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==History of AAP circumcision policy==
===Introduction===
<blockquote>{{Citation |Text='''There are no valid medical indications for circumcision in the neonatal period.''' |ref=<ref name="aap1971">{{REFweb
</blockquote>}}
<blockquote>{{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
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[[Category:USA]]
→Comment: Wikify.
[[Image:Aap.jpg|right|thumb|Emblem of the American Academy of Pediatrics]]
{{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 advances the financial and business interests of its members. Hundreds of millions of dollars are paid out by [[Third-party payment| third-parties]] to physicians, including pediatricians, obstetricians, and family physicians to provide medically unnecessary non-therapeutic [[circumcision]] of minor boys. Their slogan is: "Dedicated to the Health of All Children," however the protection of the income of its fellows ("members") overrides their duties to children. Preservation of that income stream has always been a fundamental policy of the AAP.
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 ===
The AAP evidently has an apparent long standing policy of appointing members of its various circumcision task forces who are believed by reason of published statements and/or ethnicity to be [[Bias| biased]] in favor of non-therapeutic male [[circumcision]]. Some such members are:
* [[Edgar J. Schoen]]
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)===
The first policy was a one-sentence statement in a book on care of the newborn that stated:
|url=http://www.cirp.org/library/statements/aap/#a1971
|title=Standards and Recommendation for Hospital Care of Newborn infants. 5th ed.
|accessdate=2020-03-31
}}</ref>
The policy cited the 1970 landmark paper by E. Noel Preston as its authority.<ref name="preston1970">{{REFjournal
|last=Preston
}}</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-unnecessary, 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 Jewishand none had an [[intact]] [[foreskin]].
This statement claimed for the first time that "potential " medical benefits exist.<ref name="aap1989">{{REFjournal
|last=Schoen
|first=Edgar J.
|DOI=
|accessdate=2020-03-31
}}</ref> One should understand that ''potential'' means to be '''[c]apable of being but not yet in existence; latent or undeveloped''',<ref>{{REFweb
|url=https://www.thefreedictionary.com/potential
|title=Potential
}}</ref>
===Statement on medical ethics===
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:
|last=Kohnman
|first=Arthur
|init3=
|author3-link=
|etal=yes
|title=Informed consent, parental permission, and assent in pediatric practice.
|journal=Pediatrics
|location=
|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=
}}</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
}}
===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
|quote=
|url=http://www.who.int/hiv/topics/malecircumcision/en/
}}</ref>
The AAP allied itself with the [[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:
* Ellen Buerk, {{MD}}, representing the board of directors of the AAP.
* [[Michael Brady]], {{MD}}, a an [[HIV]] specialist with pro-circumcision views.
* Waldemar Carlo, {{MD}}, a specialist in the care of the newborn.
* [[Andrew Freedman]], a Jewish urologist from Los Angeles who [[circumcised ]] his own son on the kitchen table.
* [[Douglas Diekema]], a pediatric medical ethicist.
* Lynne Maxwell, {{MD}}, a [[pain]] control specialist.
* 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 [[circumcision ]] on newborn baby boys, although males are outside of their practice area.
* Lesley Atwood, {{MD}}, representing the [[American Academy of Family Physicians]]. whose fellows also make extra money by performing non-therapeutic circumcision.
====Discussion====
The AAP, in association with [[ACOG]] and [[AAFP]], issued a circumcision policy statement in 2012. That statement was heavily criticized by many due to its obvious [[bias]] toward obtaining and preserving [[third-party payment]] for non-therapeutic child circumcision.<ref name="doc2013">{{REFweb
|quote=
}}</ref>
{{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>}}
Although the patients of the fellows of the AAP are children, the AAP consistently has failed to acknowledge the [[human rights]] of its child patients.<ref name="doc2013" />
<blockquote><p>"In a 2012 position statement, the Academy stated that a systematic evaluation of the medical literature shows that the "preventive health benefits of elective [[circumcision]] of male newborns outweigh the risks of the procedure" and that the health benefits "are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns," but "are not great enough to recommend routine circumcision for all male newborns". The Academy takes the position that parents should make the final decision about circumcision, after appropriate information is gathered about the risks and benefits of the procedure. By doing this, the AAP attempts to shift the liability for the certain injury of child non-therapeutic circumcision from the doctor to the parents. </blockquote>
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.
* {{REFjournal
}}</ref>
The AAP's difficulties with a child circumcision policy are largely of its own doing. The AAP 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 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 its lawyers forbid it. Nevertheless, a suit has been filed against the [[AAP ]] that alleges fraud in its circumcision statements.<ref name="delaney2021" />
{{SEEALSO}}
* [[AAP Circumcision Task Force 2012]]
* [[AAFP]]
* [[ACOG]]
* [[Circumcision study flaws]]
* [[Financial incentive]]
* [[Penis]]
* [[Position statements on infant circumcision]]
[[Category:Parental information]]
[[Category:Physicians]]
[[Category:Medical society]]
[[Category:Organization]]
[[Category:Promoter]]
[[Category:American Academy of Pediatrics]]
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[[Category:USA]]
[[Category:From CircLeaks]]