NEW ORLEANS: Intact America confronts Ob/Gyns at their conference

Intact America
May 4, 2013

Intact America Pickets Ob/Gyn Conference

Intact America's mobile banner at the ACOG conference
Genital autonomy activists have gathered in New Orleans to call on the American Congress of Obstetricians and Gynecologists (ACOG) to join the global medical community’s movement away from neonatal male circumcision.

Intact America held a press conference, placed an advertisement in the New Orleans Times-Picayune and used a mobile billboard, saying “Tell America’s Obstetricians – No More Circumcision.” The sign includes the message “His Body, His Rights” to underscore the organization’s human rights concerns. Approximately 70 activists were expected to take part in the demonstration, displaying banners, carrying placards, and handing out literature

Executive director Georganne Chapin said, "The leaders of ACOG apparently do not think their members – who, according to estimates, perform at least half of the one million circumcisions in the United States on unconsenting baby boys each year – should hear the arguments that have led medical authorities across the developed world to reject the surgery as unnecessary, inherently risky, and a violation of baby boys’ right to an intact body."

The ACOG rejected IA's application to rent space for an educational booth in the convention’s exhibition hall, saying male circumcision “is only indirectly related to women’s health and of only casual interest to members of ACOG.” So Chapin decided Intact America should communicate with ACOG directly.

“It is both sad and disingenuous that ACOG claims circumcision is of no interest to the very doctors who perform the surgery hundreds of thousands of times each year,” Chapin said. “It is also not surprising they have embraced the widely-discredited 2012 circumcision policy statement of the American Academy of Pediatrics (AAP)." That policy "lauded the benefits of circumcising infants, while admitting that evidence for such benefits is lacking, acknowledging that the risks have never been adequately studied, and ignoring the ethical problems inherent in permanently removing normal genital tissue from individuals who cannot consent.”

The AAP’s policy was endorsed by ACOG. In contrast, IA endorses the view of 38 international pediatricians, urologists and medical ethicists, whose response to the AAP is published in the its own journal, Pediatrics

“There is growing consensus… that physicians should discourage parents from circumcising their healthy infant boys,” the physicians say, “because non-therapeutic circumcision of underage boys in Western societies has no compelling health benefits, causes postoperative pain, can have serious long-term consequences, constitutes a violation of the United Nations’ Declaration of the Rights of the Child, and conflicts with the Hippocratic oath: primum non nocere: First, do no harm.”

“Intact America’s intent for this demonstration in New Orleans,” said Chapin, “is to make sure ACOG hears and understands the ethical quagmire they have put themselves into.”

SAN DIEGO: Universal circumcision not cost-effective

Ob.Gyn.News
June 14, 2012

Mandatory Circumcision Not Cost Effective for HIV Prevention

By Sherry Boschert, Ob.Gyn. News Digital Network
SAN DIEGO – Mandating circumcision in the United States would prevent 24 more cases of HIV than does the traditional optional approach to circumcision, but would increase costs by approximately $389 million, making it far less cost effective, an analysis of published data suggests.

The investigators assumed that the overall incidence of HIV in the United States is 27 cases/100,000 people and the lifetime cost of care for someone with HIV is $119,000, based on published data from government statistics and peer-reviewed studies. Using the $392 cost of a circumcision at their institution, they developed computer-generated estimates of the cost-effectiveness of mandatory or traditional circumcision strategies for various populations, said Dr. Sarah E. Drennan, a third-year resident in ob.gyn. at Ochsner Medical Center, New Orleans. [They also assumed that the reduction of heterosexually-transmitted HIV apparently found in three studies in Africa was applicable to the USA.]
 
For the overall U.S. population, mandatory circumcision would prevent 494 cases of HIV at a cost of approximately $790 million. Traditional circumcision – in which the parents choose whether or not to circumcise a newborn – would prevent 470 cases of HIV at a cost of approximately $401 million, she reported at the annual meeting of the American College of Obstetricians and Gynecologists.
[Only a handful of fanatics have ever suggested mandatory circumcision, and it is irrelevant to the study how 100% circumcision is achieved. It would be sufficient for their purposes to refer to "universal" circumcision. It would be illuminating for them to have considered no circumcision, since the rate of "traditional" circumcision is falling.]

The idea of mandatory circumcision policies in the United States has come up because of randomized, controlled trials in Africa showing that male circumcision reduces the risk of female-to-male transmission of HIV by 50%-60%, Dr. Drennan said.

She and coinvestigator Dr. Rajiv Gala, also of the Ochsner Medical Center, conducted the current analysis to account for key differences between the two geographical regions. HIV is spread mainly through heterosexual contact in Africa and by intravenous drug use or men having sex with men in the United States. The prevalence of HIV is 5% in sub-Saharan Africa and 0.6% in North America.

The study also compared the two strategies in the United States among African American and Hispanic populations, who have lower rates of circumcision and a higher prevalence of HIV, compared with the population as a whole. Traditional circumcision was the more cost-effective strategy in those subgroups too, although not as strongly as in the population as a whole, she said.

For African Americans, mandatory circumcision would prevent 1,878 cases of HIV at a cost of approximately $816 million. Traditional circumcision would prevent 1,807 cases of HIV at a cost of approximately $613 million.

For Hispanics, mandatory circumcision would prevent 472 cases of HIV at a cost of approximately $792 million. Traditional circumcision would prevent 435 cases of HIV at a cost of approximately $342 million.

"Given the U.S. incidence of HIV, recommendations for mandatory circumcision are not supported" and require more U.S. studies on the role of circumcision in HIV prevention, Dr. Drennan said.

Circumcision would have to cost a mere $2.90 for the two strategies to be equally cost effective in tmillion/case for the two circumcision strategies to be equally cost effective in the general population.

The topic has generated controversy in recent years as the Centers for Disease Control and Prevention was said to be considering recommendations promoting routine circumcision for HIV prevention. The CDC still is considering what might be recommended, but any recommendations will be voluntary in nature, according to the CDC website.

The analysis was limited by a lack of data from randomized clinical trials and by the subjective nature of measuring behavioral risk, she said. The study also did not consider adverse events associated with circumcision or other health benefits other than prevention of HIV.