Rabbis Delay NYC's Metzitzah B'Peh Regulations - Meanwhile, in Israel...

After looking the other way for the longest time, the New York City Health Department finally decided to do something to address the issue of orthodox mohels spreading herpes through the practice of oral suction after ritual circumcision, also known as "metzitzah b'peh."

Or, at least, do something to look busy.

What did the New York City Health Department do to protect further boys from being infected?

They issued a mandate that would require parents to sign a consent form before allowing a mohel to perform metztizah b’peh on their sons.

According to Deputy Commissioner Jay K. Varma, the health commission would impose penalties at its own discretion. They would respond to public complaints and investigate the claims, (Because this has happened in the past? Do you seriously need a special law that requires parents to sign a waiver to do this?) and that repercussions could range from a phone call or a formal warning letter, to fines of up to $2,000 for each violation. (Again, when has this happened, and shouldn't this be standard procedure for ANY time a child is being put in danger? What happened in 2006 when Thomas Frieden was Health Commissioner?)

The mandate is basically worthless; there is no actual ban or regulation of metzitzah b'peh, and mohels would face no penalties whatsoever if the waivers were not signed. (I ask, what ultra-orthodox Jewish parent doesn't know the health implications of what is probably their most cherished religious tradition?)

But despite the new mandate being essentially impotent, ultra-orthodox rabbis were intolerant of what they see as an "unconstitutional, shocking governmental overreach." According to Rabbi William Handler, leader of Traditional Bris Milah, a self-proclaimed group formed to “protect Jewish ritual circumcision,” this mandate is "the first step in completely taking away traditional bris milah from the Jewish people in New York City.”

To prevent this mandate from taking effect, several rabbis and Jewish organizations, including Agudath Israel of America and the International Bris Association, filed a lawsuit at the Federal District Court in Manhattan. They accuse mayor Bloomberg of "blood libel," and the New York City Health Department of "trying to enforce erroneous opinions on the people of New York City." They claim the city lacks “any definitive proof” that metzitzah b’peh “poses health risks of any kind," despite the fact that the CDC found a total of 11 baby Jewish boys in NYC were infected with herpes.

Well, as they say, the squeaky wheel gets the grease, and it looks like the very vocal rabbis have gotten their wish.

New York City agreed to a brief stay in the enforcement of the above mandate, so that the plaintiffs who filed the lawsuit in Manhattan can submit a motion for a preliminary injunction.

The implementation of the city’s regulation, originally set to begin Oct. 21, has been pushed back until Nov. 14. 

Meanwhile, in Israel...
While rabbis were successful in holding back a law that does basically nothing to stop ultra-orthodox mohels from putting boys at risk for herpes transmission, the Israel Ambulatory Pediatric Association is calling for an end to the practice of metzitzah b'peh.

Going beyond a mere (and optional) waiver form as proposed in New York City, the Israel Ambulatory Pediatric Association is calling on Israel’s Health Ministry to require maternity wards and clinics to advise parents against metzitzah b’peh.

They are recommending that mohels, or ritual circumcisers, use a tube to take the blood from the circumcision wound, preventing direct contact with the infant’s incision.

Note the strange difference; in New York, officials want to take a "hands off" approach, going as far as highlighting the fact they neither ban nor are regulating how the practice is performed. In Israel, IAPA calls on Israel's Health Ministry to full on advise parents against the practice, and for the practice to be regulated.

Why an Israeli organization is displaying less reservation in regulating a Jewish religious practice than one in New York is beyond me. I would expect more for the Israeli organization to tread lightly on the issue, not the other way around.

Special Pleading
 The angry rabbis in New York try to act as if "religious freedom" is absolute, and government treats all religious practices as "off limits." Government intervenes in religious practices and beliefs all the time. Polygamy and child marriage is illegal, for example. In many states now, parents may not refuse to take their children to the hospital on the basis of "religious beliefs." And, since 1996, all forms of female genital cutting in healthy, non-consenting minors, including a "ritual nick" as proposed by the AAP in 2010, are punishable by law.

So while polygamists, perpetrators of child sex, circumcisers of girls etc., face the law, even in the so-called name of "religious freedom," circumcisers of boys get special kid-glove treatment, especially if they happen to be ritual circumcisers that put boys in extra danger by putting their mouths on the wounds they create.

Because pointing out the reality that cutting a child's penis and then placing one's mouth on it puts a child in danger and DOING something about it constitutes "blood libel," and would "upset" those who engage in the practice.

AAP: New Statement Over-Hyped by US Media?

We've all seen it all before. Media outlets wave about the so-called "latest research" from Africa, and they keep insinuating that the AAP is "about to recommend" circumcision. The hype would actually not be based in fiction, as leaders from the AAP and CDC have been saying they're working on new position statements on circumcision.

Well, according to the Washington Post, it looks like the AAP is finally getting ready to release a new policy statement sometime by the end of this month, and some commentary by one Michael Brady has intactivists worried. According to Brady:

"While details are not yet available, the new position concludes that the health benefits of circumcision outweigh the risks, said Michael Brady, a pediatric expert at Nationwide Children’s Hospital in Columbus, Ohio, and a member of the AAP’s task force on circumcision." 

If Brady is right, the AAP will be the first medical organization in the world to actually make the claim that the "health benefits of circumcision outweigh the risks."

There is already a letter-writing campaign and a petition. (If you're on Facebook, you can see a page devoted to writing to the AAP here.) But before they jump to conclusions, intactivists need to remember that the AAP and CDC have been leading on that they're "about to release new position statements on circumcision" for a few years now. They keep saying their statements are about to come out "this spring," or "by the end of the year," or "at the beginning of next year," and yet their "new statements" don't seem forthcoming. That is, until now...

The number of times the eminent AAP position statement has been postponed raises the question; what's been taking them so long?

In this post, I will explain why intactivists need not get too worried.

Media Hype: The "Great Circumcision Controversy" Trope
Could it be that there are unseen figures spurring media outlets on to release pro-circumcision articles and reports? (What with the Cologne ruling and all?) Or is it that media outlets are suffering slumps in their ratings, and they periodically release hyped up stories on "the benefits of circumcision" because they know it generates controversy? Or is it a combination of the two?

American audiences may not be aware at first glance, but media outlets are perpetrators of what I call the "Great Circumcision Controversy" trope. That is to say, that they are taking advantage of viewer gullibility, not to mention the fact that circumcision, particularly the circumcision of healthy, non-consenting infants, is a custom that is already deeply entrenched in American culture, to create "controversy" where there is actually none.

How it works; in order to encourage the belief that male circumcision is a surgery that is carried out for medical reasons, media outlets present male circumcision as a controversial and ongoing debate between altruistic "expert" medical authorities, who are attempting to vouch for male infant circumcision as "disease prevention," and the resistance of extremist "special interest" groups. However, this portrayal of reality is not at all consistent with the view of male infant circumcision given in the position statements of world medical authorities.

While the media presents male circumcision as an "ongoing debate" going on between medical "experts" and angry activists, the trend of opinion on routine male circumcision is overwhelmingly negative in industrialized nations. No respected medical board in the world recommends circumcision for infants, not even in the name of HIV prevention. They must all point to the risks, and they must all state that there is no convincing evidence that the benefits outweigh these risks. To do otherwise would be to take an unfounded position against the best medical authorities of the West.

How Do Medical Boards In and Outside the US View Infant Circumcision?
According to the American Medical Association (AMA) Report 10 of the Council on Scientific Affairs:

"The British Medical Association has a longstanding recommendation that circumcision should be performed only for medical reasons... Recent policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns".

In their last position statement on infant circumcision, the American Academy of Pediatrics (AAP) stated that:

"...benefits are not sufficient for the American Academy of Pediatrics to recommend that all infant boys be circumcised."

In their "Position Paper on Neonatal Circumcision, the American Association of Family Physicians (AAFP) stated:

"...the association between having a sexually transmitted disease (STD) - excluding human immunodeficiency virus (HIV) and being circumcised are inconclusive... most of the studies [of the effect of circumcision on HIV] ...have been conducted in developing countries, particularly those in Africa. Because of the challenges with maintaining good hygiene and access to condoms, these results are probably not generalizable to the U.S. population".

According to the College of Physicians and Surgeons of British Columbia:

"Current understanding of the benefits, risks and potential harm of this procedure no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention."

The Canadian Paediatric Society says:

"[We] do not support recommending circumcision as a routine procedure for newborns."

The British Medical Association says:

"The BMA considers that the evidence concerning health benefits from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it."

The Royal Australasian College of Physicians stated in 2010 that:

 "[The foreskin] exists to protect the glans [and that it is a] primary sensory part of the penis, containing some of the most sensitive areas of the penis."

In the Netherlands, the Royal Dutch Medical Association (KNMG) issued a statement in 2010 stating that "The official viewpoint of KNMG and other related medical/scientific organizations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity." Circumcision can cause complications, including infection and bleeding, and are asking doctors to insistently inform parents that the procedure lacks medical benefits and has a danger of complications. In addition to there not being any convincing evidence that circumcision is necessary or useful for hygiene or prevention, circumcision is not justifiable and is reasonable to put off until an age where any risk is relevant, and the boy can decide himself about possible intervention, or opt for available alternatives. They went on to say "There are good reasons for a legal prohibition of non-therapeutic circumcision of male minors, as exists for female genital mutilation."

The WHO and CDC
There are some circumcision advocates who boast that the WHO and CDC have endorsed circumcision to prevent HIV, however they will not mention the fact that these organizations have been careful to specify that they endorse adult circumcision as a way to prevent HIV in high risk locations in AFRICA. The WHO has NOT endorsed infant circumcision to prevent HIV anywhere else, and the CDC, like the rest of its counterparts in the rest of the world, says that there is insufficient evidence to endorse infant circumcision, and refrains from "recommending" it in the United States of America, "leaving it up to parents."

6 Years, and Still No Change
It has been 6 years since the WHO used some very dubious "research" to endorse male circumcision to prevent sexually transmitted HIV in Africa, and yet, with the exception of the CDC who has endorsed it on adult males in Africa, no other medical organization in the world has followed suit. Even the CDC falls short of endorsing infant circumcision in the name of HIV transmission. If the best medical authorities in the West have not endorsed infant circumcision, it is because they have reviewed all of the evidence and have found it to be insufficient.

So Why Doesn't the AAP Simply Just Come Out Against Infant Circumcision?
People have a misconception of what the AAP actually is. Most think it is this altruistic organization whose prime interest is the health and wellbeing of children. The fact of the matter is that they are nothing more than a trade union whose prime purpose is the protection of the interest of its members.

Therefore, the AAP has a delicate balancing act to preform. On the one hand, they cannot put members who profit from the procedure in a tight spot. On the other, they cannot actually jeopardize their credibility by releasing a statement that will defy the whole of modern medicine. And, as a professional medical organization that is, at least ostensibly, concerned with the well-being of children, they're expected to take a position, keeping it up to date.

The true purpose of the so-called "circumcision taskforce" is therefore not to actually "weigh the evidence," but to appear to mull the so-called "evidence" and figure out how they can keep the AAP from ever coming out against circumcision, weaseling out of addressing the ethical concerns of cutting off normal, healthy tissue from healthy, non-consenting infants, while still appearing to be professionally, ethically responsible. Basically keep their circumcising members blameless and in business, while feigning an interest in the well-being of children.

The AAP endorses FGM, backpedals shortly afterward...
This is not the first time the AAP is under fire for a questionable position statement on genital cutting; in 2010, the AAP advocated for allowing female genital mutilation in the form of a “ritual nick”, under the pretext that endorsing said "ritual nick" might dissuade parents of immigrant daughters from taking them abroad to undergo a more severe form of genital mutilation. The AAP admitted that the so-called "ritual nick" would dwarve in comparison to male infant circumcision. Not surprisingly, this position was met with a world outcry, and the AAP had to promptly withdraw their statement.

In the end...
Oh there's no doubt about it. The new AAP position statement is going to milk every so-called "benefit" for what it's worth. It's going to dance around the HIV "research" in Africa numerous times. They're going to huff and puff and blow as hard as they can. In the end, however, like pretty much the rest of the medical authorities in the West, they're going to have to conclude that there still isn't enough evidence to endorse the circumcision of healthy minors, and fall short of the much hoped-for "recommendation"circumcision advocates keep pining for, and still insist "parents must weigh the pros and cons," continuing to rid themselves of any professional responsibility. After much ado, their stance will remain comfortably "neutral," never actually having "recommended it."

I say again; unless the AAP seriously plans to jeopardize their credibility by defying the whole of modern medicine, they're going to continue sitting on the fence, as Hugh Young put it, shifting their bottoms on it every once in a while.

A passage in the Washington Post article already reads:

"The AAP’s new position falls short of a routine recommendation, Brady said, adding that parents should continue to take into account their own cultural, religious or social views."

In other words, the new statement will be nothing but more of the same.

But this little detail, as usual, will be unimportant for circumcision advocates and American media to report...

Intactivists should learn not to panic every time some news outlet releases some new blurb some pro-circ quack manages to publish. This is nothing more than a saber-rattling tactic, and seeing intactivists panic is precisely what the pro-circs want; it gives credibility to their accusations that we're just a bunch of loons.

DISCLAIMER:
The views I express in this blog are my own individual opinion, and they do not necessarily reflect the views of all intactivists. I am but an individual with one opinion, and I do not pretend to speak for the intactivist movement as a whole, thank you. ~Joseph4GI

NYTimes Plugs PrePex, Consorts With Known Circumfetish Organization

It's all happened before. And it's all happening again. But this time, it happened in New York.

Yes, it seems, that since the WHO used three dubious "studies" to endorse male genital mutilation as HIV prevention, circumcision advocates, each with their own different interests, have been looking for ways to promote so-called "mass circumcision campaigns" full speed ahead.

PEPFAR and Bill Gates are in Africa bankrolling so-called "mass circumcision campaigns." These have started a race to come up with an efficient gadget that will speed up circumcision. Eager circumcision advocates are trying to use the WHO judgement to get medical organizations around the world to endorse the practice of infant circumcision, and to recuperate public funding which once paid for it. In Australia, circumcision enthusiast Brian Morris can't seem to keep quiet about getting the Royal Australian College of Physicians to endorse "mandatory circumcision" for all boys. In America, Arleen Leibowitz laments the fact that 17 states have stopped Medicaid funding for infant circumcision.

All of this hullabaloo surrounding an eminent "scale-up" of circumcision seems to be focused on one concentrated purpose:

To secure acquiescence to the idea that circumcision actually does anything to prevent HIV transmission.

In recent months, a number of news outlets have run what appears to be an infomercial for a circumcision device, namely the PrePex device, developed by Israeli inventors.

A video version of the PrePex infomercial was published on the BBC, which wasn't even viewable to Britons. Perhaps the BBC knew that if Brits saw this ridiculous excuse for journalism there would be an outcry demanding an explanation. A few days later, a more dumbed down version of the infomercial was published on the Washington Post in news article form. The message and the purpose remained the same; to move the audience past the evidence (or lack thereof), and focus attention on "mass circumcision campaigns," and how the new PrePex device is the answer.


The PrePex Infomercial on the New York Times
The PrePex company has managed to get the New York Times to publish an infomercial for them, masquerading as a news article. This article goes a step further than its predecessors, however, as it is actually now calling circumcision, an amputative procedure, an actual "VACCINE."

I am going to go through the entire article and highlight all the deliberate misinformation that the New York Times tries to pass off as fact.

"AIDS Prevention Inspires Ways to Make Circumcisions Easier," reads the headline.


Already, the author is assuring his readers that yes, circumcision does in fact, prevents AIDS. No actual analysis of the "evidence" is needed, readers should just believe that this is a foregone conclusion.


Reads the caption under the picture of the "new" invention: "‘LIKE A FINGERNAIL’ One new product, PrePex, uses a ring to block blood flow. After a week, the dead foreskin falls off or can be clipped." 

Hardly innovative, the PrePex is nothing more than a glorified tourniquet device. A number of other devices use the exact same principle of cutting off blood circulation to the foreskin, including the TaraKlamp, the Smartklamp, the Ismail Clamp, the Zhenxi Ring and the Shang-ring before it.

"Like a fingernail" is an attempt to trivialize the foreskin. Tie off any part of the body and it will shrivel up and die. Reader, ask yourself; when was the last time you had to cut off circulation in your fingernails before you had to cut them off?

Let's continue with the article:
"The day of the assembly-line circumcision is drawing closer."

This seems more like wishful thinking on the part of the author, and the circumcision advocates he is writing the plug piece for. In actuality, "assembly-line circumcision" has been going on in the US for a few decades now. And actually, as per the CDC, the practice is in decline. This, I believe, is the real cause for concern for advocates of circumcision in the so-called name of disease prevention.

Moving on:
"Now that three studies have shown that circumcising adult heterosexual men is one of the most effective “vaccines” against AIDS — reducing the chances of infection by 60 percent or more — public health experts are struggling to find ways to make the process faster, cheaper and safer."

A deliberate lie, mashed together with a half-truth. "Studies" have shown no such thing.

Let us begin with this half-assed quantification of circumcision as a "vaccine." It needs to be made clear:

A vaccine functions by strengthening the immune system against pathogens that cause disease. When HIV, or any other disease, invades the body, it makes no difference to the immune system whether or not a man is circumcised. Saying that circumcision behaves ANYTHING like a vaccine is a deliberate LIE, it is an unscientific statement and a disservice in the fight against disease, and news outlets have got to stop repeating it.

It may be true that health "experts" (Experts? WHAT experts? Who are they?) are scrambling to find ways to spread circumcision, but there is absolutely no "study" in the world that can demonstrate that circumcision functions anything like a vaccine.

The worn 60% figure is never addressed. 60% of what? What did the supposed "studies" actually show?

The "studies" supposedly involved 10,908 men, 5,411 of which were circumcised, and 5,497 which were left intact as a "control" group. By the end of the studies, 201 men contracted HIV. The famous 60% figure we hear repeated over and over comes from the comparison of 137 intact men  vs. 64 circumcised men who contracted HIV. This figure quickly shrinks to an insignificant 1.37% however, when we factor in the rest of the 10,707 men who didn't get HIV. Circumcision is being heavily promoted using a ridiculously inflated number, but the New York Times etc. are touting it as gospel truth.

No, even if the "research" were correct, circumcision could not hold a candle to condoms.

Additionally, real world empirical evidence fails to correlate with the WHO's select studies.

Let's continue...
"The goal is to circumcise 20 million African men by 2015, but only about 600,000 have had the operation thus far."

Which raises a few questions. The WHO endorsed these "studies" since 2006, and campaigns such as Soka Uncobe have been blasting the message in Africa for at least a year now.  "Those foreskins are flying," assured Robert Bailey in a past article on the very New York Times. If the programs are being so "successful," how is it that there are efforts to "streamline" circumcision? Have organizers thought of the possibility that they may never even reach one or two million men, let alone 20? That despite all of the "science" and "research" thrown at them, the men may not be interested in having part of their penis cut off? Have they thought of plan B? Have they envisioned a future where HIV might be prevented WITHOUT surgery? Why does it seem like organizers in Africa are more concerned about spreading circumcision, than they are about spreading HIV awareness, and education in the use of condoms, which, even according to "research" would far supersede it?

Aren't organizers concerned that promoting circumcision is going to discourage the use of condoms?

Continuing:
"Even a skilled surgeon takes about 15 minutes, most African countries are desperately short of surgeons, and there is no Mohels Without Borders."

And why on earth would you need RELIGIOUS practitioners of circumcision? What is this effort ACTUALLY about? Aren't circumcision advocates even going to try to conceal their ulterior motives anymore?

The questions continue. KNOWING that surgeons and doctors are in short supply, and that healthcare is needed elsewhere, how is it circumcision advocates insist on exhausting this limited supply? How is it they're not looking for less invasive methods of HIV prevention that are as effective, if not even more so than circumcision?

The article continues:

"So donors are pinning their hopes on several devices now being tested to speed things up."

Or, rather, using WHO endorsement of male genital mutilation as HIV prevention, circumcision device manufactures have managed to secure a piece of the circumcision/HIV pie.

Continuing: 
"Dr. Stefano Bertozzi, director of H.I.V. for the Bill and Melinda Gates Foundation, said it had its eyes on two, named PrePex and the Shang Ring, and was supporting efforts by the World Health Organization to evaluate them."

Evaluate? Or endorse?

(And look who is doing the evaluating! None other than David R. Tomlinson, the "chief expert on circumcision" at the WHO, who also just happens to be an inventor of various circumcision devices himself, namely the AccuCirc device.)

Are Bill and Melinda Gates really interested in humanity? Or is this merely a PR endeavor?

The clincher:

"Circumcision is believe[d] to protect heterosexual men because the foreskin has many Langerhans cells, which pick up viruses and “present” them to the immune system — which H.I.V. attacks."

Here we see the New York Times, yet again, trying to merge science with quackery.

HIV most definitely attacks the immune system; this is an observable phenomenon that anyone can see and confirm for themselves. But there is absolutely no scientific evidence whatsoever that the Langerhans cells in the foreskin "picks up" viruses and "presents" them to the immune system.

Actually, scientific evidence proves quite the opposite: Not only do the Langerhans cells act as a natural barrier for HIV, they actually secrete Langerin, which destroys HIV on contact.

de Witte, Lot; Alexey Nabatov, Marjorie Pion, Donna Fluitsma, Marein AW P de Jong, Tanja de Gruijl, Vincent Piguet, Yvette van Kooyk, Teunis B H Geijtenbeek (2007-03-04). "Langerin is a natural barrier to HIV-1 transmission by Langerhans cells" (PDF). Nature Medicine. doi: 10.1038/nm1541. http://www.circumcisionandhiv.com/files/de_Witte_2007.pdf.

The claim that the Langerhans cells facilitate HIV transmission is categorically false.

The New York Times is "picking up" and "presenting" deliberate scientific falsehoods to the American public.

Let it be clear:

The idea that circumcision prevents male heterosexual HIV transmission is a belief; a belief that cannot be scientifically demonstrated. A "decrease" in HIV transmission can be "observed" in three hopelessly flawed, heavily skewed "studies" that fail to correlate with real world empirical evidence. That this "decrease" was indeed caused by circumcision, however, is a far-fetched belief that "researchers" have yet to substantiate. "Researchers" are trying to frame their cherished beliefs and traditions in "research," and that's not science.

The article continues:
"PrePex, invented in 2009 by four Israelis after one of them, a urologist, heard an appeal for doctors to do circumcisions in Africa, was approved by the Food and Drug Administration three weeks ago. The W.H.O. will make a decision on it soon, said Mitchell Warren, an AIDS-prevention expert who closely follows the process."

The inventors of the PrePex device are of Israeli origin which brings into question their true motives. The Jerusalem AIDS Project (JAIP) created Operation Abraham, which is an organization whose sole purpose is to promote circumcision any which way it can. They too have used the WHO's endorsement to travel all over the world to promote circumcision. Are they truly interested in public health? Or are they interested in safeguarding and promoting a religious ritual which is ever under scrutiny? Or is this purely an endeavor to cash in on the opportunity?

The PrePex plug piece continues:
"From the initial safety studies done so far, PrePex is clearly faster, less painful and more bloodless than any of its current rivals. And it relies on the simplest and least-threatening technology — a rubber band.

The band compresses the foreskin against a plastic ring slipped inside it; the foreskin dies within hours for lack of blood and, after a week, falls off or can be clipped off “like a fingernail,” said Tzameret Fuerst, the company’s chief executive officer, who compared the process to the stump of an umbilical cord’s shriveling up and dropping off a few days after it is clamped."

Again, this is hardly innovative; the PrePex is nothing but a glorified tourniquet device. A number of other devices use the exact same principle of cutting off blood circulation to the foreskin, including the TaraKlamp, the Smartklamp, the Ismail Clamp, the Zhenxi Ring and the Shang-ring before it.

"Like a fingernail" is an attempt to trivialize the foreskin. Any part of the body will shrivel up and die if you cut off circulation to it. Unlike the foreskin, or any other part of the body, fingernails are a dead part of the body, and don't need to be tied off to cut off circulation before trimming them. The umbilical cord does not need to be tied off either, as it too is a dead part of the body which will eventually shrivel up and fall off on its own.

Focus on PrePex

I'd like to zero in on this Tzameret Fuerst woman. Who is she? Why is she so enthusiastic about circumcision? Particularly this new "PrePex" device? And why does it seem like she's more excited about getting millions circumcised, than she is about HIV prevention? Why is the fact that, even if "studies" were correct, circumcision is not "100% effective" an afterthought?

If my presumptions are correct, she is the wife of Oren Fuerst, co-inventor of this device. Millions of men circumcised means that millions of PrePex devices will be bought and used. She's cashing in on the HIV gravy train, and that's why she's so enthused.

It is difficult to get a man to understand something when his job depends on not understanding it.
~Upton Sinclair

Continues the PrePex ad:
It is done with topical anesthetic cream, and there is usually no bleeding. And PrePex can be put in place and removed by nurses with about three days’ training.

All really irrelevant afterthoughts... If there is no scientific proof that circumcision prevents HIV, and even given the "evidence" condoms still do a far better job, what does the minimalization and the simplicity of the procedure even matter...

The rings come in five sizes, A through E, Ms. Fuerst said, “and you won’t believe how high-tech the rubber band is.”

She's right! I don't!

"Each size must apply just enough pressure to cut off blood flow without being tight enough to cause pain"

Fuerst, does PrePex have an AIDS prevention method that DOESN'T involve cutting off part of my penis, please?

Continuing...
"The W.H.O., Mr. Warren said, is also evaluating the Shang Ring, a plastic two-ring clamp developed in China to treat conditions in which the foreskin becomes so tight that it cuts off urination."

And here we see the injection of a condition which necessitates circumcision, and another device that facilitates it. Are we even going to be given a scientific explanation as to what these "conditions" are? If they actually cut off urination, and they actually need circumcision viz Shang Ring?

What is the name of the condition where the foreskin becomes so tight it cuts off urination? What causes it? Is circumcision the only option? More gratuitous promulgation of non-science.

Moving forward:
"However, it requires cutting off the excess foreskin beyond the clamp, which means the circumciser must inject anesthetics directly into the penis and groin, wait for them to take effect, create a sterile surgical field and be trained in minor surgery."

“The Shang is not as fast, but it’s faster than full-fledged surgery,” Mr. Warren said. “And it hasn’t submitted as much safety data."

"In a safety study presented at an AIDS conference last month, scientists from Rwanda’s health ministry said they had used PrePex to circumcise 590 men. Only two had “moderate” complications; one was fixed with a single suture, and one required a new band in a different spot."

All useless information that draws attention more and more away from whether or not circumcision actually prevents anything... I'm sure with just the right amount of "research" one could invent a device that facilitates the extraction of the labia with only "moderate" complications...

Or better yet, come up with an actual solution that doesn't involve genital mutilation...

Continuing on: 
"According to Dr. Jason Reed, an epidemiologist in the global AIDS division of the Centers for Disease Control and Prevention, 2 of 590, or 0.34 percent, is a tenth the typical complication rate of surgical circumcision."

More statistics to blind the reader with. That's 2 out of 590 in a controlled study. What does that look like for the rest of Africa outside of the scientific environment? And what does this figure look like at 20,000,000 men? One in 295 men will suffer complications. Over 20,000,000 men that these people plan to circumcise, that's about 67,800 men who will suffer complications.

And that's *if* the people writing these "studies" were writing the truth. Remember, they're trying to MARKET their device.

I'm also being kind in assuming that all 20,000,000 African men will have undergone circumcision using the PrePex device; surgery will still be used, and, given the WHO green light, tribes will continue to circumcise youth and men traditionally. The number of complications is going to exceed 70,000, as will the number of iatrogenic HIV transmission. (In Africa, visiting a health center in and of itself is a risk for HIV. Is Daniel McNeil Jr. not aware of this fact?)

All of this, when HIV can already be easily and effectively prevented via education and condoms???

There is another lie that Jason Reed is trying to slip by here; that 0.34 percent is a "tenth" of the typical complication rate of surgical circumcision.

What kind of circumcision could Jason Reed possibly be referring to? Adult circumcision? Child circumcision? What is being counted as a "complication?"

There are reasons to believe that CDC statistics on circumcision in the United States is flawed, namely that they report "zero deaths" when intactivists have a long list of deaths documented. They report an infinitesimally small number of "complications," when we have reports that botched circumcisions have been on the rise for the past few years. Is the CDC telling the truth? Or are they circumcising it?

Instead of investigating, the New York Times takes Reed's presentation of CDC statistics at face value. Let's hear it for American journalism!

Continuing:

"None of the men became infected."

That's great! Does circumcision prevent HIV? Is it even relevant in light of HIV prevention methods which already supersede it?

Continuing:
"On the 10-point pain scale, they reported [a]n average [of] only about 1 when the ring was placed and only 3 when it was removed (about the same level of pain caused by erections during the week they wore it).

By the end of the study, the two-nurse teams could do a procedure in three minutes.

By contrast, Dr. Reed said, the best surgical “assembly lines” — a practice being pioneered in Africa with American taxpayer support — can get down to seven minutes per patient, but only by getting six nurses and a surgeon into a tight harmony."

"Looking busy" is but a distraction from the main points:

Does circumcision prevent HIV? Even if it did, even if the science were correct, is it even worth it in light of less invasive, more effective methods of prevention that already exist? Is it ethical to promote deliberate genital mutilation in the name of "research" and "public health?" Would we ever promote female circumcision if we had the same "research" to support it? What if it could be made "painless" or "bloodless?" What if we could make it so it doesn't decrease a woman's sexuality? Would we consider female circumcision then?

Continuing:
"In theory, he said, breaking that into three two-nurse PrePex teams could mean circumcising around 400 men a day, rather than the 60 to 80 a busy team now does. And the surgeon could go do something more important."

That's assuming 400 men a day would indeed line up to get circumcised. Many programs, such as Soca Uncobe, have completely missed their mark.

Or, instead of spending millions of dollars on needless devices, instead of emburdening surgeons with a time-consuming, needless procedure to mutilate the genitals of millions of men, they could be spending money on condoms and sex education, which, even if the "science" were correct, is worlds more effective. HIV transmission could be decreased WITHOUT genital mutilation, WITHOUT the need for these ridiculous devices. Men could keep their organs, condoms and sex education would prevent HIV in both men and women, and no time, money or energy has to be wasted on a dubious form of "prevention."

Continuing: 
"In fact, Dr. Reed said, American AIDS dollars for circumcisions often go toward an operating room with lights and an instrument sterilizer. Instead of circumcisions, hospitals are more likely to use it for procedures like saving women in obstructed labor"

"Which is understandable — of course that takes precedence,” he said. “But then the circumcisions don’t get done."

Which doesn't make a whole lot of sense.

It doesn't make any sense to be spending millions on genital mutilation, when, even if the science is correct, would fail to live up to a condom. It doesn't make sense that there are other, more important issues to address; healthcare in general, mother-to-child HIV transmission, food, water, etc., and "experts" like Reed are more concerned that money isn't wastefully being spent on circumcision, for which there is already cheaper, less invasive, more effective ways to prevent HIV.

What is this all about? Is this about healthcare? HIV prevention?

Or is this purely about circumcision?

Some "experts" need to get their priorities straight.

Continuing:

"Robert C. Bailey, an epidemiologist at the University of Illinois at Chicago who helped design Kenya’s circumcision efforts, opposes timesaving devices because training nurses in minor surgery has other benefits, he said. A trained nurse could close a wound or take out an appendix, for example. And the time-consuming parts of the process are counseling and H.I.V. testing, Dr. Bailey said, so 'doing it in five minutes instead of 20 is trivial.'

"But he conceded, 'If PrePex really doesn’t require anesthesia, that’s truly an advance.'"

This part of the article is a bit confusing, and I'm not sure I understand it myself.

First off, am I to understand that nurses are being trained in surgery OTHER than circumcision? But furthermore, am I to understand that circumcision is being used as an "opportunity" for counseling and HIV testing? Couldn't circumcision simply be skipped and men could be given counseling and HIV testing directly? Or are intact men simply incapable of receiving these things?

Imagine, for a moment, a dentist using a total tooth extraction as a pretext to hand people information on oral hygiene and dental care. But his patients still have to use false dentures.

Imagine the converse. What if we started offering circumcision to the women so that doctors can then “take the opportunity” to tell them about better hygiene practices and sex education?

The million dollar question is, since when does a man need surgery to learn how to wash his penis and use a condom properly? Does not being circumcised somehow impede a man’s learning of these concepts? Does not being circumcised somehow nullify the protective effect of condoms?

The article continues:
"Rwanda is training 150 two-nurse teams; it is a small country, but it serves as a bellwether for Africa because its health care system is well organized, government corruption scandals are rare, and it is heavily supported by donor funds."

Rwanda is also a country where HIV has been shown to be more prevalent amongst the CIRCUMCISED. According to a demographic health survey taken in 2005,  the ratio of circumcised vs. intact men who contracted HIV was 3.8% vs 2.1%.

And, incidentally, according to a 2010 study published in the New England Journal of Medicine, rates of HIV among adults in Washington, D.C. exceed 1 in 30; rates higher than those reported in Rwanda. (In America, 80% of the male population is circumcised from birth.) The Washington D.C. district report on HIV and AIDS reported an increase of 22% from 2006 in 2009. According to Shannon L. Hader, HIV/AIDS Administration, Washington D.C., March 15, 2009, "[Washington D.C.'s] rates are higher than West Africa... they're on par with Uganda and some parts of Kenya." Hader once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe.

Somehow, though, something tells me that the New York Times is not going to publish this part of the story.

The PrePex ad continues:

"Other, rival devices are not far along in safety testing or are failing it."

Hint hint... it's the PrePex, everyone!

"The Tara KLamp, manufactured in Malaysia since the 1990s, has created controversy in South Africa. It is a hinged plastic bracket the size of a small drinking cup. A plastic tube goes over the head of the penis, and the foreskin is pulled up it and painfully crushed by the bracket. Then the whole contraption must be worn at least five days. A 2005 clinical trial in South Africa was stopped early after the device caused far more injuries and infections than surgery did."

It is essentially the same exact contraption as the PrePex, and follows the exact same mechanism and principle of cutting off circulation to the foreskin, thereby facilitating its excision. Rest assured, though readers, the PrePex is the better design.

But again, a man needs a PrePex likes a fish needs a bicycle.

Continuing:

 "The national health ministry has banned it in most of South Africa, but it is still used heavily in KwaZulu-Natal Province, which has the country’s highest AIDS rate and where the Zulu king, Goodwill Zwelithini, reversing 200 years of tradition, ordered that all Zulu men circumcised. 

The W.H.O. knows about the stopped trial and is not considering the KLamp, Mr. Warren said."

Oh thank heavens! They don't seem to be too concerned that non-authorized devices and circumcision methods are being used in their name, though.

One must wonder as to the relevance of the Zulu king anecdote; is the author more concerned with HIV prevention, or with "reversing 200 years of tradition?" This really shows you where his heart actually is.

Reed continues:
"Dr. Reed said he had heard that another device, Ali’s Klamp, was being tested in Kenya under protocols that seemed to match W.H.O. requirements. According to Circlist.com, a circumcision information Web site, it is a Turkish device dating to 2007, and works on principles similar to those of the Tara KLamp and another device, the SmartKlamp, approved by the F.D.A. in 2004."

For all intents and purposes, all of these devices are essentially the same. They all function under the exact same principle of cutting circulation off to the foreskin. The PrePex is simply a different design.

Now, I'd like to take the time to correct a horrific error that this article commits, and that is present circlist.com as a mere "cirumcision web site."

What is Circlist? What do they do?
Circlist is a circumfetishist organization. A circumfetishist is someone who has a sexual fixation for the circumcised penis, and/or derives sexual gratification from the act of circumcision itself. The Circlist organization has a website and discussion group for men who sexually fantasize about performing and receiving circumcisions, often on small children. Circlist members openly admit to a morbid fascination with circumcision, to the point of being a sado-masochistic fetish. Circlist has been long known to intactivists as a meeting place for circumfetishists, where they discuss the erotic thrill they experience from watching other males being circumcised, swap fiction and non-fictional stories about it, and trade in videotapes of actual circumcisions. They are a fetishistic organization comparable to NAMBLA, and yet, here they are, being given credibility on the New York Times.

The fact that Circlist is being used as a reference in this piece, even though it doesn't rely on them for any facts, demonstrates how uninterested the New York Times is in logic and ethics. The site’s inclusion with a direct link to it is absolutely shameful. What a sick, disgusting shame that Daniel McNeil Jr. of the New York Times has decided to quote them as any kind of reliable resource.

SHAME on you, Daniel McNeil Jr. for daring to give publicity to this sick, disgusting group in the New York Times.

On to the end:

"PrePex was cleared by the F.D.A. because it was judged “substantially equivalent” to the SmartKlamp, Ms. Fuerst said. Proving equivalence in safety to an approved device is the fastest way to get approval, she said..."

Which seems to be her actual main concern...

"...although the technology is quite different."

No, the technology is the same, and it's rather old.

And finally:
PrePex’s ultimate cost is still being negotiated with donor agencies and foundations, Ms. Fuerst said, but may end up in the $15-to-$20 range, about the same as a surgical circumcision kit.

Let's see, at 20,000,000 men, that's $300,000,000 at minimum, and $4,000,000,000 at most.

For a useless, extraneous device looking for a purpose, not bad.

Not bad at all.

Closing comments
The "science" behind this massive effort to stuff circumcision down African people's throats is horrendously flawed. Why news outlets simply publish lies without questioning their validity is perplexing. A question that I keep encountering on the blogosphere is "Whatever happened to actual journalism?" But that's a different discussion for another blog post.

Even IF we lent any credibility to the latest twaddle some people dare to call "science," we have got to ask, why is the solution always circumcision?

Contrary to what is published here in the New York Times, there is actually no demonstrable scientific proof that the Langerhans cells "pick up viruses and "present" them to the immune system." But let's just assume just for a moment, that the claims were true. Let's just assume for a moment, that the Langergans cells, as they claim, "presents HIV to the immune system."

Is there any reason why the so-called "researchers" aren't looking for ways to deactivate Langerhans cells, as opposed to cutting them off?

Is there any reason why PrePex is not looking for non-destructive ways to prevent HIV transmission, and instead facilitating male circumcision which just happens to be a cherished tradition in their own country of origin?

Let's ask other questions. Assuming the Langerhans cells behave the way circumcision advocates claim, is there a reason why "researchers," PREPEX etc. aren't looking into FEMALE CIRCUMCISION? It is irrefutable scientific fact that Langerhans cells are found in the genital mucosa in BOTH sexes. If the Langerhans cells "facilitate" HIV transmission for men, then it would also do so for women. Circumcision, would only be offering "benefit" to men; women would still be vulnerable to the viral load in semen.

Which raises the question:

How is it conscionable to be spending millions of dollars on the promotion of an alternative to the most conclusively effective mode of HIV prevention known to us?

Why aren't the WHO, PEPFAR, PrePex etc. worried at all that the promotion of male circumcision is going to result in the grossest of violation of the most basic of human rights?

The Bottom Line
The foreskin is not a birth defect. Neither is it a congenital deformity or genetic anomaly akin to a 6th finger or a cleft. Neither is it a medical condition like a ruptured appendix or diseased gall bladder. Neither is it a dead part of the body, like the umbilical cord, hair, or fingernails. The foreskin is normal, natural, healthy tissue with which all boys are born.

Unless there is a medical or clinical indication, the circumcision of healthy, non-consenting individuals is a deliberate wound; it is the destruction of normal, healthy tissue, the permanent disfigurement of normal, healthy organs, and by very definition, infant genital mutilation, and a violation of the most basic of human rights.

Genital mutilation, whither it be wrapped in culture, religion or "research" is still genital mutilation.

Consider this: There would never be enough "science" or "research" to endorse the promotion of female circumcision to prevent ANYTHING.

It wouldn't matter if female circumcision were made "painless," "bloodless," and it didn't affect a girl's sexuality. It wouldn't matter if female circumcision were performed in the clean environment of the hospital, by a trained professional, using pain killers and the most pristine, and most "advanced" utensils. Why do "researchers" grope for reasons to promote male circumcision?

The day will come when anyone whoever endorsed this despicable human rights violation will be too embarrassed to ever admit that they did.

May god have mercy on their souls.

Intactivists Give Abigail R. Esman a Run for Her Money

In response to recent efforts by the the Royal Dutch Medical Association (KNMG) to discourage the non-theraputic circumcision of boys, Abigail R. Esman uses her blog at Forbes to go on a libelous diatribe against the organization, spouting lies and false claims.

When one reads her headline, which reads "Circumcision Makes You Crazy. So Holland Moves To Stop It.", one gets the misleading impression that the KNMG actually is actually claiming that circumcision drives men insane, and that they want to move to stop circumcision on these grounds.

At least, that's what I thought until I decided to read through her post.

The amount of outright lies and blatant misinformation was astounding. I wonder if Forbes is aware that one of their contributors is embarrassing them with horrible writing.

And, as if this weren't enough, she starts deleting voices of dissent in her comments section, ultimately just closing the comments section down. I've decided I'm going to pick apart her silly post on my blog, piece by piece.

She begins:

"Calling the practice "a violation of human rights" and a precursor to mental illness, Holland’s Royal Society of Medicine is encouraging the country’s parliament to place a ban on male circumcision."

The KNMG does indeed call the practice of non-therapeutic circumcision of healthy, non-consenting minors a violation of human rights. But where on earth do they say that circumcision will in fact lead to mental illness? Is she not even going to provide a link so that we can read what in fact the KNMG says? Or are we simply expected to take her word for it?

The KNMG's 2010 position statement on male circumcision can be accessed here.

There is absolutely nothing in there that says that circumcision "makes you crazy."

The next few sentences are interesting:

"Of course, such proposals come up regularly – there’s one out now in San Francisco, for instance – but they are usually the work of political groups; after all, the idea of banning circumcision is itself politically based."

Regularly? Where? I happen to be a Californian, and to my knowledge, in all my years as an intactivist, this is the first and only proposal in this state that I've ever heard of, quite possibly the last in a very long time.

And the idea of banning circumcision is itself politically based? One would wonder how she actually came to such a conclusion. And I wonder if she thinks this, the idea that banning circumcision is "politically based", applies to ALL circumcision, or just male circumcision.

It gets more interesting:

"That [a proposal to ban the male circumcision of minors] comes from a medical association, however, suggests something significantly more sinister, if for no other reason than the fact that the arguments they offer to support the measure fly in the face of actual science."

This she claims without giving a single example. Again, we're expected to take her word at face value.

And speaking of lies and political ends, let's talk about what Abigail R. Esman is trying to insinuate. She seems to be implying, with no proof whatsoever, that failing to circumcise males on a great scale increases the risk to public health, and that it is a direct cause of health issues. She also seems to be implying that there is already prevalence of circumcision in the Netherlands that would be threatened by the KMNG's proposal, thereby putting Dutch public health at risk of all the health issues that the foreskin causes. She is either ignorant or she hopes her readers aren't smart enough to know better.

The Netherlands is a country where circumcision is in fact rare and limited to Jews, Muslims, and to procedures that are medically necessary. STD transmissions are in fact lower in the Netherlands, where circumcision is rare, than in America, where the majority of men are circumcised at birth.

To be sure, America has the highest rates of HIV transmission in the industrialized world. 80% of American males are circumcised from birth, while in most countries in Europe, circumcision is uncommon. Despite this, our country does poorly when it comes to the transmission of STDs.

In fact, AIDS rates in some US Cities rival hot-spots in Africa. In some parts of the U.S., they're actually higher than those in sub-Saharan Africa. According to a 2010 study published in the New England Journal of Medicine, rates of HIV among adults in Washington, D.C. exceed 1 in 30; rates higher than those reported in Ethiopia, Nigeria or Rwanda. The Washington D.C. district report on HIV and AIDS reported an increase of 22% from 2006 in 2009. According to Shannon L. Hader, HIV/AIDS Administration, Washington D.C., March 15, 2009, "[Washington D.C.'s] rates are higher than West Africa... they're on par with Uganda and some parts of Kenya." (Hader once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe.)

Esman continues:

"And it’s not just the doctors. Indeed, the move, coming on the heels of a so-called “modified ban” on kosher and halal slaughter, demonstrates just how far Europe has come in its response to what it sees as a threat on Western democratic values posed by its growing Muslim population; increasingly, as I argued after the Norway massacre, Europe is at serious risk of transforming itself into a white, Christian supremacist state in its efforts to avoid becoming an Islamic one."

It's very interesting how just after accusing doctors of having some sort of racist political agenda, Esman proceeds to talk about the systematic oppression of Jews and Muslims by "White Supremacist Europe," as if the people responsible for all of the other issues she brings up were "one and the same." Have Europeans all unanimously embraced Christianity now? And incidentally, how is bringing up other issues proof that doctors at the KMNG are all politically and racially motivated? Has it not occurred to her that the KMNG may actually be motivated by human rights? What does she think of governments cracking down on female circumcision? Does she stick up for Islamic practices then? Or is that "different?"

Moving on...

"According to the Dutch medical society, for instance, circumcision — practiced by Dutch Muslims and Jews and standard procedure for almost all newborn males in the USA..."

According to recent CDC reports, the rate of infant circumcision in America has dropped to approximately 55%.

I know she lives in the Netherlands... should I give her the benefit of the doubt?

"...can result in castration (just how many times does that happen, I wonder?) or death; cause infections; create “mental anguish”; cause sexual problems (we all know about Einstein’s sexual issues, right?), and more."

Well it can.

How many times can castration happen? How many times would it be acceptable? Especially given the fact that circumcision is medically unnecessary in healthy minors? If Esman would have bothered to check, she would have found the David Reimer case. There have been other documented incidences of castration, particularly in Jewish and Islamic circumcision rituals. She would have found that there have been quite a number of lawsuits in the in the States because, mohels specifically, have severed the heads of the penises of a few infant boys. She would have found that a New York rabbi gave herpes to three babies, one of whom died, by sucking on their wounded penises, an ancient practice performed by ultra-orthodox rabbis called "metzitzah b’peh."  She would have found other documented cases of death. She would have found that MRSA infection is actually a big problem at hospitals. She will have found that, according to studies in Israel, ritual circumcision is a risk factor in UTI. She will have found that circumcision botches are so common that there are actually doctors who specialize in repairing them. And she will have found that there are studies that show that circumcision can cause sexual problems.

Obviously she really couldn't care less.

"And here’s the kicker: “no medical association anywhere in the world,” they claim, endorses male circumcision for health reasons."

And the KMNG is accurate. In particular, no medical association in the world endorses *infant* male circumcision for health reasons.

As if to try and sound matter-of-fact, she continues:

"This, of course, is an outright falsehood, and surely they know it. In fact, the California Medical Association, faced with a similar proposal, recently wrote the following statement to the Senate Judiciary Committee: “”From political to religious, there are many differing views on the practice of male circumcision. However, in the medical world, the CMA has long endorsed the concept of newborn circumcision as an effective public health measure.”"

This paragraph speaks to Esman's ignorance on the matter. As I explained in a reply that she has deleted, it is clear she merely copied and pasted this quote straight out of amednews.com, which was issued by one Ruth Haskins. If Esman would have tried to verify this quote, she would have found out that Ruth Haskins either suffers from Amnesia or was outright lying. There was a resolution to endorse circumcision back in 1989, but it lapsed years ago.

Esman continues by quoting the AAP, and even here, she must admit that their policy does not endorse routine neonatal circumcision, just as the KMNG has said. In fact, in their latest position statement, they declare, much to her chagrin, that "[the] ...benefits are not sufficient for the American Academy of Pediatrics to recommend that all infant boys be circumcised."

I told her in my reply, I've said it before, and I will keep saying it, the trend of opinion on routine male circumcision is overwhelmingly negative in industrialized nations. No respected medical board in the world recommends circumcision for infants, not even in the name of HIV prevention. They must all point to the risks, and they must all state that there is no convincing evidence that the benefits outweigh these risks. To do otherwise would be to take an unfounded position against the best medical authorities of the West.

For some unexplained reason, she feels it is necessary to insert the next paragraph:

"Meantime, Holland’s wise doctors have yet to issue any formal statement about the far more serious problem of the country’s enormous infant mortality rate (among the worst in Western Europe) and high breast cancer fatality rate (the fourth highest in Europe, and rising)."

Notice how instead of writing about these other issues, which apparently are worse problems that are being neglected, she writes an entire blog post about her disdain for the KNMG's positon regarding the non-theraputic circumcision of healthy minors.

She says:

"To be sure, the KNMG... has not called for an outright ban on the procedure; they are far too politically clever for that."

I'd like to point out how in her opening sentence, Esman was alleging:

"Calling the practice “a violation of human rights “ and a precursor to mental illness, Holland’s Royal Society of Medicine is encouraging the country’s parliament to place a ban on male circumcision."

The KMNG is either calling for a ban, or they are not. So which is it?

"Claiming that such a ban would only put the practice into the hands of the unskilled, they have rather recommended a “change in mentality” among those groups which practice circumcision in the Netherlands – namely Jews and Muslims, those same minority groups which happen also to be affected by the ban on ritual slaughter."

My, yes! What a coincidence isn't it!

"Because what this is really about is not health at all, but culture."

This is quite possibly the most intelligent sentence in Esman's entire blog post. I hadn't realized it before, but Esman actually admits what her real problem with the KMNG is all about.

Esman would be disingenuous if she failed to declare to her public an important conflict of interest; she is Jewish, where the circumcision of infants is a religious requirement and central to her ethnic and cultural identity. She has reasons to defend circumcision that betray an interest in public health.

Some may say that I'm racist in pointing out that the circumcision of male infants is an important custom to Jews, but that's not any more racist in pointing out that whaling is a custom that is important to the Japanese, and that this conviction to culture betrays an interest in "science" and "research." It is not biggotted or racist to point out that female genital cutting is an important custom to Malaysians and Indonesians.

It is rather dishonest to be defending circumcision by feigning an interest in public health, when your true convictions lie elsewhere.

"As radical Muslim groups increasingly put pressure on Holland’s politicians to change policies in order to accommodate their religious preferences – from censoring art exhibitions to (speaking of medicine) requiring that female Muslims be treated only by female physicians (an effort that thankfully failed) — indigenous Dutch are responding with a stronger nationalism and a tightened grasp on their Christian roots – even to the point of mangling the truth."

Mangling the truth indeed.

It is interesting to see Esman pick and choose just what religious impositions the Dutch should and should not respond to. She seems to be thankful that the effort to require female Muslims to be treated only by female physicians has failed, but is dreading the KMNG actually wants to see to it that surgical procedures in minors are actually medically indicated.

For better or for worse, female genital cutting is also seen by many, especially some sects of Islam, to be a religious custom. I can only assume that European governments cracking down on this religious custom is something Esman is grateful for. Does Esman really care about public health? Does she really care about "culture?" Or merely just her own?

Invisible Addition
Here's something interesting:
If you try saving her blog post as a PDF using PDFMYURL, an additional paragraph appears as follows:

ADDENDUM:
The following links present some of the latest studies and reports on the subject, all demonstrating the health benefits of male circumcision both in Third and First World countries. Note that the most recent reports have led to determinations by the CDC, WHO, UNAIDS and AAP to revise their positions on the issue, definitive supporting male circumcision at birth.

http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm
http://www.who.int/mediacentre/news/releases/2007/pr10/en/index.html
http://www.nytimes.com/2010/08/17/health/research/17circ.html
http://articles.chicagotribune.com/2011-02-16/a-z/sc-health-0216-circumcision-20110216_1_circumcised-men-john-geisheker-health-benefits-geisheker-health-benefits
http://www.medicinenet.com/script/main/art.asp?articlekey=124426

Abigail R. Esman gives the word "idiotic" a whole new different meaning.

The links she provides do indeed allege all the usual "health benefits of circumcision." Her claim that recent reports have led any of the organizations she mentions to endorse infant circumcision, however, is false.

The WHO/UNAIDS have definitely endorsed the use of circumcision in adult men in AFRICA, and the CDC is the American health organization that has embraced the latest studies the most, however there have been no such revisions "definitive supporting male circumcision at birth."

Once again; the trend of opinion on routine male circumcision is overwhelmingly negative in industrialized nations. No respected medical board in the world recommends circumcision for infants, not even in the name of HIV prevention. They must all point to the risks, and they must all state that there is no convincing evidence that the benefits outweigh these risks. To do otherwise would be to take an unfounded position against the best medical authorities of the West.

Abigail R. Esman is either willfully ignorant, or she is outright lying through her teeth.

Trouble in the Amen Corner
As if Esman's inflammatory post weren't enough, she continues to make a fool of herself in her comments section. It seems Esman simply had no idea what she was getting into. I don't think she was actually expecting to encounter people who actually knew what they were talking about. By the end, it was clear that she was losing and she couldn't handle all the replies that were clearly destroying everything she had to say. She resorted from deleting comments to eventually just shutting down the comments section.

She is gravely mistaken if she thinks she's just going to circumcise her comments and make herself appear to be the victim. I saved some of the most juiciest comments and am posting them here. 

ml66uk 
The position of the KNMG seems to be motivated by a concern for human rights rather than an attack on Muslim or Jewish faiths. Personally, I think that everyone should be able to decide for themselves whether or not they have parts of their genitals cut off. It’s illegal even to make a pinprick on a girl’s genitals though some people regard that as their religious right or duty. Why don’t boys get the same protection? It’s *their* body.

The AAP doesn’t actually recommend male circumcision in their official position statement, and the CMA’s policy doesn’t seem to be publicly available, so the KNMG may have been unaware of it. The Canadian Paediatric Association has been recommending against circumcision for years btw.

“standard procedure for almost all newborn males in the USA”?

Hardly. The rate seems to be below 60% and dropping. The USA and Israel are the only two countries in the world where more than 50% of baby boys are circumcised btw.

Drops in male circumcision since 1950:
USA: from 90% to about 55%
Canada: from 48% to 17%
UK: from 35% to about 5% (about 1-2% among non-Muslims)
Australia: 90% to 12.4% (“routine” circumcision has recently been *banned* in public hospitals in all states)
New Zealand: 95% to below 3% (mostly Samoans and Tongans)
South America and Europe: never above 5% 

jaywalk 
I agree that this article badly needs a correction. Saying that it’s standard procedure for almost all US males is an outright false statement.

Also, standing up for the right for an infant to keep all of their body parts, including from sensitive sexual areas when they can’t consent to the removal does not make someone a racist anymore than standing up against a hypothetical satanic ritual or tribal child sacrifice would also not be racist or anti-religious. It’s not the religion being attacked, it’s the damage to another human being. If your religion called for murdering another human for being impure, I’d be against that as well. It would have nothing to do with being against the religion in that case, either – only the act.

I was circumcised as an infant, and deeply regret that decision by my parents. It’s my body, and if there is no medically imminent need to have a part of it removed, that choice should be left up to me. 

torell 
Uhm, Forbes, it’s The Netherlands, not Holland – Holland is only a part of The NL – it’s like calling the USA ‘Texas’.

Second, “In other words, doctors in the Netherlands have clearly put themselves in a position of being willing to put public health at risk in order to achieve racist, political ends – and to lie in order to do so.”

Since RIC (routine infant circumcision, as practiced in the US) is non-existent in the NL anyway, they’re talking mainly about religious circumcisions here. The public health in the NL is hardly being put at risk by outlawing the approx. 10,000 religious circs that are done each year. You see, since RIC is non-existent in the NL, that means that boys have *always* been left intact. And guess what? WE (yes, we, I’m Dutch) are kicking YOUR (Forbes is American) butts with much lower HIV and other STD rates that are supposedly helped by RIC.

Also, since medicine in the NL is not for profit as it is in the US, they have no reason to lie. It seems to me drs who make a ton of money off of RIC have more reason to lie about ‘benefits’ of RIC, than drs who make what they make regardless of whether they do RICs or not, have a reason to lie about RIC being physically and mentally damaging.
 
And lastly – political motives? Uh, no. In the NL, drs have no influence on politics unless they’re a politician in their spare time. The NL does NOT work like the US. If you’re going to try to slam someone or something, you’d do better to have sufficient background information.

And rascism, really? You find something that’s proven physically and mentally damaging and you’re going to not try to outlaw it because muslims and jews want to practice it… THAT’s racist – not protecting babies and children because they’re jewish or muslim. Allowing them to be harmed because they’re a certain race or religion. *That’s* bad. 

Abigail R. Esman responds:
I will answer this one post only.
1. I live in the Netherlands. “Holland” and “The Netherlands” are used in that country interchangeably, which you yourself would know if you either lived in that country or spoke Dutch.

2. As a matter of fact, this effort was made by doctors in the Netherlands to encourage the Parliament to consider legislation. Just as the AMA has the ability to encourage the American government– via the Surgeon General’s office, the FDA, and other government bodies — to consider health issues, so, too, in the Netherlands.

3. I defy you to find me the studies that counter the significant body of published literature, some of which is cited in my piece, that specifically point to the substantial health advantages of circumcision in preventing fatal diseases both in men and women. These studies are cited by all of the organizations cited by Ms. Netherton, below. I am pleased to see that, despite herself, she does recognize their authority in advancing the benefits to the male and female population of circumcision.

4. This is not about maintaining a practice because Jews and Muslims want it. It is about not twisting the facts of science to suit a political agenda.

To the person below who refers to “urinary infections” – I simply wish to point out that cervical cancer, HIV, penile cancer, and human papilloma virus are not urinary tract infections. I presume that he knows this and is simply avoiding the fact, but perhaps not.

I will leave to the medical professionals the matter of pointing out the endless number of medical errors posted in various comments here. 

marcetienne 
As for cervical cancer, HIV, penile cancer, and human papilloma virus, the Australian medical association and numerous others in Australia and New Zealand and others have answered that.

5.2 Sexually transmitted diseases (STDs)
The published evidence concerning the relationship between circumcision and STD is often conflicting(41). An Australian study from 1983(42) suggested herpes genitalis, candidiasis, gonorrhoea and syphilis were all more common in uncircumcised men. A more recent Australian study(43) , however, suggested that circumcision has no significant effect on the incidence of common STD’s. One study has suggested a higher risk of non-gonococcal urethritis among circumcised men than among uncircumcised men(44). Genital ulcer disease, on the other hand, has been reported as being more common among uncircumcised men, and those with a genital ulcer are more likely to contract HIV.

There is increasing evidence, particularly from sub-Saharan Africa, which suggests an increased risk of female to male transmission of HIV in uncircumcised men(45-48). However, how much circumcision could contribute to ameliorate the current epidemic of HIV is uncertain(49). Whatever the future direction of this debate it can not be seen as an argument in favour of universal neonatal circumcision in countries with a low prevalence of HIV.

5.3 Human papilloma virus and carcinoma of the cervix
A recent international study reported an increased risk of human papilloma virus (HPV) infection in uncircumcised men who indulged in high-risk behaviours, compared with circumcised men(50). Monogamous women whose male partners had six or more sexual partners and were circumcised had a lower risk of cervical cancer than women whose partners were uncircumcised. Public health measures aimed at early detection have been shown to decrease cervical cancer fatalities; targeting sexually promiscuous men to decrease risk taking and increase condom use may inhibit sexual transmission of HPV and prophylactic vaccination against HPV is being developed. At present there are no data to suggest advocating neonatal circumcision would be of additional benefit to these strategies(51).

5.4 Carcinoma of the penis
Carcinoma of the penis is a rare condition, with an annual incidence of approximately 1:100,000 men in developed countries, regardless of whether there is a high or a low circumcision rate(4,5). There is evidence that neonatal circumcision confers protection from carcinoma of the glans penis but not of the penis shaft(52-56). Even though the evidence suggests neonatal circumcision does reduce the risk of carcinoma 10-fold, universal circumcision is clearly not justified on these grounds(46).

Other risk factors for penile cancer include phimosis (which is limited to uncircumcised men), genital warts, increased number of sexual partners and cigarette smoking(57,58). It has been hypothesised that good penile hygiene may help prevent both phimosis and penile cancer(59).
http://www.nocirc.org/position/racp2002.php 

torell (Comment Deleted) 
Nou ja zeg. Ik zal die onzin morgen wel verder lezen, maar als jij werkelijk zoveel over Nederland weet, dan zou je voor punt 1 weten dat mensen die niet in Noord- of Zuid-Holland wonen absoluut anti ‘Holland’ zijn. Holland is alleen toegestaan voor ons als het om Oranje gaat. Jij zal inmiddels wel zo’n beetje weer wakker zijn, maar ivm het tijdsverschil verwacht je mijn antwoord maar jouw tijd morgenavond.

It’s incredibly unprofessional to suggest you don’t even believe I speak Dutch or have lived there, so I’m not even sure why I’m bothering with you.

It should be common sense not to chop off the most sensitive part of a boy’s penis.

Like I said in my Dutch reply, I’ll read your comments tomorrow, as it is now bedtime here. Thanks you so much for taking the time to read the comments and take time out of your busy day to make sure people know you are actuall smartest. (Although that remains to be seen). 

fortheking
Hi Abigail,

Let me begin by stating I have never read any of your other work and am solely going by your statements above, as well as your intro and website on the right of this article. I assume you are an American living in the Netherlands. I was born and raised in the Netherlands, but have lived nearly half of my life in the United States. It seems we both have a vantage point that includes both cultures.

I find several issues with your piece, and would like to address them one by one. I am looking forward to your reply.

1. You state early on that “after all, the idea of banning circumcision is itself politically based.” That’s quite the statement, and I would like to know how you came to that conclusion. Do you believe that ALL banning of circumcision is politically motivated, or just male circumcision? How about the legal banning of female circumcision – do you believe that is politically motivated?

2. You state “…doctors in the Netherlands have clearly put themselves in a position of being willing to put public health at risk…” in reference to their proposal to ban circumcision. I would like to see some documented evidence – especially since you live in a country where historically virtually no indigenous male has been circumcised – showing that lack of circumcision on a great scale (such as in Holland) shows increased risk to public health, and more importantly, DIRECT causation of other health issues. Your piece lacks this very important information.

3. In your 3rd paragraph, you swiftly move to explain the push for a ban on circumcision (circ for short from now on) w/ Europe’s desperate desire to combat the growing ‘threat’ of Islam, and state that “Europe is at serious risk of transforming itself into a white, Christian supremacist state.” What you fail to recognize is that Europe, particularly Western Europe, and considering this article, especially Holland, is far from what could be considered a Christian state. You’d need quite the evidence and premises to suggest that a ban of circ is motivated by the “Christian whites” in Holland.

4. You state that the Dutch medical association is wrong in stating that no medical association in the world recommends routine circumcision.

Setting aside the AAP’s comments on circumcision preventing certain medical issues, the AAP does NOT recommend routine circumcision in infants (as you write as well, however you include it in your paragraph on medical organizations recommending it – misleading). In fact, on their website, which automatically redirects to another, is states: “Scientific studies show some medical benefits of circumcision. However, these benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised. Because circumcision is not essential to a child’s health, parents should choose what is best for their child by looking at the benefits and risks.”

The only medical organization you mention as recommending circ is then the CMA whose statement was recently published in order to pass a bill (AB-768) in the CA legislation preventing future proposals to ban circumcision from entering the ballot. Clearly politically motivated, which you seem to loathe (see 1.). Fact is, there is no medical organization in the world that routinely recommends male infant circumcision.

5. You state: “Meantime, Holland’s wise doctors have yet to issue any formal statement about the far more serious problem of the country’s enormous infant mortality rate (among the worst in Western Europe) and high breast cancer fatality rate (the fourth highest in Europe, and rising).” This is not only indicative of poor journalism, but of poor debating skills. Bringing up completely unrelated topics to insinuate that Holland’s doctors should focus on something else that’s more ‘attention deserving’ or that they are somehow not credible is logically incredibly fallacious.

As far as your comment above to which I am replying (I have not read the original post to which you are replying), you seem to focus on the supposed medical benefits of circumcision, and are asking for studies that debunk others, or conclude the opposite. (Again, please keep in mind that I have no read the other comments, so I apologize in advance for being repetitive).

A. HIV/STD’s: The claim that routine infant circumcision reduces the risk of HIV/STD’s has been debunked and countered in several ways:

A1. Infants do not have sex and do not catch HIV or STD’s from penile exposure to those diseases. IF there truly is reason to believe that circumcision lowers (we all know it does not prevent… only condoms or abstinence does) the infection risk, why not present this to a child that is older and can make a decision for himself as to what will happen to HIS body? There is no logical or ethical reason to remove a healthy body part on our infant males because in the future it might possibly allow them to catch an STD. The very suggestion of that seems preposterous.

A2. It should be noted that the country where the vast majority of sexually active males are circumcised (United States) has one of the highest STD/HIV infection rates of any industrialized country in the world, and surely more so than Holland. While correlation is not causation, it is clear that circumcising male neonates does not decrease HIV/STD prevalence when compared to countries where circ is not routinely performed.

A3. There have been quite a few studies that show there is no correlation between circumcision and lower prevalence of HIV. One of those was published by BBC/The Lancet on July 7, 2009. The article reported on a Ugandan HIV circumcision study ending early because it showed that circumcising men who already have HIV does not protect their female partners from the virus. The research, from the Lancet, has shown no benefit in men who already had the virus and was stopped early because of the continued risk to women.

An intensive study by the USAID also showed that circumcision does not lower the risk/prevalence of HIV. Published here: http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf

I will post a separate posts containing several studies that show no correlation or in fact an increased risk (circ = increased risk of HIV contraction).

This Reuters article states that circumcision does not affect HIV status in US men: http://www.reuters.com/article/2007/12/04/us-aids-circumcision-idUSN0345545120071204

The MOST interesting thing about any of these studies is that the participants were all sexually active adults. Infants are not sexually active.

A4. There are only three proven and undisputed ways of lowering HIV prevalence and contraction: Condom use, abstinence, and monogamous relationships for life.

B. Penile/Cervical cancer

B1. Penile cancer is incredibly rare. In fact, it occurs less often than male breast cancer does. Even the studies (which have also been debunked) that suggest it is more common in uncirced men show we’re dealing with a miniscule difference, we again would have to ask ourselves whether routinely removing a healthy body part from infant males (among whom penile cancer is non-existent) is worth the risks of circumcision side effect that even you mention and that occur far more often than penile cancer does.

B2. Suggesting we should routinely remove a healthy part (foreskin) from newborn males because it potentially decreases the already miniscule risk of them getting penile cancer later in life is a serious ethical issue. Nowhere in the medical world is healthy tissue removed from infants to prevent illness of such low prevalence. For the same reason we do not remove healthy breast tissue from newborn males (and, breast cancer in men is more common than penile cancer in men), we should not remove penile cancer from newborn males.

C. In your article, you suggest, basically summarize, than a push for a ban on infant male circumcision is rooted in antisemitism, and/or a push by ‘white supremacist Christians’ to regain control of their culture in the face of ‘intruding Islam.” It is disappointing to me, that as an award-winning journalist, is has (presumably) not occurred to you that the push for such might not have anything to do with religion or politics but simply with human rights.

“We” have lawfully banned circumcision (from the tiniest pinprick, to full removal of female genetalia) on females, whether that is done out of cultural reasons OR religious reasons (by the way, it’s eery how arguments pro male circumcision mimic those of pro female circumcision). We do not allow parents to scar their children’s faces with burning hot iron as is common cultural and religious practice among certain African tribes. We do not allow foot-binding as still practiced in certain parts of China, nor do we allow anything else that physically alters our children’s bodies for LIFE without a medical need.

We HAVE TO acknowledge that we prevent male infant boys from having the SAME genital rights by law as female infants do and ask ourselves if our reasons are truly strong enough and morally and ethically justifiable. 

fortheking 
As promised, the studies…

(PS: despite many typo’s that are easy to figure out, I feel the need to correct myself in B2. last sentence, should be “should not remove healthy penile tissue”)

The following studies either show no relationship with circumcision status or a higher risk in circumcised men.

No relationship to circumcision status (13 studies):

1. Hira SK, Kamanga J< Mcuacua R, et al. Genital ulcers and male circumcision as risk factors for acquiring HIV-1 in Zambia. J Infect Dis 1990;161:584-5.

2. Pépin J, Quigley M, Todd J, et al. Association between HIV-2 Infection and genital ulcer diseases among male sexually transmitted disease patients in The Gambia. AIDS 1992;6:489-93.

3. Bollinger RC, Brookmeyer RS, Mehendale SM,l et al. Risk factors and clinical presentation of acute primary HIV infection in India. JAMA 1997; 278:2085-9.

4. Chiasson M, Stoneburner RL, Hildebrandt DS, et al. Heterosexual transmission of HIV-1 associated with use of smokable freebase cocaine (crack). AIDS 1991;5:1121.

5. Carael M, Van De Perre, PH, Lepage PH, et al. Human immunodeficiency virus transmission among heterosexual couples in Africa. AIDS 1988;2:201-5.

6. Moss GB, Clemerson D, D'Costa L, et al. Association of cervical ectopy with heterosexual transmission of human immunodeficency virus: results of a study of couples in Nairobi, Kenya. J Infect Dis 1991;164:588-91.

7. Allen S, Lindan C, Serufilira A, et al. Human immunodeficiency virus infection in urban Rwanda: demographic and behavioral correlate in a representative sample of childbearing women. JAMA 1991; 266:1657-63.

8. Seidlin M, Vogler M, Lee E, et al. Heterosexual transmission of HIV in a cohort of couples in New York City. AIDS 1993;7:1247-54.

9. Konde-Lule JK. Bergley SF, Downing R. Knowledge attitudes and practices concerning AIDS in Ugandans. AIDS 1989;3:513-18.

10. Van de Perre P, Clumeck N, Steens M, et al. Seroepidemiological study on sexully transmitted diseases and hepatitis B in African promiscuous heterosexuals in relation to HTLV-III infection. Eur J Epidemiol 1987;3:14-8.

11. Quigley M, Munguti K, Grosskurth H, et al. Sexual behavior patterns and other risk factors for HIV infection in rural Tanzania: a case control study. AIDS 1997;11:237-48.

12. Hudson CP, Hennis AJM, Kataaha P, et al. Risk factors for the spead of AIDS in rural Africa, hepatitis B and syphilis in southwestern Uganda AIDS 1988; 2: 255-60.

13. Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA 1997;277:1052-7.

A higher risk in circumcised men (4 studies):

1. Barongo LR, Borgdorff W, Mosha FF, et al. The epidemiology of HIV-1 infection in rural areas, roadside settlements and rural villages in Mwanza Region, Tanzania. AIDS 1992;6:1521-8.

2. Grosskurth H, Mosha F, Todd J, et al. A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results. AIDS 1995;9:927-34

3. Chao A, Bulterys M, Musanganire F, et al.Risk factors associated with prevalent HIV-1 infection among pregnant women in Rwanda. National University of Rwanda-Johns Hopkins University AIDS Research Team. Int J Epidemiol 1994;23:371-380.

4. Urassa M, Todd J, Boerra JT, et al. Male circumcision and susceptibility to HIV infection among men in Tanzania. AIDS 1997;11:73-80. [study 1] 

http://ije.oupjournals.org/cgi/reprint/dyh127v1.

Int J Epidemiol. 2004 Mar 24 [Epub ahead of print]

Trends in antenatal human immunodeficiency virus prevalence in Western Kenya and Eastern Uganda: evidence of differences in health policies?

Moore DM, Hogg RS.

Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada.

OBJECTIVE: To observe recent trends in human immunodeficiency virus (HIV) prevalence in antenatal clinic attendees to determine if previously noted falls in HIV prevalence are occurring on both sides of the Kenyan-Ugandan border. Design An ecologic study was conducted at the district level comparing HIV prevalence rates over time using data available through reports published by the Kenyan and Ugandan Ministries of Health and UNAIDS.

METHODS: Sentinel sites were compared with respect to population, ethnicity, language group, and the prevalence of circumcision practice. The prevalence of HIV found at each sentinel site was recorded for the years 1990-2000 and analysed visually and by conducting bivariate correlations.

RESULTS: Ethnographic analysis revealed a wide mix of ethnic and language groups and circumcision rates on both sides of the border. All sentinel surveillance sites in Uganda showed trends towards decreasing HIV prevalence, with three of five sites showing statistically significant declines (r = -0.87, -0.85, -0.86, P < 0.05). In contrast, all of the surveillance sites in Kenya showed trends toward increasing HIV prevalence, with two of the five sites showing statistically significant increases (r = 0.62, 0.84, P < 0.05).

CONCLUSIONS: The declines in HIV prevalence occurring in Uganda are not being seen in geographically proximal districts of Kenya. No obvious differences in ethnic groupings or their associated prevalence of circumcision appeared to explain these differences. This suggests that decreasing HIV prevalence in Uganda is not due to the natural course of the epidemic but reflects real success in terms of HIV control policies.

PMID: 15044420 [PubMed - as supplied by publisher] 

Joseph4GI (Myself; this comment was deleted.) 
You will reply as many times as you see fit to counter your dissenters. (And I was right) 

Realize that you are writing in English. Most English speakers do not live in the Netherlands or speak Dutch. If your writing is aimed towards residents of Holland who speak Dutch, then write in Dutch.

You can cite all of the “studies” you want. The fact remains that every single medical organization you name has stated that there is not enough evidence to endorse infant circumcision. They must all point to the risks, and they must all say that there is not enough “benefit” to warrant them.

I defy the author to deny the fact that while circumcision is limited in her own country, it fares better in all the so-called benefits she sites than countries where circumcision is prevalent. In the US, Approx. 80% of all males are circumcised, and yet STD transmissions, even HIV, are the highest there. The US has higher HIV transmission rates than even Africa. Deny that, Abby, deny that.

Deny the fact that you are Jewish and that the only reason you’re interested in any “medical benefits” and “research” is because you know that arguments of “religious freedom” and “parental rights” don’t get you anywhere.

Thank you for pointing out that cervical cancer, HIV, penile cancer and HPV are not urinary tract infections. I’m not exactly sure why you feel you must point this put. Do you think demonstrating your ability to differentiate between these gives you any credibility?

It sounds like you’re trying to insinuate that infant circumcision actually makes a difference and that the world’s medical organizations back you up.

I defy YOU, Abigail Esman, to furnish a single study that has proven there is any connection between infant circumcision and the prevention of any of these diseases. I defy you to produce a single statement from a well respected medical organization that endorses infant circumcision to reduce the likelihood of these diseases. I defy you to deny the fact that despite a high prevalence of circumcision, the US does poorly when compared to it’s European counterparts, including the Netherlands.

It would be better for you to leave making value judgements regarding circumcision to medical professionals, rather than embarrassing yourself further. 

cyndavaz (Comment Deleted) 
“This is not about maintaining a practice because Jews and Muslims want it.”

Of course it is.

BTW – are Muslims allowed to cut the genitals of their little girls where you live? Doubtful.

But for some reason, certain religious groups cling to the notion that subjecting boys to this barbarism is perfectly acceptable. Double standards much? 

barefootintactivist (Comment Deleted) 
1. Who cares what you call the country. The problem is your misinformed article promoting the genital cutting of infants.

2. First of all, you’re wrong: the doctors have explicitly and repeatedly said that they don’t think legislation is a good idea, because the procedure would go underground. Second of all — where were you writing articles when the USA banned female genital mutilation (down to the slightest pinprick), withOUT religious exception, in 1997?

You are aware that female circumcision is considered a religious mandate for hundreds of millions of people in Africa, the Middle East, and Southeast Asia?

You are aware that up until recently, some girls were being circumcised in America as a “cure for masturbation,” the same reason that it became popularized in the US?

3. Sorrells et al, 2006 found that circumcision involves amputating the 5 most sensitive parts of the penis, confirming Taylor et al’s earlier studies showing that the foreskin of the penis contains the most highly innervated part of the entire male genitalia, the “Ridged Band” of nerve endings.

USAID found in 2009 that in 10 of 18 countries with data available, circumcised men were MORE likely to have HIV. All of the rest of your “medical” claims have not only been de-bunked time & time again (many Western countries where circumcision is virtually non-existent have less problem with infections, STD’s, and HIV than the US), but perhaps MORE IMPORTANTLY — children don’t have sex! Why the hell do they need protection from sexually transmitted diseases when they are BABIES? If they are dumb enough to believe all of the de-bunked myths that cutting off half the skin on their penises will offer protection from STD’s, they can have it done to THEMSELVES as consenting adults.

4. Look in the mirror and ask yourself who is twisting the facts to fit a personal political agenda. 85% of the world’s men are intact. Girls in the US are protected from the slightest pinprick. Male genital mutilation rates are plummeting even in this country. Yet you continue to promote it as a “public health measure,” and anybody who disagrees with you is a “racist” who is pushing “ethnic cleansing for the 21st century.”

Apparently you will leave it to the medical professionals to decide on this — except when they disagree with you. KNMG represents over 40,000 Dutch doctors and tens of thousands more health professionals. They are taking a brave stance against the harmful & unnecessary genital mutilation of children in the face of unfounded criticism from ignorant people such as yourself. ADULTS are free to do whatever they want to their OWN genitals.

Speaking of which, feel free to go have yourself circumcised next time you think it’s a bright idea to trivialize genital mutilation. Then see you how much you like it. Just don’t force it on children.

~Barefoot Intactivist 

marcetienne 
This article is ignorant and misleading.

First, the Dutch medical association’s report is the most detailed report by any national medical association on the topic and is backed by 7 other national medical associations in the Netherlands.

Second, the British, Australian and South African medical associations made similar, though not as detailed or hard-hitting, findings. For example, the British Columbia College of Physicians and Surgeons’ 9/09 report did not suggesting banning infant male circumcision but it declared:

“There is no evidence to support routine circumcision of newborn and infant males.”

“There is evidence that circumcision does result in memory of painful experiences, and is not quite as simple and low risk as your report suggests.”

“The stated benefits of protection against urinary tract infection are marginal, and do not justify mass circumcision. Our changing understanding of the relationship between urinary tract infection and chronic renal disease further weakens the case for routine circumcision.” 

www.smh.com.au/national/letters/no-evidence-to-support-routine-circumcis…

The South African Medical Association denounced infant male circumcision as unethical and illegal and expressed “serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information.”

Not a single national medical association recommends routine infant male circumcision. The California Medical Association, cited in this article, made a quick one-liner about prior beliefs without analyzing the more recent evidence discussed by the British, Dutch and other medical associations. And the quote from the American Academy of Pediatrics (AAP) had to do with the studies on HIV reduction in Africa and was not conclusive at all as to anything except that the AAP needs to re-examine it’s prior position. At this point there is still no national medical association that supports routine infant circumcision.

The author is also oblivious to the double standard that the Dutch medical association points out. Even the slightest ceremonial incision on a girl’s vagina is illegal and considered a human rights violation. But male circumcision is allowed even though it’s gynecologically equivalent to removing the clitoral foreskin (or, “hood”), one of several forms of female circumcision all of which are illegal and which also have some of the same or similar purported (but false) medical “benefits.”

It’s a complete double standard to argue that parents should have a “right” to mutilate their baby boys’ genitals while baby girls’ genitals are fiercely protected from any such mutulation.

Male circumcision removes the most sensitive part of the penis, which has over 20,000 erogenous nerve endings and acts as a natural buffer and lubrican during sex. www.livescience.com/health/070615_penis_sensitivity.html 

www.psychologytoday.com/blog/moral-landscapes/201109/myths-about-circumcision-you-likely-believe 

Studies based on self-reports are mixed. But the ones showing now loss in sensitivity were done either on men who were cut as adults for medical purposes, or on men in African who came straight from the clinics that financially benefit from the circumcisions. By contrast, a study of Korean men who were cut as adults out of mere tradition (introduced by U.S. military) found about half of the men reported significant losses of pleasure in masturbation, and 20% reported significant losses in pleasure during sex. http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2006.06646.x/full

Regardless, removing a girl’s clitoral hood is illegal irrespective of whether it removes sensitivity. Boys should have the same protection. and readers should look at what the national medical associations have recently been saying about infant circumcision before believing the usual prevalent myths. 

rolandday 
Esman is true to her Jewish roots and is faithfully spouting the usual defense of an antique practice that violates the human rights of children.

The most important statement on human rights is the United Nations Covenant on Civil and Political Rights (1966). That covenant guarantees a right to security of the person – a right which is violated by involuntary circumcision of children.

One might think that Jews have a right to circumcise their children because it is part of their religion, however that is not the case.

The above mentioned covenant gives parents the right “to ensure the religious and moral education of their children in conformity with their own convictions.”

The foreskin is a healthy functional body part. Parents are not empowered to amputate or to consent to the amputation of the foreskin by circumcision. That is beyond their rights under international human rights law.

Children are entitled to having their human right to the security of their person protected.

That is what the Royal Dutch Medical Association is saying.

One is surprised that a magazine of Forbes’ sterling quality would stoop to printing such garbage. 

jaywalk 
I wonder if the author would consider these Jews as rasicsts? http://www.jewsagainstcircumcision.org/

Can you be racist against your own race? And just because a race of people mainly follow one religion, does disagreeing with one practice of that religion then make you a racist? 

stormwatch 
Back in the 1970s, Brazilian psychoanalyst Moisés Tractenberg wrote about the mental side effects of circumcision. He, a jew, found circumcision to be destructive to the human psyche and morally indefensible. 

isaac 
listen i am a jewish man. i am so glad i escaped having this done to me. my jewish mpther protected me from a world who would have thought it strengthened their identity to remove part of my dick.

for men AND WOMEN: if you are uncircumcised you have a foreskin, and smegma. if it said so in the koran (which i am sure you would be quick to point out that it does not) then it would be okay for your own clitoral hood to have been removed at birth; altered in your most personal area by an elderly person/razor? how would it be to live with the knowledge of erogenous tissue having been removed?

before Israel was created many arabs had the clitoral hood removed at birth, whether they were Jewish or Muslim or Christian, and they did it at that bar/bat mitvah instead instead of eight days.

It is a removal of erogenous tissue, it is worse than rape it is mutilation. i said “no” many times and was spared, but their are men like me who had it done to them anyway. Loss of part of their dick with no socio-cultural support to explain the abuse except made-up diseases.

please stop supporting this horrible treatment of children. 

whatUneverknew 
This article is absurd. I’m saddened to think that anyone would actually BELIEVE that the idea that circumcision should be discontinued from a medical perspective comes from racism or hate. Foreskin is a normal body part, and amputation of a healthy organ is NOT medicine. If you have no diagnosis, then it is completely invalid to remove a body part. This is standard worldwide accepted medical ethics. That this sentiment comes from Doctors is highly appropriate (though it’s also appropriate for it to come from those human rights campaigners who say that men deserve to refuse amputation of their healthy genitals, ‘cause they do). It is upon them to serve the rights of their patient, and not go lopping healthy parts off just because parents have religious reasons, or ideas about what problems might occur with those parts in the future. The reason that this SINGLE exception is made in the face of such an otherwise obvious incongruence with ethics comes from cultural blindness, which the author obviously suffers from.

It is NOT true that “almost all newborn males in the USA” are circumcised. The CDC has shown the hospital rate of 2009 to be slightly over 32%, so we can imagine that the overall rate is less than 40%.

I can’t speak to the other belligerent accusations of racism, but I will say that the people responsible for all of these other issues are not even the same people, (and if you think being Dutch qualifies as being the same people, you’re being bigoted yourself) and it doesn’t serve anything but misdirection on THIS issue to bring them up as if they were proof.

As to the mounds and mounds of ‘evidence’ of circumcision’s health benefits I say: consider the source. Remember that cultural blindness? There are a few VERY active people trying to prove a medically valid reason for infant circumcision and if you pay attention, you will see the same names on most of the work. Even if it were so, popular opinion does not negate a man’s right to his own body. Even Muslim and Jewish babies have rights Ms. Esman. 

chooseintact 
“3. I defy you to find me the studies that counter the significant body of published literature, some of which is cited in my piece, that specifically point to the substantial health advantages of circumcision in preventing fatal diseases both in men and women. These studies are cited by all of the organizations cited by Ms. Netherton, below. I am pleased to see that, despite herself, she does recognize their authority in advancing the benefits to the male and female population of circumcision.”

If we’re going to speak of fatality risk, the risk should be discussed in context. What is the risk of death from these diseases? How are the diseases acquired? What is the absolute risk of each, which we need if the numbers cited in the original post are to mean anything in context? Relative risk isn’t enough.

More importantly, where is the discussion of ethics? The ability to achieve a potential benefit does not grant it an ethical exemption. The decision is not cost-free. It takes more than just saying “science” to justify imposing surgery on a non-consenting individual. The health (i.e. lack of medical need) of the individual at the time of the proposed surgery is also science. Absent this consideration, almost any intervention can be justified with the incomplete logic offered by Ms. Esman. Making a one-sided claim is incomplete and merely begs the question one wants to answer.

Ms. Esman implies that the complications cited aren’t common. If we grant that, the question remains: how many complications are too many? Is a recipient of a complication wrong for objecting simply because Ms. Esman, his parents, and/or the CMA approve of non-therapeutic circumcision, regardless of his preferences for what should or should not be imposed on him? What about the unavoidable harm caused in every case, since even the most according-to-plan circumcision involves physical harm?

Also, it’s factually incorrect to state that circumcision is “standard procedure for almost all newborn males in the USA” under any interpretation of statistics or consideration of the reality of (problematic) proxy consent. 

Abigail R. Esman Speaks:
Note to commenters:

It was said by one member of this discussion that I will answer as often as I need to to defend my position. I believe that my position is defended clearly enough by medical experts and the substantive evidence I’ve provided in the piece. However, I will add several points, some of which relate to the piece directly, and others which refer to the behavior of those commenting on this post. 

(Right. ;-))

1. I have deleted some comments and will continue to do so when they are either (a) defamatory and abusive; (b) racist or imply an anti-Semitic tone; (c) involve a personal attack on me or on another commenter. The rules of conduct for participation on this site are clear.

(Readers, you be the judge.) 

2. As with right-to-life issues, there are many false reports and emotionally-hamstrung propaganda sources that will happily distort the truth for those who seek it. Nonetheless, I stand by my reporting.

(By using false reports and emotionally-hamstrung propaganda sources that will happily distort the truth for those who seek it! X-D)

Several resources (which ones?) continue to show that the majority of ma[l]es born in the USA are circumcised at birth (http://www.circinfo.net/rates_of_circumcision.html) though it is intriguing (and not surprising) to note that those with lower levels of education are less likely to have their sons circumcised. Estimates run as high as 91 percent. 

(Case in point: *I* provided a recent link to the latest CDC reports. She, instead, insists on a website run by I a known circumcision zealot! X-D)

3. In reviewing the literature, it is important to distinguish between emotionally-charged re-interpretations of objective statements and the actual science involved. 

(LOL! And then she spews the following gem:)

The scientific evidence is abundantly clear: circumcision reduces the rate of diseases in men — and consequently in their partners. That medical associations have refused to call it mandatory simply shows that it is not a medical necessity. And indeed, it isn’t – not, say, the way that removing an inflamed appendix is, or removing a cancerous tumor. But medically advisable? Yes. Like vaccinations, for instance. And that is the point that the medical associations have made. 

(Medical associations have made no such point. Far from simply "refusing to call it mandatory," or saying that it is "not a medical necessity," medical associations ALL say that there is not enough evidence to endorse the procedure. They must all point to the risks, and they must all state that there is no convincing evidence that the benefits outweigh these risks. To do otherwise would be to take an unfounded position against the best medical authorities of the West.)

4. Please note, once again, that comments that do not constructively add to the discussion, are in any way racist, defamatory, involve personal attacks, or in other ways violate the rules of conduct for this site, will continue to be removed. 

mrsnetherton 
Circumcision does NOT provide you immunity to diseases. Why is this concept so hard for people to understand? U.S. has one of the highest rates of circ’d men and also one of the highest rates of STD’s. If the scientific evidence were so great, you’d think we wouldn’t have so many STD’s. But, wait, EVERY world health organization believes that the “science” you speak of isn’t convincing enough to recommend infant circumcision. Use a condom. Don’t amputate healthy, functioning and vitally important sexual organs. (which goes against all medical bio-ethics of a non-theraputical surgery of a minor)

You got your statistics from circinfo!?!? LOL is all I have to say to that.

Try going to the CDC or a more reputable site lol.

My first comment didn’t go through, So i’ll say it again.

Not only is circumcision of all kinds against basic human rights, it’s immoral and unethical by personal and medical standards. Any *potential* benefit you cite, has already been thoroughly reviewed by ALL world health medical organizations and they have ALL concluded that ANY *potential* medical benefit is NOT worth the risk of infant circumcision. This is abundantly clear.

Also, you completely took a citation from the AAP out of context. Go on and continue to read their statement which says that the evidence you cited is NOT enough to recommend infant circumcision.

Just for arguments sake, even if they did recommend it (which of course they do not), does that justify chopping off a healthy body part of a non-consenting minor? Absolutely not. Amputations of body parts is NOT a form of modern, preventative medicine. 

steph 
I truly can’t believe this article, but I’m reluctant to be too critical in fear that I’ll be accused of supporting ethnic cleansing. We ridicule those who object to male circumcision, but not those who object to female circumcision. Those who object to female circumcision are hailed as human rights’ heros, while those who object to male circumcision are snubbed as liberal wack-jobs. Female circumcision is a mutilation, while male circumcision is a parent’s right. We can preach science and studies until we are blue in the face, but in the end it shouldn’t matter. Ethics should trump science.

I’m a labor and delivery nurse, and see parents attempt to make decisions about circumcisions all the time. In an attempt to be arbitrary and impartial, doctors now tend to totally stay out of the decision making. They assume that parents have done their due diligence. The result is that parents make their decision in ignorance, based on hearsay, speculation, and fear. That’s not good medicine, and wouldn’t be tolerated as ethical practice in any other medical procedure. Why with this one? 

tlctugger 
The bias of author Esman is quite transparent. Holland’s published policy on male circumcision is quite rational and does not ignore science. It is 17 well-footnoted pages. It even includes WHO findings the WHO itself is choosing to ignore, like Wawer/Gray 2009 (Cut Ugandan men 50% more likely to infect partners with deadly HIV) and Bailey 2010 (cut Kenyan men no less likely to have HIV).

What Holland’s statement does that other policies don’t is acknowledge the human rights of male infants. Any evidence regarding STIs is interesting to adults but irrelevant to infants, WHO DON’T HAVE SEX. The decision about how to weigh the evidence and whether to amputate can be made by the OWNER of the genitals at a rational age. 

tlctugger 
It’s interesting that a man claiming to represent the California Medical Association suddenly says the CMA has long supported forced genital cutting. There is ZERO evidence of such a policy at the CMA web site or in any CMA publication, and in fact the state of California de-funded routine circumcision from Medicaid in 1982.

Circumcision is not a medical procedure when there is no diagnosis of defect or disease, nor any record of other less destructive remedies tried before falling back to the to last-resort step of amputation. By any rational standard amputating healthy normal body parts is malpractice, mayhem, wounding, battery – illegal. The lack of enforcement to punish this crime is a cultural loophole like letting people drive 5 miles an hour over the limit.

We protect every other body part of every other gender at every other age. Let’s just protect male infants too. 

jackieno 
There have been many that have noted that HIV reduction from male circumcision is not observed in the real world and that the AFRICA studies have many flaws. The other side of this is that if male circumcision lowers HIV risk (the allegation is a risk change of about 3.2% down to 1.78%) then the same benefit would be provided by female circumcision — same type of tissue and cells and similar moist places issues. Two studies say they female circumsiion shows the same benefits. So why is that not mentioned much? Stallings et al. (2009) reported that, in Tanzanian women, the risk of HIV among women who had undergone Female Circumcision was roughly half that of women who had not; the association remained significant after adjusting for region, household wealth, age, lifetime partners, and union status. Female circumcision and HIV infection in Tanzania: for better or for worse? (3rd IAS conference on HIV pathogenesis and treatment) International AIDS Society. Kanki et al. reported that, in Senegalese prostitutes, women who had undergone Female Circumcision had a significantly decreased risk of HIV-2 infection when compared to those who had not. Kanki P, M’Boup S, Marlink R, et al. “Prevalence and risk determinants of human immunodeficiency virus type 2 (HIV-2) and human immunodeficiency virus type 1 (HIV-1) in west African female prostitutes Am. J. Epidemiol. 136 (7): 895-907. PMID

The reason not to do this in either case, even if this small risk reduction can be detected in the real world, is that both forms of circumcision deprive the owner of the genitals of a source of pleasure for life. That is not really mentioned in the piece above. Somehow those that have bought into male circumsiion miss the point of taking away main male pleasure zones!

We would never cut off genital parts of girls and harm their sensor system, so why would we do this to boys?

BTW, Why was my previous post taken down? 

Abigail R. Esman:
Posts will be removed if they violate the terms noted above, if they plagiarize, or otherwise violate terms for use of the site. Several posts seem to have gotten caught in spam because of length or a poster posted too frequently or too quickly.

However, the repeated harangues by a few here have gone far enough, and I will shut down comments completely unless new ideas and real contributions to the discussion begin soon. 

fortheking 
Abigail, I would still love for you to engage my post, as I am desiring a genuine discussion. Simply stating that those who challenge you (on your points that circumcision should be advised because of it’s potential benefits as indicated by certain studies), are wrong without taking into account the many studies they (myself included) have included to show you otherwise is not much of a discussion and comes across as narrow-minded.

I’d also like to read your thoughts on the ethical implications of suggesting the routine removal of healthy tissue to prevent (going by your statements) miniscule potential risk increase of cancer, in light of the fact that we do not routinely remove any other healthy tissue from newborns, even when studies indicate removal would significantly (vs. miniscule) reduce risk of cancer (such as breast tissue removal) in their future.

Would you not agree that logically, removing any body part, or PART of a body part would reduce the occurrance in said body part? You suggest in one of your comments that the KNMR and any other medical organization should advice circumcision because it reduces risk of cancer occurrance and UTI’s – am I correctly rephrasing you? —> Would you not agree that if medical associations begin to advice the surgical removal of healthy body parts because leaving them ‘as is’ slightly increases infection risk, they would have to recommend surgical removal of nearly every other healthy body part on newborns? Do you perhaps now understand why no medical organization in the world DOES advocate for circumcision, EVEN if they would go by certain studies (assuming they are correct in their conclusions)?

By the way, not that this contributes anything to the discussion, but since I don’t want you to feel like this is ‘personal’: I am an evangelical Christian (and with that a minority voice on circ w/in my circles) who lives in the US, who has a BA in Theology, a Masters in Apologetics. I am what most would consider very Pro-Israel, and abhor anti-semitism. One of my favorite college classes (on the Holocaust and the problem of evil) was taught by a Messianic Jew whom I dearly love. I’ve read numerous articles and have sat under several speakers on the topic of Sharia Law and Jihad. I am both Dutch and American, and a mother of a little boy who was about to be circumcised (afterall, we do live in the US, in one of the states where the circ rates are still very, very high), until I spent hours upon hours reading up on the ethical implications, the function of the foreskin, and the fallacious logic used in advocating for the procedure.

I’m not out to ‘get you’, but I AM passionate about truth. When I see a piece or journalism like yours, that makes several statements containing logical fallacies (see my first reply), statements that do not cite their sources (you have yet to provide the studies, even though others have, which you have blown off instead of engaging)/research, it needs to be called out.

I understand this an opinion piece, but when you write one of those, you have to realize you will be called out on those premises you use to draw your conclusion that are false or invalid. In turn, you should be ready to defend them, and to engage counter arguments without blatantly ignoring them (the reason posters repeat the same over and over) and mainly stating that you’re ‘sticking to your statements’. 

Esman's "final word" post reads:
"As the result of incessant spamming, personal attacks and other violations of the rules of conduct by one particular member of this discussion, comments are now closed."

Could she have been refering to me?

At any rate, this entry was poorly written, full of misinformation if not outright lies, Abigail R. Esman is an insult to medicine, and Forbes should re-consider having her on as a contributor.