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Norm Cohen
NOCIRC of Michigan

Pediatricians Plea to Protect Payments for Circumcision

The American Academy of Pediatrics’ new 361-word opinion on circumcision overstated the hypothetical benefits, understated the risks and complications, and ignored the obvious physical damage visible in this radical change of the penis. 

by Norm Cohen

On the other hand, the AAP’s 32-page technical report that accompanied the policy statement can actually be read as an argument against circumcision, given that it acknowledged the effects of circumcision are limited, inconsistent, and risky.
 
Here is my own brief summary of the technical report that accompanied the Circumcision Policy Statement released in August 2012 by the AAP Task Force on Circumcision:
 
Someday, a boy may or may not get a disease if he is not circumcised, and someday he may or may not get a disease if he is circumcised, and the difference due to circumcising him is so small that we can’t even recommend that all parents should have it done, even after spending five years looking for the research findings that agreed with our preference, unless parents, for whatever reason, also have the same preference, in which case the government or insurance companies should pay us doctors to do it.

Oh, and by the way, we don’t know the purpose of the foreskin that we’re cutting off, and we’re not sure how often the surgery goes bad.
 

Underwhelming Benefits

Over five years after the publication of studies that claimed circumcision prevented AIDS, the AAP finally issued a revised policy statement. This hardly makes circumcision a compelling means of AIDS prevention. The related technical report is a weak case for performing this surgery on newborns using benefits that are all speculative rather than actual. The evidence for these benefits was underwhelming enough that the Task Force did not recommend circumcision for universal adoption, even after reviewing over 1,000 journal articles on the subject and finding what it already agreed with. 

We read in the full report that surgical complications are not tracked, that the functions of the foreskin are not well studied and poorly understood, and that the hypothetical benefits are remote both in time and in the possibility of achieving them in any given individual.

The AAP Task Force failed to explain why having a foreskin is the direct and unavoidable cause of any disease. The cost-effectiveness of the procedure was not demonstrated due to the large number who must be circumcised, the inconsistent results, and the complications that are certain to occur. Not a single benefit of having a foreskin was mentioned. Normal foreskin anatomy, development and functions were skipped or cited as abnormal and a risk factor.

The Task Force admitted that “the medical benefits alone may not outweigh other considerations for individual families,” but that “the benefits of newborn male circumcision justify access to this procedure for those families who choose it.”

The new AAP policy is an insurance reimbursement policy, not a circumcision policy. Because the AAP does not make a clear recommendation for routine circumcision, its statement reads like an appeal to get insurance payments for parents who, for whatever reason, have already chosen the procedure for their child.


“This AAP statement has been graded by almost all other pediatric societies and associations worldwide as being scientifically untenable . . . cultural bias reflecting the normality of non-therapeutic male circumcision in the US seems obvious, and the report’s conclusions are different from those reached by doctors in other parts of the Western world, including Europe, Canada, and Australia.”
 
Dr. Wolfram Hartmann
President of the German Association of Pediatricians


This article is continued online ->


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Nicole Lennox, Norm Cohen, and Mary Taylor staff the NOCIRC information table at Dally in the Alley 2012, Detroit, Michigan.
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