Recently, circumcision has resurfaced as a hot topic in the media. All last week, numerous articles with misleading titles were published by big name media outlets, promoting the latest “study,” which supposedly “confirms” the so-called “benefits” of circumcision.
Here are some of the titles:
“Infant circumcision is the healthiest choice, new study claims“
“Researcher says circumcision should be offered like childhood shots“
“Circumcision should be offered ‘like vaccines’ to parents of boys“
“Study determines circumcision comparable to vaccination” (Israel and Stuff)
“Call for circumcision gets a boost from experts“
“Circumcision rates declining in US infants, raising health risks later in life“
“Circumcision should be seen ‘in same light as childhood vaccination’: study“
“Circumcision benefits far outweigh the risks, finds study IN MAYO CLINIC PROCEEDINGS“ (elsevier connect)
“MAYO ON MILAH – Mayo clinic study confirms health benefits on circumcision” (The Jewish Press)
“New Journal argues circumcision should be mandatory“
“The benefits of circumcision outweigh the risks 100 to 1“
“To snip or not to snip – academic claims circumcision should be treated like vaccination“
But, is it true? Did the Mayo Clinic perform a new study on circumcision? And, was the study published legitimate?
To the casual observer, these headlines appear to say all they need to know. When they approach a conversation about circumcision, they will remember one of these headlines and quote it or paraphrase it without any real knowledge of what it means or what really happened. And this is exactly what some sectors want.
Now, let’s go step by step:
First off, the Mayo Clinic did not perform a study on circumcision.
The study being discussed is not new, original research, but a literature review of select articles.
The article was not written by unbiased researchers. The three authors have been known to promote circumcision for many years.
To call this article a “Mayo Clinic study” is misleading and manipulative. Independent authors submitted the article to the journal of Mayo Clinic, Mayo Clinic Proceedings. The Editorial Board procured peer reviewers, who then approved the article for publication. This is very different from having actual staff researchers or commissioned experts performing a study at the Clinic’s request. The article was not written at Mayo Clinic’s request or by Mayo Clinic personnel.
Related: Problems with Peer Review
Related: Is peer review broken?
This article (or literature review) was written by Australian retired professor and molecular biologist Brian Morris, and co-authored by Dr. Thomas Wiswell and psychologist Stefan A. Bailis, both of whom had already co-written other publications promoting infant circumcision with Brian Morris.
Some articles referred to Brian Morris as Dr. Morris. While the fact that Brian Morris has a PhD makes this reference technically correct, it is misleading because it makes it sound like he is a qualified medical physician, when he does not hold a medical degree of any kind. Brian Morris is not a physician or a medical doctor in any way, and the public should know that. He is a professor of molecular science, and does not hold a degree in urology, surgery, pediatrics or epidemiology.
In their last Policy Statement on circumcision (2012), the American Academy of Pediatrics tries desperately to push the soundbite that “The benefits of circumcision outweigh the risks.” Be that as it may, the AAP stops short of the recommendation that circumcision advocates like Brian Morris were hoping for. In this new review, Brian Morris takes a position far more extrem, going as far as comparing circumcision with vaccines; yet, the implied goal of both papers is to get Medicaid and insurance companies to re-establish coverage for neonatal circumcisions in those U.S. states where they no longer cover it.
This review makes claims that are manipulative and hard to prove, for example that the “benefits exceed risks by at least 100 to 1” and that “over their lifetime, half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin”.
Because awareness that circumcision of minors violates human rights has been moving from the “anti-circumcision lobby groups” (as Brian Morris refers to pro-genital integrity organizations on his website) to mainstream organizations such as the Royal Dutch Medical Association, the Parliamentary Assembly of Council of Europe, the International NGO Council on Violence against Children and many others, professor Morris now is trying to manipulate the language to suggest that “not circumcising a baby boy may be unethical because it diminishes his right to good health“, again a claim hard to substantiate.
Morris’ desired conclusion is that “as with vaccination, circumcision of newborn boys should be part of public health policies” particularly on “population subgroups with lower circumcision prevalence“.
Unsurprisingly, the same authors, in cahoots with some of the promoters of circumcision in Africa, presented a paper called “a snip in time” two years ago, arguing that infancy is the best time to circumcise and that “by making MC (male circumcision) normative in a community, [...] the prospect of [psychological problems] would be largely eliminated“.
As usual, in this new article Morris references his own previous publications numerous times. Out of 80 references, he is author or co-author of at least 12 of them. On the contrary, the American Academy of Pediatrics in their 2012 Policy Statement did not quote a single publication by Brian Morris.
So this is the problem:
In the eyes of the casual observer (and reporter), the fact that this article is being published by Mayo Clinic Proceedings (a publication of the Mayo Clinic) is almost equivalent to saying that the Mayo Clinic performed an original study and/or agrees with it. While this is certainly not true, it is an easy assumption for people to make or believe.
Media headlines are used to manipulate the general opinion by using the more dramatic claims from the abstract to embed them in the collective consciousness. Most people will not read past the headlines, and will reach their conclusions based on this limited information.
Few reporters and authors dare to criticize peer reviewed publications. In this case, one notable exception is Wellington Professor, Dr. Kevin Pringle, who perfectly summarized: “Vaccination is a low-risk intervention to prevent a problem with significant adverse outcomes. Circumcision is an intervention with significant risks (ignored or minimised by the authors of this paper) to prevent problems that will not develop in the vast majority of males; most of which can be simply addressed if and when the need arises.”
For those wishing to seriously challenge Brian Morris’ new article, the following is a response from the Editor-in chief of the Mayo Clinic Proceedings journal:
April 4, 2014 at 2:46 am
The article, “Circumcision Rates in the United States: Rising or Falling? What Effect Might the New Affirmative Pediatric Policy Statement Have?” was authored by 3 experts in the subject matter. All 3 have previously authored numerous scientific articles on this topic, and their combined credentials are far more than adequate to allow them to authoritatively address the topic.
Once submitted to Mayo Clinic Proceedings, the aforementioned manuscript was rigorously peer reviewed by other experts in the field, revised, and later accepted for publication. The Journal’s Editorial Board oversaw this process. All of these are typical processes for the review and acceptance of a manuscript. As a result of these processes, the approved manuscript was deemed to provide solid scientific information and appropriate speculative synthesis on the subject matter.
Formal comments regarding this article and other materials published in Mayo Clinic Proceedings should be directed to the journal, in the form of a Letter to the Editor. That communication should be submitted through the journal’s manuscript management portal, http://mc.manuscriptcentral.com/mayoclinproc . There, those wishing to comment will find instructions on the allowable content and other guidelines for formulating a Letter to the Editor. The comments within the Letters must be restricted to the scientific matter under investigation, and will be evaluated by a peer-review process to determine their educational and clinical value to the general/internal medicine readership of the Proceedings. In general, only 15% to 20% of all submissions to the journal are eventually accepted for publication. Ad hominem attacks on the authors, the Journal, or its sponsoring institution, Mayo Clinic, will not be permitted in any published Letters. Further, any letters eventually accepted for publication will be accompanied by a published response from the authors.
William L. Lanier, MD
Mayo Clinic Proceedings