatrics’ task force on circumcision responsible for the Policy Statement and Technical Report of 2012, declared: “I don’t think anybody knows the functions of the foreskin,” and then reiterated, “Nobody knows the functions of the foreskin.”

That is strange, because just 29 years earlier the American Academy of Pediatrics had a pamphlet discussing the “Care of the uncircumcised penis”, which included a brief discussion of some of the functions of the foreskin, and a drawing clearly showing the anatomy of the intact penis.

The first edition of this 1984 pamphlet had the word “uncircumcised” spelled incorrectly: “uncircumcized”. There was a second batch printed with this misspelling corrected, but then, when a new batch was printed in 1990, the paragraph about functions of the foreskin and the anatomical drawing suddenly went missing.

Ronald Goldman, Ph.D., of the Circumcision Resource Center, started inquiring about this curious omission on January of 1996. He contacted the AAP eight times about this change. After having been passed by four  AAP officials, he finally obtained this response in September of 1996:

The reviewers felt it was not necessary to reinstate the paragraph because the revision of the brochure included a complete reorganization of the information contained in previous editions.”

According to Dr. Goldman, a comparison of new and previous editions did not show “complete reorganization of the information” and there was no reason why the removed information would have stopped being relevant to parents.

In fact, the AAP still has a page on the “Care for an uncircumcised penis” on their website. It is not a bad page, although there are some things that could be a lot better, and the functions of the foreskin are still missing.

Perhaps if they had listened to Dr. Goldman in 1996, Dr. Brady would have been able to describe some functions of the foreskin when asked about them, during the 2013 debate.

So… what was that controversial paragraph?

The Function of the Foreskin: The glans at birth is delicate and easily irritated by urine and feces. The foreskin shields the glans; with circumcision this protection is lost. In such cases, the glans and especially the urinary opening (meatus) may become irritated or infected, causing ulcers, meatitis (inflammation of the meatus), and meatal stenosis (a narrowing of the urinary opening). Such problems virtually never occur in uncircumcised penises. The foreskin protects the glans throughout life.

This is the anatomical drawing, prepared by Edward Wallerstein (author of the 1980 book “Circumcision: An American Health Fallacy“), which was included in the pamphlet:

wallerstein

It is important to note that no anatomical drawings are included in the 2012 AAP Policy Statement and Technical Report on circumcision. The word “Frenulum” (or “frenum”) does not even appear in either document.

This is a scan of the 1984 pamphlet, as shared by Dr. Goldman (click to enlarge).

AAP1

AAP2

Given these obvious omissions, it seems hypocritical from the AAP to claim, as they do, that “It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.

Our conclusion is that perhaps circumcision causes amnesia. Selective amnesia. That, or they have a vested interest in maintaining high rates of circumcision for financial gain, but that would be dishonest, wouldn’t it?

Dr. Goldman’s discussion of the pamphlet: http://circumcision.org/pamphlet.htm

CIRP page mentioning this pamphlet: http://www.cirp.org/library/normal/aap/

CIRCUMSTITIONS discussion of this pamphlet: http://www.circumstitions.com/AAP-care.html

Attorneys for the Rights of the Child telling of the 2013 debate: http://www.arclaw.org/our-work/presentations/charleston-debate-marks-turning-point-movement-recognize-circumcision-human-r

AAP Current page: Care for an uncircumcised penis. https://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Care-for-an-Uncircumcised-Penis.aspx

 

 

Dr. Anthony Chin is severely biased on circumcision

Anthony Chin, MD

Anthony Chin, MD

U.S. News Healthcare published an article (“Circumcision: Why it May Be as Important as Vaccines to Your Child’s Health“) by one Anthony Chin, MD, pediatric surgeon and director of surgical critical care at Children’s Hospital of Chicago. This article is so biased and willfully blind to facts that it is not even worth the cost of the pixels used to display it on your screen.

The author claims that science is clear, that circumcision is a matter of good medicine and smart prevention. I don’t know of any other kinds of “prevention” that remove normal parts of the body without taking into consideration the wishes of the patient, particularly when there is no reason to expect any major pathology of said part (i.e. genetic reasons, preexisting symptoms, etc).

The doctor claims that as physicians “we must respect [the family's] choice“. But, why? What other reductive surgeries are performed for “family’s choice” and -again- without consideration to the wishes of the actual real patient?

He then says “we have a professional obligation to educate parents and help them make as informed and as safe as call as possible“. Well, if one is to educate a parent on the removal of the foreskin, one should be willing and able to discuss what the foreskin is and what it does. And this doctor fails at that, as we will see.

Just to compare, a recent policy for labiaplasties on teenagers, by the American College of Physicians and Pediatricians, recommends appropriate counseling, screening for body dysmorphic disorder, and recommends that the obstetrician-gynecologist be ready to discuss normal sexual development, wide variability in appearance of genitalia, nonsurgical treatment options and autonomous decision making. None of this basic elements is discussed when it comes to circumcising male children.

Then, to support the “science behind an ancient ritual“, he tells us that studies indicate that circumcised males have fewer urinary tract infections. Of course he omits that this UTIs are rare, that the “protective” effect applies only to the first year of life -while circumcision is for life-, that UTIs are generally easy to treat, that with the exception of the first year of life females have more UTIs than males and we don’t perform surgery on them, and that over 100 circumcisions have to be performed to prevent a single UTI -which again, would be easy to treat. So it is hardly proportional to what it is supposed to prevent.

He then says that circumcised males have a lower risk for sexually acquiring and transmitting certain infections. While some studies show a reduced incidence of some STDs on circumcised males, there are far more factors than the presence or absence of foreskin, such as appropriate sexual education, safe sex practices, and the specific risk groups and behaviors the individual moves in, which is why anyone promoting circumcision for STD prevention without educating on safe sex is actually endangering people. Anyone, circumcised or not, can contract an STD. Many STDs are transmitted in the semen, so circumcised or not, an infected male will transmit the STD unless a proper barrier is used.

The next predictable claim is the infamous 60% risk reduction of contracting HIV. As always, he misses the fact that this applies only to female to male transmission through unprotected penetration, that this does not apply to males who have sex with males, to unprotected oral or anal sex, or to any non-sexual form of HIV transmission. Besides, there are numerous questions about the methodology used in the African trials and about their significance in non sub-Saharan environments.

He then tells us that “the biological mechanism behind the protective effect is not entirely clear“. Well, after about 150 years of “medical” circumcision in the United States, something as simple as this is still not clear? He goes on to repeat a biological feasibility that has not been demonstrated, meaning that it is nothing but speculation.

The one good point is the acknowlegding that circumcision is no “silver bullet“, no “replacement  for practicing safe sex” etc.

Then he goes on to try to dispell some “myths” about circumcision.

The first “myth” of course is that circumcision interferes with penile sensitivity. He calls it pernicious and persistence, and says research has found that it doesn’t. I wish that was the case. For one, the 2007 study by Sorrells showed that the foreskin is the most sensitive part of the penis to soft touch. A 2016 study and thesis by Jennifer Bossio that tried to contradict Sorrells actually corroborated it – even if the author then failed to recognize it. She did write that the foreskin was significantly more sensitive to touch stimulus.

Besides, it’s simply logic. If the foreskin is alive, if it is any sensitive, removing it by definition removes any amount of sensitivity provided by the foreskin. Thus, there is a loss in sensitivity no matter what.

His second myth is that only newborns can get circumcised. He claims that the optimal time is before 3 months of age (when the individual is not competent yet so cannot refuse – ethical issue), but that children and even adults can be circumcised safely. Then he says some families “choose to defer circumcision until a child is older and can decide for himself” but he cautions these families that “circumcision later in life tends to be more emotionally scarring“. Interesting that he cautions families AGAINST respecting the individual’s  bodily autonomy. Did he even consider what he was writing?

The third “myth” is that circumcision can damage the penis. His first sentence is that “circumcisions can go bad, but they very rarely do“. But since they do, then myth has not been dispelled. How many lives does your child has? How many penises can he afford to lose? There are frequent case reports of partial and total amputations. Unsightly scarring, skin bridges, loss of too much tissue, re-circumcisions, all these happen and frequently. Dr. Chin then provides us with an optimistic rate of complications of “fewer than half percent of newborn circumcisions” developing complications. Well, 0.5% applied to 1.2 million newborn circumcisions in the United States every year amounts to 6,000 babies experiencing complications from a surgery that they didn’t need. I wouldn’t qualify that number as small. At least 2 or 3 die each year, per official estimates – some estimate a lot more. Imagine a room large enough to host 6,000 babies with complications from their circumcision.

One of the most common complications is meatal stenosis, and this is not even factored into that “half percent“.

He says that circumcision is “safe, inexpensive and relatively simple” and that it can “protect individual health, alleviate collective suffering and curb health care costs reducing the number of preventable infections“. What about the preventable complications? The preventable deaths? What is the cost of 1.2 million circumcisions? What is the cost of providing proper sexual education? What is the cost of treating 6,000 baby boys with complications, some requiring transfussions, some requiring additional surgeries…

What about the cost of violating the bodily autonomy and genital integrity of 1.2 million baby boys every year?

Subtle language to perpetuate the fraud – by Touro Infirmary

I believe we all, regardless of whether we oppose circumcision of children, or promote it, can agree that circumcision is not a necessary procedure.

In fact, the third paragraph of the American Academy of Pediatrics’ 2012 Policy Statement on Circumcision starts: “Although health benefits are not great enough to recommend routine circumcision for all male newborns“. Then it goes on to boast the “benefits” and endorse insurance coverage of the procedure.

Nevertheless, the important point is, the procedure is considered elective. Intactivists and the medical community disagree over who has the right to “elect” the procedure, but there is no medical view that considers the procedure necessary.

Which is why it is important to see how subtle language is used to convince parents otherwise.

Touro Infirmary

Touro Infirmary, Louisiana

We were alerted to Touro Infirmary’s verbiage and had  the chance to verify it on their website. Touro, founded in 1852, claims to be New Orleans’ only community based, not-for-profit, faith-based hospital, and their “about us” page claims they have always  taken a progressive path.

But are they progressive when it comes to male newborns’ genitalia?

The “before delivery” page reads:

You may have already signed the “Consent for Circumcision” for your male child when you signed your other consents at 36 weeks. If not, this consent will also need to be signed shortly before the circumcision procedure is done.”

Notice the language: this consent will need to be signed before the procedure is done. There is no question of whether you are the parents have decided. The language presents circumcision of the male child as something inevitable, and the consent form as something that just needs to be signed so we can move forward and be done with this.

The “after delivery” page then starts with this question and answer:

“I have heard that after the birth of my baby, the baby will remain in my room, with me, rather than go to the nursery. Is this true?”
“Touro offers “rooming-in/mother-baby care” before and during the newborn’s initial bath and examination by the nurse and pediatrician. Of course, circumcisions and other necessary procedures are done in the nursery, not in the mother’s room.”

Notice the wording: “circumcision and other necessary procedures” which seems to imply  that circumcision is one of those necessary procedures. In fact, it seems it is so important that it is the first one mentioned!

The only place where they hint that circumcision is not necessary or otherwise mandatory is on their example of a birth plan, which includes this line:

“If your baby is a boy, do you want to have him circumcised?”

The website makes no attempt to educate parents on why they would want or not, to have their male child circumcised. But by using careful language,  they present circumcision as a necessity, as something that is simply done. And by doing this, they attempt to ensure the perpetuation of male infant circumcision in the United States.

Touro, shame on you.

 

So what happens when a baby dies after circumcision?

In my time as an intactivist, I have seen this scenario play out a few times. A parent, relative or friend of a relative posts in facebook asking for prayers for a baby who became severely ill after a circumcision. One of them kept bleeding and had seizures. Another one developed a UTI and a fever after a second procedure to try to fix an already botched circumcision.

Then the baby dies.

The intactivist community at large starts expressing sadness and grief, but they also start sharing the story, hoping that some parents will realize that there is a real danger of death when you send a baby to circumcision.

And then the family comes back… asking for silence. They claim that it was not the circumcision what caused the death. They claim that they are being attacked for their decisions and their beliefs.

What should the community do in those cases?

Accepting that their child died as a consequence of their circumcision means accepting that their child died because of a decision they took. It’s easier to go into denial. In fact, the circumcisers have an interest in keeping the family quiet, so they will likely distort the facts to make it seem as if circumcision was the only chance for the child to survive a pre-existent condition.

In the case of the baby that bled in 2013, the parents later said that bleeding gave them the only chance to fight a bleeding disorder; never mind that their baby didn’t make it.

In fact, in an amazing display of arrogance and irresponsibility, doctor Nisha Jain, M.D., chief of the Clinical Review Branch in FDA’s Office of Blood Research and Review, wrote Patients [of hemophilia] can be diagnosed as infants during circumcision”

In the case of a baby that stopped breathing shortly after a circumcision in Israel in June 2013, the Rabbis claimed a pre-existent condition and said that the circumcision had been performed “flawlessly”.

That same week, a teenage girl died in Egypt after circumcision (FGM) by a medical doctor. A health inspector report said the cause of the death was due to “a sharp drop in blood pressure resulting from shock trauma”. The doctor who performed the female genital mutilation was found guilty, but it is said he is not in jail.

But shock trauma is never considered in the case of baby boys dying after circumcision.

It is likely that hospitals offer some kind of incentive to families of babies dead after circumcisions. Families in turn will keep quiet about what happened. For example, when Jacob Sweet became severely disabled after having an infection and seizures after circumcision, and the hospital “lost” the records, the family offered a reward to anyone coming back with the records. The legal proceedings lasted for years, and the family was finally compensated. The family, that up to that point had even attended genital integrity events, suddenly became silent. When Jacob died, at the age of 26, his circumcision was not even mentioned in the obituary and related news.

But, who benefits from this silence?

The families don’t want to have their story plastered on the news and all over the internet. They want to settle and move on. The doctors don’t want the bad publicity. So, is it a surprise that the AAP didn’t find studies of mortality, only case reports, and thus didn’t provide any numbers on mortality on their policy statement on circumcision of 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)
- American Academy of Pediatrics
Technical Report on Circumcision 2012

In Canada, a baby, the son of an Iranian couple, died in 2013 after a circumcision that the parents didn’t even want in the first place, but were convinced by a doctor to have it done for medical benefits. The story remained silent for two years, until the family succeeded in seeing the doctors named. So you can see that there is an interest in keeping silence over these cases.

But, who speaks for the child? Who speaks for the one whose voice was never heard?

Genital integrity activists claim that circumcising a minor is a violation of human rights. Many medical communities refuse to accept this and frame circumcision as a parental right. But when a baby dies after his circumcision, can we claim that his rights were violated?

The World Health Organization (WHO) frames female genital mutilation as a violation of human rights, with this paragraph:

FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.

We disagree that it “reflects deep-rooted inequality between the sexes” as those societies that practice FGM also practice traditional forms of male circumcision, often resulting in death and mutilation. However, in this moment, we are more interested in the last part of the paragraph:

The practice also violates a person’s rights to [...] life when the procedure results in death

Circumcision apologists claim that every medical procedure has risks. Genital integrity activists remind them that circumcision is not essential to the well-being of the child, and as such is considered an “elective” procedure – and yet the subject is not given the chance to “elect” (or refuse).

So what happens when circumcision results in death?

Who speaks for the baby whose right to life was violated?

How can we stay silent, and wait in silence for the next victim? What good is that?

Sorry families of those babies who died after circumcision. We grieve with you. We feel your pain. But staying silent is the worst form of disrespect for your lost one, and we will speak, if anything with the hope that one family won’t have to go through what you just went.

The sick compulsion to circumcise

“Elective circumcision should be
performed only if the infant’s condition
is stable and healthy.”

American Academy of Pediatrics
Technical Report on Circumcision, 2012

A baby was circumcised on November 10, 2015 at Kosairs Children’s Hospital in Louisville, Kentucky. Ordinarily, this wouldn’t be newsworthy; it is estimated that more than 3,000 male babies are circumcised daily in the United States. However, this was one particular baby. As the parents described on a GoFundMe page, he “was born August [**], 2015 at [**]  at 34 weeks 3 days gestation. He weighed 4lbs 4oz and was 15 inches long. Shortly after birth, he started having breathing problems and was intubated and put on ventilation. The doctors at Owensboro Health noticed he had a very small ribcage, after doing xrays, they decided to fly him to Kosairs Children’s Hospital. He was seen by many geneticists and doctors, and they noticed he was showing signs of something called Klippel Feil Sequence. He has a cleft palate, small ribs, and a short neck along with some renal issues (enlarged kidneys).

While at Kosairs, his spine was found to be detached from his skull (internal decapitation), making his condition even more critical. The baby was intubated and wearing a brace to keep his head from moving.

brian goode wave tv - Copy

And then, they decided to perform a circumcision at the same time as a major surgery on November 10.

The Intactivist community jumped to recommend that the baby be spared from the circumcision; after all, this was a baby with extreme health problems who has been fighting for his life for months now. But all the attempts to contact the parents were met with disdain, with the mother at some point commenting:

Well, uncirced penises look like a turtle hiding in it’s[sic] shell. I don’t prefer them, sexually. And [father's name omitted] gets much pleasure out of sex with his circumcised penis.

mother reason

The Facebook page for the child’s battle posted that they had blocked over 300 people that day. 300 people who were concerned that this baby had suffered too much and didn’t need to be put through a circumcision in his current condition. It’s said that some activists contacted CPS out of concern of what the consequences of the surgery could be to the baby.

Then the Facebook page for the child’s battle informed that the baby “is out of surgery and recovering now. All surgeries went well, just hope that the Nissen is the correct size“.

A few hours later, the page deleted all photos and videos and was marked under construction. Pictures and videos started going back up with watermarks, and about an hour later, the page and the parents’ Facebook profiles went offline.

Attempts to find out the condition of the baby by some activists went unanswered – due to privacy laws. But then in a strange twist, the mother’s profile showed up again commenting in different places:

If you are worried about [baby's name], instead of attacking his family on Facebook, contact us. [phone number]

mother2Activists who called were cursed out.

On November 11, Kosair Children’s Hospital posted on their FB page:

In keeping with the American Academy of Pediatrics’ policy statement on circumcision, parents at Kosair Children’s Hospital are advised of the benefits and risks of the procedure, and make the decision to circumcise based upon religious, ethical and cultural beliefs. If parents do choose circumcision for their baby boy and the infant is already scheduled for a surgery, the procedure is done at the same time under anesthesia. In other instances, pain control measures are used to keep the baby comfortable.”

What they failed to mention is that the American Academy of Pediatrics clearly indicates that “Elective circumcision should be performed only if the infant’s condition is stable and healthy.”

kosair

This post was deleted about one hour later, as the intactivist community kept commenting and providing real information.

Evidently, American doctors have a difficult time realizing that they have a responsibility to their infant patient over the “beliefs” of the parents and understanding that there are times when babies are struggling to survive, when they are suffering so much, that they should do the best to spare them from any additional pain.

We wish we didn’t have to tell parents not to perform unnecessary genital alterations on their babies (our agenda), but more than that, we wish doctors were capable of policing themselves and were capable of telling parents that there are times when their babies are not good candidates for the unnecessary surgery, and this is no doubt one of those cases.

I don’t want to use any baby’s or any family’s suffering to “advance an agenda”. Some suffering is preventable, if only the medical community would be accountable and would stop enabling cultural customs at least in the cases where good sense and logic advise against them.

In my heart I wish the best for this baby. I wish that he survived and that he will heal and grow up to be the best person that he can be. That’s all I can do really.

 

 

 

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

 

Little sproutings and circumcision – more of the same

Jeni Taylor, MPH MSN RN is a nurse, public health advocate and new mom from Northern Virginia, who blogs on her website, Little Sproutings, to share her experiences as a mother and discuss relevant baby-health topics to help parents.

On July 25th, 2015, Jeni published an article called “The circumcision decision“. On this article she intended to “research what the current evidence says about whether or not it’s indicated to circumcise in the developed world“. Her article obviously caused some backslash among the intactivist community.

Jennifer Marali Taylor, MPH MSN RN - we cropped the image to respect the privacy of her baby.

Jennifer Marali Taylor, MPH MSN RN – we cropped the image to respect the privacy of her baby.

In response, Jeni added a disclaimer: “I want to clarify that I am not an expert on the subject of circumcision, and this post is not intended to cover every aspect of such a complex issue. This post is focused strictly on the medical perspective.” Also, responding to a commenter who indicated that Jeni “never once bothered to mention the structure and function of the foreskin“, she responded that she “didn’t discuss the function of the foreskin. That wasn’t what this article was about and that wasn’t what I was set out to do when I wrote this article.”

At the end of the article, Jeni claims that “with regards to expert opinion, the research all points to maintaining this evidence-based practice“. Jeni, however, only reviewed U.S. sources. European medical associations for example hold different points of view in spite of having access to the same evidence.

The problem we have with this kind of article is that many parents will take it as a recommendation, in spite of the disclaimer (“I am not an expert”). And, many people who are not familiar with the topic won’t even ask the question of whether the foreskin has any kind of function or not.

Sure, Jeni said that “wasn’t what this article is about“, but you cannot separate these two elements. When you circumcise a baby, you negate the functions of the foreskin. The baby will never experience those functions. When you do not circumcise the baby, he will grow up to experience those functions. It’s just like the two sides of the coin. You can’t just flip one single side of the coin. Wherever one side goes, the other side follows.

Jeni wrote: “The risks of complications from a circumcision are very low, and most of those that occur are minor“. This statement alone is very incomplete and misleading.

According to the American Academy of Pediatrics, AAP, on their 2012 technical report on circumcision (page 17 of 32): “The true incidence of complications after  newborn  circumcision  is  unknown, in part due to differing definitions of “complication”and differing standards for determining the timing of when a complication has occurred

A few sentences later the same report indicates: “Significant acute  complications are rare, occurring in approximately 1 in 500” – But is this really number really “rare”? Take into consideration approximately 1.2 million circumcisions in the United States every year, and you have 2,400 babies suffering significant acute complications every year, over a surgery that they didn’t need.

The Royal Australasian College of Physicians, on their policy statement from 2009, actually says: “Some of the risks of circumcision are low in frequency but high in impact (death, loss of penis); others are higher in frequency but much lower in impact (infection, which can be treated quickly and effectively, with no lasting ill-effects). Low impact risks, when they are readily correctable, do not carry great ethical significance. Evaluation of the significance of high-impact low-frequency risks is ethically contentious and variable between individuals. Some are more risk averse than others“.

But we are talking about babies. How do we know how risk adverse is a baby? Can parents even know?

We know for sure that babies had died as a result of circumcisions, and others have lost their penises (at least two of them in the U.S. in 2013). Babies have been forced to grow without penis, with the most known case being David Reimer (1965-2004) who was raised as a girl after the destruction of his penis, resumed male identity as a teenager, underwent two phalloplasties, and finally committed suicide in 2004. There were also two cases on the same day in a hospital in Atlanta on Aug.22, 1985. A two year old child suffered the same fate in 1984. Then, we have Mike Moore, who lost his penis during circumcision at age 7, circa 1991. And of course, the two babies from 2013, one in Pittsburgh and one in Memphis.

How many babies and children is it tolerable to force to go through life without their penis? Dear reader, how many of your sons would you consider tolerable to endure this complication?

While the American Academy of Pediatrics touts benefits -without being able to fully recommend circumcision-, the Royal Dutch Medical Association indicated in 2010:

“There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene. Partly in the light of the complications which can arise during or after circumcision, circumcision is not justifiable except on medical/therapeutic grounds. Insofar as there are medical benefits, such as a possibly reduced risk of HIV infection, it is reasonable to put off circumcision until the age at which such a risk is relevant and the boy himself can decide about the intervention, or can opt for any available alternatives.

“Contrary to what is often thought, circumcision entails the risk of medical and psychological complications. The most common complications are bleeding, infections, meatus stenosis (narrowing of the urethra) and panic attacks. Partial or complete penis amputations as a result of complications following circumcisions have also been reported, as have psychological problems as a result of the circumcision.

“Non-therapeutic circumcision of male minors is contrary to the rule that minors may only be exposed to medical treatments if illness or abnormalities are present, or if it can be convincingly demonstrated that the medical intervention is in the interest of the child, as in the case of vaccinations.

“Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity.”

In 2013 the Nordic Association for Clinical Sexology wrote: “Ancient historic account and recent scientific evidence leave little doubt that during sexual activity the foreskin is a functional and highly sensitive, erogenous structure, capable of providing pleasure to its owner and potential partners

Not discussing the functions of the foreskin, dismissing the sexual role of  the foreskin and minimizing the impact of the risks, are three ways in which the American medical community shows its bias in favor of circumcision.

Jeni claims that “Both the AAP and the medical community recommend male circumcisions, for the health and medical benefits”. The AAP never actually recommends circumcision. They favor it, but they do not recommend it, leaving the decision to the parents (which we disagree with since the parents are not the ones who have to live with the consequences, and as we showed before, these consequences can be catastrophic). It would be difficult to limit what Jeni means with “the medical community”. As we have seen in this article, the global medical community at large finds much less value in circumcision than the American medical community.

The AAP says: “Parents are entitled to factually correct, nonbiased information about circumcision“. Skipping the functions and anatomy of the foreskin is providing incomplete and biased information. The AAP themselves are guilty of this omission, and so is Jeni.

A 2013 letter by 38 European and Canadian Physicians, heads of medical associations, says of the AAP: “while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report’s conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia.” Furthermore, “To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.

This conclusion contradicts the conclusion in Jeni’s article that we noted earlier, that “the research all points to maintaining this evidence-based practice“.

We wish that Jeni will understand that circumcision and non-therapeutic genital alterations on children of any gender violate the bodily autonomy and physical integrity of children, violates their human rights, and that she as a nurse, as a mother and as a blogger has a responsibility to protect children from unnecessary and harmful procedures.

If you are neutral in situations of injustice, you have chosen the side of the oppressor. If an elephant has its foot on the tail of a mouse and you say that you are neutral, the mouse will not appreciate your neutrality. Desmond Tutu

If you are neutral in situations of injustice, you have chosen the side of the oppressor. If an elephant has its foot on the tail of a mouse and you say that you are neutral, the mouse will not appreciate your neutrality.
Desmond Tutu

 

A situation of injustice. Which is your side?

A situation of injustice. Which is your side?

 

Intermountain moms, nurse Dani and Doctor R. bring their lies to circumcision

Oh the circumcisers are desperate and they have the lies to prove it. It’s been a while since I last woke up to two terrible YouTube videos full of half truths and obvious lies about circumcision.

So, let’s see. Intermountain Moms’ nurse Dani “tries to” answer this question: “Will a doctor numb a baby boy if he gets circumcised?”

Nurse Dani says “circumcision is usually done before a baby goes home from the hospital or two weeks later“… What about the other possibility, like, not doing it at all? Not mentioned, which reinforces the sense of normality that all boys are circumcised.

And the good thing about doing it when a baby is very very new”, says nurse Dani, “is that they kinda are in a natural sleep state, this is almost a natural anesthetic

Yes folks, that’s what she says. She must have missed that Oxford University study published in April and widely reported in the media, where “researchers at Oxford University have watched infants as young as a day old as their brains process a light prodding of their feet. The results confirm that yes, babies do indeed feel pain, and that they process it similarly to adults.

The Time article reports that: “Until as recently as the 1980s, researchers assumed newborns did not have fully developed pain receptors, and believed that any responses babies had to pokes or pricks were merely muscular reactions.“, but clearly nurse Dani still believes it. In fact, as early as 1997, most of the neonatal circumcisions (some 95% or so) were performed without any anesthestic. The American Academy of Pediatrics on its last policy statement on circumcision states that “adequate analgesia should be provided whenever newborn circumcision is performed“.

Nurse Dani continues: “in addition to that, we give babies a binky that has sugar water on it, and let them suck on it, and that is very soothing to them“. The AAP indicates: “Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision.”

She then completes her statement: “and yes, they are also numbed

So what was that all about? Why the “natural sleep state”? Why the “soothing binky with sugar water“? To make parents feel better?

Nurse Dani says “if you don’t want to watch, then that’s okay“. What’s that all about? As a parent, if anyone is going to do ANYTHING to my baby, it will be in front of me. And if it’s too horrible for me to watch, it’s probably too horrible for my baby to endure. And if on top of it all, it is unnecessary, then you better believe I’ll keep my baby safe.

No nurse Dani, I won’t recommend you to my friends or family. You are just too willing to hurt babies.

From there we go to Doctor R. who brings Dr. Geoffrey Nuss, an urologist with Urology Associates of Texas and a surgeon specialized in reconstruction of the urinary tract, to speak about circumcision.

Doctor R. spends some time making puns and jokes about circumcision.

Doctor Nuss describes the foreskin saying: “there is a redundant portion of skin that covers the glans“. How was it defined that the foreskin is “redundant“? Who ever made that call?

Asked what functions the foreskin has, doctor Nuss goes on: “mainly protecting the glans from the  outside environment but really we don’t… we don’t have… it doesn’t have a major function today“. You can see him choking on his words.

Perhaps he needs to be reminded that “The amount of tissue loss estimated in the present study is more than most parents envisage from pre-operative counselling. Circumcision also ablates junctional mucosa that appears to be an important component of the overall sensory mechanism of the human penis.” Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-295.

Why remove it, that’s a good question. Many people will remove it for religious reasons” (except that it’s not the person getting it removed the person who practices the religion, which means it is an intromission on a person’s physical integrity, an assault), he goes on: “health related reasons: the American Academy of Pediatrics recommends circumcision to prevent … ” STOP.

The AAP recommends? Let’s see what the AAP ACTUALLY says: “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.”

And to prevent AIDS, AIDS, or HIV infection“. Unfortunately referring to the African studies in this non-specific way is irresponsible and does way more harm that good. Need we remind our readers that thousands of circumcised Americans have died of AIDS related complications?

But that’s in very young boys, less than six months. Adult circumcision is much different“.

Here we have that other common myth. It’s easier when they are young. “Buy now and you will get!”. See, if the American medical community wished, they could do away with this myth by certifying for use in the United States the devices that were invented for adult circumcisions in Africa. The PrePex, the Shang Ring, the AccuCirc. With these devices the cost of an adult circumcision can decrease from thousands (due to required location and general anesthesia) to a few hundred, like infant circumcision is now. But of course that’s not a good business for the American medical community, as many adults won’t submit since they would know that their foreskin is pleasurable, and the hospitals would lose their role as suppliers of human tissue to the biomedical industry.

Asked if the foreskin makes a different for sex, dr. Nuss answers “I tell men, what you have is what you should have“. He says “changing your foreskin or altering in any way will not provide any benefit” (so what happened with those health benefits he was touting for young boys?) “ and in fact some men will complain that it’s different and they don’t like it. So I don’t recommend circumcision for enhancing sexual performance or sensation

He says he doesn’t recommend that men get circumcised for aesthetic reasons, and he says that when men go to him for circumcision it is due to phimosis.

He says: “Unless kids are [at least] 6 months they don’t have the sensation developed to have a painful experience.”  We just discussed this point at the beginning of the article. Apparently the medical community was too busy in April to read the news.

Asked what is the current trend, he says:  “to circumcise most men still in America however there are many people who are advocating against it.”

Let’s think about this one point. If he knows that adult men who get circumcised often do not like it afterwards, what makes it okay for parents to decide (or for doctors to coerce parents into “deciding”) to alter a baby into a state which, if he had reach as an adult, he would not have liked it?

Asked about complications he says: “Potential complications would be shortening of the foreskin and just an altered cosmetic appearance as an adult. As a kid, you obviously will not know what the difference was as you grow up with it.

Can we send these guys back to the 19th century, where they truly belong?

 

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.

WHY????

Really?

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.