Changes

In 1997, the ''NEJM'' printed a strongly pro-circumcision editorial by Dr. [[Thomas E. Wiswell| Thomas Wiswell]],<refname="wiswell1997">Wiswell TE. Circumcision circumspection. ''N Engl J Med'' 1997; 336:1244-5.</ref> but did not print the alternative opinion in favor of normal anatomy (see Abstracts & Analysis). When misinformation in Wiswell's editorial was brought to the attention of the editor, there was no attempt to correct Wiswell's exaggerated benefit claims. In contrast, the ''NEJM'' had printed a Sounding Board discussion of circumcision examining the purported advantages and disadvantages of circumcision earlier in 1990.<refname="schoen1990">Schoen EJ. The status of circumcision of newborns. ''N Engl J Med'' 1990; 322:1308-12.</ref> <ref>Poland RL. [http://www.cirp.org/library/general/poland/ The question of routine neonatal circumcision]. ''N Engl J Med''. 1990; 322:1312-5.</ref>

In a previous article in the ''NEJM'', Royce ''et al''. insinuated that the prepuce may be a risk factor for HIV infections.<refname="royce1997">Royce RA, Sena A, Cates W Jr, Cohen MS. Sexual transmission of HIV. ,,''N Engl J Med,, '' 1997; 336:1072-10788.</ref> This factually inaccurate article was referenced in a letter to the editor as proof that circumcision protects an individual from HIV infections.<refname="laumann1997">Laumann EO, Masi CM, Zuckerman EW. [http://www.cirp.org/library/general/laumann/ Circumcision in the United States: prevalence, prophylactic effects, and sexual practices, and sexual practice]. ''JAMA'' 1997; 278(3)277:2011052-7.</ref> The ''NEJM '' failed to mention, however, that Laumann pointed out the fallacy of this logic. "The lack of rigorous, systematic controls for co-factors relevant to the particularities of the African context, the prophylactic status of the presence or absence of the foreskin remains an open question."<ref>Laumann EO. JAMA 1997; 278(3):203<name="laumann1997" /ref>

Circumcision is losing popularity in the United States and has been discredited by the Canadian Pediatric Society<ref>Fetus and Newborn Committee, Canadian Paediatric Society. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1487803/ Neonatal circumcision revisited]. ''Can Med Assoc J'' 1996; 154:769-80.</ref>and the Australasian Pediatric Surgeons<ref>Australasian Association of Paediatric Surgeons. [http://www.cirp.org/library/statements/aaps/ Guidelines for circumcision]. April 1996.</ref> in 1996 position papers. Taylor described the unique innervation of the preputial mucosa in 1996, and its loss to circumcision.<ref>Taylor JR, Lockwood AP, Taylor AJ. [http://www.cirp.org/library/anatomy/taylor/ The prepuce: specialized mucosa of the penis and its loss to circumcision]. ''Br J Urol'' 1996; 77:291-95.</ref> Taddio et al. showed that circumcision with and without local anesthesia (EMLA) resulted in negative behavioral changes in a child's response to pain.<refname="taddio1997">Taddio A, Katz J, Ilersich AL, Koren G. [http://www.cirp.org/library/pain/taddio2/ Effect of neonatal circumcision on pain response during subsequent routine vaccination]. ''Lancet'' 1997; 349:599-603.</ref> Laumann has shown that circumcision causes sexual behavior changes and an apparent increased risk of many venereal diseases in adult men. <ref>Laumann EO, Masi CM, Zuckerman EW. [http:/name="laumann1997"/www.cirp.org/library/general/laumann/ Circumcision in the United States: prevalence, prophylactic effects, and sexual practices, and sexual practice]. ''JAMA'' 1997; 277:1052-7.</ref> Price has questioned whether parents can ethically change their child's genitalia.<ref>Price (Bull. Medical Ethics).</ref>

The research on EMLA and circumcision presented by Taddio ''et al''. was proclaimed as a major advance.<ref>Taddio A, Stevens B, Craig K, Rastogi P, Ben-David S, Shennan A, Mulligan P, Koren G. Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision. ''N Engl J Med'' 1997; 336:1197-1201.</ref> When the limitations of this form of local anesthesia was brought to the attention of the editors, they failed to print the criticism (see Abstracts & Analysis). They failed to point out that this form of local anesthesia (EMLA) did not prevent the long term negative behavioral response to pain previously reported in the ''Lancet''. <ref>Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. ''Lancet'' 1997; 349:599-603.<name="taddio1997" /ref> The lack of effects of EMLA on long term negative behavioral changes caused by circumcision was printed in British medical journals.<ref>Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. ''Lancet'' 1997; 349:599-603.<name="taddio1997" /ref><refname="taddio1995">Taddio A, Goldbach M, Ipp M, Stevens B, Koren G. [http://www.cirp.org/library/pain/taddio/ Effect of neonatal circumcision on pain responses during vaccination in boys]. ''Lancet'' 1995; 345:291-2.</ref>