September 1, 2012
E-letters to Pediatrics all critical of AAP policy
Three letters were published in Pediatrics, the journal of the American Academy of Pediatrics, before the weekend. All were critical of its circumcision policy:
Christopher R Lawson, Deputy Head
Sunshine Coast Clinical School, University of Queensland
Sunshine Coast Clinical School, University of Queensland
Among many basic errors of epidemiology, the authors do not even understand how to calculate Number Needed to Treat. (From p. e767: "Given that the risk of UTI among this population is approximately 1%, the number needed to circumcise to prevent UTI is approximately 100.")
Two of the referenced papers from which this figure was derived, written by investigators who do understand how to calculate NNT, found respectively that 111 and 195 circumcisions were needed to prevent one UTI. These data were reported in the abstracts.
Finally, for the authors to say "Most available data were published before 1995 and consistently show an association between the lack of circumcision and increased risk of UTI" and then arbitrarily exclude all data prior to 1995 is an unforgiveable design flaw.
This paper is epidemiologically incompetent and an embarrassment to the AAP.
EHR SIIS & Informed Consent Document Needed
Eileen M. Wayne, Director
InformedConsent.org, Inc. 501 C3
InformedConsent.org, Inc. 501 C3
I am an informed consent expert witness. I represent the patient, not the patient's parents, surgeon, pediatrician, or religious representative.
Surgery requires a chief complaint, abnormal physical findings, and a pathological diagnosis. It requires signed, legal, informed consent. ...
Surgery in general, & amputative surgery in particular, must follow the rule of "Severity of Illness, Intensity of Service." Starting with local therapy, progressing to oral, then intravenous therapy, all must be documented to have failed before contemplating amputative surgery. ...
AAP Circumcision Policy Statement and Technical Report
James W. Prescott, Ph.D., Developmental Neuropsychologist
BioBehavioral Systems
BioBehavioral Systems
It is not true that Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it.
The unresolved injuries and risks of inflicted pain have yet to be resolved ... . The analytic legal and judicial issues of inflicting pain upon an unconsenting person were not addressed ...
The forceable shredding of the foreskin from the glans--a fused biological organ in newborns and young children--is an act of torture, as is the stripping of the skin from the body is universally recognized as an act of torture that is prohibited by the Universal Declaration of Human Rights and the U.N. Convention on the Rights of the Child. a) No child shall be subjected to torture or other cruel, inhuman or degrading treatment or punishment
...
Judith Palfrey, M.D., Past President, American Academy of Pediatrics was compelled to renounce the AAP Bioethics Committee's policy statement on Ritual Cutting of Female Minors with the following statement: "The AAP does not endorse the practice of offering a "clitoral nick". This minimal pinprick is forbidden under federal law..." (17 May 2010).
The equal protection clause of the 14th Amendment to the US, Constitution extends the protection of PL 104-208 to male children ...
To affirm that FGM and not MGM is an act of torture defies reality and judicial rulings.
The American Academy of Pediatrics has misused its authority by not addressing the analytic legal, judicial, cultural and religious history of genital mutilation that has so influenced medical opinion and practices throughout human history and has corrupted its current and wrongful recommendations on circumcision.
There are no religious rights or freedoms to inflict harm or injury upon another person contrary to the history of religious traditions and medical history.
There are no parental or medical rights to the sexual abuse of newborns/children, which genital mutilation entails. FIRST, DO NO HARM
...
Another part of the Pediatrics website is also publishing responses to the policy. Yet another is here.
ReplyDeleteDr Michael Hoffman suggests "I would recommend that purely elective circumcision be done as a newborn, or deferred until a male can decide for himself at age 18 years or older." This hardly consititutes a recommendation, and redefines "elective". It deserves a reply, but I have already posted to each of the others.