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}}</ref> As a result, many Americans have never seen a human foreskin and most are profoundly ignorant of its care, purposes, and functions.
With such an environment the medical industry has been able to develop its circumcision business into a colossus that exceed exceeds an estimated $3 billion per year.<ref name="bollinger2012">{{REFweb
|url=https://www.academia.edu/6442587/High_Cost_of_Circumcision_3.6_Billion_Annually
|title=High Cost of Circumcision: $3.6 Billion Annually
}}</ref> so there is intense interest in keeping the Goose alive.
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 randomized controlled trials (RCTs) from sub-Saharan Africa,<ref name="bailey2007">{{REFjournal
|last=Bailey
|first=R.C.
|issue=9562
|pages=657-666
}}</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 |last= |first= |author-link= |title=AAP reviews policy on circumcision |journal=Relias Media |date=2007-06-01 |volume= |issue= |pages= |url=https://www.reliasmedia.com/articles/103802-aap-reviews-policy-on-circumcision?v=preview |accessdate=2020-08-02}}</ref>
{{REF}}