New Article Finds Fault With The AAP’s Support for Circumcision, Provoking a Formal Response

“Human rights attorney J. Steven Svoboda and pediatrician Robert S. Van Howe, M.D. have published a new article in one of the world’s leading journals on medical ethics arguing that the American Academy of Pediatrics’ (AAP’s) position regarding male circumcision lacks credible support. The article, titled, “Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision,”http://jme.bmj.com/content/early/recent, is being published online today, leading off the latest issue of the Journal of Medical Ethics (JME). The US’ premier organization of pediatricians has already arranged for the JME to publish its response in what Svoboda and Van Howe view as an ill-fated attempt to justify the medically and ethically flawed arguments in its policy statement and technical report.

Svoboda and Van Howe criticize the AAP’s apparent cultural bias in favor of circumcision, which they note puts the AAP firmly out of step with world medical opinion on this issue. They argue that the AAP documents suffer from troubling deficiencies, ultimately undermining their credibility. According to the authors, these deficiencies include the omission of critical issues, biased use of the medical literature, and conclusions that are not supported by the evidence given.

Svoboda commented, “The AAP ignores so many important topics that it is hard to know where to begin. For example, the anatomy and function of the foreskin are not mentioned in their documents, even though they propose to cut it off without first considering the harm and pain that result from its removal. The AAP’s circumcision recommendations contradict its own bioethics policy statement, which requires pediatric care to be based only on the needs of the patient. Non-therapeutic circumcision is incompatible with widely accepted ground rules for surgical intervention in minors.”

Dr. Van Howe, a Clinical Professor at Michigan State University College of Human Medicine, said, “When physicians decide whether to do a procedure, they must, and normally do, exclude from their medical decisions non-medical factors regarding the parents’ culture. Contrary to what the AAP suggests, doctors are not cultural brokers. Their duty is promoting and protecting the health of their patients, not following practices lacking a solid ethical and medical foundation.”

Svoboda and Van Howe write that the AAP report suffers from being two-and-a-half years out of date at the time of its publication. They note that the last literature search was performed in April 2010 for a report published in August 2012. Svoboda and Van Howe write that studies that suggest benefits for circumcision appear in the technical report while at least one hundred studies that fail to support a benefit or that find detrimental effects of circumcision are left out. The authors add that the AAP also cherry-picks information from within the articles it cites, selecting bits of language out of context that lend support to its position while often ignoring contradictory data.

Svoboda commented, “The response to our article by the AAP Task Force calls for avoiding an ideological agenda. When European authorities agree that cultural bias rather than scientific fact is driving the AAP’s position, I would suggest that our only agenda is ethical and medically sound care for infants and young children. The AAP fails to raise any substantive argument pointing to either evidence or reasoning about which we are mistaken.”

The AAP itself concedes, Svoboda and Van Howe write, that the there are vast differences between HIV transmission to adults in Africa and to children in the US. In Africa, the authors observe, one of the most likely places to contract HIV is in a health clinic. Svoboda observed, “The US has the highest rates of circumcision, of HIV, and of other sexually transmitted infections in the industrialized world, so the chance that the first can prevent the other two seems extremely remote.”

Svoboda asked, “Why is the AAP promoting public funding for an unnecessary and harmful surgery when we find ourselves struggling even to provide basic care for all our children? In these days of rising medical costs and scarce resources, we simply cannot afford to continue to carry out such a harmful and outmoded practice.”

While the AAP attempts to paint itself in its reply in the JME as being in line with world medical opinion, in fact, as noted by Svoboda and Van Howe, the AAP has put itself in a shrinking minority in attempting to justify an outmoded cultural practice that results in the death of more than one hundred boys each year. Even the American Medical Association agrees that there is insufficient justification for performing the procedure on newborns absent specific medical indications. Unlike the AAP, its peer organizations in Europe and also in Australia, the United Kingdom, and Canada recognize that medical considerations must be considered in conjunction with ethical and legal considerations and therefore, male circumcision should be neither recommended to parents nor funded by government insurance systems.

A few months ago, the Royal Dutch Medical Association favorably cited an earlier version of Svoboda’s and Van Howe’s article, noting that even if benefits do exist the procedure can safely be delayed until the boy himself can make the decision.

The JME considers the issue of male circumcision important enough to have devoted an entire special issue to the topic, including a second article by Mr. Svoboda on male circumcision and human rights, and a second article by Dr. Van Howe about male circumcision and parental rights.

Svoboda and Van Howe’s article appears at a similar publication date with a commentary to appear in the AAP’s own Pediatrics by thirty-eight leading European medical authorities, who have independently reached a conclusion consistent with Svoboda and Van Howe’s in criticizing the cultural bias in the AAP’s two documents.

After graduating from Harvard Law School, Svoboda founded the human rights organization Attorneys for the Rights of the Child (http://www.arclaw.org) in 1997 to safeguard children’s right to bodily integrity. In Geneva in 2001, Svoboda and ARC first placed male circumcision on the official United Nations record as a human rights issue.”  – original article found here

A Man Confronts His Circumciser

Watch this very powerful video. Anthony Losquadro describes finding and confronting the man who cut part of his penis off when he was an infant. 2012 Genital Autonomy Symposium, Helsinki, Finland.


“So I asked him, when he turned the screw on the gomco  clamp and when I screamed out in pain, I asked him, ‘Did that make you feel like more of a man to do that to me, when I was eight pounds, as an infant?’ and he had no response…he had nothing to say.” – Anthony Losquadro.

Video Copyright by James Loewen.
Video on Bonobo3D’s YouTube Channel

Why Circumcision Does NOT Slow The Spread of HIV

The average person clearly would know that the practices of safe sex, monogamy, and knowing one’s HIV status are by far the most effective ways of slowing the spread of HIV. Proponents of circumcision have long touted that male circumcision offers the man up to a 60% chance of protection from contracting HIV through the infected female partner.  Russian Roulette anyone?  This definitely has given men, in Africa, a false sense of security.  They think because they are circumcised, that they are immune to contracting HIV, therefore they have unprotected sex with women who may possibly be infected.  That is what I call playing Russian Roulette.  The man may not contract HIV the first time, but he may contract HIV by the second or even third encounter with an HIV infected partner.  As I said before, CONDOMS, other safe sex measures, proper sex education and easy access to HIV testing are by far the most effective ways of combatting the spread of HIV!  Did you know that in Africa, where they have started a campaign to encourage as many men as possible to get circumcised, they still tell the men that they must wear condoms even after having their foreskins severed from their penis?

Just to highlight some key points from the three randomized controlled clinical trials in Africa; the three controlled trials were terminated early because in a separate experimental group, results showed reduced HIV infections, but it was too soon to learn the long-term effectiveness.  The trials didn’t involve any relevance for women or for men who have sex with men.  Also, a number of participants who were HIV negative contracted HIV from nonsexual sources! 23 of the 69 infections reported in the South African trial and 16 of the 67 in the Ugandan study. The researchers responsible for the trials did not want the public to know this information. These are just a few highlights regarding the flaws of the studies and trials in Africa.  Below, you will have a chance to read the complete report, with proper citing.

“Both the U.S. and sub-Saharan Africa have relatively high incidence rates of HIV infection, considering that about 75% of U.S. men and about 70% of sub-Saharan African men are circumcised – higher percentages than in most other regions or countries with lower prevalence of HIV” – www.measuredhs.com

According to the American Journal of Preventive Medicine and its publisher, Elsevier Inc, the following content you are about to read is intended for health professionals.  In accordance with the Fair Use Act of the United States, I am hereby sharing the information with you.

Please click on the evidence tape image below to read
“Male Circumcision and HIV Prevention – Insufficient Evidence and Neglected External Validity.”

A Nursing Student is Introduced to Circumcision

The Whole Network posted a story about a nursing student who was introduced to circumcision. Visit the story here. Below are quotes from the author.

“The nurse then layed the now naked infant down on a hard plastic body board and strapped down his arms and legs. The baby was crying very hard now, trying to fight having his arms and legs strapped down in such a straight unnatural position for a newborn.”

“The doctor then draped the infant in surgical drapes which covered his abdomen and legs but exposed his penis. The doctor using a swab, rubbed a solution on the infants’ penis explaining what the solution was, and that it works to cause an erection on the infant so that he can grasp his penis easier.”

“Many parents aren’t properly informed of the procedure. It IS a very serious procedure with very many real risks involved. In my experience as a post partum nurse, many parents who were led to believe it was a ‘minor’ procedure and observed their sons’ circumcision, were sickened just as I was at the actual pain and distress it caused their infant. I have had many patients who, after witnessing their first son’s circumcision, decided immediately that they would not get any other boys they may have circumcised.”

Original story can be found here.

How Circumcision Affected Me; A True Story.

Ruffy writes, “I have a thought regarding circumcision and I just would rather share it here than suppress it, especially since it’s just been growing in my mind and consuming most of my thinking.

I’ve lived my life thinking I was normal. That appears to be how it works: they don’t tell you it happened. You’re expected to find out at a point in your life where you’re so deep in denial you won’t accept that circumcision isn’t natural. When I first found out about circumcision as a “rite to manhood” (by removing the “manhood”?), I hated it. I still thought I was natural at the time and even thought to myself “I’m glad I’m not circumcised.”

Interest led me to find out more about it and with a few images came questions. I found out that most boys in America are circumcised, and that horrific fact led me to ask my dad if I was, which he confirmed. Of course, when I asked for an explanation, he wanted to say as little as possible. Worst of all, and this is far from exaggerated: he said that it “had” to be done because it was “connected to the umbilical cord.” I was shocked by such an idiotic remark and asked him if he really thought I was that stupid and then even explained where the umbilical cord is actually connected. He wouldn’t try to explain himself any further.

Ever since, circumcision has been in the back of my mind. Just thinking about it causes mental and even slight physical pain (I’m sure you’ve felt something like that before). Thinking of the operation being performed on an infant, even if it’s a reference or if I just hear the sounds, I’ll feel the pain, I’ll cringe, I’ll have chills, and I’ll even wish I was dead sometimes.

Knowing that the operation causes brain damage as well really consumes me. I want to be normal. I at least want to think normally. The thought of my mind deep down being messed up in some way is horrifying. I often wonder if I’d have less aggression and be happier if I weren’t mutilated as an infant. I’ve also wondered recently if that’s why I’m uncomfortable around guys. I don’t like talking to guys or being around them. It’s like I’m subconsciously scared of them.

All of this makes me think circumcision has ruined my life. I know it has, but the extent appears far worse every day. It’s literally hell in my mind. I sleep most of every day away now.”

[Editor's note] – Ruffy, we want to let you know that we are here for you.  Although we cannot undo the harm done to you, we are here for social, mental and emotional support. There are many of us who too underwent infant circumcision.  Some of us cope with our loss in different ways than others.  Some are starting to restore their foreskins, others find that talking about their experiences with others helps them out emotionally.  Your story will help save other babies, and they’ll have you to thank one day — cause you made a difference. – ERIC.

A Circumciser’s Kiss of Death

Reposted from New York Post.

“Two children are dead, more are injured — yet a group of ultra-Orthodox rabbis say they plan to defy a health order in the name of religious freedom.  Less than a year after a Brooklyn tot died following an ancient circumcision ritual, the rabbis say they will ignore a proposed law that would mandate parental-consent forms before performing the dangerous procedure.  Over the past decade, at least one other newborn died after contracting herpes from the rite, in which the rabbi draws blood from the penis with his mouth…The city’s law would require mohels to distribute consent waivers, detailing the herpes risk, before the ritual.  Rabbi David Niederman, executive director of the United Jewish Organization of Williamsburg, said no one will comply with the law, even if it’s passed…At least 11 babies in the city have contracted the herpes simplex virus since 2000 — and two developed brain damage and two died, according to a Health Department investigation.  In July, an Orange County infant was hospitalized after contracting a deadly strain of the virus.  Earlier this year, prosecutors were investigating the September 2011 death of a Brooklyn newborn at Maimonides Hospital from Type 1 herpes.”

Read the FULL article here.