Circumcision

[bluebell]

1 minute ago, pogi said:

I understand that you are phasing out of the conversation.  That is fine. I just want to clarify that I have defended parents who chose to circumcise their children in this thread.  A parent is not ethically wrong for trusting the AAP and their own pediatricians in regard to circumcision.  My arguments should not be construed as an attack or judgment on any parent who has decided to circumcise their children. I, myself circumcised my son.  I give myself slack.  I don't view my decision as a sin or ethical violation on my part, per se.  Pediatricians can't expect lay parents to be able to adequately weigh the evidence when none is presented to them.  We are expected to simply take their word for it.  It is based on trust.  If anything, we are guilty of blind trust.  That is all. The ethical violation is with the AAP.  They clearly violate their own ethical standard of practice as outlined by them. Their own ethical adviser agrees - along with the rest of the developed world.  That should count for something. 

This link is simply to the original 2012 AAP statement.  It does nothing to address the multiple concerns that I have brought up that other medical organizations across the globe and providers have with it.  It simply doesn't address my concerns.  Until they are addressed, I have good reason to be concerned.  No one has been able to, or even tried to address them. 

 

Thanks for clarifying.  I'm not arguing with your right to be concerned.  If you believe you have good right to be concerned, then I have no issues with that.  I'm simply saying that I'm not concerned and disagree with your earlier statements that I need to be.

[pogi]

1 hour ago, bluebell said:

Thanks for clarifying.  I'm not arguing with your right to be concerned.  If you believe you have good right to be concerned, then I have no issues with that.  I'm simply saying that I'm not concerned and disagree with your earlier statements that I need to be.

I do think that all parents should be concerned for reasons that I have thoroughly explained.  I don't apologize for taking that position.  I wouldn't necessarily call it a "need" though (If I used that word, then I misspoke).  I don't necessarily blame you or any other lay parent who decides to circumcise their children based on their trust of the system.  I would simply suggest that people take a critical look at the 2012 statement of the AAP.   I have laid out several reasons to question their position, all of which are backed by the rest of the developing world and prominent ethicists in the field, and their own ethical adviser.  So, until someone can tell me why the rest of the developing world is wrong (even though they have access to the same data that the AAP does), I remain unconvinced that parents should not be concerned about this practice.   

On top of all the reasons I have mentioned to question their statement, there are plenty of other valid reasons here:

https://www.doctorsopposingcircumcision.org/for-professionals/medical-organization-statements/

I would love to hear counter arguments to these points, but I understand if you have lost interest.

 

Edited January 16, 2019 by pogi

[Hamba Tuhan]

7 hours ago, pogi said:

The vast majority of medical organizations in developed nations consider it unethical - we are the sole survivors of a practice, it seems.

As we learn from scripture, the traditions of the fathers have enormous inertia in many areas of life.

[pogi]

To whom it may concern.  I have been reading in the comment section of the AAP article that bluebell linked to above.  Some really excellent comments from experts in the field.

I highly recommend that people go read them. 

[Hamba Tuhan]

45 minutes ago, pogi said:

I have been reading in the comment section of the AAP article that bluebell linked to above.

Can you please re-link? I can't find the original.

[Scott Lloyd]

11 hours ago, bluebell said:

It's certainly arguable, people argue it all the time.  I'm not saying it isn't.  What I'm saying is that something being "arguably unethical" does not mean something is actually unethical.   People argue that vaccinating children is unethical, but we all know that that doesn't make it so.

Sorry if you think I equivocated. I’ll now assert that it is indeed unethical. Happy now?

Edited January 17, 2019 by Scott Lloyd

[JLHPROF]

3 minutes ago, Scott Lloyd said:

Sorry if you think I equivocated. I’ll now assert that it is indeed unethical. Happy now?

I share your distaste for the practice.  But "unethical" (ie not morally correct) seems an overstep when we scriptural record of God commanding it at one point.

I don't think God acts immorally or unethically.  I do think we still need to understand how agency fits in his command on this.

That said, very glad it's no longer commanded.  (Wow, this could be a post on a polygamy thread).

[Scott Lloyd]

5 hours ago, pogi said:

I do think that all parents should be concerned for reasons that I have thoroughly explained.  I don't apologize for taking that position.  I wouldn't necessarily call it a "need" though (If I used that word, then I misspoke).  I don't necessarily blame you or any other lay parent who decides to circumcise their children based on their trust of the system.  I would simply suggest that people take a critical look at the 2012 statement of the AAP.   I have laid out several reasons to question their position, all of which are backed by the rest of the developing world and prominent ethicists in the field, and their own ethical adviser.  So, until someone can tell me why the rest of the developing world is wrong (even though they have access to the same data that the AAP does), I remain unconvinced that parents should not be concerned about this practice.   

On top of all the reasons I have mentioned to question their statement, there are plenty of other valid reasons here:

https://www.doctorsopposingcircumcision.org/for-professionals/medical-organization-statements/

I would love to hear counter arguments to these points, but I understand if you have lost interest.

 

Thank you for linking anew to the Doctors Opposing Circumcision refutation of the AAP statement. I had linked to it earlier in this thread and was about to do so again when I saw that Bluebell had linked again to the AAP material. You have saved me the trouble. 

I guess what we have here is a case of dueling doctor groups. That’s hardly a compelling case for circumcision advocacy. 

Edited January 17, 2019 by Scott Lloyd

[Scott Lloyd]

20 minutes ago, JLHPROF said:

I share your distaste for the practice.  But "unethical" (ie not morally correct) seems an overstep when we scriptural record of God commanding it at one point.

I don't think God acts immorally or unethically.  I do think we still need to understand how agency fits in his command on this.

That said, very glad it's no longer commanded.  (Wow, this could be a post on a polygamy thread).

I feel a strong case has been made here that the circumcision of Bible times was quite unlike the circumcision of today. And I defined earlier what I mean by unethical, that being contrary to generally accepted contemporary standards of ethics such as the standard that, absent a compelling medical need, surgery ought not be performed on one incapable of consenting to it. It’s a standard that seems eminently reasonable to me, and I sustain it. 

Finally, I offer my opinion that in commanding the ritual of circumcision as a symbolic rite of the covenant, the Almighty was appropriating a practice that was already somewhat known among ancient peoples. Ancient Israel were not the only people to have practiced it. 

Ultimately, of course, the rite was abandoned when Christ came to earth to fulfill the law. 

Edited January 17, 2019 by Scott Lloyd

[bluebell]

10 hours ago, Scott Lloyd said:

Sorry if you think I equivocated. I’ll now assert that it is indeed unethical. Happy now?

I wasn't actually talking about equivocation.  I was just saying that though many people believe it is unethical (and argue that), that doesn't make it so.  Different opinions exist and reasonable (and knowledgable people) disagree.  

[pogi]

15 hours ago, Hamba Tuhan said:

Can you please re-link? I can't find the original.

Here you go,

http://pediatrics.aappublications.org/content/130/3/e756

The first two comments are pro-circumcision, they over exaggerate the benefits and say things like "every parent has the responsibility to make sure their child is circumcised."  The problem is that goes FAR beyond what the AAP report itself recommends.  The AAP estimates that the benefits are so negligible that circumcision is NOT recommended to be routinely performed on children.

In fact, one of the task force members later conceded that there was insufficient evidence to declare a net benefit:

Quote

 

In 2012, the Academy of Pediatrics (AAP) reviewed the many current claims of benefit for circumcision and published a position statement that concluded that “the health benefits outweigh the risks.”[172] However, in this same statement, they admitted no less than four times that the rates of complication, morbidity, and mortality are unknown.[172, p. e772, e775]

Indeed, in a follow-up editorial published in Pediatrics, in May 2016, Andrew Freedman, a member of the AAP’s 2012 Circumcision Task Force, referring to the literature review his committee undertook, conceded that “[d]ifficulties with this approach included the lack of a universally accepted metric to accurately measure or balance the risks and benefits. In particular, there was insufficient information about the actual incidence and burden of non-acute complications.”[173]

It is astonishing that, given such an admission, a leading professional organization would declare any net benefit for an amputative procedure upon children, a failing for which the AAP has been soundly – and rightfully – criticized.[174]

https://www.doctorsopposingcircumcision.org/for-professionals/alleged-medical-benefits/american-academy-of-pediatrics-2012-policy/

 

The rest of the comments are against childhood circumcision and absolutely demolish the AAP report. I especially liked the one from the expert on informed consent.  

Edited January 17, 2019 by pogi

[pogi]

1 hour ago, bluebell said:

I wasn't actually talking about equivocation.  I was just saying that though many people believe it is unethical (and argue that), that doesn't make it so.  Different opinions exist and reasonable (and knowledgable people) disagree.  

Just curious, if it is true that there is no net medical benefit to the practice of circumcision (as the AAP has now admitted in a follow up editorial published in 2016), would you say that the practice is ethical on purely cultural (non-religious) reasons?  Would you still defend the practice for purely cultural reasons?  Is it ok to amputate part of our child's penis simply because we think it looks better and that is how we were raised?  How does culture in and of itself justify the practice?  

Edited January 17, 2019 by pogi

[Scott Lloyd]

1 hour ago, pogi said:

Just curious, if it is true that there is no net medical benefit to the practice of circumcision (as the AAP has now admitted in a follow up editorial published in 2016), would you say that the practice is ethical on purely cultural (non-religious) reasons?  Would you still defend the practice for purely cultural reasons?  Is it ok to amputate part of our child's penis simply because we think it looks better and that is how we were raised?  How does culture in and of itself justify the practice?  

Do you have a link to that AAP follow-up editorial? I’d like to read it. 

The AAP seems to shift its position quite often on this subject. Makes me think it is subject to the winds of politics. 

[pogi]

32 minutes ago, Scott Lloyd said:

Do you have a link to that AAP follow-up editorial? I’d like to read it. 

The AAP seems to shift its position quite often on this subject. Makes me think it is subject to the winds of politics. 

Here you go:

http://pediatrics.aappublications.org/content/137/5/e20160594

These are a couple good reviews of the editorial:

https://www.doctorsopposingcircumcision.org/for-professionals/alleged-medical-benefits/american-academy-of-pediatrics-2012-policy/

https://www.circinfo.org/AAP_in_retreat.html

And as a bonus, here is an excellent article in the AMA journal of ethics on the ethics of circumcision.  It is not a review of the editorial, but it does reference it. 

https://journalofethics.ama-assn.org/article/nontherapeutic-circumcision-minors-ethically-problematic-form-iatrogenic-injury/2017-08

 

[bluebell]

4 hours ago, pogi said:

Just curious, if it is true that there is no net medical benefit to the practice of circumcision (as the AAP has now admitted in a follow up editorial published in 2016), would you say that the practice is ethical on purely cultural (non-religious) reasons?  Would you still defend the practice for purely cultural reasons?  Is it ok to amputate part of our child's penis simply because we think it looks better and that is how we were raised?  How does culture in and of itself justify the practice?  

The follow up AAP article seems to say the same thing as the original.  Both say “the procedure’s benefits justify access to this procedure for families who choose it,” and “health benefits are not great enough to recommend routine circumcision.”  What did the AAP admit in the 2016 report that was absent in the 2012?  (Sincere question).

As to the cultural question, I really don't know.  I would say that having a child circumcised just because we think it looks better would be wrong, but I would consider that to be a separate issue from doing it for cultural reasons.  

 

[pogi]

1 hour ago, bluebell said:

The follow up AAP article seems to say the same thing as the original.  Both say “the procedure’s benefits justify access to this procedure for families who choose it,” and “health benefits are not great enough to recommend routine circumcision.”  What did the AAP admit in the 2016 report that was absent in the 2012?  (Sincere question).

As to the cultural question, I really don't know.  I would say that having a child circumcised just because we think it looks better would be wrong, but I would consider that to be a separate issue from doing it for cultural reasons.  

Ya, it is remarkable to me that he again emphasized that "the procedure’s benefits justify access to this procedure for families who choose it", after clearly conceding that the benefit vs.risk ratio is impossible to measure.  What a crack!

The difference is that in the 2012 statement, they clearly indicate that the medical benefit is greater than the risk.  However, in this 2016 editorial, they concede the following:

Quote

Difficulties with this approach included the lack of a universally accepted metric to accurately measure or balance the risks and benefits. In particular, there was insufficient information about the actual incidence and burden of nonacute complications.

In other words, after suffering "wide-ranging ramifications" and "fierce criticism from other physician and medical societies", they have conceded that it is inaccurate to conclude that the net risk is greater than the benefit, and that it cannot in fact be "accurately measured".  They even take it a step further and concede that it is "immeasurable".  

Quote

 In circumcision, what we have is a messy immeasurable choice that we leave to parents to process and decide for themselves rather than dictate to them.

"Messy and immeasurable" is VERY different from saying that the medical "benefit is greater than the risk".  If the medical benefit was truly greater than the risk, even slightly, why wouldn't it be even softly recommended?  Answer:  Because as they now openly admit here - the risk vs benefit is immeasurable and always has been.

In other words, circumcision CANNOT be medically framed in a risk vs benefit comparison as they attempted to frame it in the 2012 statement.  People (including on this forum) have used that misleading and fallacious statement to justify the ethicality of what is purely a cultural/social practice.  Many people, including myself, were mislead into believing that there was an actual medical net benefit, even if it was small.  

That is not the role of the AAP to protect cultural practices (especially by using misleading and false statements)  - their role is to advise on evidenced-based practices, anything else is not good science.  

Edited January 17, 2019 by pogi

[pogi]

1 hour ago, bluebell said:

As to the cultural question, I really don't know.  I would say that having a child circumcised just because we think it looks better would be wrong, but I would consider that to be a separate issue from doing it for cultural reasons.  

If you circumcised your children partly for the purported medical benefit, do you now question those justification?  If it cannot be said to be medically beneficial, and in fact comes with "immeasurable" medical risk, how could it possibly be ethical for cultural purposes. These are the reasons that most American's circumcise, according to this editorial:

Quote

for the most part parents choose what they want for a wide variety of nonmedical reasons. There can be no doubt that religion, culture, aesthetic preference, familial identity, and personal experience all factor into their decision. Few parents when really questioned are doing it solely to lower the risk of urinary tract infections or ulcerative sexually transmitted infections. Given the role of the phallus in our culture, it is not illegitimate to consider these realms of a person’s life in making this nontherapeutic, only partially medical decision. The task force was sensitive to the fact that as physicians, although we claim authority in the medical realm, we have no standing to judge on these other elements.

For some reason, this medical task force took it upon themselves to be sensitive to cultural practices, even when there is no medical indication for this type of surgery.  That simply is not their role to protect cultural practices.  Not all cultural practices are worthy of keeping.  Especially considering that risks are unknown. As Doctors Against Circumcision put it, the 2012 statement was simply "window dressing to disguise ‘cultural brokerage’[175], rather than good science."

We are talking about partial penile amputation with no known net medical benefit.  Is there an ethical argument for continuing a painful, amputative practice of healthy genital tissue, with unknown risks, sometimes life-threatening, simply because that is how we have always done it in our family?  How is this not messed up!  Why don't the ethical considerations of the child mentioned in this article come into play when there is no net medical benefit buffering the ethics of it?

https://journalofethics.ama-assn.org/article/nontherapeutic-circumcision-minors-ethically-problematic-form-iatrogenic-injury/2017-08

Edited January 17, 2019 by pogi

[bluebell]

26 minutes ago, pogi said:

The difference is that in the 2012 statement, they clearly indicate that the medical benefit is greater than the risk.  However, in this 2016 editorial, they concede the following:

In other words, after suffering "wide-ranging ramifications" and "fierce criticism from other physician and medical societies", they have conceded that it is inaccurate to conclude that the net risk is greater than the benefit, and that it cannot in fact be "accurately measured".  They even take it a step further and concede that it is "immeasurable".  

"Messy and immeasurable" is VERY different from saying that the medical "benefit is greater than the risk".  If the medical benefit was truly greater than the risk, even slightly, why wouldn't it be even softly recommended?  Answer:  Because as they know openly admit here - the risk vs benefit is immeasurable.

In other words, circumcision CANNOT be medically framed in a risk vs benefit comparison as they attempted to frame it in the 2012 statement.  People (including on this forum) have used that misleading and fallacious statement to justify the ethicality of what is purely a cultural/social practice.  Many people, including myself, were mislead into believing that there was an actual medical net benefit, even if it was small.  

That is not the role of the AAP to protect cultural practices (especially by using misleading and false statements)  - their role is to advise on evidenced-based practices, anything else is not good science.  

Have studies done by the World Health Organization and the CDC agreed with the AAP, that the benefit was greater than the risk?  From what I've read, the CDC said (in 2017) that it is measurable and that data shows that the benefit is greater than the risk by 100:1.

[Scott Lloyd]

33 minutes ago, pogi said:

Ya, it is remarkable to me that he again emphasized that "the procedure’s benefits justify access to this procedure for families who choose it", after clearly conceding that the benefit vs.risk ratio is impossible to measure.  What a crack!

The difference is that in the 2012 statement, they clearly indicate that the medical benefit is greater than the risk.  However, in this 2016 editorial, they concede the following:

In other words, after suffering "wide-ranging ramifications" and "fierce criticism from other physician and medical societies", they have conceded that it is inaccurate to conclude that the net risk is greater than the benefit, and that it cannot in fact be "accurately measured".  They even take it a step further and concede that it is "immeasurable".  

"Messy and immeasurable" is VERY different from saying that the medical "benefit is greater than the risk".  If the medical benefit was truly greater than the risk, even slightly, why wouldn't it be even softly recommended?  Answer:  Because as they now openly admit here - the risk vs benefit is immeasurable and always has been.

In other words, circumcision CANNOT be medically framed in a risk vs benefit comparison as they attempted to frame it in the 2012 statement.  People (including on this forum) have used that misleading and fallacious statement to justify the ethicality of what is purely a cultural/social practice.  Many people, including myself, were mislead into believing that there was an actual medical net benefit, even if it was small.  

That is not the role of the AAP to protect cultural practices (especially by using misleading and false statements)  - their role is to advise on evidenced-based practices, anything else is not good science.  

I look forward to yet another revised statement from the AAP on the subject of circumcision. For now, I think It noteworthy that the benefits, whatever they may be, are not sufficient to justify <routine> circumcision and that they emphasize that parents need to be notified that the procedure is optional. This is quite a difference from years past.  

[Scott Lloyd]

Just now, bluebell said:

Have studies done by the World Health Organization and the CDC agreed with the AAP, that the benefit was greater than the risk?  From what I've read, the CDC said (in 2017) that it is measurable and that data shows that the benefit is greater than the risk by 100:1.

I looked at the CDC statement. It was obvious to me that it parroted the AAP document. Furthermore, my understanding is that it is still just a “draft” statement and doesn’t yet have an official stamp on it. 

My impression is there is little if any original thought or research that has gone into it in its current form. A classic example of group think. 

[bluebell]

15 minutes ago, pogi said:

If you circumcised your children partly for the purported medical benefit, do you now question those justification? 

Not at all.  One of the reasons that I circumcised my boys was because of my mother's experience (as a nurse) caring for older males who had to be circumcised due to health problems and how horrible the process and recovery was for them.  That, coupled with the medical information that I had back then and have recently read, cause me to feel good about my decision.  

Quote

If it cannot be said to be medically beneficial, and in fact comes with "immeasurable" medical risk, how could it possibly be ethical for cultural purposes. These are the reasons that most American's circumcise, according to this editorial:

I think that it can be said to be medical beneficial, and has been said to be that by doctors.  Also, the 2017 study by the CDC refutes the idea that the risks are immeasurable.  But to answer your question on culture and ethics, I think you would have to prove that it's unethical for a parent to make medical decisions for their children based on culture.  I don't necessarily disagree with that, but neither do I believe it's a given like you do.

Quote

As Doctors Against Circumcision put it, the 2012 statement was simply "window dressing to disguise ‘cultural brokerage’[175], rather than good science."

Did DAC have something to say about the 2017 CDC report.  I think that would be interesting to read.

[bluebell]

13 minutes ago, Scott Lloyd said:

I looked at the CDC statement. It was obvious to me that it parroted the AAP document. Furthermore, my understanding is that it is still just a “draft” statement and doesn’t yet have an official stamp on it. 

My impression is there is little if any original thought or research that has gone into it in its current form. A classic example of group think. 

I really don't know.  But it doesn't seem valid to dismiss this report, which states "the CDC has a mandate to use the best available evidence to inform the public on interventions for disease prevention. In the case of early infant MC, there are few public health interventions in which the scientific evidence in favor is now so compelling," as group think and a parroted document.  

[Scott Lloyd]

39 minutes ago, bluebell said:

I really don't know.  But it doesn't seem valid to dismiss this report, which states "the CDC has a mandate to use the best available evidence to inform the public on interventions for disease prevention. In the case of early infant MC, there are few public health interventions in which the scientific evidence in favor is now so compelling," as group think and a parroted document.  

My impression came from comparing the two documents. Clearly the CDC  in this instance is relying on the AAP to do the heavy lifting. And the Doctors Opposing Circumcision statement, linked to at least twice now on this thread, handily rebuts both. 

But consider the bottom-line message. Even as it touts the benefits, the AAP statement does not endorse routine neonatal circumcision — which is what I’ve been against all along. Contrast that with the AAP’s unequivocal endorsement of childhood immunizations. 

If the AAP says the benefits outweigh the risks but they stop short of saying every boy should be immunized at birth, that’s not enough to persuade me to inflict that pain and bodily alteration on my children — or to encourage others to do so. 

Edited January 17, 2019 by Scott Lloyd

[bluebell]

1 minute ago, Scott Lloyd said:

My impression came from comparing the two documents. Clearly the CDC  in this instance is relying on the AAP to do the heavy lifting. And the Doctors Opposing Circumcision statement, linked to at least twice now on this thread, handily rebuts both. 

But the CDC article rebuts Frisch and Earp's claims and findings.  Where can I see their rebut of the rebuttal?

[Scott Lloyd]

1 minute ago, bluebell said:

But the CDC article rebuts Frisch and Earp's claims and findings.  Where can I see their rebut of the rebuttal?

Have you examined the DOC statement?