American Academy of Pediatrics Now Says Circumcision's Benefits Outweigh Risks

[Malthus]

@Simple_Linctus

I’m really not seeing the difference. Let’s assume it’s tribalism instead of racism then. What’s the difference between tibalism and racism?

Racism is the belief that one group of humans is superior to others based on visible characteristics of difference.

Tribalism is wholly different. It is allegance to a particular group that is, in a sense, one’s (vastly extended) family or clan - though often the actual relationship is more or less fictive. There is no necessity for an allegation of superiority (though there may be).

It is characteristic of racism that one can never, ever change one’s “race” (however defined). In contrast, allegance to one’s tribe can change. People can be adopted into the tribe. They can leave it.

Racism is considered, basically, a bad thing. Not so allegance to one’s family, right? Same with one’s tribe (or “nation”, though of course Judaism long, long predates nationalism). The reasons one dislikes racism (that it creates unchangeable classes of superior & inferior humans) does not apply to tribalism.

[JRDelirious]

Back to this:

@Patty_O_Furniture

No grown man is going to voluntarily ask a doctor to snip off the end of his penis unless there’s a bomb attached to it. Guys would rather live with the risk of catching a disease than volunteer for circumcision.

Sure, but that’s it, isn’t it? That stereotype about gents’ relation to their Little Friend that’s so succintly described there. Some people seem to believe that because they would rather die that consciously allow a sharp edge anywhere near, then all men must feel so and so no man should ever submit to it; when in fact many men every year willingly undergo circumcision, including for merely cosmetic ends. Which latter bit does make me flinch a little but it’s their own business.

I should imagine the editors of the research must have been aware that by ending up with something that could be paraphrased as “turns out this may have some health benefit and not be as bad as is claimed, and therefore should be paid for by health coverage” they were opening themseves up for an impugnation of their motives. Had there been no mention of insurance coverage and it merely stopped at “it’s up to the parent” it may not have gotten such a rise.

(and yes, we know, strictly it’s not cutting off the end of the penis, it’s cutting off the skin around the end of the penis – hence circumcision – but why let such details impinge on the righteous outrage, besides it makes for a pithier comment).

[lance_strongarm]

@JRDelirious

many men every year willingly undergo circumcision, including for merely cosmetic ends.

How many and how do you know this?

[JRDelirious]

@lance_strongarm

How many and how do you know this?

The standard way of making that request around here is : “Cite?”
I think Patty O’Furniture was being ironic. C’mon, is it really that impossible to imagine??
But oh, all right, guess I asked for it… (grumble, search, search, browse, shake head, grumble, search, browse, roll eyes, search, despair of humanity, browse some more) Have you an idea of how hard is it to search this not knowing what are the proper search strings?

Turns out hard numbers are hard to find on this subject matter. Has taken me all this time to barely scratch the surface (and thank you very much for having had to click on pages catering to circumfetishists who are looking for the “cleanest, tightest cut” :eek: ). Some of the few search hits that give any numbers:

2002 study of effects of adult circumcision, the sample group reported 7% elective. But to be honest, it looks like this very same study keeps getting requoted everywhere, it’s like they were the only ones to ask…

2008 LA Times Article: “…a urologist who runs the Circumcision Center in Atlanta, sees men who want a circumcision because they prefer the appearance and because they want to feel more comfortable socially[…] performs 250 procedures a year on men who, for cosmetic reasons, want a circumcision or a revision to one they don’t think looks right.”

In the page for another clinic in Miami they claim some 7,000 elective cuts in the last 20 years – but that’s in their promotional material and like heck I’m going to give them the free publicity.
Still that seems to suggest that yes, at least in the USA thousands of adult men will submit to an elective circumcision for cosmetic purposes (surely there’s not only two clinics in Atlanta and Miami). I say to them, knock yourselves out, dudes, it’s your thing, not mine …

[lance_strongarm]

@JRDelirious

The standard way of making that request around here is : “Cite?”

I know. It’s such a cliche though, and grammatically incorrect.

250 procedures a year

7,000 elective cuts in the last 20 years

Still that seems to suggest that yes, at least in the USA thousands of adult men will submit to an elective circumcision for cosmetic purposes (surely there’s not only two clinics in Atlanta and Miami). I say to them, knock yourselves out, dudes, it’s your thing, not mine …

Thousands. Okay. I wouldn’t use “many”.

But you hit the nail on the head - these men CHOSE the procedure. Informed consent and all that. Cutting off part of a newborn is not informed consent.

[DSeid]

And again, neither is placing an infant under phototherapy lights, injecting them with Vitamin K, vaccinating them against diseases. Heck sometimes my nurses give shots to kids who are expressing loudly and clearly that they don’t want that shot. The parent is the one who is entrusted to decide, even over-ruling the expressed wish of the child.

And beyond the medical children often do not have a choice about being raised in a particular culture, be that entailing not being allowed to eat certain foods, having dental and jaw structures modified to fit some arbitrary culturally desired norm, whatever.

Do you believe that parents should not be able to make any of those decisions on their children’s behalves (within some fairly wide berth)? Or is it just that the foreskin is a special case to you for some reason?

[Sicks_Ate]

Ok, lets play the ‘hypothetical’ game.

Let’s pretend that the Church of Scientology suddently started practicing a brand new form of genital mutilation on newborns. However, they were able to show that there was possibly a marginal medical benefit.

Guess that would be ok. Bring on the baby girls!

[DSeid]

@JRDelirious

… Had there been no mention of insurance coverage and it merely stopped at “it’s up to the parent” …

This is a reasonable point worthy of some discussion of its own, beyond the impugnation of motives. Keeping the procedure accessible to those who chose it (deciding on behalf of their sons) does not necessarily imply that insurance or society should pay for it. Or does it? Does “accessible” automatically imply removing a cost barrier that would impede access to a procedure to those who do not have enough disposable income to afford to pay for it?

What should be the standard for third party or governmental coverage of a medical intervention/procedure? How in practice does such a standard get applied? Or is just catch as can?

The AAP Committee can review the scientific data and conclude that there is evidence that benefits outweigh harms, but without answers to the above they have little basis to comment on whether or not it should be covered by third parties.

Having more benefit than harm is not enough. Cost has to factor in. How much net cost per unit benefit (however one decides to measure that) is cost effective enough or not? Do the cost savings from prevention of the occasional problems off set the cost of the procedures? If not are lives saved or morbidity prevented great enough to justify the expense?

The fact is that we do not have any consistent standard. We as a society have shirked away from developing a rational basis for deciding how to allocate healthcare resources, let alone doing so according to any consistent standard.

I’m not yet sure what I think about whether or not it should be a universally covered benefit and would interested in hearing some thoughts from other rational people about that. Be prepared to apply your standard to other covered and not covered procedures and interventions in comparison please. Thank you.

[Malthus]

@Sicks_Ate

Ok, lets play the ‘hypothetical’ game.

Let’s pretend that the Church of Scientology suddently started practicing a brand new form of genital mutilation on newborns. However, they were able to show that there was possibly a marginal medical benefit.

Guess that would be ok. Bring on the baby girls!

Benefits are only half the equation. The other half is costs - in the form of health risks, complications, impariment of funtion and quality of life, monetary costs of the procedure itself, etc.

That’s what makes it a “costs/benefits” analysis. Your hypothetical has to tell us what the costs and benefits are, before anyone can reasonably comment.

[Sicks_Ate]

@Malthus

Benefits are only half the equation. The other half is costs - in the form of health risks, complications, impariment of funtion and quality of life, monetary costs of the procedure itself, etc.

That’s what makes it a “costs/benefits” analysis. Your hypothetical has to tell us what the costs and benefits are, before anyone can reasonably comment.

Well assume that, apart from being a brand-new procedure based upon the teachings of the Church of Scientology, the costs and benefits are roughly equal to those of male circumcision.

[lance_strongarm]

@Malthus

Benefits are only half the equation. The other half is costs - in the form of health risks, complications, impariment of funtion and quality of life, monetary costs of the procedure itself, etc.

That’s what makes it a “costs/benefits” analysis. Your hypothetical has to tell us what the costs and benefits are, before anyone can reasonably comment.

And I say that imposing a mutilation on a child’s genitals without his/her informed consent is a cost.

[Malthus]

@DSeid

This is a reasonable point worthy of some discussion of its own, beyond the impugnation of motives. Keeping the procedure accessible to those who chose it (deciding on behalf of their sons) does not necessarily imply that insurance or society should pay for it. Or does it? Does “accessible” automatically imply removing a cost barrier that would impede access to a procedure to those who do not have enough disposable income to afford to pay for it?

What should be the standard for third party or governmental coverage of a medical intervention/procedure? How in practice does such a standard get applied? Or is just catch as can?

The AAP Committee can review the scientific data and conclude that there is evidence that benefits outweigh harms, but without answers to the above they have little basis to comment on whether or not it should be covered by third parties.

Having more benefit than harm is not enough. Cost has to factor in. How much net cost per unit benefit (however one decides to measure that) is cost effective enough or not? Do the cost savings from prevention of the occasional problems off set the cost of the procedures? If not are lives saved or morbidity prevented great enough to justify the expense?

The fact is that we do not have any consistent standard. We as a society have shirked away from developing a rational basis for deciding how to allocate healthcare resources, let alone doing so according to any consistent standard.

I’m not yet sure what I think about whether or not it should be a universally covered benefit and would interested in hearing some thoughts from other rational people about that. Be prepared to apply your standard to other covered and not covered procedures and interventions in comparison please. Thank you.

As you know, I’m against prohibition of the procedure. I also do not think it should be covered by public insurance (private insurance is a matter of contract - cover away, if the parties are paying for that benefit).

My reason: the procedure is too minor. It offers greater benefits that risks to be sure, but neither are truly significant. It isn’t like childhood vaccination. More an elective, extra benefit. The benefits to the general public are too minor to expend scarce public resources on, but it is still rational for parents to pay the relatively minor fee out of their own pocket.

[Malthus]

@Sicks_Ate

Well assume that, apart from being a brand-new procedure based upon the teachings of the Church of Scientology, the costs and benefits are roughly equal to those of male circumcision.

Then logically it ought to be treated the same.

[DSeid]

Sicks Ate the answer to your question depends on what you believe the standard should be for prohibiting parental action and of course how one defines “mutilation.” The answer should be able to be applied consistently across all forms of parental actions. An answer that allows parental actions for actions that you are culturally comfortable and familiar with, be they changing a child’s appearance in a lasting manner (like removal of a large facial birthmark, or orthodontics) or not, be they associated with marginal medical/functional benefit or even if not (so long as no significant medical or functional net harm is resultant) but that prohibits it only for those actions that are culturally foreign to you, or because of your culture you find offensive but on no basis other than its alieness, is one that only reveals ignorance.

So hypothetical “Procedure A” - results in a net medical benefit and no functional harm? Sure, I’d allow it. I wouldn’t call it “mutilation” because there would be no reason to call it such other my prejudices.

[Malthus]

@lance_strongarm

And I say that imposing a mutilation on a child’s genitals without his/her informed consent is a cost.

Forget the scare words “mutilation on a child’s genitals”. All procedures performed on infants are, by definition, imposed without the infant’s informed consent. I see nothing particularly special about genitals in this respect.

What weight would you give to that alleged “cost” in the cost-benefit analysis? That is, how much harm does a procedure have to avert, before a guardian can reasonably make the decision to have a procedure done on an infant?

[lance_strongarm]

@Malthus

As you know, I’m against prohibition of the procedure. I also do not think it should be covered by public insurance (private insurance is a matter of contract - cover away, if the parties are paying for that benefit).

My reason: the procedure is too minor. It offers greater benefits that risks to be sure, but neither are truly significant. It isn’t like childhood vaccination. More an elective, extra benefit. The benefits to the general public are too minor to expend scarce public resources on, but it is still rational for parents to pay the relatively minor fee out of their own pocket.

Circular argument. It’s only considered “minor” because we are used to it.

Many cultures consider female genital mutilation to be “minor” too.

Cutting off a part of the genitals of a baby is not “minor.”

[lance_strongarm]

@Malthus

Forget the scare words “mutilation on a child’s genitals”. All procedures performed on infants are, by definition, imposed without the infant’s informed consent. I see nothing particularly special about genitals in this respect.

You don’t see something special about cutting off part of the genitals of an infant?

And they are not scare words, they are literally what happens.

Would you have no problem with cutting off the female labia too, as long as the clitoris is left intact? It serves little purpose after all.

What weight would you give to that alleged “cost” in the cost-benefit analysis? That is, how much harm does a procedure have to avert, before a guardian can reasonably make the decision to have a procedure done on an infant?

A hell of alot more.

The risks averted by circumcision are small and easily averted simply with proper hygiene.

[Malthus]

@lance_strongarm

Circular argument. It’s only considered “minor” because we are used to it.

Many cultures consider female genital mutilation to be “minor” too.

Cutting off a part of the genitals of a baby is not “minor.”

You are arguing by assertion. I base “minor” on the fact that, scientifically, it has been proven to have a low incidence of adverse effects and no testible imparment to function. The contrast with the more common forms of FGM could not be more marked - it causes severe adverse effects and impairment to function.

That isn’t a “cultural” judgment, but one based on objective factors.

[Malthus]

@lance_strongarm

You don’t see something special about cutting off part of the genitals of an infant?

No I do not - not any more than (say) modifying any other body part, such as teeth, eyes, or hands. Methinks you are too invested.

A hell of alot more.

That’s not a very useful guide to policy.

[Sicks_Ate]

@DSeid

Sicks Ate the answer to your question depends on what you believe the standard should be for prohibiting parental action and of course how one defines “mutilation.” The answer should be able to be applied consistently across all forms of parental actions. An answer that allows parental actions for actions that you are culturally comfortable and familiar with, be they changing a child’s appearance in a lasting manner (like removal of a large facial birthmark, or orthodontics) or not, be they associated with marginal medical/functional benefit or even if not (so long as no significant medical or functional net harm is resultant) but that prohibits it only for those actions that are culturally foreign to you, or because of your culture you find offensive but on no basis other than its alieness, is one that only reveals ignorance.

So hypothetical “Procedure A” - results in a net medical benefit and no functional harm? Sure, I’d allow it. I wouldn’t call it “mutilation” because there would be no reason to call it such other my prejudices.

It’s not culturally foreign, nor do I find it offensive based on my culture. It’s not alien. I’m circumcised, as are most men my age. My son is not, however.

It’s completely disingenuous to equate circumsision with the removal of large disfiguring birthmarks, orthodontics, knock-knees (mentioned above) etc. In addition to having a medical benefit, these procedures are also carried out to prevent the child from having to deal with their social conseqences.

If my parents didn’t put orthodontics on me when I was a teenager, I would now be dealing with the social concequences of having very crooked and unattractive teeth, not to mention a bad bite or problems chewing. Further, I don’t know of any parents who put their child in braces because it’s a tenent of their religion.

The social consequences of circumcision are nil. Nobody I meet on a daily basis is forming an opinion of me based upon that criteria. With the exception of extremely rare cancers etc., there is basically no effect of circumcision/no circumcision on an adult…except for circumcised men who feel that they were done an injustice by being circmcised as an infant.