The American Medical Association Should Be Ashamed!

Yesterday, the American Medical Association, whose core values are leadership, excellence, integrity and ethical behavior, announced that its membership has voted to “oppose any attempt to legally prohibit infant circumcision.”

The AMA’s president, Peter W. Carmel, M.D., was quoted as saying, “There is strong evidence documenting the health benefits of male circumcision, and it is a low-risk procedure….  [T]he AMA … will oppose any attempts to intrude into legitimate medical practice and the informed choices of patients.”

Strong evidence? Presumably, he’s talking about evidence from flawed studies conducted among adults in parts of Africa with high HIV prevalence? Even these studies show that while female to male sexual transmission of HIV might be lessened when the male is circumcised, male to female transmission actually increases. And it’s not clear what any of this has to do with newborn babies, who don’t have unprotected sex.

Health benefits? Compared to what?  The foreskin is there to protect the penis, keep the glans moist, and enhance sexual pleasure throughout a man’s lifetime. Do the AMA doctors know about recent studies showing higher rates of erectile dysfunction in circumcised men than in intact men? Do they know anything about the benefits of the foreskin?

Low risk? Do Dr. Carmel and the AMA know that more than 100 babies die each year in the United States from circumcision? Do they know about the $2.3 million award made earlier this year to the family of a Georgia baby whose penis was severed and thrown into the trash after a botched circumcision? Or about Jamaal Coleson, Jr., who died in New York City this spring, following a “routine circumcision?” Or about little Eric Keefe, who bled to death following his circumcision in a South Dakota Indian Health Service hospital in 2008?  Certainly, they don’t know that just this week, the blogosphere was ringing with the discussion of another post-circumcision infant death, this one allegedly from a heart attack.

Legitimate medical practice? Do the AMA members who voted to keep the United States safe for circumcisers know that most of their European colleagues believe “routine” circumcision is not legitimate – but, instead, barbaric? Have they read the call by the Royal Dutch Medical Association for doctors to refuse to surgically remove part of the genitals of babies and children, on the grounds that there is no medical reason for it, and it violates children’s rights?

Informed choices of patients? Did the AMA stop to think about WHO IS THE PATIENT who supposedly is making an “informed choice?” Answer: the BABY is the patient – not the parents – and the baby cannot consent. On the contrary, only someone with a vested interest in denying the truth can assert that babies react with anything other than terrorized, panicked protest to the ripping, crushing and severing of their tender foreskins.

In the United States and most of the modern world, cutting a normal, healthy body part from the genitals of a girl is “genital mutilation” and it’s illegal. No ethical, moral or legal rationale distinguishes boys from girls in this regard.

Shame on you, Dr. Carmel. And shame on the AMA.

Georganne Chapin

An Open-Minded Pediatrician and Me – Part 2

In my last post, I told you about my conversation with a self-described “open-minded” pediatrician at the annual convention of the American Academy of Pediatrics. I was as distressed by his seeming ability to consider the circumcision question as a simple matter of “point of view,”  as I was with the magnitude of pain and harm he had caused, and the fact that thousands of boys and men were living with the consequences. I did, however, know what he meant when he said that for him to stop performing circumcisions would be “complicated.”

If this doctor stops now, what will he tell the repeat “customers,” young parents asking him to circumcise their second or third son?  What will he tell his colleagues?

If he stops, what will he tell the boys he cut who later learn that he – indeed – did put down the knife?

If he stops, and one day a young man in the small community where he practices sues him for injuries, or for lack of consent (the statute of limitations on a malpractice claim typically re-opens for a time when an individual turns 18), what defense will he offer?

On the other hand, if he doesn’t stop, how will this doctor live with his conscience – or with the consciousness that made him come to talk with us? What will he do if he botches terribly a surgery, and a baby loses half of his penis, or dies, after he knew he should stop circumcising, but didn’t?

Since the AAP conference, I’ve lost hours of sleep pondering this conversation, unable to imagine the magnitude of the suffering – one or two babies a day, week after week, month after month, year after year, strapped down and mutilated – caused by this man who took an oath to do no harm. I went online and learned that the small northeastern city where he practices has only 16,000 people. This means – again, if his numbers are correct – he has circumcised pretty much every male under the age of 25 in the community and the surrounding area.

Except his own son, that is. And by the way, what does he tell his intact son?

Let’s say your postman one day stopped by to tell you that he’d touched the genitals of all the neighborhood children, and all the children in his son’s school (though not his own child), as well as the children in the surrounding towns, over the past 25 years; and then he told you he wanted to know your point of view about that. You’d reach for the phone, and call the police.

Yet there I was, in this huge exhibit hall in Boston, standing under the bright lights of the infant formula, baby lotion, and drug companies, talking politely with a man who had cut the penises of 5000-6000 babies, but was “open-minded” and wanted to understand Intact America’s point of view.

by Georganne Chapin

An Open-Minded Pediatrician and Me

Last month, I spent three days at the Intact America exhibit booth during the annual convention of the American Academy of Pediatrics. Together with my colleagues Marilyn Milos, Dan Bollinger and Amy Callan, we spoke to many, many doctors. By far, the greatest endorsement of our work came from foreign pediatricians who were nearly universally opposed to circumcising babies. I often tell doctors from the U.S. that their colleagues in Europe and Latin America do not cut babies, a fact too many find surprising.

Each year I attend, at least one conversation stands out as particularly rewarding or particularly upsetting. This year, on day two, a man who appeared to be in his early 50’s approached our booth, which was decorated with an 8 ft. banner listing “10 Reasons Why You Should Stop Circumcising Baby Boys.”

Georganne Chapin at the 2011 American Academy of Pediatrics conference in Boston

Georganne Chapin at the 2011 American Academy of Pediatrics conference in Boston

“Hi,” he said. “I came here because I’m open-minded and I want to learn.”

He went on to tell me that, in the course of his career, he’d circumcised somewhere between 5,000 and 6,000 babies, but that his own 24-year-old son wasn’t circumcised.

I was stunned. When I asked him how much money he’d thought he’d made from all those circumcisions, looking hurt he said, “I have to tell you, I’m feeling attacked.”

He tried to explain that he performs circumcisions because he’s developed a reputation for being efficient and good at it, and that all the other doctors send him their patients.

Recovering my poise somewhat, I asked the doctor why he’d left his own son intact. His reply was vague, something about the AAP’s position on circumcision at the time his son was born, the implication being that the AAP’s position had been sufficiently unsupportive of the procedure for him to decide not to circumcise his own son.

I asked him what he told the parents of the babies he circumcises. “I don’t need to tell them anything,” he said. “They come to me with their minds made up.” Did he tell them his own son is intact? No, that would violate his son’s privacy, he told me.

I finally said, “Your son is intact, and you were concerned enough to come to speak with us. The AAP still doesn’t recommend circumcision, so why don’t you stop? Our campaign this year is Put Down The Knife! You could simply stop.”

“It’s very complicated,” he answered. “I don’t think I could just stop.”

He’s right. In the absence of an external ban, or an unequivocal change in position by the feet-shuffling AAP, it is “complicated” and requires great bravery for a committed circumciser to stop.

In my next post on this topic I will explore the immense, but not insurmountable challenges the entire medical profession must face at the prospect of Putting Down The Knife! and ending the practice of circumcision.

by Georganne Chapin