March 24, 2013
AAP Circumcision Task Force fails again
by Hugh Young
In the latest
Journal of Medical Ethics, a
paediatrician and a lawyer have demolished the ethics of the 2012 American Academy of Pediatrics circumcision policy. (pdf may require opening in a reader to show the comments.)
They say the policy suffers from several troubling deficiencies,
including "...the exclusion of important topics and discussions,
an incomplete and apparently partisan excursion through the medical
literature, improper analysis of the available information, poorly
documented and often inaccurate presentation of relevant findings, and
conclusions that are not supported by the evidence given."
- Topics excluded:
- Anatomy and function of the foreskin
- Harm caused by its removal
- Biomedical ethics
- Human and children’s rights
- Incomplete and partisan survey of literature:
- Case reports, case series, ecological studies, reviews and opinions excluded
- Studies finding detriments from circumcision excluded
- Cost/benefit analyses that fail to find benefit ignored
- No North American STD or HIV studies (which consistently fail to find circumcision benefit)
- Cherry-picking from within studies
- Improper analysis:
- Internally contradictory statements
- Conclusions that do not follow from data
- No risk/benefit analysis (either of circumcision or intactness)
- Move toward recommending based entirely on three African HIV studies
- Poorly documented and inaccurate presentation:
- Ignores anti-circumcision findings within cited studies
- Gets numbers wrong, e.g. in cancer risk
- Discusses circumcision, but not Gardasil, to prevent HPV
- Fails to apply cost/benefit to UTI, the only early-onset risk
- Fails to consider cost of meatotomy
- Conclusions not supported by evidence:
- Third-party payment called for, yet still "elective"
- Doctors advised to be cultural brokers for parents
Accordingly, the critics say, the AAP should immediately replace its
policy with one reflecting such critical concerns as the functions of
the lost tissue, medical ethics and the importance of respecting
non-consenting children’s rights.
This is followed by
a reply by the Task Force
(pdf may require opening in a reader to show the comments) that
addresses none of the issues it raises, but just questions the tone of
opposition to circumcision in general, asking four times that criticism
to be "respectful".
This is essentially the fallacy of
Appeal to Authority.
The most disrespectful word in the Svoboda-Van-Howe paper is "myopic".
This repeated demand for "respect" ignores one of the major realities
of that case - that an increasing number of men are very angry that
this was done to them, and they resent the lack of respect shown for the
most intimate part of their bodies, for their individuality, their
privacy, their religious freedom, their sexuality, their equality with
women and for the security of their persons.
Nobody should be surprised when these men show disrespect toward those who stand by the ones who did that to them.
The Task Force claims to be "unbiased", unlike its critics, but it
has an inherent bias to which it is blind: it treats cutting a normal,
healthy, functional, non-renewing part of a baby's (and hence a man's)
genitals off as if it were equal and opposite to just leaving the baby's
body alone - when in fact it is is medically and ethically a different
kind of activity, with a different kind of consequences.
The Task Force ends its reply "It is our fervent hope that, through
the combined efforts of well-intentioned, open-minded researchers, we
will achieve greater understanding so as to better serve our young
patients."
The Task Force's melifluous, unctious tone belies its subject-matter,
cutting parts off babies' genitals - "patients" who have nothing the
matter with them. People from cultures where this is not a norm will be
baffled by the disconnect between the Task Force's words and its
actions.
