Corwin

Of course what this last post doesn't mention is that Dr. E. Schoen is the primary advocate for routine cirucmcision in the United States, and is quite fanatical about having all boys be circumcised.

Dr Rick

Ad hominem fallacies deserve little consideration, either.

Schoen headed the AAP task force on circumcision. He has conducted research on the subject, much of it very recent, that has led him to conclude that there are benefits to male circumcision.

At the beginning of the past decade and prior to some of the research, Dr. Schoen published this "fanatical" position on male circumcision:

Urology 1992 Aug;40(2):99-101 Schoen EJ
Department of Pediatrics, Kaiser Permanente Medical Center, Oakland, California:

"Although urologists have played a key role in performing clinical studies providing the rationale for newborn circumcision, they have not had primary responsibility for the decision to perform the procedure. Recent confirmatory evidence that newborn circumcision has significant preventive health benefits has called attention to previous urologic articles. This review summarizes the contributions of urologists to the controversy on circumcision of newborns over the past sixty years and emphasizes the importance of clinical objectivity in this field."

Corwin

Yes... and time and time again he's been called out on his LACK of objectivity. He completely ignores anything that doesn't justify circumcision, he labels anyone who disagrees with him as an irrational nutcase....

You must admit. Bringing up a statement backing up your point is all well and good... but not mentioning that this statement is from someone who's position is not only rejected by the medical community at large, but also has a vested interest in convincing people of his position... is just a bit deceptive.... no?

Stranger than paradise

Corwin, I agree very much with the point of your last post. I do not on the other hand, agree with the various values and similarities people try to assign to the cultural sexual controls exerted on the genitals of children. Many people say that cutting off the clitoris is only comparable to cutting off the whole penis. Untrue! Cutting off the whole penis would be paralleled to removing the girl's vagina. If even male and female organs can be compared to eachother I would tend to divide the organs into three basic forms and functions-

The external genitals which serve to protect the internal genitals and also happen to provide the person with a great deal of pleasure. this pleasure is probably evolutionarily linked to the fact that humans do not have heat cycles and a rutting season, so at any time the male can make himself available to a mate- it is advantagious to the species that she would be receptive to him because of pleasure.

Then you have the internal genitals which actually allows the coupling of the two people and allows for the reproductive function of the last parts to come into play. On a woman this is the internal tube of the vagina, and on a man, this is the erectile tissue inside his penis skin and glans.

The last part is the actual reproductive aspect of the organ, the testes and internal workings of a man, and the uterus and ovaries of a woman.

I am no expert on FGM, but here is a quote I pulled for you off the WHO FGM fact sheet about the age FGM usually happens. Of course, there might be regional differences... but since the point of the FGM in many cases is to ensure chastity, certainly they want to get to the girl before she becomes sexually active. Also, since I think so much of the restraining for the operation is done by hand and not KO drugs- the smaller the person is who is being restrained, the easier it will be. Which is why infant male circumcision is so popular.


"The age at which the mutilation is carried out varies. The practice may be carried out during infancy, childhood, at the time of marriage or during a first pregnancy. The most common age seems to be between four and ten, although it appears to be falling, indicating a weakening of the link to initiation into adulthood."

From the UN population fund:
"At what age is FGM/FGC performed?
In some areas it is carried out during infancy (as early as a couple of days after birth), in others during childhood, at the time of marriage, during a woman’s first pregnancy or after the birth of her first child. The most typical age is between 7 – 10 years or just before puberty, although reports suggest that the age is dropping in some areas."

Corwin

I've heard of it being done as late as 18. Younger happens as well... and may be becoming more common.

Dr Rick

If this is true, then I've been deceived, as well.

Please provide the evidence you've gathered to support your assertions that:

1) He "is quite fanatical about having all boys be circumcised."

and

2) His position is "rejected by the medical community at large."

Thanks

NatureMade

A close look at Schoen and his credibility:

It looks like Schoen's career is ending in disgrace..

1. He was dropped from the AAP task force on circumcision:

His views have been rejected by the American Academy of Pediatrics. Notably, he was not chosen to be on the recent task force on circumcision. His previous service on the 1988-89 task force on circumcision resulted in considerable embarrassment to the AAP due to his scandolous behavior.

A dissenting article was published in the New England Journal of Medicine by Dr. Ronald Poland, who was also a member of the 1988-89 task force.

<a href="http://www.cirp.org/library/general/poland/" target="_blank">http://www.cirp.org/library/general/poland/</a>

Dr. Poland's views were later adopted by the CPS and the AAP, while Dr. Schoen's views were rejected.

<a href="http://www.cps.ca/english/statements/FN/fn96-01.htm" target="_blank">http://www.cps.ca/english/statements/FN/fn96-01.htm</a>

<a href="http://www.cirp.org/library/statements/aap1999/" target="_blank">http://www.cirp.org/library/statements/aap1999/</a>

2. He was laughed out of Europe:

The British publication "Archives of Diseases in Childhood" published his opinion piece but the editors had pre-arranged to publish simaltanously in the same issue not one but two scholarly rebuttals of his fantastic claims. Dr. Schoen does this periodically, and each time his work is rebutted. This apparently is done to show how far Dr. Schoen is from the mainstream of medicine.

An earlier rebuttal was published in Acta Paediatrica Scandianavia by respected Swedish doctors Jan Winberg and Ingella Bollgren in 1991.

The two rebuttals of Dr. Schoen's 1997 article are here:

<a href="http://www.cirp.org/library/general/hitchcock/" target="_blank">http://www.cirp.org/library/general/hitchcock/</a>

<a href="http://www.cirp.org/library/disease/HIV/nicoll/" target="_blank">http://www.cirp.org/library/disease/HIV/nicoll/</a>

3. He was ridiculed in the public media:

<a href="http://www.healthcentral.com/drdean/DeanFullTextTopics.cfm?ID=34420&src=n2" target="_blank">http://www.healthcentral.com/drdean/DeanFullTextTopics.cfm?ID=34420&src=n2</a>

4. He has been caught lying in his papers:

In their respective papers, Weiss and Schoen made these claims, even though they both cited a 1993 study that found a 20% rate of penile cancer in American males circumcised at birth and 37 % for all circumcised either at birth or in childhood.

In the same 1997 paper, Schoen made his oft-repeated claim that there have been only 10 cases of penile cancer in men circumcised at birth since the 1930s. Not only is this statement false, but it presents an ethical problem in that Schoen was made aware of this fact and provided with supporting references in the pages of the BMJ in l996. Schoen also failed to acknowledge other published cases of penile cancer in neonatally circumcised males, of which he was well aware at the time.

Schoen's claim that there have only been ten cases of men affected with penile cancer who were circumcised as newborns is deceptive on two levels.

First, the national incidence of disease is not determined by the number of published case reports. Not every case of a disease, no matter how rare, is, or could ever be, published as a case report in a medical journal. The United States Department of Health, Education, and Welfare determines disease incidence by examining a large sample of hospital records from across the country. There is no meaningful relation between the number of case reports published and the incidence of disease.

Secondly - at the time he made this statement, there were more than ten such cases reported in the published medical literature. Between 1936 and 1997, at least 16 individual medical journal articles presented case reports of penile cancer for 34 neonatally circumcised males. Thirteen (38%) of these patients were Jews. One of these studies, by Wade et al. [45] documented Bowenoid papulosis of the penis, which histologically is squamous cell carcinoma in situ, in 11 young males, 10 of whom had been circumcised at birth.

In addition to these case reports, there have been a number of important largescale studies, published PRIOR to 1997 (i.e. PRIOR to the Schoen and Weiss papers), that have documented significant rates of penile cancer in circumcised males. In addition to Maden's 1993 study, which found 41 cases (a rate of 20%) of penile cancer in neonatally circumcised males, a 1993 study by Malek et al. found that 79% of 34 patients with penile intraepithelial neoplasia had been circumcised at birth or in early childhood. [46] A subsequent study by Cupp et al. found that 9.5% of 25 patients with penile intraepithelial neoplasia or carcinoma in situ had been circumcised at birth. The circumcision status was not noted, however, in 16% of the patients. These large-scale studies demonstrate that the total number of cases of penile cancer in neonatally circumcised males is far in excess of 10.

Wiswell-

In 1990, he stated in Pediatric-:

'Penile cancer is the only neoplasm which can be prevented categorically by a prophylactic procedure, neonatal circumcision'.

[NB all but 1 of the 16 papers -above- reporting penile cancer in cut men were before 1988, and most were 1970s or earlier --so there is NO excuse for his not being aware of them]

In 1997 however, he stated in the New England Journal of Medicine:

'Furthermore, circumcision reduces thc risk of penile cancer'

5. He was totally ignored by his own hospital group-Kaiser Permanente:

from the Kiser circumcision bulletin:

"The letter has (3) paragraphs on the subject, which says in part: "Circumcision is the removal of the foreskin that covers the tip of the penis. After circumcision, the tip of the penis is always uncovered. Originally this procedure was done for religious and cultural pruposed or because of concerns about cleanliness, cancer prevention or improved sexual performance. None of these reasons have proven to be scientifically valid, however, and the choice to have an infant circumcised remains a social decision, not a medical decision. Currently, fewer than half of the baby boys born each year in the western United States are circumcised."

6. His collegue at Kaiser Permnente ridiculed the UTI nonsense published by Schoen and Wiswell:

<a href="http://www.cirp.org/library/disease/UTI/altschul/" target="_blank">http://www.cirp.org/library/disease/UTI/altschul/</a>

7. Now Schoen is being confronted about his BS in front of his collegues at KP--and he wilted away:

<a href="http://www.cirp.org/news/cin/1995.02.18" target="_blank">http://www.cirp.org/news/cin/1995.02.18</a>

CIN CompuBulletin Circumcision Information Network Volume 2, Number 6, 18 February 1995

SCHOEN ZAPPED; NOHARMM PLEASANTLY SURPRISED Compiled by reports from NOHARMM founder Tim Hammond and a NOHARMM member:

On February 15th, seven NOHARMM field workers rallied at Kaiser Permanente hospital in Oakland, California, where the most vocal proponent of newborn circumcision, Edgar Schoen, gave an "in-service" training session on circumcision to the doctors and nurses working there. During the speech itself, the team marched outside the entrance to the hospital carrying signs and a NOHARMM banner with a large picture of a baby being circumcised with a Gomco clamp on his penis. One of the team carried a portable sound system that broadcast the screams of a baby being circumcised to help bring home the horror of the picture on the banner. It worked. Many passers-by showed facial signs of upset, and some put their hands over their ears, but it was the message, not the volume that made them do that. Many people stopped to say they agreed that circumcision is painfully wrong.

At the end of the hour, the team infiltrated the room where the meeting was being held, but did not interrupt the speaker. When he called for questions from the floor, several young doctors started to ask questions about the problems of circumcision. When it was clear Dr. Schoen was evading the issues, Tim Hammond, director of NOHARMM, seized the floor and pointed out that long term harm does exist, and that several men in the room had been affected by it. Then those men stood up to say that they had personally been harmed. One of them described his situation and the surgeries he had to endure to try to correct the problems, and accused Dr. Schoen of trying to push "genital abuse". Schoen was stunned, silenced and visibly shaken by the confrontation. The meeting ended and NOHARMM gave out pamphlets to the staff as they left the room. NOHARMM did not enter that room expecting a pleasant reception, but as the doctors and nurses filed out of the room, they thanked NOHARMM for being present and for presenting the opposing point of view. The young doctors clustered around the team and asked for extra copies of the materials and especially copies of medical papers describing the ugly consequences that Dr. Schoen failed to mention. The NOHARMM team was stunned by the friendliness shown by the Kaiser staff, and very gratified.

Wiswell is included as the critiques of Schoen always include the duplicitous duo.!

Cindy

Dr Rick

Cindy garnered these ad hominems from an anti-circ site, but let's examine some of these accusations, anyways.

<strong> He has continued to publish scholarly work in prestigious peer-reviewed journals such as Pediatrics in the past 24 months;

<strong> The current AAP policy specifically mentions the "benefits" of circumcision, just as Schoen does. Schoen's views have never been "rejected" by the AAP which has continued to publish his work in their flagship journal, Pediatrics.

<strong> What scandoulous behaviour? What are you talking about?

<strong> This article, published over a decade ago, doesn't even mention or reference Schoen, who continued on the task force after the article was published and after Poland was "dropped." While Schoen continues to flourish in his work, there is nothing in the Medline database from Polland on the subject of circumcision in the past five years.

Poland's opinions on HIV aquisition and UTI's have been refuted by subsequent studies, including one recently by Schoen.

<strong> The CPS and AAP are neutral on the issue and neither recommend nor disavow routine neonatal circumcision in their conclusions.

<strong> Only if he told a joke; the journal you cite below took his work seriously and published it.

<strong> It's very common in scientific literature to publish opposing views from renowned experts on controversial issues. This journal would not have included Schoen in a scholarly debate if he wasn't a recognized authority on circumcision; it is considered an honor to be asked to participate in one of these exchanges and an acknowledgement of ones expertise. Of course these scholarly debates are "prearranged."

<strong> How could a rebuttal be published 6 years before the article it was meant to refute.

<strong> Cindy should have read some of these articles before cutting and pasting them.

The first author states in his article, "I too practice circumcision." His comments on HIV aquistion and UTIs have been refuted by recent studies and his speculation on the role of hygiene remains unfounded.

The second author devotes his article to HIV aquisition, and his views expressing doubt about the protective effects of circumcision were refuted 3 years later with studies presented at the Xlll International AIDS conference in 2000.

<strong> Cindy forgot to cut and paste the specific article the anti-circ cite is disputing (Schoen has publsihed many), and she forgot to cut the reference to Weiss; it appears that the cite is devoted to lying about other authors than just Schoen.

This is dreary stuff. It's also a waste of time to refute spurious claims about authors and articles that Cindy has not even bothered to evaluate before posting. Let's have Cindy or someone respond to the above before we go any further.

Rick

[ February 28, 2002: Message edited by: rbochnermd ]</p>

NatureMade

Yup (tail between my legs), I cut and pasted someone else's attempt at refuting Schoen. Sorry, it was the best I could do with limited time, but I will admit to the heinous crime

I appreciate you taking the time to refute what I posted, however, and will now go through both posts, as well as others that I have seen on Schoen and will report back on my findings.

In the mean time, I would also appreciate your critical analysis of the following:

<a href="http://www.pediatrics.org/cgi/content/full/102/4/e43" target="_blank">http://www.pediatrics.org/cgi/content/full/102/4/e43</a>

<a href="http://faculty.washington.edu/gcd/CIRCUMCISION/v2n1.html#ab16a" target="_blank">http://faculty.washington.edu/gcd/CIRCUMCISION/v2n1.html#ab16a</a>

<a href="http://www.cirp.org/library/legal/USA/consent1/" target="_blank">http://www.cirp.org/library/legal/USA/consent1/</a>

Cindy

Corwin

Neither the AMA nor the APA dispute that there are some benefits to circ.... however, both reject the idea that the procedure should be routinely practiced, as these benefits have been proven to be minimal, at best. He neglects to mention this small detail.