Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Friday, October 14, 2016

In Defence of Circumcision

"There's a lot of hysterical nonsense by the anti-circumcision movement that is really like the anti-vaccination movement, and it's appalling when a body like the Canadian Paediatric Society can fall for this nonsense."
"They've got to really step back and look at the hard scientific evidence, and the scientific evidence is unequivocal in showing that male circumcision, especially performed in infancy, has enormous benefits." 
"Some parents, no matter what, will decide not to vaccinate their children. That's their choice. But it's crucial they receive proper information -- accurate, scientific information, so they can make an informed decision."
"And that has to happen early in pregnancy, or very soon after the birth of the child if it's a boy."
Brian Morris, professor emeritus, University of Sydney school of medical sciences
Sean Gallup/Getty Images
Sean Gallup/Getty Images     Instruments used in the Jewish circumcision ceremony lie on a table prior to the circumcision of baby infant Mendl Teichtal at the Chabad Lubawitsch Orthodox Jewish synagogue on March 3, 2013 in Berlin, Germany. 
Professor Morris is referring to studies showing a lower risk of urinary tract infections among boys who have been circumcised as opposed to uncircumcised boys, as well as a lower lifetime incidence of penile cancer risk. He also speaks to scientific research validating absolute health benefits attributable to circumcision among which is a lower risk of acquiring HIV, genital herpes, the human papilloma virus (HPV) and syphilis.

Interestingly enough, back in May of this year it was revealed that across Canada a surprising and steadily rising rate of syphilis and resistant gonorrhea has been popping up in hospitals and even at nursing and retirement homes. Public Health Agency of Canada stated that reported rates of chlamydia, gonorrhea and syphilis have been on the rise since the late 1990s, with young Canadians reporting the highest rates of infections, but among the middle aged and older adults a surprising number of such infections have also been appearing.

Dr. Morris is expressing his aghast opinion at the stance of the Canadian Paediatric Society in their position that benefits in removal of a baby's foreskin fail to outweigh risks. He calls their conclusion the result of "sloppy scholarship". And just incidentally to the situation, Dr. Morris and a colleague among the authors of the research, Dr. Neil Pollock of British Columbia, have had a paper published in the Canadian Journal of Urology, pointing out that this conclusion should be reversed to reflect reality.

The American Academy of Pediatrics concluded in its latest iteration of their formal policy with respect to circumcision the acknowledgement that scientific research does indeed demonstrate clearer health benefits than had been believed. Those benefits "are sufficient to justify access to this procedure for families choosing it", they declared, along with the stipulation that in their opinion insurers should pay for the procedure, as a valuable health measure.

Dr. Pollock, among the researchers who took part in writing the paper, had created a technique for circumcision which was self-named the Pollock Technique, promising parents "virtually painless", 60-second circumcisions for babies two months of age and younger, at a cost of $445. Another clear benefit of circumcision is its link to a reduced risk of prostate cancer among black men.

It has long been a belief of the Canadian Paediatric Society that pain to a small baby, bleeding, infection, an "unsatisfactory cosmetic result", and rarely, partial amputation of the penis or even death following from hemorrhage or sepsis, represented potential drawbacks to circumcision. A newer policy updated last year does acknowledge the growing evidence that circumcised boys remain less likely to suffer urinary tract infections and penile cancer, and are less likely to pass sexually transmitted infections or cervical cancer on to their sexual partners.

They balk, however, at recommending routine circumcision for every newborn male on the basis that the risk-benefit ratio as far as they are collectively concerned remains too "closely balanced" for them to proffer "definitive recommendations for the entire male newborn population in Canada", citing a single study finding a complication rate of 1.5 percent to support their stance.

Dr. Morris refutes this conclusion, noting that the society's policy was based on weak studies over-emphasizing harms and under-estimating benefits involved. His research team, on the other hand analyzed the situation to come up with an estimate that the combined frequency of adverse events is really 0.4 percent overall, that "the cumulative frequency of medical conditions attributable to [having an intact foreskin[ was approximately 100-fold higher" than the cumulative risks of circumcision.

According to the paper's authors, newborn circumcision is "convenient, quick, safe, low-cost and provides immediate and lifelong protections". If embarked upon later in life, however, it "takes longer, costs more and includes a ten- to twenty-fold higher risk of adverse events". Thanks largely to the position taken by the Canadian Paediatric Society, circumcision rates have dropped in the past few decades.

They advocate that parents should avail themselves of "the most up-to-date" unbiased data before deciding risk versus benefits for their own newborns in reflection of their cultural and/or religious customs.

A Mogen clamp, with other tools used in circumcision
Aaron Lynett / National Post    A Mogen clamp, with other tools used in circumcision

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