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Intact America lauds European doctors and ethicists

INTACT AMERICA LAUDS DOCTORS, MEDICAL ETHICISTS FROM 17 COUNTRIES
FOR TELLING AMERICAN ACADEMY OF PEDIATRICS TO STOP
CHAMPIONING NEONATAL MALE CIRCUMCISION

AAP REPORT RECEIVES FORMIDABLE TRANSATLANTIC CRITICISM
IN JOURNAL OF MEDICAL ETHICS AND ITS OWN PEDIATRICS JOURNAL

Tarrytown, NY—March 19, 2013

The American Academy of Pediatrics should be reeling today from two independent blasts of criticism from doctors and medical ethicists saying the AAP’s Task Force report last summer, which softened its opposition to routine neonatal male circumcision, is unsupported by scientific data or medical ethics.

Articles in the AAP’s own journal Pediatrics, and in a special issue of the British Journal of Medical Ethics, took the AAP to task for its report issued in August 2012 that stopped short of recommending in favor of circumcision, but called for public and private medical insurance to cover the costs for an unnecessary and inherently risky surgery performed more than a million times a year in the United States.

“It has become clear that the AAP, not those of us in the intactivist movement who have argued for years against the surgery, is an outlier in the discussion about the efficacy and necessity for male circumcision,” said Georganne Chapin, founder and executive director of Intact America (www.intactamerica.org), the leading voice for changing the way America thinks about circumcision.

“The AAP is more interested in its doctors getting paid for performing circumcisions than in protecting the bodily integrity and health of children. The same right to bodily integrity that led to the outlawing of female genital mutilation should extend to baby boys as well.”

The first barrage of criticism came from an article in the AAP’s journal Pediatrics, in which pediatricians and professional associations from 17 countries criticize the AAP Task Force report as riddled with bias and out of step with the increasing awareness among doctors and parents that routine infant circumcision is unnecessary and inherently risky. Circumcision rates in the United States continue to plummet, and have never exceeded 10 percent in most European countries.

“There is growing consensus … that physicians should discourage parents from circumcising their healthy infant boys 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,” wrote the 40 pediatricians, urologists, epidemiologists and other doctors who signed the article.

“Circumcision fails to meet the commonly accepted criteria for the justification of preventive medical procedures in children,” the doctors wrote.

A second flank of criticism came from the prominent British Journal of Medical Ethics, which dedicated a special issue to the ethics of infant and child circumcision.

An article in the ethics journal by Dr. Robert Van Howe, a Michigan medical school professor and pediatrician, and J. Steven Svoboda, head of the Berkeley-based Attorneys for the Rights of the Child, states: “Rather than objectively evaluating all available evidence, the AAP selectively quotes and references highly-contested and controversial studies to attempt to justify an entrenched, yet outmoded, cultural—not medical— practice.”

These authors cite comments by Oxford University ethicist Brian D. Earp, who described last summer’s AAP report as “replete with non-sequiturs, self-contradiction and blatant cherry-picking of essential evidence” in an attempt to justify a call for government-backed medical insurance to cover the surgery.

The multi-authored international article published in the journal Pediatrics systematically considered and rejected the variety of medical reasons the AAP task force attempted to use to justify its position.

  • The AAP report claimed circumcision could cut down on cases of penile cancer, one of the rarest forms of cancer, but the international physicians’ response noted that penile cancer linked to the human papillomaviruses is treatable if diagnosed early, and can be prevented through condom use or prophylactic vaccination. There is “no compelling reason” to remove healthy functioning tissue from the penis of a baby boy to prevent such a rare and treatable disease.
  • The AAP report claimed circumcision can cut down on cases of urinary tract infection. The international physicians note that UTIs can be treated with means far less drastic and risky than the removal of healthy tissue.
  • The AAP report claimed circumcision can cut down on cases of sexually-transmitted diseases, including HIV/AIDS. The international physicians point out that the AAP is relying on findings from disputed African studies of sexually active, adult heterosexual men—“findings … not in line with the fact that the United States combines a high prevalence of STDs and HIV infections with a high percentage of routine circumcisions.” Further, “The situation in most European countries is precisely the reverse: low circumcision rates combined with low HIV and STD rates. Therefore, other factors seem to play a more important role … than circumcision status.”

The international physicians argue repeatedly that boys should be allowed to decide for themselves, when they are of an age to do so, whether to permanently alter their bodies to seek a level of protection against diseases for which there are less drastic, more effective preventive strategies.

In a response to the critique by the international physicians, published in the same issue of Pediatrics, the authors of the AAP Task Force report—which included members already on record as favoring the surgery—repeated their contention that infant circumcision is justifiable from a scientific standpoint and labeled the physicians’ response as biased against circumcision. They go on to restate their position that parental consent is satisfactory for this medically unnecessary intervention.

“It is rather astonishing,” Intact America’s Chapin said, “that a predisposition to the natural male body—a product of millions of years of evolution—should be seen as a ‘bias’; it is equally astonishing that the AAP continues to insist that parents have chattel rights over their male offspring, when the entire framework of international human rights law deems otherwise.”

 

Intact America is based in Tarrytown, N.Y. Visit Intact America at www.intactamerica.org, on Facebook, and on Twitter.

Author

Marilyn

Marilyn Fayre Milos, multiple award winner for her humanitarian work to end routine infant circumcision in the United States and advocating for the rights of infants and children to genital autonomy, has written a warm and compelling memoir of her path to becoming “the founding mother of the intactivist movement.” Needing to support her family as a single mother in the early sixties, Milos taught banjo—having learned to play from Jerry Garcia (later of The Grateful Dead)—and worked as an assistant to comedian and social critic Lenny Bruce, typing out the content of his shows and transcribing court proceedings of his trials for obscenity. After Lenny’s death, she found her voice as an activist as part of the counterculture revolution, living in Haight Ashbury in San Francisco during the 1967 Summer of Love, and honed her organizational skills by creating an alternative education open classroom (still operating) in Marin County. 

After witnessing the pain and trauma of the circumcision of a newborn baby boy when she was a nursing student at Marin College, Milos learned everything she could about why infants were subjected to such brutal surgery. The more she read and discovered, the more convinced she became that circumcision had no medical benefits. As a nurse on the obstetrical unit at Marin General Hospital, she committed to making sure parents understood what circumcision entailed before signing a consent form. Considered an agitator and forced to resign in 1985, she co-founded NOCIRC (National Organization of Circumcision Information Resource Centers) and began organizing international symposia on circumcision, genital autonomy, and human rights. Milos edited and published the proceedings from the above-mentioned symposia and has written numerous articles in her quest to end circumcision and protect children’s bodily integrity. She currently serves on the board of directors of Intact America.

Georganne

Georganne Chapin is a healthcare expert, attorney, social justice advocate, and founding executive director of Intact America, the nation’s most influential organization opposing the U.S. medical industry’s penchant for surgically altering the genitals of male children (“circumcision”). Under her leadership, Intact America has definitively documented tactics used by U.S. doctors and healthcare facilities to pathologize the male foreskin, pressure parents into circumcising their sons, and forcibly retract the foreskins of intact boys, creating potentially lifelong, iatrogenic harm. 

Chapin holds a BA in Anthropology from Barnard College, and a Master’s degree in Sociomedical Sciences from Columbia University. For 25 years, she served as president and chief executive officer of Hudson Health Plan, a nonprofit Medicaid insurer in New York’s Hudson Valley. Mid-career, she enrolled in an evening law program, where she explored the legal and ethical issues underlying routine male circumcision, a subject that had interested her since witnessing the aftermath of the surgery conducted on her younger brother. She received her Juris Doctor degree from Pace University School of Law in 2003, and was subsequently admitted to the New York Bar. As an adjunct professor, she taught Bioethics and Medicaid and Disability Law at Pace, and Bioethics in Dominican College’s doctoral program for advanced practice nurses.

In 2004, Chapin founded the nonprofit Hudson Center for Health Equity and Quality, a company that designs software and provides consulting services designed to reduce administrative complexities, streamline and integrate data collection and reporting, and enhance access to care for those in need. In 2008, she co-founded Intact America.

Chapin has published many articles and op-ed essays, and has been interviewed on local, national and international television, radio and podcasts about ways the U.S. healthcare system prioritizes profits over people’s basic needs. She cites routine (nontherapeutic) infant circumcision as a prime example of a practice that wastes money and harms boys and the men they will become. This Penis Business: A Memoir is her first book.