Tag Archives: Medical Community

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.

 

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?

 

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.

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.

Janet R. Weber – teaching nurses how to harm babies

Sometimes the ignorance of some statements makes your head hurt. When a respected teacher makes mistakes which will result in harm to innocent babies for generations, you can only shake your head in disbelief.

But that is what just happened.

intactivists on facebook shared a graphic about Dr. Janet R. Weber, RN, MSN, EdD, author of the “Nurse’s Handbook of Health Assessment, 8th Edition, 2013″, where she is quoted explaining that “An unretractable foreskin in a child older than 3 months suggests phimosis. Paraphimosis is indicated when the foreskin is tightened around the glans penis in a retracted position.”

We verified the quote by going to Amazon, observing that the inside of the book can be previewed, and running a search for “unretractable” which brought up page 613.

janet_r_weber_2

janet_r_weberWhile the data on normal age of retraction has changed over the years, it is in general accepted that less than 10% of the boys are capable of retracting their foreskins before the age of 1. In fact, it is accepted that the age of retraction greatly varies from child to child, with a high percentage of boys not becoming retractable until puberty, and some until late adolescence.

Used with artist's permission.

Used with artist’s permission. Source:  http://circumcisiondecisionmaker.com/foreskin-facts/development/

It is also accepted that trying to retract the foreskin of a baby can result in pain, bleeding, infections and scarring. The foreskin and the glans start as a single structure during the fetal development and separate slowly, as the epithelium keeping them attached desquamates. Forceful retraction hurts this epithelium and can result in iatrogenic damage.

So what is Janet Weber teaching her students? That a normal condition (unretractable foreskin during infancy) indicates an abnormality and is an indication for surgery. In lack of further information, students can construe this information to mean that they need to attempt retraction in order to assess the genitalia of infants, harming their normal genitals in the process.

And this from a professor of nursing who holds a Master. My head hurts.

janet_r_weber_3

Her book will pass in history as further evidence of the American ignorance of the normal development of the male genitalia, and will hopefully serve as evidence of malpractice.

Follow up

On August 29th, Brother K posted on his facebook that after another activist contacted Mrs. Weber, she replied: ”Thank you so very much for your concern and this will be changed in the next printing. Janet Weber ”.

CircWatch will keep an eye on future printings of the book.

What the AAP says:

“Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teen years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. Until the foreskin fully separates, do not try to pull it back. Forcing the foreskin to retract before it is ready can cause severe pain, bleeding, and tears in the skin.”

http://patiented.aap.org/content2.aspx?aid=5211&lan=en

Additional resources

Normal Development of the Foreskin

Development of retractile foreskin

Success stories

We are glad to report that Moreno Valley Urgent Care has been made aware of our report that their website included information about circumcision from a wrong source, and they proceeded to remove the offending information.

We are also glad to report that a Canadian doctor previously profiled on circleaks, contacted us to let us know that he no longer performs circumcisions and opposes infant circumcision now. He wishes to remain anonymous at this time but he may write against circumcision in the future.

Does your OB/Gyn require a “circumcision deposit”?

Does your OB/Gyn require a “circumcision deposit”?

We were alerted about this (apparently not so new) trend, by a post on The Whole Network:

Fan Question: I am pregnant with my second child and my regular OB (who delivered my daughter) started a new policy that forces patients to pay a “circ deposit” before their first prenatal visit. Apparently this is a growing trend among doctors.. Whether or not you are having a boy or if you want to keep him intact you have to pay and if you don’t use it the money will be refunded after you are discharged from the hospital. I tried fighting it but they told me it won’t be done unless I sign a consent form at the hospital. Since it is a new policy I am worried that the staff at the hospital will see that I paid and do it anyway assuming I wanted it done. I just found out that I am having a boy so I need to decide what to do now. Even though they are promising that I will have a say in the end, it makes me really uncomfortable and I’m not sure how safe my son will really be. I am thinking about switching to a new OB over this but I have medicaid so my options are limited. Would it be worth switching over? I am also not sure how to find an intact friendly OB so i was wondering if you could help point me in the right direction. I didn’t search for a doctor with my daughter because he was my regular GYN. I’m in Melbourne FL. There are no birthing centers around here..

But a quick search for “circumcision deposit” allowed us to find that this has been reported at least since 2009, with questions about the legality and ethical value of this practice. It is likely that this practice will increase as Medicare stops funding newborn circumcision in more states. In this particular case, the original poster is located in Florida, where newborn circumcisions are not covered.

More reports here, here.

Some relevant comments:

I would change doctors immediately, if that is an option.  I would worry that my paying a deposit would be construed as consenting to circumcision and would be afraid that it would be done without my knowledge.

I wonder how many mothers assume they don’t have a choice in the matter because they have to pay for it anyway!

The fact that parents who express their refusal to circumcise, and parents who are expecting girls, are being forced to pay this “deposit”  - even if it’s refunded later or applied to other outstanding balances- is outrageous. This is nothing but a way to reinforce the status quo of newborn circumcision, making it look like the default treatment is circumcision, effectively pushing it onto families from non-circumcising cultures. Forget the multiculturalism, forget the respect for the parents and the child. It’s all about collecting that fee and cutting that foreskin.

Circleaks is interested in exposing this practice and helping bring it to an end. But in order to do so we need your help. Please, help us identify entities and doctors with these policies. Your personal information will be strictly confidential.

Please email circleaks {at} gmail.com