Whether or not one disagrees with the AAP’s position is beside the point. The organization’s position has changed, and the column would benefit from being updated to reflect that.
In a Sienfeld episode Elaine was asked if she preferred circumcised or non-c. Her reply was “circumcised”, as un-c “have no personality”.
Women I’ve talked to actually agree with this assessment.
That should end all argument on the issue.
Only if it also reflected the still ongoing conflict within the AAP itself. Put another way, the change is not so seismic as to warrant wholesale changes with corresponding notation on the continued objections both internally and externally (note the British Medical Association’s debates on the issue). You’re cherry picking and it won’t improve the column.
It’s not cherry-picking to address the particular facts that Cecil mentioned in the column. What you’re really saying is that Cecil was cherry-picking by not mentioning the views of medical associations in other countries, and you’re free to make that suggestion to TPTB, but that doesn’t affect my point.
More broadly, there is no “still ongoing conflict within the AAP itself.” The organization has reached a decision and issued a policy statement. Individual members might still object to that conclusion, but that’s true of any decision by any institution, and it doesn’t change the fact that the institution’s position is what it is.
And on further reflection, I do think Cecil’s statement is now inaccurate, not just incomplete. He was saying, “the AAP has not taken a position one way or another,” and now it has.
Wait, Cecil mentioned in 1994 that Taylor’s study had never been published, and you’re claiming that Cecil was “poisoning the well” because he failed to mention the study being published in 1996? I know Cecil knows everything, but even Cecil never claimed to be clairvoyant. At the time the article was written, his description was accurate and justified. Taylor’s claims were not a part of the official medical literature, and his qualifications did not support an expertise in the area he was making claims, that of nerve cell density in tissue.
That is a fair statement: that the AAP has now come out with a new statement on the topic (it had one in 1971, dropped it in 1989). It is also a fair statement that Taylor’s study has now been published in the medical literature, and thus has been peer reviewed, something that wasn’t true for the original column. It may also be worthwhile to comment on other nation’s doctors associations and their opinions, since there appears to still be a lot of controversy on the topic.
Discussion of the flaws in the studies supporting circumcision as an STD/AIDS preventer would also be appropriate.
Its policy is still careful to point out that they don’t recommend circumcision, only that they feel it should be paid for by insurance (what a surprise coming from the people to whom the payments flow).
Why is a trade association’s opinion relevant at all? Especially when it has been roundly condemned by its peer trade associations around the globe?
I have forwarded this to Ed.
You mean other “trade organizations” like the World Health Organization and UNAIDS?
In terms of the facts the statement that the AAP finds the evidence for AIDS risk reduction to be conflicting is now out of date and a statement that circumcision lowers AIDS risk is based on strong evidence. Whether or not that justifies routine circumcision is a matter of assessment of relative risks and benefits for which varying opinions exist.
DSeid do you have any further information discussing flaws in the HIV studies (if such flaws exist)?
Nope. To my read the WHO, the UNAIDS, the AAP, and the CDC (“male circumcision significantly reduces the risk of men contracting HIV through penile-vaginal sex”) are correct.
The issue remains if that benefit is great enough to recommend the procedure. That’s a fair debate in my mind (Lawd knows one we’ve had here!) and perhaps would have different answers taken depending on baseline HIV rates of a specific population. But Hugh7’s accusation of cherry picked evidence is without merit, as is TLCTugger’s claim that the AAP conclusion is out of step with the conclusion of other healthcare organizations across the world.
No, I mean for example the German Pediatricians and Urologists, and groups in the UK, and in Canada, and every medical association in Holland. The Dutch Policy on circumcision is far more comprehensive than the AAP’s. It looked at all the same evidence and concludes infant circumcision has “an absence of medical benefits and danger of complications.”
The WHO has not updated its policy to reflect 2009 research it commissioned by Wawer/Gray. They found the Ugandan men they circumcised infected their female partners 50% MORE often than the men they left intact did. Until this is refuted or verified it is very unethical to keep pretending circumcision will improve anything. Yet on they press.
There are a dozen African nations where it is the circumcised who have markedly higher HIV prevalence. Most of the US men who have died of AIDS were circumcised at birth. The mostly-cut US has three times the HIV incidence seen in Europe where circumcision is rare.
And the most recent RCTs do contradict the 3 large Africa trials.
Whatever circumcision’s effect on HIV, it is only seen when a small cadre of long-time circumcision promoters are running controlled trials.
And it is important to distinguish between adult voluntary circumcision and forced cutting of healthy children’s genitals. But in places like Swaziland the poor discernment or deliberate cultural justification by outfits like the AAP and WHO is leading them to roll out compulsory circumcision of babies.
You have no business dismissing Hugh7’s links without considering them. His assessment of the AAP policy’s weaknesses is echoed by the recent German Pediatricians’ policy letter: http://www.intactamerica.org/german_pediatrics_statement
Tell ya what, Guin. Let’s set up a time and place to have your clitoral hood removed. Now, before you object, it is important to note that you will not be given any choice in the matter. Hypothetical of course, but after said operation is complete, with or without your consent (we’re not even going to ask you, we’ll render you helpless and just do it), afterwards, do you think you would laugh it off in the same way you laugh off male circ (since you take such obvious glee in it), or do you think you would feel as if a sexual assault-y kind of crime had been committed?
I see various organizations struggling to provide a preventative-medical justification for this procedure, but those are really all bullshit. Medical ethics don’t work that way. If they did, we’d do things like this to prevent the 100% onset chance of runny noses. Sound reasonable?
Anyway, the the whole project of justifying amputation as preventative medicine seems to me a way to prevent huge numbers of malpractice lawsuits, and nothing else. There are no other examples of preventative amputation; it is an advanced exercise in denial.
As for Cecil’s column, it never even touches on the strongest reasons why circ should not be performed unless absolutely medically necessary. Our culture is stupid in this; apparently hardly anyone even has access to the ability to see what the problem is. I’ve only seen it obliquely touched upon by the likes of cmkeller, and then only in the service of the wrong answer (for non-Jews anyway). I don’t think I’m going to be able devise a way to lead you people to see it. No time soon at the least, and anyway beating my head against a wall isn’t very interesting.
Culture fail.
Hugh7’s “detailed rebuttal” link was to the AAP technical report; it did not bear mentioning.
The “cherry picking” going on here seems to be on your side: the AAP, the WHO, UNAIDS, and the CDC are not all involved in a conspiracy to justify something.
The factual statement is that these major national and international healthcare advocacy organizations currently conclude that male circumcision decreases male risk of contracting HIV through male female penile insertive sex. It can also be stated that some groups disagree with the conclusions but looking at just one, the Dutch (the first I’ve googled), it comes off more as their trying to justify what they already do, like they have a conclusion in mind looking for data to support it.
Please note, that Dutch critic is not disputing the findings of the African studies, merely their applicability to the Dutch population.
Circumcision in the Netherlands is something mostly done by those “others”, the Muslims, and often at 5 or 6 years old. Not something the “we” of that country do. Even thinking about it … sounds like a cultural bias to me. Note the government there had previously tried to ban kosher and halal animal slaughter.
This thread is not a debate about whether or not circumcision should be recommended for any population, nor is it a debate about what horrible harms some people claim it causes; it is merely a factual correction: at this point in time the AAP, the CDC, the WHO, and UNAIDS, all have concluded something about the current level of the evidence. That is a significant update to the column. What impact that has on any debate about circumcision is a separate issue.
The comparison to female circumcision is ridiculous, not to say ludicrous. Apples and oranges. Chalk and cheese. You might as well argue about hysterectomies performed on males. Or about declawing your pet goldfish.
What are the odds of a man getting HIV through vagina jntercourse with an infected woman? Didn’t Cecil write an article about this?
My recollection are that the odds are very high suggesting that circumcision, even as a prophylactic measure likely isn’t warranted.
Look at it this way, those in favour of the procedure seem to have to go to great lengths to justify it. I’ve seen nothing that would support this elective surgery on newborns. If you are over the age of consent, then by all means have it done.
Runny noses don’t work like that. They are caused by the sinuses, inside the skull. Cutting off the external nose is just as useless as cutting off the external ear to prevent inner ear infections. But I’m sure you knew that, and just wanted to be as dramatic as possible.
Please don’t irresponsibly pretend that their statements apply to anything other than adult voluntary circumcision in areas with rampant HIV and poor access to condoms.
So somehow the Dutch and the Brits can be dismissed for cultural bias but Americans, who get paid per procedure rather than per well patient and who managed to assemble a committee with not one foreskin among them, can not?
The full text of the well-footnoted Dutch policy statement is here:
http://knmg.artsennet.nl/Publicaties/KNMGpublicatie/Nontherapeutic-circumcision-of-male-minors-2010.htm (in English)
“absence of medical benefits” “urging a strong policy of deterrence”
You can decide for yourself who considered all the evidence (KNMG) and who did not (AAP).
Well, I noted that I would not be able to produce a satisfactorily convincing demonstration of the strong reason for abstaining from the discussed procedure. I do applaud you for noticing that the root of this issue does reside ‘inside the skull’, like a sinus problem, only more deeply brain-oriented; and for raising the notion of the uselessness of amputation to resolve such a condition. Nice metaphor.
Drama? No. Artistic persuasion. But know that I am beyond that. My point is: circumcision is stupid to inflict on goys.
Defend it secularly (you can’t) or secularly ban it.
Tomayto, tomahto.
Just looking at this column, the odds of getting HIV from vagunal sex is one of five million. What are the odds of getting AIDS from ordinary heterosexual sex? - The Straight Dope
Moreover, the Economist notes an increase in risky sexual practices after the circle study came out as people started believing that circumcision gave them added protection such that they stopped using condoms.