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.”

ILLINOIS: The AAP gets letters

Pediatrics
April 3, 2013

The AAP gets letters

The American Academy of Pediatrics' journal, Pediatrics, has published three eletters opposing its Circumcision Task Force's reply to the 38 senior European critics of its 2012 policy statement. But it has published them in two different places.

This one is at "published letters"

Smoke and Mirrors

Christopher L. Guest, Co-Founder
Children's Health and Human Rights Partnership

In response to concerns raised by Frisch et al, the task force seems reluctant to concede any meaningful sensory function to the human prepuce whatsoever. It is astonishing that members of the task force are able to appreciate that the prepuce is richly innervated and contains Meissner's corpuscles, but they are "unable to speculate about the effect that circumcision might have on sexual function or pleasure." Surely the task force recognizes the obstinate relationship that exists between structure and function. Structure predicts function. Function is constrained by structure.

Histologic studies indicate that the prepuce is richly innervated and contains specialized corpuscular neuroreceptors. During erection, the prepuce retracts and everts to expose the erogenous internal mucosa to external stimulation. Does this not seem like a structure whose function is, at least in some way, related to sexual pleasure? Is it reasonable to speculate that the prepuce is more likely related to sexual pleasure than say, the Achilles tendon?

If members of the task force are unwilling to consider the effect that circumcision might have on sexual pleasure, parents should ask themselves the following question: "Do I think removing richly innervated tissue from my child's genitals is more likely to INCREASE sexual pleasure or do I think removing richly innervated tissue from my child's genitals is more likely to DECREASE sexual pleasure?" It seems rather disingenuous for members of the task force not to speculate about the sensory function of the prepuce but at the same time sanction its amputation. The response to concerns raised by Frisch et al is deliberately evasive - smoke and mirrors!

Conflict of Interest:
None declared

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This is published at "early"

A goldfish knows nothing about water

Hugh P. Young, Independent researcher

A goldfish knows nothing about water. The American Academy of Pediatrics Task Force on Circumcision is unaware of the peculiar circumcising culture in which it is immersed. For example, characters in American TV sitcoms may exhibit a casual vindictiveness toward the foreskin, or the man with one, that would cause widespread outrage if it involved race.1 American medical texts portray "normal" penises as circumcised, and may define the foreskin as "the part removed by circumcision".²

This unawareness permeates the Task Force's 2012 circumcision policy.³ Dr Frisch and 37 eminent European pediatricians, speaking for 22 pediatric associations, and for 17 countries from Iceland to Lithuania, have accurately pointed it out. The Task Force's reply amounts to "Tu quoque" ("You're another").

Those countries have "a clear bias against circumcision" the same way they have "a clear bias against parentally-elective infant toe amputation". They have no Task Forces on Leaving Boys' Genitals Alone.

The reply, like the policy itself, discounts the only study that actually attempted to measure the sensitivity of the foreskin itself, by ignoring its main, uncontested, finding: "male circumcision ablates the most sensitive part of the penis."⁴

The Task Force admits the role of the innervation of the foreskin in experiencing pain, but not pleasure. Frisch et al. do not need to "speculate" about it: they almost certainly have foreskins, or partners who have them. Human lips also "have nerve fibers". Whose first thought about those would be how to minimise the pain of lip-removal? Who needs proof that the nerves of the lips are intimately involved in the pleasure of kissing? To deny that a richly innervated structure, near the head of the penis, with a unique rolling action, is involved in sexual pleasure, is perverse. Impairing that pleasure was one of the purposes of circumcision, explicit for 1900 years until "medical" circumcision became customary and a generation had grown up that had never experienced sex unimpaired⁵

The Task Force now admits that the basic right to physical integrity is an important one, but it ignored that important basic right in its 2012 policy.

It contrasts the harm of being circumcised (without any measure of the worst of that harm, such as major complications and death) with a new, undocumented and unmeasured "harm of not being circumcised", but such harm could equally apply to failure to amputate any other less-than-vital body parts, such as the earlobes.

The Task Force offers no rebuttal to Frisch et al.'s substantive case, based on the AAP's own policy, that the diseases circumcision reduces (if the studies the Task Force cites are to be relied on) 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 original claim that "the benefits outweigh the risks" was made with no actual weighing. It is now nowhere to be seen, and goes undefended.

References

1. Young, H. "That Thing": portrayal of the foreskin and circumcision in popular media, in "Human Rights Under Assault: The Atrocity of Circumcision" (Springer 2008), and online at the Intactivism Pages

2. Roberts, A. The Complete Human Body, DK Publishing (2010): Guyton, AC, Hall, JE. Textbook of Medical Physiology Saunders (2000): McCracken, TO ed. New Atlas of Human Anatomy MetroBooks (2001)

3. American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics. 2012;130(3).

4. Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int. 2007;99(4):864-869

5. Philo of Alexandria, Of the special laws, Book I (ii), in Works of Philo, trans. F. H. Colson, Loeb Classical Library, 1937, Vol. VII, p. 105

Conflict of Interest:
I edit the Intactivism Pages ("Circumstitions")
[A video version of this letter is on YouTube.]

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This letter is published at both of the above sites:

Function follows form

Dennis C. Harrison, Independent researcher

The response of the AAP Task Force on Circumcision to the commentary by Frisch et al is marred by a lack of attention to detail and a disregard for elementary principles of biology. The Task Force asserts that "all of the commentary authors hail from Europe," when the affiliation of one of the authors, Noni MacDonald, MD, is listed as "Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada." A bit later the Task Force refers to the stance of "The Canadian Medical Society," a non-existent organization.

The authors dismiss four histological studies of the prepuce on the grounds that these studies "were not designed to correlate anatomic findings with physiologic or functional roles." It is true that the function of the prepuce has not been fully elucidated, but the link between form and function is an axiom of biology. It is reasonable to suppose that specialized sensory tissue at the business end of the penis serves a specific reproductive function. In the words of Sir James Spence, "nature is a possessive mistress, and whatever mistakes she makes about the structure of the less essential organs such as the brain and stomach, in which she is not much interested, you can be sure that she knows best about the genital organs..."[1]

1. Spence On Circumcision. Pediatrics 1965;35(2):220.

Conflict of Interest:
None declared

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 "...it 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