Thursday, March 21, 2013

ILLINOIS: AAP exhibits cultural bias in its denial of it

March 21, 2013

AAP Task Force reveals cultural bias while denying it

by Hugh Young

Last August, the American Academy of Pediatrics released its new circumcision policy in a flurry of publicity. The policy claimed that "the benefits outweigh the risks" (without actually comparing them). It fell short of recommending universal infant circumcision, though it was widely reported as having done so, and it recommended that insurance pay for this "non-recommended " procedure.

This week, Pediatrics published a rebuttal from 38 heads or spokespeople for the paediatric associations of Austria, Britain, Denmark, England, Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Sweden and the Netherlands, and senior paediatricians in Canada, the Czech Republic, France and Poland, accusing the AAP of cultural bias, and finding fault with its methodology, its conclusions, and its ethics.

The AAP has published their letter with a reply from its "Task Force on Circumcision" that just underlines the same cultural bias for which it was criticised. It basically says "You're another!" without noticing that leaving a child's genitals alone, doing nothing to them, is medically and ethically a different kind of thing from cutting part off.

They reveal their bias even while denying it: they refer to the whole penis as "uncircumcised" and discount the sexual value of the foreskin found by some studies because "the relevance to individuals undergoing circumcision during infancy was questionable." but with no consideration of their relevance to individuals not undergoing circumcision during infancy.

They falsely claim that "approximately half of US males are circumcised, and half are not." In fact, a chart in their own policy indicates the rate is more like 80%. This is in order that they can say "Although that [50:50 ratio] may lead to a more tolerant view toward circumcision in the United States than in Europe, the cultural “bias” in the United States is much more likely to be a neutral one than that found in Europe, where there is a clear bias against circumcision."

In fact, in Europe, the default position is to do nothing, simply to leave the child's body alone. No need for any "cultural bias" or any Task Forces on Leaving Children's Genitals Alone.

They go on "... a culture that is comfortable with both the circumcised penis and the uncircumcised penis would seem predisposed to a more dispassionate analysis of the scientific literature than a culture with a bias that is either strongly opposed to circumcision or strongly in favor of it."
In what mad world is the United States "a culture that is comfortable with" the whole penis when the Task Force won't even call it that? When a TV show can include nine negative references to foreskins and the men with them without exciting comment? (Positive references are virtually unknown.) To rebut the claim of the 38 that the foreskin has a sexual function, the Task Force says:

Members of the task force appreciate that the foreskin has nerve fibers: the task force clearly recommends adequate pain control for infants undergoing circumcision. However, the task force did not move beyond what these studies actually reveal (the foreskin has nerve bundles and pain fibers, the foreskin contains Meissner corpuscles, the inner surface of the foreskin resembles a mucous membrane) to speculate about the effect that circumcision might have on sexual function or pleasure.
The 38 European critics do not need to "speculate": its male members or their male partners will have foreskins. Of course the inner foreskin resembles a mucus membrane, because it is one - like the lips. The lips also "have nerve fibres". Whose first thought about those would be about how to minimise the pain of lip-removal? Who either doubts, or can find a study to prove, that the nerves of the lips are intimately involved in the pleasure of kissing? Who needs one?

The Task Force, both in its policy and this response to its critics, criticises the only study that actually attempted to measure the sensitivity of the foreskin itself by ignoring its main finding - that "male circumcision [removes] the most sensitive part of the penis."

They now admit that the critics' "argument about the basic right to physical integrity is an important one, ..." yet they ignored this important argument in their 2012 policy, and now they contrast it with a new, unmeasured and undocumented claim that " is also true that some males will be harmed by not being circumcised." By that reasoning, the man who had to cut his own arm off after it was trapped under a boulder in the desert was "harmed by not having had it previously amputated" but nobody would ever think that meant infant amputation should be given even a moment's consideration - yet this is just "to prevent zipper injury" writ large.

The Task Force says nothing about the critics' case, based on the AAP's own policy, that the diseases circumcision reduces are so rare, or of such late onset, or so readily prevented or treated, that circumcising infants to prevent them is a bad option compared to letting the child grow up to decide the fate of his own genitals.

Its claim that "the benefits outweigh the risks" is now nowhere to be seen, and goes undefended.

Earlier story


  1. The AAP policy was instrumental in passing the unconstitutional German law allowing non-therapeutic circumcision. Publication of the rebuttal was delayed while the AAP's Task Force on Circumcision prepared its reply. If the Bundestag had seen the rebuttal, their law might not have passed.

  2. Thanks Hugh!
    I think that even more can be said against the Diekema's attempted rebuttal.

    This controversy suggests two sorts of studies.

    1. Collect data on a range of foreskin and penis problems from urology practices in Europe, Canada, USA, Australia and New Zealand. Is being intact correlated with certain problems? How often is circumcision recommended? Carried out? Does circumcision solve the problem? Raise new problems?

    2. Construct a large (at least 20,000 subjects) stratified random sample of American and Canadian men. Interview these men about their medical and sexual histories. Perform a clinical examination of the genitalia. Interview their regular sex partners. Then carry out the sort of statistical analyses reported in Frisch et al (2012). Is circ status correlated with PE, ED, boring sex? Vaginismus in the female? Condom use? Just what do women think who have been in long term relationships with both kinds of men? What fraction of adult men have penises damaged by RIC? Just how many middle aged men find sex boring? How many younger men go about sex in a hard aggressive manner that women find off putting?

    If NIH funding for such studies is not forthcoming within 5 years, then I conclude that the USA medical authorities are guilty of bad faith.

  3. The first part of their reply makes no sense at all. In Europe circumcision is simply not part of the culture, that's why europeans can see it as only a medical procedure ; why would they be biased against a medical procedure? Americans on the other hand also see it as a cultural thing, a family tradition, and who wouldn't be biased in favor of their traditions if they are challenged?
    Their comment that boys are often exposed to STDs "before they can legally consent to a circumcision" sounds fallacious. With parental consent, can't you get a circumcision at any age?

  4. @Intruder: that routine infant circumcision in the USA is at least as cultural as it is medical, is precisely what the American medical establishment heatedly denies.

    The age of consent for sex is typically 16. We intactivists want prophylactic circumcision deferred until after the 18th birthday. So the window of opportunity" when sex is legal, but circumcision would not be, is all of two years. Are we to slaughter foreskins by the millions merely because of risks posed by a 24 month time window??

    @Hugh: I do not think that the Bundestag would have voted differently had the Statement of the 38 been circulated to the Bundestag membership. The German law is intended to prevent Israel from accusing Germany of latent antisemitism, and to avoid picking a fight with Germany's large Moslem population. At the end of the day, medical and sexual issues had nothing to do with it.

  5. RD makes good points, but it is clear from the AAP policy and this reply that they - like every other circumcising culture - are not used to thinking about circumcision as being open to any criticism, let alone the same criticisms as other surgery.