Wednesday, January 6, 2010

I Guess I'll Post It . . .

First of all, thanks to all the people who commented on my last post. I'm glad you took the time to say something. :-) For the record, I've no intention of leaving the blogosphere any time soon.

Now I've been debating about posting the following since last night. I don't think it's really meaningful of me to post it as I doubt I'll change any minds here, but I'm going to post it anyway after talking to a couple other bloggers online. So I guess I'll post it . . .

You see, I get the AMA (American Medical Association) Morning Rounds - basically, their daily newsletter emails. Yesterday I read an article that really bugged me. So I wrote a rather involved comment in response to it, only to find out that I have to be a subscriber for my comment to be seen. Thanks a lot Wall Street Journal. -_-

Anyway, here's the "blog-friendly" version:
The article:
Should Pediatricians Recommend Routine Circumcision?

My would-be comment:
"I'm rather appalled at the bias in this article, particularly from such a reputable reporting source as the WSJ.

As a former MPH (Master's in Public Health) student in epidemiology, and currently a medical student, I don't understand how people in the field can truly translate those studies to the US population. The results of those African studies haven't been replicated in the US and observational studies can be risky to base policy on.

In fact, a study sometime in 2007 found no significant protective factor between circumcision and US men. Read here.

Furthermore, a 2008 New Zealand study on birth cohorts (groups followed since birth) of circumcised and uncircumcised men found no significant difference in protecting against STIs. Read here.

Do we discredit such studies? One done in the US and the other done in New Zealand, a country whose demographics are much closer to that of the US than Africa?

And the American Cancer Society reaffirmed in 2009 that "Most experts agree that circumcision should not be recommended solely as a way to prevent penile cancer." Read here.

Also, healthy infants do die every year from circumcisions, even in Western developed countries like the US and the UK. Infants are so vulnerable to bleeding and infection immediately after birth, why would we risk their health during that time? Even if such deaths are rare, they do happen. But when they do, one must wonder, "Would this child have lived a full, healthy, and perfectly normal life had he not undergone that surgery?" The answer is most likely "Yes."

State details safety lapse at Beth Israel
Baby bled to death after circumcision, inquest said
Four year old in hospital due to messed up circumcision

Lastly, why isn't the US looking and comparing against policies from other more similar countries such as Canada, the UK, and Australia to see what their policies are and the health outcomes of their male children? Medicine isn't country-specific, and people are people everywhere you go. Social, cultural, and economic situations vary - but that makes it all the more important to compare with a population that's more similar (e.g. Canada) than dissimilar (e.g. Africa).

Statement by the British Medical Association (BMA)
Statement by the College of Physicians and Surgeons of British Columbia
Statement by the Royal Australian College of Physicians (RACP)

There are many many points I haven't even touched on, but the above should be an alarm to caution in approaching this controversial issue. I fully support the AAP's current position on the matter, neutral though it is. Until a study done in the US with a US population to definitively show that circumcision works better than, say, condoms and safe sex programs at reducing STD rates, I will remain a skeptic. Until a study like that done in Africa can be replicated in the US with just as high an efficacy, I will remain a skeptic. The former is ridiculous and the latter is unethical. So I will just say that there's no such thing as prophylactic surgery on infants and children, especially without their consent (an issue I haven't even touched on)."
So think about it and feel free to comment, or even challenge and flame me (if you dare, lol). But I suspect the above words largely fall on deaf ears (or blind eyes, I suppose) of those who don't care one way or the other anyhow, or are set in their opinions.


Biki said...

All baby boys should be left intact! Enough said!

Thank you for bringing this topic to our attention!

Just said...

I think it should be left up to the parents but base on information base on facts not the garabage out there. Only the U.S. is behind most oversea countries don't do this ... I seen the good and bad in it .. but was kinda of pushed into cut my son... Lee P.S. Aek I am thrill to know you not going anywhere ... for a while .. thanks ... Lee

naturgesetz said...

Too bad you couldn't get that comment published on the relevant blog. It makes perfect sense to me.

What this whole business shows, especially if the AAP changes its position to be one in favor of circumcision, is that these professional groups do not base their positions on genuine science.

Ryan said...

I only have two things to say...

As a man who wishes they hadn't cut him, I wish they would do like most other countries and leave it on.

And as a interested blogger... how does circumcision effect STD rates? I mean whether its on or off they are still gonna have sex!

Thanks for the post,

Pilgrim said...

You forgot France, Belgium and Germland! :-) Propz Pilgrim

Ian said...

Great article

Anonymous said...

apparently I am more juvenile than all of you, because this part made me giggle:

"There are many many points I haven't even touched on"


love this blog, doc

uncutplus said...

Thanks, Aek!

I have been preaching this from my blog for the last 6 months.

It makes me feel so good that a young man going into medicine, possibly to become a pediatrician, wants to get the word out about leaving baby boys intact.

I invite all your readers to visit my website for a lot of information about circumcision and why it is NOT the right thing to do!


Keep up the great work in medical school and on this blog. I especially appreciate it.


R. Burnett Baker said...

I'm with you on this. Thankfully, I have no memory of the procedure since it was performed on me at birth, but I've always been curious as to why. My family came from no particular religious background that would have them "insist" on circumcision. I wonder how many people do this to infants just because...?

I appreciate the common sense you bring to your studies, research, and conclusions.


Ron said...

dude you've written it already so you should post it. when you told me that you had a comment about that article i didn't know it was gonna be this in-depth lol, so yes now i think you should put it up and hopefully someone will read it ;)


Dave83201 said...

All this talk of foreskins makes me wish I had one to play with. Saddly, my own is long gone, so can you recommend another I might try tugging on?

Anonymous said...

*prefers uncirc'ed guys...* >_>

Anonymous said...

Anon MD

As an epidemiologist myself, I find your comment that the fact the studies were conducted in Africa negates their applicability to the United States. Do cigarette smoking studies in England only apply to England? Absolutely not. The fact is a randomized trial confirmed the impact of circumcision. At this point, given the size of the effect, I doubt any further trials, in the US or elsewhere, would be considered ethical. It's about time those opposing circumcision (and I won't read motives into their advocacy) acknowledge that the data suggesting circumcision is protective from HIV are compelling. After all, the data are pretty compelling.

Anonymous said...

Anon MD here again:

You'll also find that many, if not most. of the things you do as a physician are backed by far less data indicating their efficacy than the data on circumcision and HIV infection. Do you plan to not practice the standard of care even if there's data to support its use? Or if the data only come from Europe, Japan, Africa, etc? I doubt it. After all, there's precious little data to show that coronary care units are efficacious, but they used in almost all cases of heart attack. If there were a trial showing the efficacy of coronary care units in Uganda, say, would you be as skeptical about the use of coronary care units in the US?

As I suggested, I have to wonder if there isn't some sort of hidden agenda.

Anonymous said...

Anon MD (last comment, I promise):

Let's change the situation to AZT. When AZT was first available, there was less data to support its use than that for circumcision, and the data were from the US, nowhere else (and there's never been a randomized trial of AZT in Africa). AZT does nasty things to bone marrow and liver, so unlike circumcision, it has significant risks associated with its use. If you were a physician in Europe at that time, would you insist on European data before prescribing AZT for your AIDS patients? What about if you were in Africa? If you prefer, we can shift the discussion to chemotherapy for lung cancer or a variety of other conditions with prognoses similar to AIDS when AZT came out--and the risks to the patient are far greater than those of circumcision.

Aek said...

Biki: You're welcome.

Just: I'm sorry you were pushed into having it done on your son. There should never have been coercion - that's a misuse of the power society has given doctors.

naturgesetz: Yes, alas. These groups do their best to base their decisions on science. The question is, is it good science or bad science? And that can be very difficult to sort out.

Ryan: I wish you had a choice too. :-( Depending on the study you read, circumcision either does or does not have a significant effect on reducing STD rates. Yes, people are going to have sex anyway. And when you have unprotected sex, you're at risk anyway. The "hope" is that if you're going to have unprotected sex, being circumcised might give you a "slightly" lower chance of getting an STD. But again, there's no agreement in the medical literature and it depends on which papers you read.

Pilgrim: Well, the vast majority of Europe goes without question! Choosing just one example should be "representative" enough. :-P

Ian: Thanks.

goleftatthefork: Lol, I'm glad you giggled? o_O

uncutplus: I never much liked the word "preaching." It reminds me of the hell-callers on street corners who condemned passerbyers that they're all going to hell. That said, I thank you for your comment.

R. Burnett Baker: You know, I think your sentiment is rather typical - if not for religious reasons, why was it done? I've been practicing only/mostly safe sex my entire adult life? Why couldn't I be trusted to take care of myself? And yes, a lot of people do do this "just because," which is a horrible reason, imo. Surgery is surgery and you don't do surgery just because.

Ron: I posted it here! I'm not spending money on subscribing to the WSJ just to post a one-time comment. :-P

Dave83201: Aww, I'm sorry. Find someone else's to tug on. Maybe there's a slight possibility your new bf still has his? o_O

James: Good for you. :-)

Anon MD: You always have such lengthy comments that compel me to respond just as insightfully. Again yours deserves its own proper post.

. said...

Hey Aek, as always a well written and thought provoking article. I'd have to say leave it uncut at birth but that's just me. I'm cut. I'll write more soon!! Have a great weekend and stay warm!!

Mark Lyndon said...

You posted a link to the Statement by the College of Physicians and Surgeons of British Columbia, but you may also be interested in these links from the CPS:

Canadian Paediatric Society
"Recommendation: Circumcision of newborns should not be routinely performed."
"Circumcision is a 'non-therapeutic' procedure, which means it is not medically necessary."
"After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.