Wednesday, August 15, 2012

ILLINOIS: New AAP policy may lean toward cutting

Washington Post
August 14, 2012

Circumcision, long in decline in the U.S., may get a boost from a doctors’ group

and Bangor Daily News
August 14, 2012 as

Circumcision waning in popularity as ‘intactivists’ denounce practice

By Michael Alison Chandler
When Tamar Jacobs became pregnant, she found herself hoping for a girl, mainly because she was dreading a difficult rite of passage that often comes with the birth of a boy — circumcision.

Growing up Jewish in Baltimore, “I never really questioned it,” she said, but the more she read and thought about it, the more “unnecessary and even cruel” circumcision seemed. By the time the grainy 20-week sonogram showed the outward sign of an XY chromosome, she knew she could not go through with it.

“It seemed like such a severe, out-of-this-time thing to do,” she said.

The 32-year-old fiction writer and community college professor is part of a new wave of parents who are questioning not just an ancient Jewish tradition but a long-entrenched American one.

More than 1.2 million infant boys undergo the surgery each year, making the United States one of the industrialized world’s leading producers of circumcised men. But the once ubiquitous practice, in which the foreskin is removed from the penis, is waning.

From a high of about 80 percent in the 1960s, the portion of baby boys leaving hospitals with petroleum-jelly-covered wounds in their diapers dropped to 56 percent in 2008, according to the Centers for Disease Control and Prevention. (The figures do not include those circumcised in outside clinics or by religious providers.)

The downward trend is probably fueled by Medicaid laws in many states that have stopped paying for the surgery, increased immigration from Latin America and other areas were circumcision is less common, and a growingly vocal cadre of so-called “intactivists” who argue that the practice is a human rights violation.

It also reflects a generation that’s more likely to trust nature and second-guess their medical treatment. For these parents, circumcision has become less of an assumption and more of a choice, and not always an easy one.

An expectant parent wading into the debate around circumcision is likely to discover a maze of medical research, white-hot rhetoric pitting children’s rights against religious freedom, and a choir of bathroom humor.

In interviews for this article, the untrimmed foreskin was alternately derided as an HIV-spreading “wrinkled elephant trunk” or heralded for its “elegant function” and thousands of pleasure-inducing nerve endings.

An uncircumcised California native described the embarrassed feeling of being the kid who looked different in the locker room, and an anti-circumcision activist explained how he spent the past decade trying to re-stretch his shorn foreskin and increase sensitivity in his penis by using a commercially available plastic cone that applies tension to the remaining skin.

Given the prevalence of circumcision, perhaps the most surprising perspective is one offered by American doctors, many of whom summarize the procedure as a “cosmetic” or “aesthetic” choice.

The American Academy of Pediatrics, which advises children’s doctors on research-based practices, has been officially neutral on the issue for more than a decade.

According to its 2005 position statement, which reaffirmed its 1999 stance, “existing scientific evidence demonstrates potential medical benefits” of newborn circumcision but not enough to “recommend routine neonatal circumcision.”

That position is poised to change, though, as the AAP is expected to release an updated statement and report reflecting recent research later this month.

While details are not yet available, the new position concludes that the health benefits of circumcision outweigh the risks, said Michael Brady, a pediatric expert at Nationwide Children’s Hospital in Columbus, Ohio, and a member of the AAP’s task force on circumcision.


The AAP’s new position falls short of a routine recommendation, Brady said, adding that parents should continue to take into account their own cultural, religious or social views. [Trading of the ambiguity of "routine". It would be mad to do it so routinely that parents weren't consulted - Brady's meaning.] “But from a public health perspective, I think it’s a good decision and a lot of children will benefit.” [Since circumcision isn't claimed to prevent any contagious diseases of childhood, how is it a public health issue?]

‘A human right’
Many people, however, question the safety and ethics of using surgery to prevent disease. Some opponents liken it to using mastectomy to prevent, rather than treat, breast cancer.

At last month’s AIDS conference in Washington, protesters displayed signs outside the Walter E. Washington Convention Center that read “Circumcision is torture” and “Intact genitals are a human right.”

Activists traveled from Norfolk, Boston and New York to hand out condoms as a safer way to contain the virus. They challenge the relevance of the African studies in the United States. And they argue that men, not their parents, should be able to choose what to do with their genitals.


“Things are starting to happen,” said Matthew Hess, president of San Diego-based, ...

Hess and other activists say a key challenge in their fight is countering denial among circumcised jmen who don’t want to acknowledge they have been victimized and among the parents and medical practitioners who have gone along with the status quo.

To cut a body part off a little tiny baby in cold blood, you have to [suppress] a lot of your natural instincts,” said Georganne Chapin, executive director of Intact America, a four-year-old organization opposing infant circumcision.


An estimated 30 percent of men are circumcised around the globe today,... That includes North Sudanese boys circumcised at age 8 (using a cord and a knife) before they can enter school as well as 2-day-old American-born boys clipped [sliced, actually] at the hospital using a clamp — sometimes compared to a “cigar cutter” — and some local anesthetic. [The cigar-cutter-like Mogen clamp is no longer manufatured in the US.]

Starting in 1971, the American Academy of Pediatrics ruled and then periodically reaffirmed that there was no medical imperative for routine circumcision for babies.

Medical ambivalence [distaste, actually] curbed the practice of nonreligious circumcision in some Western countries, including Canada, New Zealand and Australia, over the past half-century. In Britain, national health insurance after World War II opted not to cover it, and the circumcision rate plummeted.


A cultural alternative
Tamar Jacobs and her husband, Raymond Anthony Scott Lloyd II, who is not Jewish and is not circumcised, opted for a different path entirely.

They planned what they called an “alterna-bris,” or what some call a bris shalom (covenant of peace), with a secular rabbi. There was a traditional ha-motzi (blessing for the bread) and a kiddush (blessing of the wine) and a naming ceremony, where their new son, Ray, was given a Jewish name, Reuven, but there was no traditional cutting.

The hardest part was telling her parents. They were at first “a little taken aback,” she said, “worried that somehow that would mean Ray would not be Jewish.’’

But they soon embraced the idea. They hosted the ceremony in their living room and baked challah and hundreds of cookies with their grandson’s name written on them.

“It was really cathartic to talk about some of these things. I think it got all of us thinking in a bigger way,” Jacobs said. “I feel like we are at the beginning of something exciting.”

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