This Monday, the American Academy of Pediatrics released their new policy statement on circumcision. You might have seen the headlines: "circumcision: benefits outweigh the risks".
A photo showed the president of the AAP with marker on his hands reading "AAP rocks"
The intactivist community responded and this video is a testimonial to that. My own picture flashes really fast by the end.
As for my opinion on the report, this is the quick version:
As I read the Technical Report, I see 4 big voids that seem were logical to explore as we are talking of amputative surgery:
a) What are the functions and anatomy of the part being amputated? Seems just logical to study them. In fact, the technical report gives BAD advice as it seems to suggest that by the time the baby is 4 months old the foreskin should be retractable.
b) What are the benefits of not getting circumcised? If you "can elect" to loose a body part (or elect to have a body part removed from another person, which is the next point), what benefits would it have to keep that body part? I never saw a discussion of that in the Technical Report. If you think that there is no benefit, you should still state so, not just leave the blank, especially when you are talking of unbiased information.
c) Given that the surgery is irreversible and that the individual being operated does not have the ability to consent, is it ethical to do it? What makes it a parental right to decide to remove a body part from a baby? If it was ANY other healthy body part (a phalanx of a finger, the tip of the nose, an ear lobe, a clitoral hood) the doctor would turn down the parents' request, even if that part can become unhealthy in the future. So what makes the foreskin so different that it is seen as disposable by proxy?
d) There are a large number of adults who were circumcised as babies and are unhappy, angry or depressed about it -you wouldn't see protests otherwise, it's not like people routinely protest against brain surgeries right? So, doesn't that deserve a little bit of study as well? I didn't see any mention of that in the technical report. If those adults were your "patients" (by parental consent) 20 and 30 and 40 years ago and they are so unhappy and feel abused, there was something that obviously didn't work out that well, but you are basically selling the same product, just changing the selling speech. But what is it that didn't work for them, in spite of parental consent and such?
e) The most severe risks of circumcision (such as the potential of death or catastrophic damage to the genitalia) were not properly evaluated because they were considered "case studies" for lack of frequency. But there are no numbers to substantiate that lack of frequency. Based on conservative estimates, at least 2 babies die in the US every year as a consequence of the procedure. Other activist sources claim up to 117. And that not counting babies who get their genitalia severely disfigured or totally amputates. But if the frequency of these events was not included in the policy, now can they state that the benefits outweigh the risks?
The main new evidence of "benefit" that they quote is the famous "60% reduction in the risk of contracting HIV". There are many things wrong with that.
First, amputating part of a babies genitalia to prevent something that can be prevented teaching proper sexual behavior is wrong. And it could wait until the child grows and decides that he wants that "benefit". Especially considering that the amputation itself harms the sexual organ with life long consequences (the guys who say "but I'm fine" have no way of knowing what they missed and the fact that they may lose sensitivity or experience ED early).
Second, the basis for that 60% reduction claim were studies in Africa that do not apply to the USA due to differences in the nature of the epidemic (heterosexual in Africa vs. mainly homosexual and intravenous in the US). And even if the results could be extrapolated, the 60% is still based on experiments that were flawed by design. IT WAS a set of 3 experiments, but unlike real experiments, there were many uncontrolled (and uncontrollable) variables, and there was a loss of individuals in the trial that could have swayed the results one way or another. Basically, the experiment does not prove that all studied individuals were exposed to the risk, so the 60% is merely circumstantial because changes in the individual behavior of each person (like using condom) and mere luck (like not having sex with infected females) affect the result of the "experiment".
Other studies (in Puerto Rico, in the NAVY and even in Africa) have shown different results, some even showing more prevalence of HIV among circumcised males and some not showing any correlation. But again, all those studies suffer from the same deficiencies by nature: they cannot control the variables and study humans as if they were lab mice.
We keep fighting the Policy. We believe the AAP should retract it. There is the feeling that there was a religious bias (as many of the doctors in the Task Force are Jews) and cultural bias (as most likely most of the doctors are circumcised). There's also the fact that while most medical associations in Europe are moving to discourage non-therapeutic circumcision, the US, one of the few countries that performs routine non-therapeutic non-religious circumcision, keeps trying to find a health or economic justification to perpetuate the cutting cycle.