Changes

{{Construction Site}}The '''Circumcision study flaws''' are numerous. The medical literature relating to [[circumcision ]] is influenced by the authors' religious and cultural views of many authors. <ref>{{REFweb |url=https://circumcision.org/cultural-and-medical-bias/ |title=Cultural and Medical Bias |last= |first= |accessdate=2020-08-02}}</ref> Moreover , the circumcision status of male authors impacts their views.<ref name="hill2007">{{REFjournal

|firstinit=G.

}}</ref> <ref name="boyle2012>{{REFjournal |last=Boyle |first=Gregory J. |init=GJ |author-link=Gregory J. Boyle |last2=Hill |first2=George |init2=G |author2-link=George Hill |etal=no |title=Circumcision‐generated emotions bias medical literature |journal=BJU Int |date=2012 |volume=109 |issue=4 |pages=E11 |url=https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2012.10917.x |pubmedID=22313504 |DOI=10.1111/j.1464-410X.2012.10917.x |accessdate=2020-08-02

[[Foreskinned]] doctors tend to write papers hostile to circumcision, while [[circumcised doctors]] tend to write papers in favor of circumcision.<ref name="hill2007" /> Consequently, the medical literature regarding male circumcision is highly polarized, argumentative, and [[Bias| biased]]. American doctors do research to find reasons to carry out non-therapeutic circumcision.<ref name="fleiss1999">{{REFbook |last=Fleiss |first=Paul M. |init=PM |author-link=Paul M. Fleiss |year=1999 |title=An Analysis of Bias Regarding Circumcision in American Medical Literature: Medical, Legal, and Ethical Considerations in Pediatric Practice. |url=https://books.google.com/books?hl=en&lr=&id=ljZZ9ZvD_kQC&oi=fnd&pg=PA379&ots=GA2KpzMECk&sig=jFqDYQhV0sqAWil6LDZWXnQdJO8#v=onepage&q&f=false |work=Male and Female Circumcision: |editor=Denniston, George C., Hodges, Frederick Mansfield, Milos, Marilyn |edition= |volume= |chapter= |pages=379-401 |location=New York |publisher=Kluwer Academic/Plenum Publishers |isbn=0-306-46131-5 |quote= |accessdate=2020-08-07 |note=}}</ref> == Review of the circumcision literature == Bossio ''et al''. (2014) conducted a comprehensive review of the circumcision literature. They reported that most research was concentrated on finding a benefit for non-therapeutic circumcision and there were large gaps in the knowledge of the sexual health correlates of male circumcision, including:

|last2=PukalPukall

==Polarity==# That more rigours and consistent methodology be used. The medical literature regarding male # Empirically rigorous studies of the physiological effects of neonatal circumcision is highly polarizedare needed. Foreskinned doctors tend to write papers hostile to # Psychosocial factors, including [[Sexual effects of circumcision, while circumcised doctors tend to write papers in favor | sexual correlates of circumcision]], should be studied.<ref name="hill2007bossio2014" />

== Statements from medical trade associations ==[[Medical trade association| Medical trade associations ]] exist to protect and advance the professional, financial , business, and business legal interests of their fellows (members). A few medical trade associations , whose members perform non-therapeutic circumcision, have issued statements regarding non-therapeutic circumcision of children. Circumcision policy statements frequently exclude discussions of [[Sexual effects of circumcision| sexual]], [[Psychological issues of male circumcision| psychological]], [[human rights]], ethical, and [[Circumcision legal commentary| legal]] issues, and the [[Foreskin| anatomy and functions of the foreskin]].<ref name="goldman2004">{{REFjournal

|init=R |author-link=Ronald Goldman

===Non-US statementsAustralasia === The [https://www.knmg.nl Royal Dutch Medical Association] {KNMG) published a statement regarding the non-therapeutic circumcision of male minors in 2010. The Netherlands is a nation where [[human rights]] are respected,<ref name="smith1998">{{REFweb |url=httpFile://wwwFlag_of_Australia.cirp.org/library/legal/smith/ |title=Male Circumcision and the Rights of the Child svg|trans-title= thumb|language= 150px|last=Smith |first=Jacqueline |author-link= |publisher=Netherlands Institute Flag of Human Rights |website=CIRP |date=1998 |accessdate=2020-02-04 |format= |quote=}}</ref> so it should be no surprise that the statement emphasizes the protection of the human rights of male minors and the reduction in the number of non-therapeutic circumcisions of children as much as possible. It finds no medical purpose for child non-therapeutic circumcision. * {{REFweb |url=https://www.knmg.nl/circumcision |archived= |title=Non-therapeutic circumcision of male minors |trans-title= |language=English |last=Kruseman |first=Arie |author-link= |publisher=Royal Dutch Medical Association |website=www.knmg.nl |date=2010-05-27 |accessdate=2020-07-31 |format=PDF |quote=}} Australia]]The [https://www.racp.edu.au Royal Australasian College of Physicians] (2010) released a 28-page updated position statement on non-therapeutic circumcision of boys in September 2010. This statement is deeply flawed and outmoded in 2020. It seems to be designed to protect the physicians' income from performing non-therapeutic circumcision. The statement accepts at face value the false, now disproved,<ref name="boyle-hill2011">{{REFjournal |last=Boyle |first=Gregory J. |author-link= |last2=Hill |first2=George |author2-link=George Hill |title=Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns |journal=J Law Med |date=BoyleGJ HillG 2011-12 |volume=19 |issue=2 |pages=316-334 |url=http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf |quote= |pubmedID=22320006 |pubmedCID= |DOI= |accessdate=2020-07-31}}</ref> claims that circumcision reduces the risk of [[HIV ]] by 60 percent. The statement shows only limited understanding of the functions of the foreskin. While it recognizes the protective function, it does not recognize the immunological function or sexual function, and shows only limited understanding of the erogenous function. The RACP places parental preference above child [[human rights]]. Nevertheless, public hospitals in [[Australia]] have banned performance of non-therapeutic circumcisions<ref>{{REFnews

=== Canada ===[[File:Flag_of_Canada.svg|thumb|150px|Flag of Canada]]The [[Canadian Paediatric Society]] (2015) issued a new statement regarding non-therapeutic circumcision of boys. This statement was prompted by the three seriously flawed [[HIV ]] studies of adult males in Africa, that have now been disproved,<ref name="boyle-hill2011" /> and caused the retirement of the excellent previous 1996 statement.<ref name="cps1996">{{REFjournal

This statement has very serious omissions that [[bias ]] it in favor of circumcision. The description of the [[foreskin]] omits important information, including its innervation, its protective functions, its immunological functions, and its sexual functions. The statement claims "potential" benefits, which exist only in someone's imagination.

The CPS statement revives the claims made by circumcision promoter [[Thomas E. Wiswell]]'s discredited studies from the 1980s in an apparent attempt to restart the [[Urinary_tract_infection#The_UTI_scare| UTI scare]]. It fails to mention that UTIS are easily treated with antibiotics,.<ref name="McCracken 1989">{{REFjournal

|firstinit=G.H.GH

The statement seems amateurish. It seems to have been drafted by a committee of people who had no special knowledge or understanding of the human foreskin, circumcision, or the literature. It seems divorced from the reality in [[Canada]] that the health insurance plans do not pay for non-therapeutic circumcision and most hospitals do not allow the performance of the non-therapeutic amputation in [[Canadaamputation]].

It appears that the CPS was seeking to do promote more circumcisions so its members can make more money.

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|first3init3=AL

The [http:While the discussion of the medical evidence is very good, the authors were unaware of the methodological and statistical errors in the three African RCTs,<ref name="boyle-hill2011" //www> so they gave the RCTs excessive and undeserved weight.cua.org/en Canadian Urological Association] (2018) issued a 24-page guideline on Although the authors recognized the care loss of sensation caused by circumcision, they seemed to lack understanding of the normal foreskin and neonatal full range of [[Sexual_effects_of_circumcision| sexual injury]] caused by circumcision. The statement is very comprehensive and covers treatment authors relied on studies of various diseases and deformities as well as discussing non-therapeutic sexual function from Africa which were written by the same group that promotes circumcision of boys in CanadaAfrica. Our comments are restricted to The authors of those studies were conflicted, so the discussion of non-therapeutic circumcisionstudies cannot be believed.

While the discussion of the medical evidence is very good, the authors were unaware of the methodological and statistical errors in the three African RCTs,<ref name="boyle-hill2011" /> so they gave the RCTs excessive and undeserved weight. Although the authors recognized the loss of sensation caused by circumcision, they seemed to lack understanding of the full range of [[Sexual_effects_of_circumcision| sexual injury]] caused by circumcision. They apparently had no knowledge of the [[Psychological issues of male circumcision| psychological impact]] as that is not discussed at all.

|trans-title= |language=English |journal= Can Urol Assoc J

|url=http://www.cua.org/themes/web/assets/files/g49_en_circumcision-new_logo_am5033_foreskin_guideline_longversion.pdf |archived= |quote=

=== UK ===[[File:Flag of the United Kingdom.svg|thumb|150px|Flag of the United Kingdom]]The [https://www.bma.org.uk/ British Medical Association] 28-page statement (2019) focuses on legal and ethical advice to its fellows to help keep them out of trouble in a legal and regulatory environment that is increasingly unfriendly to practitioners of non-therapeutic male circumcision. It has little to say about the medical aspects of non-therapeutic circumcision. To its credit it cites the [https://www.legislation.gov.uk/ukpga/1998/42/contents#aofs Human Rights Act 1998] and calls for practitioners to respect the child's rights under that act.

==US statements=USA ==={{AAP Policy expired}}[[File:Flag_of_USA.svg|thumb|150px|Flag of the United States of America (USA)]]The United States is are unique because the American medical industry has been promoting the practice of non-therapeutic circumcision since the late 19th Century.<ref>{{REFjournal |last=Gollaher |first=David |author-link= |title= From ritual to science: the medical transformation of circumcision in America |journal=Journal of Social History |date=GollaherDL 1994 |volume=28 |issue=1 |pages=5-36 |url=http://www.cirp.org/library/history/gollaher/ |accessdate=2020-08-02}}</ref> As a result of the centuries-old promotion almost all American males were circumcised soon after birth from the 1930s through the 1980s.<ref name="laumann1996">{{REFjournal

|first2init2=CM

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|pubmedCID= |DOI= |accessdate=}}</ref> As a result, many Americans have never seen a human [[foreskin ]] and most are profoundly ignorant of its careanatomy, purposesfunctions, and functionscare.

With such an environment the medical industry has been able to develop its circumcision business into a colossus that exceed exceeds an estimated $3 billion per year.<ref name="bollinger2012">{{REFweb

|author-link= |publisher=Dan Bollinger

|quote=As they saying goesHow can you approve a report that extols the benefits of removing the foreskin, a normal body part, follow without one single word devoted to the money. Now you know function of that body part, or why neither it’s there in the first place?}} * {{REFdocument |title=Commentary on American Academy of PediatriciansPediatrics 2012 Circumcision Policy Statement |url=https://www.doctorsopposingcircumcision.org/wp-content/uploads/2016/08/commentary-on-american-academy-of-pediatrics-2012-circumcision-policy-statement.pdf |last=Hill |first=George |author-link=George Hill |publisher=[[Doctors Opposing Circumcision (D.O.C.)]] |format=PDF |date=2013-04 |accessdate=2020-08-03}} * {{REFjournal |last=Frisch |first=Morten |init=M |author-link= |last2=Aigran |first2=Yves |init2=Y |author2-link= |last3=Barauskas |first3=Vidmantas |init3=V |author3-link= |etal=yes |title=Cultural bias in the AAP’s 2012 Technical Report and Policy Statement on male circumcision |journal=Pediatrics |location= |date=2013-04-01 |volume=131 |issue=4 |pages=796-800 |url=http://pediatrics.aappublications.org/content/pediatrics/early/2013/03/12/peds.2012-2896.full.pdf |archived= |quote=Cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious. The conclusions of the AAP Technical Report and Policy Statement are far from those reached by physicians in most other Western countries. |pubmedID=23509170 |pubmedCID= |DOI=10.1542/peds.2012-2896 |accessdate=2020-08-03}} * {{REFweb |url=http://www.academia.edu/15617255/The_AAP_report_on_circumcision_Bad_science_bad_ethics_bad_medicine |title=The AAP report on circumcision: bad science + bad ethics = bad medicine |last=Earp |first=Brian |author-link=Brian Earp |publisher={{UNI|University of Oxford|Oxon}} |website=www.academia.edu |date=2013-05-27 |accessdate=2020-08-03 |format=PDF |quote=Some readers will be unaware that the AAP is not a dispassionate scientific research body, American Medical Associationbut rather a trade association for pediatricians. Those among its members and stakeholders who perform NTCs stand to profit from the procedure, to the collective annual tune of $1.25 billion according to one (albeit not impartial) estimate. Given the yawning potential for a financial conflict of interest, then, there needs to be a very strong, independent medical case for circumcision; and the AAP had better be able to show that it is both the safest and most cost effective means of promoting infant health. Both of these propositions fail,however, as I will continue to show in what follows.}} * {{REFjournal |last=Svoboda |first=J. Steven |init=JS |author-link=J. Steven Svoboda |last2=Van Howe |first2=Robert S. |init2=RS |author2-link=Robert S. Van Howe |etal=no |title=Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision |journal=J Med Ethics |location= |date=2013 |volume=39 |issue=7 |pages= |url=https://www.arclaw.org/wp-content/uploads/Svoboda-Van-Howe-Out-of-Step-Fatal-Flaws-in-AAP...-JME-2013.pdf |archived= |quote= |pubmedID=23508208 |pubmedCID= |DOI=10.1136/medethics-2013-101346 |accessdate=2020-08-02}} * {{REFdocument |title=Statement by statement analysis of the 2012 report from the American Academy of Family PhysiciansPediatrics Task Force on Circumcision: when national organizations are guided by personal agendas II |url=https://www.academia.edu/23431341/Statement_by_Statement_Analysis_of_the_2012_Report_from_the_American_Academy_of_Pediatrics_Task_Force_on_Circumcision_When_National_Organizations_are_Guided_by_Personal_Agendas_II |contribution= |last=Van Howe |first=Robert S. |author-link=Robert S. Van Howe |publisher=Academia |format=PDF |date= |accessdate=2020-08-03}} * {{REFjournal |last=Darby |first=Robert |init=R |author-link=Robert Darby |etal=no |title=Risks, benefits, or complications and harms: neglected factors in the current debate on non-therapeutic circumcision |journal=Kennedy Institute of Ethics Journal |location= |date=2015-03 |volume=25 |issue=1 |pages=1-34 |url=https://kiej.georgetown.edu/wordpress/wp-content/uploads/2015/03/03_25.1darby.pdf |archived= |quote= |pubmedID=25843118 |pubmedCID= |DOI=10.1353/ken.2015.0004 |accessdate=2020-08-03}}  The AAP has a long-standing policy that its published policies and statements expire after five years unless re-affirmed. The AAP has ''not'' re-affirmed the statements below so they expired on 31 August 2017. The AAP now has ''no'' official position on non-therapeutic circumcision of boys. * {{REFjournal |last=Blank |first=Susan |init=S |author-link=Susan Blank |last2=Brady |first2=Michael |init2=M |author2-link= |last3=Buerk |first3=Ellen |init3=E |author3-link= |last4=Carlo |first4=Waldemar |init4=W |author4-link= |last5=Diekema |first5=Douglas |init5=D |author5-link=Douglas Diekema |last6=Freedman |first6=Andrew |init6=A |author6-link=Andrew Freedman |last7=Maxwell |first7=Lynne |init7=L |author7-link= |last8=Wegner |first8=Steven |init8=S |author8-link= |etal=no |title=Circumcision Policy Statement |journal=Pediatrics |date=2012-09-01 |volume=130 |issue=3 |pages=585-6 |url=https://pediatrics.aappublications.org/content/130/3/585 |pubmedID=22926180 |pubmedCID= |DOI=10.1542/peds.2012-1989 |accessdate=2020-08-02}}* {{REFjournal |last=Task Force on Circumcision |first= |author-link= |etal=no |title=Male Circumcision |journal=Pediatrics |date=2012-09-01 |volume=130 |issue=3 |pages=e756-85 |url=https://pediatrics.aappublications.org/content/130/3/e756 |pubmedID=22926175 |pubmedCID= |DOI=10.1542/peds.2012-1990 |accessdate=2020-08-02}}  The [https://www.acog.org American College of Obstetricians and Gynecologists haven’t condemned this ] (ACOG) endorsed the 2012 AAP statement even before it had been published. It promptly put its own statement on its website citing the now expired AAP statement and subtly promoting non-therapeutic male circumcision to expectant mothers. It still cites the AAP statement although that statement expired in 2017. * {{REFweb |url=https://www.acog.org/en/Patient%20Resources/FAQs/Labor%20Delivery%20and%20Postpartum%20Care/Newborn%20Male%20Circumcision |title=Newborn Male Circumcision |last= |first= |accessdate=2020-08-03}}  The [https://www.aafp.org/home.html American Academy of Family Physicians] continues to promote non-therapeutic male circumcision. The AAFP report is based on the now discredited 2012 AAP statement. It touts prevention of [[urinary tract infection]] (UTI), but fails to advise that UTI is easily treatable with antibiotics if it should occur. The AAFP gives no information on the multiple functions and value of the foreskin. It fails to state that circumcision of the newborn is a medically-unnecessary surgery, non-therapeutic [[amputation]] of a valuable body part that leaves a life-long injury and why their physician members are quick impairment of function. * {{REFweb |url=https://www.aafp.org/about/policies/all/neonatal-circumcision.html |title=Neonatal Circumcision |last= |first= |accessdate=2020-08-03}} [[Doctors Opposing Circumcision (D.O.C.)]] is a non-profit, educational organization. It does not earn money from performing non-therapeutic circumcision and is not biased by [[financial incentive]]. DOC rejects all of the self-serving statements from the medical trade associations and endorses a statement by the non-profit [[International Coalition for Genital Integrity]] (ICGI). * {{REFdocument |title=Position Paper on Neonatal Circumcision and Genital Integrity |trans-title= |language=English |url=http://www.icgi.org/Downloads/ICGIoverview.pdf |archived= |contribution= |quote=Benefits to the infant boy from possessing an intact penis include: protection of the patient’s legal right to recommend bodily integrity, conservation of the protective foreskin, avoidance of postsurgical complications, avoidance of persistent pain and trauma, shielding of the [[urethra]] from feces and E. coli, improved protection from ''Staphylococcus aureus'' infection in the newborn nursery (especially the procedure increasingly present methicillin-resistant type), ease of breastfeeding initiation, with the multiple health and developmental benefits it provides, and provision of normal moisture and emollients to expectant parentsthe [[mucosa]] of the glans penis and inner foreskin. Intact infants do not require care of a circumcision wound in the perinatal period, and do not have heightened pain responses. Financial benefits include earlier post-birth hospital discharge and a reduction of healthcare costs. |last=Bollinger |first=Dan |author-link=Dan Bollinger |last2=Travis |first2=John W. |author2-link=John W. Travis |last3=Peterson |first3=Ken W. |author3-link= |last4=Hill |first4=George |author4-link=George Hill |publisher=[[International Coalition for Genital Integrity]] |location= |format=PDF |date=2007-09-28 |accessdate=2020-08-03}}</ref>