Neanderthal

Do you mean the APA or the AAP?

Here's what the AAP says:

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<a href="http://www.aap.org/advocacy/archives/marcircum.htm" target="_blank">http://www.aap.org/advocacy/archives/marcircum.htm</a>


“Circumcision is not essential to a child’s well-being at birth, even though it does have some potential medical benefits. These benefits are not compelling enough to warrant the AAP to recommend routine newborn circumcision. Instead, we encourage parents to discuss the benefits and risks of circumcision with their pediatrician, and then make an informed decision about what is in the best interest of their child,” says Carole Lannon, M.D., MPH, FAAP, chair of the AAP’s Task Force on Circumcision.

The policy concluded, however, that it is legitimate for parents to take into account cultural, religious and ethnic traditions, in addition to medical factors, when making this decision. It states that to make an informed choice, parents of all male infants should be given accurate information and be provided the opportunity to discuss this decision with their pediatrician.

Corwin

Sorry.... AAP. Posted that late last night after one helluva day. (Was thinking American Pediatric Society for some reason...)

NatureMade

Here is the current AAP Statement:

<a href="http://www.aap.org/policy/re9850.html" target="_blank">http://www.aap.org/policy/re9850.html</a>

My interpretation of the AAP statement is that they do not medically recommend RIC based on their evaluation and critical analysis of the medical research and studies performed to date. They acknowledge *potential* benefits, but when critically weighed against the proven risks of circumcision, could still not justify medically recommending RIC.

They do, however, acknowledge that the parents have every right to deny, overrule and override their *medical* recommendations. Why? Because it is legal to circumcise infant boys in America based on parental consent. But really, what business does the AAP have making any comment other than a MEDICAL one regarding RIC? It makes the MEDICAL statement soft, wishy-washy, unclear to those looking for medical guidance; both to members of that organization and to the public at large.

Why does the AAP make a medical statement declaring that the benefits are not sufficient to *medically* recommend RIC, but then allow parents to override that *medical* statement?

Truthfully, does anyone here believe that in ALL and EVERY incident of RIC, accurate and unbiased information is provided to ALL parents considering circ for their child?

Does anyone here truthfully believe that ALL parents are given ample opportunity to discuss this decision with their health provider?

And finally, does anyone here believe that ALL medical professionals that perform RIC heed the recommendation of the AAP to provide procedural analgesia?

I will offer this quote from a 1999 report from the AMA:

"Based on recent survey data, 54% of pediatricians, family practitioners, and obstetricians perform at least 1 circumcision per month. Of physicians performing circumcision, 45% use anesthesia, most commonly dorsal penile block with lidocaine (71% of pediatricians, 56% of family practitioners, and 25% of obstetricians). Those physicians who reported not using anesthesia cited concern about adverse effects and a belief that circumcision does not warrant anesthesia."

<a href="http://www.ama-assn.org/ama/pub/...-2511.html" target="_blank">www.ama-assn.org/ama/pub/...-2511.html</a>

Comments?

Cindy

Baloo

Okay, it appears that the overwhelming majority of medical studies regarding circumcisions which either support or condemn the practice have been reviewed in this forum. These should fill a primary purpose of answering the very simple question that I am trying to find the answer to: Do the medical benefits of circumcision outweight the risks. THIS SHOULD NOT BE A QUESTION OF OPINION, and yet, after reviewing the same studies, we seem to find people arriving at two entirely different answers.
So, let's try to remove the fluff and actually try to fill in a table with four columns:

1)Potential outcome
2)Medical rating* (-10 to + 10)
3)Probability of occurance with circ
4)Probability of occurance w/o circ.

*Medical rating is arbitrary... positives are given for benefits, negatives for problems, 1 - 4 is mild, 5 - 8 is serious, 9 - 10 is fatal.


For example (numbers pulled from ass),
1) UTI
2) -3
3) .0002
4) .0012

1) Inoperable Penile cancer
2) -9
3) .0000001
4) .0000006

1) Unhealthily distressed from being different from cirumcised father/peers
2) -1
3) 0
4) .01

1) Unhealthily distressed from "missing a part"
2) -1
3) .05
4) 0

Other possibilities:
1) Immediate minor pain/discomfort from surgery.
2) Long-term pain/discomfort from surgery (the next 24 - 48 hours).
3) Minor surgical/anesthetic complications.
4) Major surgical/anesthetic complications.
5) Health problems due to distress due to loss of sensation, and corresponding decreases in sexual activity.
6) Health problems due to distress due to anger at having decision made for you.
7) Contraction of HIV.

Etc... In other words, I don't care if it prevents UTI's, penile cancer, and HIV transmission. If it prevents 20 deaths but causes 10,000 cases of depression, I don't want to hear about it. If the expected nationwide savings in treatment of UTI, PC, and HIV is $2,000,000 annually, but the circumcision itself itself costs $20,000,000 annually, I don't want to hear about it.

And from where I sit, it appears that the "burden of convincing" lies on a person suggesting an operation. Ealier, I took something of a devil's advocate position for circumsicion, basically because I was undecided and wanted the strongest arguments presented from both sides. But I have to be perfectly honest - I'm now almost 100% on the non-circ side. I have simply seen no weighted analysis which leads me to believe that the probability of certain medical/emotional/lifestyle benefits outweigh the corresponding medical/emotional/lifestyle problems of male circumcision. And in a very anecdotal fashion, it appears to me that the statistically weighted benefits will not nearly outweight the risks.

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

Dr Rick

Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life. Pediatrics 2000 Apr;105(4 Pt 1):789-93 Schoen EJ, et. al.Departments of Genetics and Pediatrics, Kaiser Permanente Medical Care Program of Northern California.
"...CONCLUSIONS: Newborn circumcision results in a 9.1-fold decrease in incidence of UTI during the first year of life as well as markedly lower UTI-related medical costs and rate of hospital admissions."

Pediatr Clin North Am 2001 Dec;48(6):1539-57Lerman SE; Liao JC, Division of Pediatric Urology, Department of Urology, University of California Los Angeles School of Medicine, Los Angeles, California, USA.
"...Review of existing literature supports that most children who are uncircumcised do well from a medical standpoint and, thus, the question of whether US health care practitioners are subjecting neonates to an unnecessary surgical procedure remains. The medical benefits of circumcision are multiple, but most are small. The clearest medical benefit of circumcision is the relative reduction in the risk for a UTI, especially in early infancy. Although this risk is real, the absolute numbers are small (risk ranges from 1 in 100 to 1 in 1000), and one investigator has estimated that it may take approximately 80 neonatal circumcisions to prevent one UTI...The medical harms of circumcision lie mainly in the 1% acute complication rate and the additional patients who require revision of their initial circumcision for cosmetic or medical reasons. Anecdotally, the authors see far fewer complications in the acute and long-term phase when the circumcision has been performed by someone with expertise and experience with the procedure...A negative psychologic and sexual impact of circumcision has been argued, but solid, scientific data are lacking. Special interest groups have argued that perhaps the greatest harm of circumcision is in performing an operation without a clear indication. Many of these groups have claimed that performing a routine neonatal circumcision is akin to performing a surgical procedure without a clear medical benefit, and in an infant, that is akin to surgery without informed consent. Although this is an extreme posture, the clinician can understand the emphasis on trying to provide invasive medical services only when a clear medical benefit is expected...It is difficult to say whether the benefits outweigh the risks for all male infants.

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

2tadpoles

All I know is that no OB, midwife, or pediatrician ever spoke to me in regard to circumcision when I was pregnant. The only mention of the procedure was asking me whether I wanted it done, AFTER the children were born, and while I was on a considerable amount of narcotics.

Dr Rick

Be careful of what you assume:

Pediatrics 2001 Feb;107(2):E20
Adler R; Ottaway MS; Gould S
California School of Professional Psychology, Los Angeles, Los Angeles, CA
"OBJECTIVE: The current study sought to investigate parental attitudes about circumcision and their satisfaction with the decision...Families (68) who did not have their sons circumcised were less satisfied with their decision. Compared with families (81) of circumcised children, parents of uncircumcised boys were less likely to have been asked by their physician about whether they wanted their child circumcised, believed that they did not receive adequate information about the procedure, felt less respected by their medical provider, and were more likely to reconsider their decision."

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

NatureMade

Rbochnermd:

No need in this instance. My assumption is that not all parents are being provided with accurate and unbiased information regarding circumcision, as is recommended by the AAP. Your posted study clearly shows that some parents are not being provided with ANY information on circumcision, let alone unbiased or accurate.

Frogsmoocher:

I don’t think your situation is unique in the least. And in fact, there is a court case at this present time where a young man is suing the doctor and hospital for obtaining the consent for this man’s circ (when he was a baby) while his mother was still under the influence of narcotics/analgesics. I’ll try to find some more info on this one.

Cindy

Dr Rick

Your inquiry began by asking the right question and you evaluated the available data before coming to a conclusion; you'll get no argument from me on any of that.

NatureMade

For Baloo:

I came across this study that may be of some interest to you.

<a href="http://www.pediatrics.org/cgi/content/full/105/1/S2/246" target="_blank">http://www.pediatrics.org/cgi/content/full/105/1/S2/246</a>

It is a trade-off analysis of RIC comparing *immediate* complications of RIC vs UTIs and Penile Cancer.

Unfortunately it doesn't weigh in any long-term complications of circumcision and the methods of collection are (to me) a little suspect, but it did make for an interesting read.

Cindy