Changes

{{Notebox|'''The AAP does not recommend non-therapeutic infant circumcision.''' The AAP is regularly cited with its 2012 circumcision policy as a major US medical organization recommending non-therapeutic infant circumcision. The 2012 policy expired in 2017 and has not been renewed or re-affirmed since.<ref>{{REFjournal |last=AAP Task Force on Circumcision |url=https://publications.aap.org/pediatrics/article/130/3/585/30235/Circumcision-Policy-Statement |title=Circumcision Policy Statement |date=2012-09 |accessdate=2022-11-15 |journal=Pediatrics |volume=130 |issue=3 |pages=585–6 |DOI=10.1542/peds.2012-1989}}</ref>}}  The '''American Academy of Pediatrics''' (AAP) is a [[medical trade association ]] of American pediatricians, headquartered in Elk Grove Village, Illinois. Almost all U.S. pediatricians are members.

The AAP has not recognized the [[human rights]] of children that were granted by the ''International Covenant on Civil and Political Rights'' (1966) and the ''Convention on the Rights of the Child'' (1989), nor has it recognized the legal right of children to [[physical integrity]]. The AAP publishes [https://publications.aap.org/pediatrics/ Pediatrics]. == History of AAP circumcision policy ===== Introduction ===

It is thought that the AAP chooses [[circumcised doctors]] who don't have a [[foreskin]] to its various task forces on circumcision, so personal knowledge and understanding of a normal body part has been lacking on its various task forces. Perhaps the AAP believes that such doctors will be [[Bias| biased]] in favor of [[circumcision]]. The AAP apparently hopes to continue to produce statements in favor of [[circumcision]] so that the collection of revenue, usually by [[third-party payment]], from circumcision can continue.

===First policy (1971)===

<blockquote>{{Citation |Text='''There are no valid medical indications for circumcision in the neonatal period.''' |ref=<ref name="aap1971">{{REFweb

}} The policy cited the 1970 landmark paper by E. Noel Preston as its authority.<ref name="preston1970">{{REFjournal |last=Preston |first=E. Noel |init= |author-link= |etal=no |title=Whither the foreskin? |trans-title= |language= |journal=JAMA |location= |date=1970-09 |volume=213 |issue=11 |article= |page= |pages=1853-8 |url=http:/blockquote/www.cirp.org/library/general/preston/ |quote=Routine circumcision of the newborn is an unnecessary procedure. It provides questionable benefits and is associated with a small but definite incidence of complications and hazards. These risks are preventable if the operation is not performed unless truly medically indicated. Circumcision of the newborn is a procedure that should no longer be considered routine. |pubmedID=5468911 |pubmedCID= |DOI=10.1001/jama.213.11.1853 |accessdate=2021-07-23}}</ref>

===Second policy (1975)===The simple 1971 statement that dismissed non-therapeutic circumcision as a medical procedure did not sit well with the AAP, so efforts were made to walk back that statement. An "ad hoc" task force of four male physicians was formed to develop a new statement that was released in 1975. <ref name="aap1975">{{REFjournal |last=Thompson |first= |init=HR |author-link= |last2=King |first2= |init2=LR |author2-link= |last3=Knox |first3= |init3=E |author3-link= |etal=yes |title=Report of the ad hoc task force on circumcision |trans-title= |language= |journal=Pediatrics |location= |date=1975-10 |volume=56 |issue=4 |article= |pages=610-1 |url=https://www.cirp.org/library/statements/aap/#a1975 |archived= |quote= |pubmedID=1174384 |pubmedCID= |accessdate=2023-06-13}}</ref> The new statement attempted to shift responsibility and legal liability from the physician to the parents. The statement claimed that "traditional, cultural, and religious factors" could be considered in making a decision to perform non-therapeutic circumcision upon a boy. The statement did not recognize the boy as a person with human and legal rights to [[physical integrity| bodily integrity]] and security of the person, nor did it consider [[pain ]] control. There was no mention of the numerous [[Foreskin#Physiological_functions| functions of the foreskin]] or of [[Risks and complications| risks and complications]] of [[circumcision]]. The statement contained not a single reference. The result was that medically-unecessaryunnecessary, non-therapeutic [[circumcision ]] could still be performed and doctors could continue to [[Financial incentive| profit thereby ]] and anesthesia for surgical [[pain]] was not required.

===Third policy (1989)===The 1975 policy was considered outmoded so a new "task force on circumcision" with circumcision promoter [[Edgar J. Schoen]] as chairman was formed. It is believed that five of the six members of the task force, or 83 percent, were Jewish and none had an [[intact]] [[foreskin]].

This statement claimed for the first time that "potential " medical benefits exist.<ref name="aap1999aap1989">{{REFjournal

|title=Report of the Task Force of Circumcision.

}}</ref> One should understand that ''potential'' means to be '''Capable [c]apable of being but not yet in existence; latent or undeveloped''',<ref>{{REFweb

}}</ref> therefore the use of the word ''potential'' means the medical benefits discussed do not actually exist. The use of the word ''potential'' may be misleading to parents.

This statement acknowledged that infants feel [[pain]] but minimized the effects of pain and declined to recommend the use on of analgesia or anesthesia for foreskin [[amputation]].<ref name="aap1999aap1989" />

Based on methodologically flawed studies by circumcision promoter [[Thomas E. Wiswell]], the statement falsely claimed a reduction in the incidence of urinary tract infection (UTI) could be obtained by non-therapeutic infant circumcision.<ref name="aap1999aap1989" />

The statement does not recognize baby boys as human beings with rights that should be respected.<ref name="aap1999aap1989" />

Although the 1989 statement speaks favorably about non-therapeutic circumcision of infant boys, a careful reading shows that it does not actually recommend [[circumcision]],<ref name="aap1999aap1989" /> perhaps for avoidance of legal liability.

The statement was not well received. Professor [[Ronald L. Poland]], a member of the task force , published a dissent in the ''New England Journal of Medicine''.<ref name="poland1990">{{REFjournal

===Fourth policy (1999)Statement on medical ethics ===The American Academy of Pediatrics had been acutely embarrassed by the faults of [[Edgar J. Schoen| Edgar Schoen]]'s horrific circumcision policy statement, so a new task force was convened under the direction of Carole Marie Lannon, {{MD}}, {{MPH}}, to produce a new, more appropriate, and less embarrassing policy statement on non-therapeutic child circumcision.

The Committee on Bioethics of the AAP issued a statement on bioethics and consent in 1995 that has caused great difficulty for the promoters of male non-therapeutic circumcision of non-consenting infants at the AAP. The statement provides in part:{{Citation |Text=We now realize that the doctrine of "[[informed consent]]" has only limited direct application in pediatrics. Only patients who have appropriate decisional capacity and legal empowerment can give their [[informed consent]] to medical care. In all other situations, parents or other surrogates provide informed permission for diagnosis and treatment of children with the assent of the child whenever appropriate. |ref=<ref>{{REFjournal |last=Kohnman |first=Arthur |init= |author-link= |last2=Clayton |first2=Ellen Wright |init2= |author2-link= |last3=Frader |first3=Joel E. |init3= |author3-link= |etal=yes |title=Informed consent, parental permission, and assent in pediatric practice. |journal=Pediatrics |location= |date=1995-02 |volume=95 |issue=2 |article= |page= |pages=314-7 |url=http://www.cirp.org/library/ethics/AAP/ |pubmedID=7838658 |pubmedCID= |DOI= |accessdate=2021-07-23}}</ref>}} Non-therapeutic circumcision of children is neither diagnosis nor treatment, so the statement means that parents do ''not'' have a right to consent to non-therapeutic circumcision of children. This has caused problems for future advocates of male non-therapeutic circumcision at the AAP, so they have adopted a work-around policy. Future statements regarding male non-therapeutic circumcision resorted to citing a non-germane statement on the medical ethics of sick and dying children.<ref>{{REFjournal |last=Fleischman |first= |init=AL |author-link= |last2=Nolan |first2= |init2=K |author2-link= |last3=Dubler |first3= |init3=NN |author3-link= |etal=yes |title=Caring for gravely ill children |trans-title= |language= |journal=Pediatrics |location= |date=1994-10 |volume=94 |issue= |article= |page= |pages=433-9 |url=https://pediatrics.aappublications.org/content/94/4/433.long |pubmedID=7936849 |pubmedCID= |DOI= |accessdate=2021-07-24}}</ref> Non-therapeutic [[circumcision]] of children, however, is performed only on healthy children who can withstand the [[pain]], [[trauma]], and stress of the [[amputation]]. === Fourth policy (1999) ===The American Academy of Pediatrics had been acutely embarrassed by the faults of [[Edgar J. Schoen| Edgar Schoen]]'s horrific circumcision policy statement, so a new task force was convened under the direction of Carole Marie Lannon, {{MD}}, {{MPH}}, to produce a new, more appropriate, and less embarrassing policy statement on non-therapeutic child circumcision which was published in Pediatrics in September 1999.<ref name="aap1999">{{REFjournal |last=Lannon |first=Carole Marie |init=CM |last2=Bailey |first2=Ann Geryl Doll |init2=AGD |last3=Fleishman |first3=Alan R. |init3=AR |last4=Kaplan |first4=George W. |init4=GW |author4-link=George W. Kaplan |last5=Shoemaker |first5=Craig T. |init5=CT |last6=Swanson |first6=Jack T. |init6=JT |last7=Coustan |first7=Donald |init7=D |etal=no |title=Circumcision Policy Statement |journal=Pediatrics |date=1999-09 |volume=103 |issue=3 |pages=686-93 |url=http://www.cirp.org/library/statements/aap1999/ |pubmedID=22926180 |DOI=10.1542/peds.2012-1989 |accessdate=2021-10-10}}</ref> The AAP asserted in their 1999 Circumcision Policy Statement that parents have a right to decide to circumcise their children based on cultural or religious factors (although they removed any mention of esthetics as a possible parental motivation, despite previous inclusion in their 1989 statement). No further substantiation of this right was offered. Whether or not a medical benefit was required for parents to make this choice was also not addressed. <br>

:The AAP <b>1999 Policy Statement</b> also includes this statement on [[informed consent]]:

|Text=The process of [[informed consent ]] obligates the physician to explain any procedure or treatment and to enumerate the risks, benefits, and alternatives for the patient to make an informed choice. For infants and young children who lack the capacity to decide for themselves, a surrogate, generally a parent, must make such choice.<small>(118)</small>

:The above sentences cited <u>Informed Consent[[informed consent]], Parental Permission, and Assent in Pediatric Practice</u>, a policy guide by AAP's Bio-ethics Committee.<ref>{{REFweb

The AAP has no official position on whether a baby can refuse a procedure, nor does it specify if crying in pain counts as reluctance or refusal. However, they do write that a patient's discomfort should be taken into account, and that children should have the necessity of a procedure communicated to them.<ref name="Fleischmann 1994"/> (It might would follow that inability to do so means that proceeding with an intervention that could be harmlessly deferred constitutes needless violation of patient autonomy, or inadequate consent):

===Fifth policy (2012)=======Genesis====Several state Medicaid organizations had delisted medically-unnecessary, non-therapeutic male circumcision as a covered procedure, which caused alarm at the AAP. The corrupt [[World Health Organization]] (WHO), in a very poor and misguided decision in 2007, falsely claimed that male [[circumcision ]] would reduce [[infection ]] with human immunodeficiency virus ([[HIV]]).<ref name="who2007">{{REFweb

}}</ref> The AAP saw this as an opportunity to protect third-party payment for non-therapeutic circumcision. <ref name="jones2022">{{REFweb |url=https://www.circumcisionisafraud.com/foia-request-sheds-new-light-on-aaps-motivations |title=FOIA request sheds new light on AAP's motivations |last=Jones |first=Ryan |init= |author-link=Ryan Jones |website=Circumcision is a Fraud |date=2022-02-07 |accessdate=2022-08-27}}</ref>

The AAP allied itself with the [[American Congress of Obstetricians and Gynecologists| American College of Obstetricians and Gynecologists]] (ACOG) and the [[American Academy of Family Physicians]] (AAFP) to produce a new [[circumcision ]] policy that would claim a medical benefit. A new task force was named with [[Susan Blank]], a Jewish doctor with pro-[[circumcision ]] credentials , as chairwoman. The task force was an unusually large eight-member task force with an unusual constitution. It included:

* [[Michael Brady]], {{MD}}, a an [[HIV ]] specialist with pro-circumcision views.

* [[Andrew Freedman]], a Jewish urologist from Los Angeles who [[circumcised ]] his own son on the kitchen table.

* Lynne Maxwell, {{MD}}, a [[pain ]] control specialist.* Steven Wegner, {{MD}}, {{JD}}, a medical insurance specialist, who evidently was appointed to the task force to preserve and protect [[third-party payment]].

* Charles LeBaron, {{MD}}, representing the [[Centers for Disease Control and Prevention]], where [[Bias| biased]] doctors had been working to produce a pro-circumcision policy since 2008.* Sabrina Craigo, {{MD}}, representing the [[American College of Obstetricians and Gynecologists]], whose fellows make extra money by performing non-therapeutic circumcisions [[circumcision]] on newborn baby boys, although males are outside of their practice area.

====Discussion====

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

 {{Box|Boxtext=<big><b>'''The AAP policy regarding its statements is to give each statement a five-year life, after which the statement expires unless it is reaffirmed. The 2012 Circumcision Policy Statement has not been reaffirmed, so it expired in 2017. As of 20202023, the AAP has had ''no'' official circumcision policy for three six years, although it misleadingly continues to publish its long expired policy on its website.'''</b></big>}}

The 2012 statement is a shift in the Academy's position from its [https://www.cirp.org/library/statements/aap1999/ 1999 statement ] in that the Academy now says the health benefits of the procedure outweigh the risks, and supports having the procedure covered by insurance. The 2012 position statement is an obvious effort to preserve [[third-party payment]] to physicians, without which most non-therapeutic circumcisions would not be done.</p>

====Criticism====<p>After the release of the position statement, there was a substantial immediate critical comment by Brian Earp.

|last=Hill |first=George |author-link=George Hill |publisher=[[Doctors Opposing Circumcision(D.O.C.)]]

|archived= |title= Circumcision (annotated} |trans-title= |language=

|quote=The authors suggested that a “ritual nick,” in which the clitoral [[skin ]] is pricked or incised, might satisfy these symbolic requirements, and “is no more of an alteration than ear piercing”.

|Text=But [[parental rights ]] have limits -- [[FGC]] is damaging so it should be disallowed. But maybe we should change the law for the mild alterations.<small>(119)</small>

<blockquote>The function of the foreskin and the glans at birth is delicate and easily irritated by [[urine ]] and feces. The foreskin shields the glans. With circumcision this protection is lost. In such cases, the glans and especially the urinary opening (meatus) may become irritated or infected, causing ulcers, [[meatitis ]] (inflammation of the meatus) and [[meatal stenosis ]] (a narrowing of the urinary opening.) Such problems virtually never occur in [[uncircumcised]] penises. The foreskin protects the glans throughout life.</blockquote>

It is now self-evident that many, perhaps most, of America's child care doctors, including pediatricians and family doctors, do not know how to care of a boy's intact penis. The foreskin an an infant boy is non-retractable by design. An attempt to forcibly retract a non-retractable foreskin of a boy can only lead to a painful injury to the boy. There are frequent reports of attempts by ignorant physicians to retract a boy's non-retractile foreskin.<ref>{{REFjournal

The AAP is the nation's leading child care organization, but it has taken no action to educate its pediatrician members and other doctors on the [https://en.intactiwiki.org/wiki/Foreskin_Care_for_Boys proper care of the infant foreskin], so as to avoid [[iatrogenic ]] injury of boys.

A major lawsuit<refname="delaney2021">{{REFweb

The AAP's difficulties with a child circumcision policy are largely of its own doing. The AAP puts continues to put its members' financial well-being ahead of the [[human rights]] and well-being of its child patients, which it does by omission of significant information and distortion of the medical facts from in its numerous circumcision policy statements. Medical societies outside of the [[United States ]] are in near total disagreement with the [[AAP ]] and its American allies with regard to non-therapeutic child [[circumcision]].

Although the AAP speaks very highly of non-therapeutic circumcision, a close reading indicates that it has never made an actual overt recommendation for [[circumcision]], probably because their its lawyers forbid it.Nevertheless, a suit has been filed against the [[AAP]] that alleges fraud in its circumcision statements.<ref name="delaney2021" />

[[Category:USAMedical society]][[Category:Organization]][[Category:OrganizationsPromoter]]