HESSE, GERMANY: Charges dropped against circumcising rabbi

Haaretz
February 24, 2013

German prosecutor drops anti-circumcision charges against mohel

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Court says Hof chief rabbi, David Goldberg, who was charged in 2012 after a Cologne court ruled circumcision illegal in Germany, satisfies child welfare requirements.

A statement by the Hof prosecutor on February 21 said that Rabbi David Goldberg of Hof satisfied all requirements regarding child welfare “which are not jeopardized by the circumcision,” the Jewish-German publication Jüdische Allgemeine reported.

“Circumcisions which are applied with the consent of parents or custodians are not subject to criminal liability,” the prosecutor added. [The prosecuter seems to interpret the new law retrospectively.]

Charges were brought against Goldberg last year after a court in Cologne ruled that circumcision was illegal in Germany. Goldberg, who has been working as a mohel in Germany since 1997, said he was very pleased the case was now closed and that there was clarity on the issue.

“I never had any doubts, I still performed circumcisions,” he said. "But I think this is very good news for parents who did have doubts, and for the entire Jewish community.”

The German parliament has since passed a new law allowing circumcision, with some restrictions.

Earlier story

NEW YORK: Metzitzah: Federal court upholds consent form

They just don't give up, do they?

Jewish Daily Forward
February 22, 2013

Federal Court Refuses To Block New York Circumcision Consent Form Law

Rejects Metzitzah B'Peh Motion Filed by Orthodox Groups

by Seth Berkman

Proponents of metzitzah b’peh, the controversial circumcision ritual, were denied a request for an emergency stay in the enforcement of a recent New York City law that regulates the procedure. The decision was handed down by the United States Court of Appeals for the Second Circuit.

The motion, filed by the Central Rabbinical Congress of the USA & Canada, Agudath Israel, the International Bris Association and a group of rabbis, failed “to meet requisite standards,” according to the court.

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Recent studies by the New York City DOHMH have revealed 12 area infants who have contracted herpes after circumcision, with two of the infants dying soon after.

JAKARTA: Boy with haemophilia bleeds after circumcision (!)

Jakarta Post
February 21, 2013

Toddler with hemophilia bleeds after circumcision

by Panca Nugraha

Haikal Syafi’i, a three-year-old with hemophilia, has been receiving repeated treatment in hospital for severe bleeding from a circumcision wound.

Haikal from Lombok, West Nusa Tenggara (NTB), was taken to Gerung Hospital in Lombok Barat after a mass circumcision event last month . He continued to suffer constant bleeding so his parents took him to Bhayangkara Hospital in Mataram, NTB.

“After receiving treatment in those two hospitals, his bleeding continued; so, he was brought to NTB General Hospital (RSUP) on Monday. We found that Haikal is suffering from hemophilia, a disorder in the blood clotting process,” the hospital’s Lalu Ahmadijaya, told The Jakarta Post, on Thursday.

Hemophilia is a genetic disorder that affects mainly boys, famously prevalent in the royal families of Europe.

“This should be a lesson for our people that they should check the health conditions of their children before circumcision.” said Ahmadijaya.

Speaking to the Post, Haikal’s mother, Sanemah, said that her boy attended a mass circumcision with seven other boys from their kampung on Jan.27 to commemorate the Prophet Muhammad’s birthday.

“After being circumcised, he had no complaints. But four days after the procedure, he began bleeding from his circumcision wound,” she said.

“Hemophilia treatment can be costly. Koate, for example, costs around Rp 10 million (US$1,030) per injection and Haikal needs three injections to stop his bleeding,” Ahmadijaya said, adding that Haikal’s treatment would be covered by the government-fund health coverage scheme Jamkesmas. (ebf)

SASKATOON: Father's status more important than "reasons" to cut

Canadian Family Physician (also on this site)
February, 2013

Father's status influences circumcision decision

by Hugh Young

A study in Saskatoon, Saskatchewan, has found that regardless of the reasons parents give to circumcise, the father's status is an important factor in the decision.

Medical student Chris Rediger and his supervisor Dr Andries Muller surveyed 230 people at prenatal classes in the Saskatoon Health Region over a 3-month period.

Of all parents responding who were expecting children, 56.4% indicated they would consider pursuing elective circumcision if they had a son; 24.3% said they would not. They were asked before any prenatal classes, which may have changed their final decision.

The reasons they most often gave for supporting male circumcision were hygiene (61.9%), prevention of infection or cancer (44.8%), and the father being circumcised (40.9%). The reasons most commonly reported for not supporting circumcision were it not being medically necessary (32.0%), the father being uncircumcised (18.8%), and concerns about bleeding or infection (15.5%).

But when the expecting father was circumcised, 81.9% of respondents were in favour of pursuing elective circumcision. When he was not circumcised, only 14.9% were in favour of pursuing elective circumcision. The result was statistically significant.


The father's circumcision status also influenced whether parents-to-be thought circumcision was safe. 82.2% with a circumcised father-to-be thinking circumcision by an experienced medical practitioner was a safe procedure for all boys, and none thinking it unsafe, compared to 64.1% of couples with an intact father-to-be thinking it safe and 7.8% thinking it unsafe.

NOTTINGHAM: African HIV trials fudged registration dates

So what else did they play fast and loose with?

Ripe Tomatoes, September 13, 2013


Circumcision and HIV

Two out of three key trials registered late

Does circumcision of adult men reduce HIV transmission? Initial scepticism, surely the foreskin reduces friction between penis and vagina, and prevents abrasions and blood transfer, and conflicting observational data, were eventually overcome by three randomised trials, one each from South Africa (click here), Kenya (click here) and Uganda (click here). In each trial men were randomly allocated to immediate circumcision or to wait for two years. All three trials showed about half the number of new HIV infections in the immediate circumcision group. The relevant Cochrane review (click here) summarises them as follows:

“The resultant incidence risk ratio (IRR) was 0.50 at 12 months with a 95% confidence interval (CI) of 0.34 to 0.72; and 0.46 at 21 or 24 months (95% CI: 0.34 to 0.62). These IRRs can be interpreted as a relative risk reduction of acquiring HIV of 50% at 12 months and 54% at 21 or 24 months following circumcision.”

The Cochrane reviewers judged “the potential for significant biases affecting the trial results [as] low to moderate”. Referring to selective reporting they wrote “All three trials clearly stated in their protocols that the primary outcome was HIV incidence. The risk of bias due to incomplete outcome reporting is therefore low in all three trials.”

The trial protocols have not been published so we have to trust that the Cochrane reviewers interpreted them correctly. But if they relied on trial registration documents (click here, for South Africa, here for Kenya and here for Uganda) they would have been misled. They they all indicate more of less the same primary outcomes and planned sample sizes as in the respective papers. But according to the date of first entry, only the Kenyan trial was prospectively registered. The South African trial was registered a year and a half after recruitment ended and seven days before the results were published! The Ugandan one a month after recruitment ended,and a month before publication.

	Recruitment period	Date of 1st publication of results	1st trial registration date	Registry planned sample size	Primary outcome in registry	Primary outcome in paper
South Africa	July 2002 – Feb 2004	26 July 2005	July 19 2005	3274 planned. 3274 in paper	HIV infection at 3, 12 and 21 months	All HIV infections at 3, 12 and 21 months
Kenya	Feb 2002 – Dec 12 2006	24 Feb 2007	April 23 2003	Initially 3,000. Altered to 2887 in registry. 2784 in paper	HIV incidence at 2 years Complications of circumcision	HIV incidence after three interim analyses
Uganda	August 2002 – Dec 2006	24 Feb 2007	Jan 23 2007	5,000 planned 4996 in paper.	HIV acquisition no time point specified	HIV incidence

It looks like PLOS One and The Lancet wanted to publish sexy high impact trials, found they weren’t registered, so got the authors to do it retrospectively, and hoped no-one would notice! All three trials were funded by the public sector.

Jim Thornton (Professor of Obstetrics and Gynaecology at Nottingham University)

BRAZIL: Circumcision kills one in 7700 (=156 deaths/p.a. in the USA)

Einstein (Sao Paulo) 2012 Sep;10(3):342-346.

Circumcisions for medical reasons in the Brazilian public health system: epidemiology and trends.

Korkes F, Silva Ii JL Pompeo AC

Abstract
OBJECTIVE:
To evaluate the epidemiological factors associated to medical circumcision, based on data from the Brazilian public health system.

METHODS: Using the Unified Health System public database between 1984 and 2010, hospital admissions associated with surgical treatment of phimosis were searched. A total of 668,818 men admitted to public hospitals who underwent circumcision were identified and included in the present study.

RESULTS:
A mean±standard deviation of 47.8±13.4 circumcisions/100,000 men/year was performed through the Unified Health System for medical reasons. During the 27-year period evaluated, 1.3% of the male population required circumcision for medical reasons. [So 98.7% of routine circumcisions are wasted on boys and men who will never need it.] Total number of circumcisions and circumcision rate increased in childhood, declined progressively after 5 years of age and rose again progressively after the sixth decade of life. In the regions of the country with better access to healthcare, 5.8% of boys aged 1 to 9 years old required circumcisions. [Or were circumcised whether they needed it or not.] From 1992 to 2010 there were 63 deaths associated with circumcisions (mortality rate of 0.013%).

[That's one death in 7692 circumcisions. In this USA, that would amount to 156 circumcision deaths per year.]

CONCLUSION:
In conclusion, yearly circumcision rates could be estimated in Brazil, and a very low mortality rate was associated with this procedures. Circumcision is mostly performed in children in the first decade of life and a second peak of incidence of penile foreskin diseases occurs after the sixth decade of life, when circumcision is progressively performed again.

[This study was circulated by Prof. Brian Morris, who presumably thinks this is an "acceptable" death rate.]

CANBERRA: Circumcising doctors restricted, one must see psychiatrist

Canberra Times
February 17, 2013

Unkindest cut: Restrictions placed on doctors

by Phillip Thomson

Several doctors have had restrictions placed on them by the ACT Medical Board.

THE national watchdog has slapped restrictions on more than 40 Canberra health practitioners to ‘‘protect the public’’.

Those with restrictions placed on them include one practitioner under scrutiny for the way he performs circumcisions, with the regulator stating he is not to perform circumcisions without the use of adequate pain relief and that he must use the correct equipment during these procedures. [So what equipment was he using?]

Until the end of 2013, the doctor must list for the ACT Medical Board each circumcision he has performed and the anaesthetic used in each procedure.

The doctor’s future use of analgesics during circumcisions must be in line with the Royal Australian College of Physicians guidelines and he must see a psychiatrist paid for and appointed by the medical board.

He has been allowed to choose his own mentor who was to supervise him for six months and write a report for the board.

The doctor declined to comment when contacted

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