Circumcision study flaws: Difference between revisions

  |init=G

[[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

== 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:

Bossio et al. made three recommendations:

# That more rigorous and consistent methodology be used.

# Empirically rigorous studies of the physiological effects of neonatal [[circumcision]] are needed.

== Statements from medical trade associations ==

[[Medical trade association| Medical trade associations]] exist to protect and advance the professional, financial, business, and 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

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">{{BoyleGJ HillG 2011}}</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

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.  

  |init=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]].

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

  |init2=JC

  |init3=AL

The [[Canadian Urological Association]] (2018) issued a 24-page guideline on the care of the normal foreskin and neonatal non-therapeutic circumcision. The statement is very comprehensive and covers treatment of various diseases and deformities as well as discussing non-therapeutic circumcision of boys in [[Canada]]. Our comments are restricted to the discussion of non-therapeutic circumcision.  

The [[United States]] are unique because the American medical industry has been promoting the practice of non-therapeutic [[circumcision]] since the late 19th Century.<ref>{{GollaherDL 1994}}</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

  |init2=CM

  |init3=EW

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

}}</ref> so there is intense interest in keeping the Goose alive. [[Third-party payment]] is frequently available in the United States.

Several state Medicaid programs stopped paying for non-therapeutic circumcision in the early in the 21st Century. It is believed that this caused alarm in the circumcision industry. Shortly after ''The Lancet'' published two reports on [[HIV trials in Africa|randomized controlled trials (RCTs) from sub-Saharan Africa]],<ref name="bailey2007">{{RCT Bailey et al 2007}}</ref><ref name="gray2007">{{RCT Gray et al 2007}}</ref> it was announced in 2007 that the [[American Academy of Pediatrics]] (AAP) would take the lead, in association with the [[American Congress of Obstetricians and Gynecologists| American College of Obstetricians and Gynecologists]] (ACOG) and the [[American Academy of Family Physicians]] {AAFP}, these being the three trade associations (stakeholders) whose members perform most of the non-therapeutic circumcisions, in developing a new circumcision policy for America.<ref>{{REFjournal

  |publisher=[[Doctors Opposing Circumcision (D.O.C.)]]

  |author-link=Brian Earp

  |publisher={{UNI|University of Oxford|Oxon}}

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.

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, non-therapeutic [[amputation]] of a valuable body part that leaves a life-long injury and impairment of function.

[[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).

  |quote=Benefits to the infant boy from possessing an intact penis include: protection of the patient’s legal right to 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 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 the [[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.

  |author-link=Dan Bollinger

  |author2-link=John W. Travis

  |author4-link=George Hill

  |publisher=[[International Coalition for Genital Integrity]]