Category Archives: Promoters

How medical staff pushes unnecessary circumcisions

The AAP on its “technical report” on circumcision writes:

“Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.”

While the purpose of this sentence is to indicate that some people may choose to circumcise for religious and cultural reasons, it also means that parents should be entitled to make a negative decision in the light of their own experience (cultural, religious, medical, preference or otherwise). Which is why it is disturbing when hospitals and medical staff blatantly ignore negative decisions and reiterate their request over and over, in what amounts to solicitation of an elective surgical procedure.

The following review was posted on Lexingon Medical Center’s facebook page on March 18th of 2015. (Name, profile picture and other details blurred for privacy).

b_r_edited

According to the American Medical Association, AMA:

Physicians should not provide, prescribe, or seek compensation for medical services that they know are unnecessary

This compulsion to circumcise has sometimes resulted in “wrongful” circumcisions – circumcisions that were not consented by the parents, and which should amount to bodily harm.

One such “wrongful circumcision” occurred in 2010 in Miami. Another one in Indiana, 2003, had a jury find no harm to the boy, after a lawyer argued that “an award of (…) in damages to the boy would “open the courthouse door to every kid who’s been circumcised.””.

Imagine if it was any part other than the foreskin. You know your son does not need to have a finger amputated. You leave your child for a moment in the care of medical staff, and when they return the baby to you, the finger has been amputated. How do you react to that?

For people who are from non-circumcising cultures, or who oppose circumcision, it doesn’t matter if, as the Miami hospital said back then, “the procedure itself was performed following appropriate surgical guidelines“. What matters is that it was done or offered at all, that there was the intention or the fact of removing part of a child’s penis. It matters that the child now has a wound and is missing part of his normal anatomy.

A mother we recently talked with, was enraged that her ethical opposition to circumcision became reflected on her son’s medical history after she questioned a facility to find out if they performed circumcisions. See scan from the medical history:

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The person who wrote this on the history would like to think that the CDC and the AAP “recommend” circumcision. These two organizations in fact argue for the benefits, but do not “recommend” the procedure as a routine, leaving the decision to the parents. A decision that activists argue does not belong to the parents because there is no medical urgency, most potential “benefits” can be obtained by less invasive ways without surgery, and the marks and scarring of circumcision last a lifetime regardless of the preference and feelings of the person who should really be concerned about it, the child, when he obtains the age and maturity to provide his own informed consent.

At circumcision protests, there is usually a blame game. Pediatricians argue that most circumcisions are performed by OB/Gyns, yet it was the AAP (pediatricians) who came with the 2012 policy statement on circumcision. OB/Gyns argue that they do it because the parents request it. But what we hear from parents is different. We see a picture where the medical establishment is interested in continuing to push the procedure. Whether this is done by the establishment per se, or by the staff as a result of their own personal bias, is not always clear. We will soon show some of the problems with circumcision consent forms. In the meantime, here’s an intactivist meme that clearly reflects this problem:

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When having your normal body is seen as problem: Medical facilities providing improper advice

The American medical community’s ignorance of the normal care of intact male minors’ genitals is evident, but few times we run into written evidence of how doctors fail to follow even American medical standards, providing instead misinformation that is likely to harm children.

Before showing the specifics, let me explain:

During fetal development, the glans and the foreskin of the penis start as a single structure, and later on start to separate by the dequamation of a membrane, called sometimes the balanopreputial synechia. Typically, at birth this membrane has not separated completely and the opening of the foreskin is tight, a condition that is called physiological phimosis, and which requires no treatment.

Note: the term “balanopreputial synechia” appears to be uncommon outside the intactivist community, but the membrane described by those words has been studied and known for a long time, described in 1933 as ”a layer of stratified squamous epithelium”, also referenced by MediLexicon as “glandoprepucial lamella“.

After a relatively long time, this membrane dissolves completely and the opening of the foreskin becomes more flexible, allowing for retraction of the foreskin in order to expose the glans, the head of the penis. This may happen at any time, it could be as early as a few months, or as late as 17 or 18 years of age.

Used with artist's permission.

Used with artist’s permission.

Source:  http://circumcisiondecisionmaker.com/foreskin-facts/development/

Read: Øster J. Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish Schoolboys. Arch Dis Child 1968;43:200-3.

Typically physiological phimosis should be superated at least after puberty, as a sign of sexual maturity. Not being able to retract the foreskin before the sexual debut can sometimes make sex difficult.

See Leonard MP. Pathologic and physiologic phimosis: Approach to the phimotic foreskin. Canadian Family Physician 2007;53(3):445-448.

When a sexually mature individual cannot retract the foreskin, or the opening of the foreskin becomes scarred and does not allow the glans to come through, we are now talking of a pathological phimosis. This is not very common but not extremely rare either. Depending on the cause, pathological phimosis may be resolved through non invasive procedures (such as stretching, exercises, steroid creams, etc), or some surgical paths can be taken  such as preputioplasty, dorsal slit, synechiotomy, or circumcision (as an informed and consenting adult).
See: Orsola A, Caffaratti J, Garat JM. Conservative treatment of phimosis in children using a topical steroid. Urology. 2000;56:307–310.  [PubMed]
Nevertheless, some adults are not bothered by their phimosis and may choose not to do anything about it, even if that means keeping the glans covered during sexual relations.

Most medical organizations, including the AAP, agree that:

  • Having a non-retractable foreskin during infancy is normal
  • Trying to retract the non-retractable foreskin of a child (forceful retraction) causes pain, and may cause bleeding, scarring, infections, damage to the foreskin, and may even result in a iatrogenic phimosis (phimosis caused by intentional injury).

The myth that parents of uncircumcised (intact) children needed to retract the foreskin and wash the inside every day, was started in 1941 by Allan F. Guttmacher, who also promoted mass circumcision (Should the baby be  circumcised? Parents Magazine 1941 Sept;16(9):26,76-8]). Unfortunately this myth still persists, even in many members of the medical community, even when standards, policy statements and medical school books advice against it.

So think about this:

You have a 10 months old baby with a stomach problem. You take your baby to the ER. Upon examination, the doctors notice that your baby is not circumcised. The foreskin becomes their prime suspect. They check your baby for infections and find none. However, retraction is difficult and painful (as it should be at that age). They diagnose your baby with viral gastroenteritis AND PHIMOSIS, even though your reason for consultation had nothing to do with the penis.

And then they proceed to give you a care sheet, where their main concern is to tell you to RETRACT THE FORESKIN WITH EVERY DIAPER CHANGE and clean area with a q-tip, even before telling you about the actual care for the real problem (which was to provide motrin for fever and discomfort as needed, no dosage indicated).

Now, if you are an inexpert parent, you may go home to do just what they told you to do. And what you will find out is that retracting the foreskin is not easy and it causes pain every time, but they recommended it so that’s what you do. And if you keep doing it, you may notice some bleeding at times (ah, it’s the phimosis, you will say), and it may become progressively more difficult (due to scarring of the wounds caused by retraction), or the child will cry more every time (because he learns that diaper change means pain), and soon you may give up and just ask for a referral to circumcision, kicking yourself for ever trying to keep your baby uncircumcised.

We’ve seen it happen before. I’ve heard a mother share: “I tried to retract but no matter what I did it wouldn’t retract far enough“. When she learned the truth she felt abused and violated by the health providers, but it was too late for her child.

Today, we have a scan of a care sheet providing such misguided advice. Fortunately for this baby, the mother was educated enough to dismiss the recommendation.

Providing wrong information which results in harm to a baby should be denounced as malpractice.  If we can confirm the name and location of the facility that provided this care sheet, we will update this post to let you know.

Phimosis? Forced retraction?

 

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.

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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.

 

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.

Vernon Quaintance sentenced

On October 3rd, 2014, Vernon Quaintance was sentenced to two years and four months in prision for targeting young boys and asking them to expose themselves under the pretense of inspecting whether or not they were circumcised. Judge Anthony Leonard QC said Quaintance used his interest in the surgical procedure to look at young boys. The judge took into consideration that this offending did not carried over into Quaintance’s later years, and his less than perfect health, to offer some allowance.

Quaintaince recently confessed to a string of offences against five young boys as young as 10 in the 1960s and 1970s. Thousands of images were found in his computer, many showing bloody and ritualistic circumcisions in the Brazilian rainforest.

The Croydon Advertiser referred to Quaintance as “circumcision fetishist”, paedophile, pervert, deviant, and stated that the Gilgal Society was just a facade for the ‘distribution of images of young boys’ for erotic and paedophilic use.

While the Gilgal Society’s website has been removed, its content remains public as the Circumcision Helpdesk, which is openly registered to Quaintaince.

http://circleaks.org/index.php?title=Vernon_Quaintance#2014_Sentence

http://www.croydonadvertiser.co.uk/Upper-Norwood-circumcision-fetishist-jailed/story-23040107-detail/story.html

Vernon Quaintance pled guilty (pro circumcision – Gilgal Society)

A former sacristan for the Knights of Malta has pleaded guilty to nine sex offences including those against boys as young as 11 he had met in the 1960s and 70s.

(…)

On Wednesday this week a court heard that Quaintance, 71, was a paedophile who also ran a pro-circumcision group. Southwark Crown Court heard he accumulated images as recently as 2011.

He was also a leader of the Gilgal Society, a group claiming to promote male circumcision and “its benefits in terms of health, sexual satisfaction and self-image.”

In 2012, he was found guilty of possessing nine hours of child pornography on video tapes. This week he pleaded guilty to five counts of indecency with a child between 1966 and 1976 and four counts of possession of indecent images. An additional count of sexual assault alleged to have taken place in 2011 on a child was left to lie on file.

http://www.thetablet.co.uk/news/981/0/former-knights-of-malta-member-pleads-guilty-to-abuse-of-young-boys

* The Gilgal Society’s website has now been rebranded The Circumcision Helpdesk

A sport-based intervention to increase uptake of voluntary medical male circumcision

Last year we heard a story about HIV researchers / circumcision advocates in Africa. Of course, being just a story, having no evidence, we didn’t mention it. But the story seems to be now corroborated and will be presented at the AIDS 2014 Conference in Melbourne, Australia, July 20 to 25.

So this is what we heard:

“In one presentation I sat through at a world AIDS conference (summer of 2010), a young doctor with these circumcision campaigns [in Africa] (he was marketing chief) took to the podium and explained a “successful” program. They went into the poorest communities, where the boys were mad for soccer, and bought them all new equipment and uniforms. Built them beautiful pitches to play on. Brought in well-known soccer players to inspire the boys, and got coaches. Let the boys play and get to love it. And when it came time to play in the regional tournaments, the bar came crushing down: they’d be sponsored to travel and play only if the team captain could convince most of the boys on the team to get circumcised. The peer pressure was tremendous not to let the team and community down. This doctor was positively gleeful at how successful this strategy was.”

This story might come to be corroborated here: http://pag.aids2014.org/Abstracts.aspx?SID=1104&AID=5834

Abstract

MOPDC0106 - Poster Discussion Session

A sport-based intervention to increase uptake of voluntary medical male circumcision among adult male football players: results from a cluster-randomised trial in Bulawayo, Zimbabwe

Presented by Zachary A Kaufman (United Kingdom).

Z.A. Kaufman1, J. DeCelles2, K. Bhauti3, H.A. Weiss1, K. Hatzold4, C. Chaibva5, D.A. Ross1

1London School of Hygiene and Tropical Medicine, Epidemiology and Population Health, London, United Kingdom, 2Grassroot Soccer, Curriculum and Innovation, Cape Town, South Africa, 3Grassroot Soccer Zimbabwe, Bulawayo, Zimbabwe, 4Population Services International Zimbabwe, Harare, Zimbabwe, 5National University of Science and Technology, Bulawayo, Zimbabwe

The title of the abstract reads “adult male football players”. We are definitively interested in reading all the details.

We will be waiting for the full abstract, to be made public next Friday. But now you know what to wait for.

Manipulation. Peer pressure.

GRASSROOT SOCCER

PEPFAR, the U.S. President’s Emergency Plan for AIDS Relief, shared this photo a few hours ago through their facebook page:

In the Mchinji District of Malawi, local Peace Corps volunteer counterpart and Grassroot Soccer coach Henry Ching'ombe, works with the Kamwendo Youth Group on the GRS activity "Cut and Cover," which addresses medical male circumcision.

In the Mchinji District of Malawi, local Peace Corps volunteer counterpart and Grassroot Soccer coach Henry Ching’ombe, works with the Kamwendo Youth Group on the GRS activity “Cut and Cover,” which addresses medical male circumcision.

Notice that the photo mentions “Grassroot Soccer“. This is an organization with the following explicit goal, according to their facebook page: “Using the power of soccer to educate, inspire, and mobilize communities to stop the spread of HIV”

Combing through Grassroot Soccer’s website, the Bill & Melinda Gates Foundation makes its apparition:

The Bill & Melinda Gates Foundation and the Doris Duke Charitable Foundation (DDCF) are supporting Grassroot Soccer (GRS) in a unique and innovative randomized control trial in Zimbabwe that will assess the impact of an educational intervention using the power of soccer and its role models to increase awareness and uptake of medical male circumcision (MMC) as an HIV prevention measure. The trial, known as MCUTS (Male Circumcision Uptake Through Soccer), will target men ages 18-35 with educational outreach through soccer-related messages.

http://www.grassrootsoccer.org/2012/10/15/mcuts/

While this target age should be 18-35, some other articles on the website show a different panorama:

[May 12th 2012, GRS Zambia] for the first time ever at GRS, we held mobile Medical Male Circumcision (MMC) at the school grounds. The procedure was conducted by Marie Stopes International (MSI), and was sanctioned by the Ministry of Health for outreach service delivery.  There were four boys, between the ages of 16 and 24, who elected for the medical procedure. The operation takes between 25 to 30 minutes, and there is an additional pre and post counseling session dedicated to MMC. Each boy left the post counseling session knowing they now had 60% more protection against acquiring HIV.

http://www.grassrootsoccer.org/2012/05/25/grassroot-soccers-first-mobile-mmc/

 

“Make The Cut” (MTC)

Navigating more through the website we found a poster/report of just the very same abstract discussed above, the one that is still embargoed until next Friday. But now you can read it here: http://www.grassrootsoccer.org/wp-content/uploads/ICASA-Poster_MCUTS-Qual_6-Dec-2013_FINAL.pdf

Participants found MTC (in particular the Coach’s Story) persuasive because the MTC coaches had been circumcised and could discuss the procedure.

Future implementation should incorporate home-based follow-up and small incentives while avoiding delivery during the holidays and mid-season for professional soccer players.

http://www.grassrootsoccer.org/wp-content/uploads/ICASA-Poster_MCUTS-Qual_6-Dec-2013_FINAL.pdf

Goal Trial: targeting teenagers

goal

Generation Skillz is an eleven-session sport-based HIV prevention intervention delivered in secondary schools in South Africa, primarily focusing on age-disparate sex, multiple partnerships, gender-based violence, and male circumcision 

http://www.grassrootsoccer.org/wp-content/uploads/GOAL-Trial-IAC-Poster_Final-A4.pdf

 

Vernon Quaintaince’s trial starts – Gilgal Society website is down

Vernon Quaintance

Vernon Quaintance

The founder of the Gilgal Society, Vernon Quaintance, accused of a string of child sex offenses, is scheduled to start trial today July 14th of 2014.

The Gilgal Society’s website has suddenly gone blank. But it has been rebranded.

Vernon Quaintance also owns the International Circumcision Information Centre’s website (circinfo.com), which used to read “The International Circumcision Information Reference Centre is sponsored by The Gilgal Society”. Today it reads: “The International Circumcision Information Reference Centre is sponsored by The Circumcision Helpdesk”

Sure enough, The Circumcision Helpdesk website (registered since 2003 by Vernon Quaintance) now contains the information formerly on the Gilgal Society’s Website.

What is this guy playing? Who does he want to fool?

The Skeptic – Does science support infant circumcision?

We often criticize Brian Morris’ methods and advocacy of circumcision, particularly his underestimating of risks and complications, his denial of the harm, his overestimation of benefits, and his recurrent self-referencing.

It’s good to read others who share our concern. This is a great article by Brian D. Earp and Robert Darby, published on The Skeptic: http://www.skeptic.org.uk/magazine/onlinearticles/articlelist/711-infant-circumcision

It calls attention to an interesting contradiction. Morris argues for circumcision to avoid having to treat urinary tract infections with paracetamol (pain medication) in light of new studies that associate early exposure to paracetamol with an increase in the risk of autism… yet fails to correlate the fact that paracetamol is used after newborn circumcisions.

Anyway, great read. It’s sad that people are still being fooled by Brian Morris’ air of respectability and the scientific community continues playing his game and not exposing his pseudoscientific arguments. Really sad.

Circumcision in Swaziland: your tax dollars working

CNSNews reports that  The United States Agency for International Development (USAID) is planning to spend $24.5 million to circumcise an estimated 150,000 to 200,000 male infants and males aged 10 to 49 in the kingdom of Swaziland by 2018, to raise the prevalence of circumcision from 19% (in 2010) to 70% (in 2018) and the prevalence of infant circumcision to 50% in 2018.

A demographic survey for 2006-2007 in Swaziland showed that the prevalence of HIV among circumcised males was 22% vs. 20% for those uncircumcised (see table 14.10, page 235)

Swaziland has the highest rate of HIV (26.5% estimated in 2012).

The United States has already invested over 15.5 million dollars in circumcision programs in Swaziland through the President’s Emergency Plan For AIDS Relief, PEPFAR in an ambitious and unsuccessful “accelerated saturation initiative” called Soka Uncobe (circumcise and conquer), a campaign that some say, could be interpreted to say that circumcised men no longer need to use condoms.

PEPFAR has particularly targeted infants (as opposed to voluntary adults) by encouraging hospitals to circumcise all male newborns unless the parents opt out.

The country is culturally polygamous. Multiple concurrent sexual partners are common.

Related:

15 May 2013, Circumcision plans go awry in Swaziland

July 2012, Why a U.S. circumcision push failed in Swaziland