Financial incentive

“	The Merchant's Conflict of Interest It's hard to get a man to understand something, when his livelihood depends on his not understanding it. – Upton Sinclair

Financial incentive in the United States to perform medically-unnecessary, non-therapeutic circumcision is very large. Non-therapeutic circumcision is a multi-billion dollar industry. Profit is reaped not only from the practice of circumcision itself, and associated hospital charges, but also from the sale of harvested foreskins, the sale of products derived from harvested foreskins, the sale of circumcision specific tools and utensils, and the treatment of oomplications and botched circumcisions.

The procedure itself

Mansfield et al. (1995) report there are no medical indications for non-therapeutic infant circumcision.

1.2 million baby boys are circumcised a year in the United States alone. At a dollar per procedure, that is already $1,200,000 a year. The going rate for a circumcision procedure is approximately $1,700 when hospital charges are included, multiplied by 1.2 million, that is approximately $2,040,000,000 a year that circumcision brings in based on the procedure alone.

When a baby boy is to be circumcised, mother and baby remain in hospital for about one-fourth of a day longer, so that increases the profit to the hospital.

Bollinger (2012) estimates that the total cost of non-therapeutic male circumcision, including hospital costs, repair of botched circumcisions, treatment of complications, and so on is more than $3 billion per year. Third-party payment is a major support to the performance of this medically-unnecessary surgery.

The now expired and discredited AAP 2012 Circumcision Policy Statement stated that "Although health benefits are not great enough to recommend routine (i.e. non-therapeutic) circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner." and "The American College of Obstetricians and Gynecologists has endorsed this statement." Many new born circumcisions are performed by obstetricians.

Government support

Although the foreskin has immunological and protective functions, Government medical insurance in the United States still holds the notion, which originated in the late 19th century, that the foreskin is a cesspool of disease, and circumcision improves hygiene and prevents sexually transmitted diseases (STDs), therefore it is best cut off and insurance should pay for it without any proof of medical indication or necessity, so there are no effective controls in force to see that only medically necessary services are covered. This view is not supported by current medical evidence.

Medicaid

Medicaid is a medical insurance program for people whose income is below the federal poverty level (FPL}. However, in most states, pregnant women are covered to a variable amount above the FPL.

The costs are many births are borne by Medicaid. The percentage of births covered by Medicaid varies by state. It ranges from a low of 20 percent in Vermont to 71 percent in New Mexico. Medicaid financed 45 percent of all births in 2010. Circumcision is frequently included as part of the birth package of covered expenses, so third-party payment is provided.

While 18 states have stopped paying for non-therapeutic circumcision, 32 states still pay for it. Doctors may be driven to promote non-therapeutic circumcision if they get a free stipend from the state. Adler (2011) has argued that such payments are contrary to law.

Indian Health Service

The Indian Health Service provides non-therapeutic circumcision to native Americans, even though circumcision is not part of the culture of native Americans.

Tricare

Tricare is the government medical insurance for military dependents. Tricare covers non-therapeutic circumcision of the newborn male infant.

Civil servants

There are about 2 million United States government employees in the United States whose health insurance covers non-therapeutic circumcision.

Medicare

The United States Medicare Program provides health insurance for persons who have reached the age of 65 years. It assumes that any man with a foreskin needs a circumcision. It does not require proof of medical necessity to provide third-party payment.

State and local government

There are approximately 7,000,000 employees of state and local government. The great majority of these have health insurance that provides third-party payment for non-therapeutic circumcision.

Private insurance

The United States has an unusual system, which originated during World War II, of having employers provide a non-taxable benefit of medical insurance to employees. The system is not universal so many employers do not provide insurance. Of those who do, many provide third-party payment to support non-therapeutic circumcision.

Auxiliary tools

Industries that depend on the practice of circumcision, particularly infant circumcision include makers of the circumstraint (the board to which a baby is strapped down to for the procedure), makers of circumcision clamps, manufacturers of circumcision kits, and other utensils used for circumcision.

Clamp manufacturers:

• Gomco
• Mogen (out of business)

Makers of other circumcision tools:

• AccuCirc
• TaraKlamp
• Plastibell

Makers of circumcision kits:

• Priontex Products & Services

Makers of restraints:

• Circumstraint

Other costs:

• Anaesthetic (rarely used)
• Nerve blocks

Profit from harvested foreskins

Foreskins are sold to pharmaceutical companies for stem-cell research, the creation of synthetic skin, and the creation of consumer products. Since the 1980s, private hospitals have been involved in the business of supplying discarded foreskins to private bio-research laboratories and pharmaceutical companies who require human flesh as raw research material. They also supply foreskins to transnational corporations. Dr. Tania Phillips, professor of dermatology at Boston University School of Medicine, insisting foreskin gathering and cultivating is scientifically and technologically "very promising."

Corporate benefactors

The following transnational corporations reap corporate profits from the sale of marketable products made from harvested human foreskins:

• Advanced Tissue Sciences (ATS)
• Organogenesis
• BioSurface Technology
• Genzyme
• Ortec International
• LifeCell Corporation (Nasdaq:LIFC)
• SkinMedica

FDA approved products

The following products fashioned from harvested foreskins were approved by the FDA for marketing:

• Dermagraft-TC
• Apligraf
• AlloDerm
• TNS Recovery Complex

Grants from pro-circumcision interest groups

There are pro-circumcision interest groups that give grants to doctors and researchers to "study" and promote circumcision. Organizations that do this include the Bill & Melinda Gates Foundation. In 2009, Schusterman Family Foundation gave a grant to mohel and professional infant circumcisor Neil Pollock to promote infant circumcision in Rwanda, particularly the Mogen technique, in the name of HIV prevention.

See also

• Third-party payment

External links

• The Foreskin Industry, Acroposthion. Retrieved 2 March 2020.