HEIDELBERG: Germany-born US babies still at risk

Stars and Stripes
July 23, 2012

German court's circumcision ban does not affect US military clinics

By Nancy Montgomery
HEIDELBERG, Germany — U.S. military doctors will continue performing circumcisions on male infants when parents request it, officials say, despite a controversial German court decision that banned the procedure as inhumane.

The June decision by a court in Cologne applies only in that jurisdiction, not in any of the German states in which U.S. military clinics are located, said Ed Rohan, a spokesman for Europe Regional Medical Command.

“If another jurisdiction in which we have military treatment facilities were to pick up the same legal reasoning, there is a possibility that it would apply to health care providers” there, he said.

“At this point they will continue to perform circumcisions, but our legal experts will continue to follow this issue and provide advice based on any other court or legislative actions,” Rohan said.

U.S. facilities may be among the few places now in Germany to do the procedure that removes some or all of the foreskin from the penis. After the June court ruling, the head of Germany’s medical association said he was advising colleagues throughout the country against performing circumcisions to avoid any risk of criminal prosecution.

Even before the ruling, however, many German pediatricians would not perform them.
“For example, in Heidelberg, all circumcisions (on Americans) are performed in the Army Health Clinic. But in Stuttgart, about half were performed by host nation providers in the local community,” Rohan said.

Rohan agreed that the ruling had muddied the legal waters surrounding the procedure, which has never been embraced in Europe, but since the 1900s had been done on the majority of U.S. male babies.

Teams of U.S. and German lawyers had been discussing the implications of the court ruling, Rohan said, and had “reached varying conclusions as to its impact” on U.S. military facilities, he said. “The general consensus, however, is that we will not see a wave of prosecutions based upon this singular and narrowly applied interpretation of law.”

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It’s not the first time circumcision has been subject to restrictions in Europe.

In 2001, Sweden passed a law allowing only people certified by the National Board of Health to circumcise infants. Swedish Jews and Muslims objected to the law and the World Jewish Congress called it “the first legal restriction on Jewish religious practice in Europe since the Nazi era.”

In 2006, a Finnish court ruled the circumcision of a 4-year-old boy to be an illegal assault, but in October 2008 the Finnish Supreme Court ruled that the circumcision, “carried out for religious and social reasons and in a medical manner,” was not criminal.

The swiftness of the German parliament’s response seeking a law allowing circumcision is attributed to the sensitivity surrounding Germany’s Nazi past.

Circumcision rates vary throughout the world. The U.S. has had one of the highest rates: The conventional view was that a foreskin-free penis was healthier and cleaner. But the procedure became increasingly controversial, with some arguing that it was a sort of mutilation that conferred few benefits and caused harm, such as pain to the baby and later decreased penile sensitivity.

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Rohan said circumcision rates in the U.S. were falling, from some 63 percent in 1999 to 54.5 percent in 2009. The German circumcision rate is about 20 percent, he said. [That sounds improbably high.]
In 2011, 518 boys were born at Landstuhl Regional Medical Center, officials there said, and 145 of them were circumcised [only 28% - much lower than in the US] shortly after birth, which is when doctors say it is least traumatic [- contrary to the evidence].
 
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Earlier story

DENVER: Colorado Medicaid will not resume funding circumcision

Health Policy Solutions
May 5, 2012

Circumcision bill dies in Colorado House

By Katie Kerwin McCrimmon
A bill that would have restored Medicaid funding for circumcisions in Colorado died Friday.
The measure squeaked through a hearing in the House Health and Environment Committee on Thursday, then died in Appropriations Friday morning.

Opponents, who included health professionals, budget hawks and anti-circumcision activists told health committee members on Thursday that circumcision is cosmetic and potentially harmful, and taxpayers should not fund it.

Proponents for the bill argued that funding for circumcision for babies on Medicaid is a social justice issue. In general, insurance companies pay for the procedure for insured Colorado babies even though the American Academy of Pediatrics does not deem circumcisions to be “medically necessary.” Meanwhile, low-income parents who want their babies circumcised are being put on waiting lists for the procedure until parents can prove they’ve paid in advance.

Sen. Irene Aguilar, D-Denver, an internal medicine doctor for Denver Health, testified on behalf of restoring public funding for circumcision. Last year, Colorado lawmakers decided to save money and cut funding for Medicaid circumcisions. They were following the lead of 17 other states. Proponents wanted taxpayers to once again pay for the procedures for parents who choose to have their infants circumcised.

Fiscal analysts estimated that covering the procedures again would cost the state about $195,000 next year and $230,000 the year after that.

“As a physician, I don’t try to influence parents one way or the other,” Aguilar said. “People make this decision based on religious and cultural reasons.” [What business does a doctor have performing surgery based on religious or cultural reasons? (Answer: good business....)]
 
She said that there is some evidence that infant boys who don’t get circumcised have higher rates of urinary tract infections and that adult men who are uncircumcised and live in poverty tend to have increased rates of HPV, which can lead to higher rates of cervical cancer in female partners.

Only one other doctor testified on behalf of circumcision. The rest of the witnesses opposed public funding for the procedure for a variety of reasons.

They included Dr. Jennifer Johnson, a family physician who works with Medicaid and uninsured patients at Clinica Family Health Services.

“I’ve done at least 100 circumcisions and just recently decided to stop,” Johnson testified.

She said she and her husband, who is Jewish, decided not to circumcise their own son, who is now 4. She said she was concerned when she researched the issue and found that removing the foreskin from a boy’s penis damages numerous nerve endings. While circumcision is traditional in the Jewish community, Johnson said her husband was open to new research about the potential harms from circumcision.

If boys or men decide to remove the foreskin as adults, then they can make that decision, Johnson said. But she decided that as a physician, she should no longer do a procedure that is “potentially harmful.”

“This is not a necessary procedure,” Johnson said. “It’s a healthy, normal body part.”“There are a lot of medical needs in our population. We have no business using limited health care dollars on a medically unnecessary cosmetic procedure.”

One lawmaker, Rep. Sue Schafer, D-Wheat Ridge, elicited laughter in the hearing room when she asked Dr. Johnson if circumcision might help reduce teen pregnancy rates and teen sexual activity by reducing nerve sensation in boys’ penises.

“I’m wondering if there’s a risk of more sexual activity, more male irresponsibility” for uncircumcised boys, Schafer asked.

 [Rep. Janak Joshi, R-Colorado Springs, looks incredulous at Rep. Schafer's question.] Joshi, a retired doctor, voted against restoring circumcision funding, saying circumcision is uncommon in India and he's never seen infections due to lack of circumcision.

Johnson answered that teen pregnancy is certainly a problem, but said circumcision won’t halt teen sexual activity.

“Circumcision is not a cure for behavior. That’s about education,” she said.

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While circumcision is an ancient tradition in some religions, circumcision opponents said it became popular in the U.S. as a method to prevent masturbation among boys. Later, fathers wanted their sons to look like them.

“Frankly that’s cosmetic surgery…and I strongly urge you to vote against it,” said Dr. Matt Mason, a physician from Telluride. He was skeptical about cost estimates and said circumcision is now rare in Western Europe, Canada and New Zealand. [Circumcision has always been rare in Western Europe.]
 
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Earlier story