AFRICA: Botwsana to Implement Controversial Infant Circumcision Devices

Circumcisionist Ambitions Realised
As if calling circumcision an HIV prevention method, and implementing "mass circumcision campaigns" in the so-called name of HIV prevention weren't controversial enough, Botswana is one of those countries whose medical authorities have been convinced to take it a step further, and start campaigns to circumcise newborn boys. Perhaps they see this as the next step, seeing as adult men aren't falling for the propaganda, and some countries, such as Japan, have begun to stop funding adult male circumcision programs?

It should be no surprise that babies are finally being targeted for circumcision under the pretext of HIV prevention. The justification of male infant circumcision is what circumcision "researchers" have been aiming for all along. Circumcision is not this medical "solution" that "researchers" supposedly "discovered" merely 30 years ago; the fight to justify male infant circumcision has been raging on since Greco-Roman rule.

Circumcision, particularly male infant circumcision, is a cherished tradition in Judaism, and it's a money-maker for American physicians. The goal isn't to stop HIV in Africa; the goal is, and has always been, to justify male infant circumcision in the US, and elsewhere. Circumcision "researchers" want for medical organizations, such as the AAP, to point to Africa and say "Male infant circumcision prevents HIV in Africa, therefore we recommend infant circumcision for American babies." Is it any wonder that much of the funding for "mass medical male circumcision," or any similar variant, happens to be American money?

Implementation of Controversial Infant Circumcision Devices
Circumcising male infants should be controversial enough, as amputative surgery in healthy, non-consenting minors is unethical. There goes the "voluntary" part of the so-called "Voluntary Medical Male Circumcision" slogan...

The plot should thicken when, not only are baby boys being circumcised, but they're being circumcised with controversial devices.

According to StarAfrica, the Botswana Ministry of Health has adopted the Mogen clamp and AccuCirc device, to be administered to healthy, non-consenting, non-sexually-active children. National coordinator Conrad Ntsuape told state-run Radio Botswana that the two devices were the best that Botswana opted for.

The following passage is disconcerting:

"Ntsuape noted that the entire procedure would be bloodless, requiring no anaesthesia, suturing or a sterile setting."

It sounds very similar to the lines of a certain Neil Pollock.

Of course there is no such thing as a "bloodless" circumcision, requiring no anaesthesia, nor a sterile setting. Even the latest AAP statement features a lengthy passage on adequate pain management for infants undergoing circumcision. A sterile setting is necessary to avoid infections, such as those with MRSA.

Let's continue further:

"Ntsuape said the decision to adopt the two devices followed a lengthy consultation process that focused on acceptability of infant male circumcision as part of HIV prevention and male reproductive health efforts that was conducted by Botswana and the United States through Harvard Institute in 2008."

Instead of the acceptability of male infant circumcision, shouldn't it have focused on other things? Like, for example, whether or not male infant circumcision is effective in reducing HIV? (There are no studies that exist on this subject, and world data shows that it does not.) Shouldn't there have been an actual evaluation of the risks involved, especially given the devices being considered?

"Ntsuape said the results of the survey indicated that 96 per cent of mothers in Botswana accepted early infant circumcision while the remaining four per cent were undecided or not interested."

Before considering what mothers have to say in a survey after being told that circumcision would prevent HIV in their sons, where is the proof that infant circumcision reduces HIV transmission? Were the risks of circumcision discussed with these mothers? Were the risks of each device disclosed to these mothers? Was the fact that circumcision cannot prevent HIV transmission, and therefore even circumcised men have to wear condoms discussed with the mothers?


What Botswana Circumcision Advocates May Not Tell Parents

The Mogen device being marketed here has a terrible track record for circumcision mishaps, including glans amputations. So infamous is the Mogen clamp for circumcision mishaps that numerous million-dollar lawsuits put the company out of business.

Common Mogen Problem: The circumciser is blind to the condition of the child's glans. Some or all of the glans is pulled up along with the foreskin, resulting in partial or full glans amputations.

What mothers have to say about circumcision has no bearing on the fact that there is no scientific evidence that circumcising newborns will prevent HIV transmission, but would the women in this survey answer the same, if they were given this information?

The AccuCirc device is a recent invention that doesn't have much of a history, not that it needs any, as we know its intended purpose of cutting off part of a healthy child's penis.

I hate discussing the better or worse of two evils, and discussing what is the "better" male infant circumcision method is no different than discussing which is the "better" female infant circumcision method. There simply isn't a "right" way to mutilate a perfectly healthy, non-consenting child. However, there is a good critique on why the AccuCirc is particularly terrible here.

Conflict of Interest

David R. Tomlinson

"Chief Expert on Circumcision," WHO

Inventor of AccuCirc

The citizens of Botswana may be interested to know that the inventor of the AccuCirc device also happens to be "chief expert on circumcision" at the World Health Organization. He develops, implements and evaluates male circumcision training programs in Africa, and he wrote the WHO's manual for male infant circumcision. (Reference here.) Is it any wonder that the AccuCirc device is included in many African "surveys?"

To Close
Adopting a device known to cause problems is not very wise, not to mention circumcising healthy, non-consenting newborns who are at zero risk for HIV transmission is ethically repugnant no matter what methods employed. Botswana is complicit in implementing what is effectively male infant genital mutilation, under the deceptive guise of HIV prevention.

Related Posts:

Circumcision Botches and the Elephant in the Room

The Ghost of Mogen

CINCINNATI: Intactivists Protest Circumcision "Experiment" at Good Samaritan Hospital

CINCINNATI: Intactivists Protest Circumcision "Experiment" at Good Samaritan Hospital

Last week, intactivists gathered at TriHealth Good Samaritan Hospital in Cincinnati, Ohio, to protest a clinical "trial" they are conducting, which aims to compare two circumcision devices commonly used for neonatal circumcisions. The experiment aims to compare the Gomco and Mogen circumcision clamps to see which one causes "less pain."

Bottom-left: Mogen clamp. Top-right: Gomco clamp

Details of the Circumcision "Study"
The claimed purpose of this study is to see which circumcision method is "less painful." Parents are being solicited to enroll their male infants in a study comparing two clamps used for non-medical circumcision.

In addition, the experiment seeks to see which method causes more bleeding, takes more time, which is followed by the most "parental satisfaction" in follow up visits (never mind the satisfaction of the child, on whom the circumcision is being performed) , which one causes more need for revisions within 6 weeks, and which one is more likely to cause infections.

Bleeding is being measured by weight of blood soaked gauzes after the procedure. Other outcome measures include neonatal pain score and a standarized score, including vital signs and facial expression.

The so-called "researchers" are starting from the hypothesis that the Mogen technique of circumcision is less painful, faster, and associated with less bleeding for newborns when compared to the Gomco technique after a resident circumcision standard teaching curriculum.

The participants are being euphemistically called "volunteers," and they are male babies 4 days old or less, born healthy from pregnancies without complications.

The experiment, entitled "Gomco Versus Mogen: Which is Best?" is currently "recruiting participants," or rather, persuading parents to enroll their healthy newborn baby boys. More than 200 babies have or will become subjects in the experiment, planned to run through April 2014.

More details on this "study" can be seen here.

Glaringly Obvious Problems

Deliberate Pain
The claimed purpose of this "study" is to decide which clamp "causes less pain." While up until recently, circumcision advocates argued that babies felt "no pain," and some continue to insist circumcision is painless still, the researchers here are not pretending the procedure is painless anymore; they are conceding that pain results regardless of used method. (Actually, it's been known for years that newborns feel pain more acutely than adults, and that circumcision is excruciatingly painful.)

In other words, for the purpose this "study," healthy, non-consenting babies are being enrolled, who will be deliberately made to experience pain. This is inescapably necessary to purportedly track which non-medical surgery method causes "less pain."

Non-medical surgery on healthy, non-consenting minors
The babies being circumcised for this experiment are being called "volunteers," which is a horrible stretch. The "researchers" can get by doing this because they've obtained signed consent from parents, placing on them the onus of responsibility, and circumventing the important question of medical necessity.

A big problem with this is the fact that researchers need "volunteers" for their experiment, and for this reason, parents who are being asked to have their children "participate" may not be being told how much pain circumcision actually causes. They CANNOT know; researchers cannot tell them exactly how much pain their child will endure, for measuring pain is the very purpose of the study. How much information are parents being given to obtain their consent to allow their children to participate in this study? Will they be shown a video of each procedure? Would the parents still consent for their children to "participate" in this experiment if they were truly informed?

But more importantly, consent from parents must be asked only after it has been determined that the child is suffering a medical illness for which there is no other alternative. Without medical or clinical indication, can a doctor even be performing surgical procedures on healthy, non-consenting minors? Let alone be eliciting consent from their parents? Let alone be asking them to let their children "participate" in an experiment, where the researchers cannot deny that the children will be experiencing deliberate pain? 

Short Timeframes for Other Factors
The "researchers" state they will be collecting data for other factors, such as bleeding results, "parental satisfaction" results, botched circumcisions, as well as others. The timeframes for many of these seem inappropriately short, such as measuring bleeding only 10 minutes after the surgery; babies have been known to have bleeding complication for hours, if not days. Additionally, some of these complications, particularly botched results and the need for revision, do not present themselves until the parents have gone home, sometimes even months, years down the line, so these babies will be excluded from this "study."

Note that one of the factors measured is "parental satisfaction," as if that had anything to do with the premise of their "study," which is ostensibly to measure and compare the pain of each device. Excluded here is the satisfaction of the person whose penis is in question.

Medical Ethics and Human Rights Consciously Breached
Not only do the "researchers" know that the procedure is painful, they are also aware that there are risks and complications they expect to see. (Infections and bleeding being the most common complication; not mentioned here are adhesions and the need for surgical revision of botched circumcision jobs.)

In other words, they are running a medical experiment on human babies, knowing that they are going to suffer pain, and that some are going to need additional surgeries, and/or may suffer even more severe complications.

The Use of the Mogen Clamp
An important fact that is not being acknowledged, or deliberately omitted here, is the fact that one of the clamps being "compared," the Mogen clamp, has a bad track record and is notorious for circumcision mishaps, even when used by professionals.

The "Manual for early infant male circumcision under local anaesthesia,"published by the World Health organization in 2010, details that both the Mogen clamp and the Gomco clamp have a risk for penile laceration and amputation, but extends to say that "penile amputation can occur even under ideal circumstances" with the Mogen clamp.

In a 2013 study in Botswana, the Mogen clamp and the Plastibell were compared. The adverse events with the Mogen clamp were considered to be more frequent but "minor" (removal of too little skin and development of skin bridges and adhesions). Bleeding was more frequent with the Mogen clamp as well.

Circumcision botches are so common with the Mogen clamp, that its manufacturer has been put out of business by numerous lawsuits involving partial or complete amputations of the glans penis. In a very recent case, a judge approved a $4.6 million settlement on a behalf of a boy who lost the head of his penis in a botched circumcision attempt. In the $11 million dollar lawsuit that finally put the Mogen company out of business, a mohel severed the end of another baby's glans using one of their clamps.

Data from Attorneys for the Rights of the Child, ARCLaw, show over 80 million dollars paid on settlements over botched circumcisions since 1985. Beyond the economic value (when compared to a billion dollar a year industry), those numbers represent children whose lives will have been impacted for the rest of their lives due to a non-medical elective surgery.

The peculiar thing about Mogen is that until the very end, they claimed that injury was impossible with the use of their clamp, even after other glans amputations were reported. The injury behind a prior lawsuit at Fulton County Superior Court had already put Mogen on notice about the danger of the device. In a different case, at South Fulton Medical Center, another law suit was won in 2009. In that case, a child lost a third of his glans, and the plaintiffs were awarded 2.3 million dollars.

While Mogen is out of business, their clamps have not been recalled, and they continue to be in use, as we observe here. Some doctors continue to market the Mogen technique as "bloodless, painless" and "state of the art."

Given the history of the Mogen clamp, it is beyond me how the "researchers" in this so-called "study" can begin with the hypothesis that the Mogen clamp is "better." It's almost as if the actual purpose of this "study" is to vindicate the Mogen clamp. Perhaps researchers hope that by publishing their study, they could blot out the Mogen clamp's history and clear its record?

So long story short, "researchers" at TriHealth Good Samaritan Hospital in Cincinnati, Ohio, are conducting an experiment on healthy, non-consenting minors, where they will be deliberately made to experience pain, with obsolete and dangerous equipment. Without any medical or clinical indication, they will be eliciting "consent" from parents for surgery, and their permission to include their children for this experiment.


Problems with the Good Samaritan Hospital Statement:
According to WLWT, TriHealth Good Samaritan released the following statement in their defense:

"At Good Samaritan Hospital it is understood that patient care, education and research respect and support the total good of the patient and uphold the sanctity of human life and the principles of Catholic teaching.

The circumcision study compares two medically accepted circumcision processes. Only after the parent or guardian requests and consents to circumcision for their infant, is informed consent sought for this study; they are free to decline their child’s participation in this study. Steps to ensure pain relief are integral to the study protocol.

Male infant circumcision has been practiced for centuries and is not among the procedures prohibited in the Ethical and Religious Directives for Catholic Health Care Services."

The statement is problematic from the get-go; healthy newborn males are not patients. The children on which these "researchers" will be experimenting are not sick. In fact, that the children are in good health is a requirement of this repulsive "study." Nevermind the complete disregard and disrespect for the child's basic human rights, and nevermind the first dictum of medicine "First do no harm," circumcising a healthy, non-consenting minor contradicts the principles of Catholic and Christian teaching.

In the second paragraph, the hospital conveniently fails to mention Mogen's history, and they conveniently circumvent the fact that the children involved will not be suffering any kind of illness for which circumcision is the only method of treatment by placing the onus of responsibility on parents, who, because of the nature of the study (it is to deliberately cause and measure pain), may not be given full information as the truth may discourage them.

At this point it needs to be asked; without medical or clinical indication, can doctors be performing surgery on healthy, non-consenting minors? Let alone be giving parents any kind of "choice?" Let alone be asking parents to "volunteer" their children for an experiment whose stated purpose is to deliberately cause and measure pain? Using a clamp with a negative track record for circumcision mishaps?

The last sentence in the second paragraph is conflicting with the stated purpose of the so-called "study."

 Steps to ensure pain relief are integral to the study protocol.

This seems counter-intuitive to the purpose of the "study," which aims to determine which circumcision method is "less painful," as ensuring pain relief will make it difficult to measure pain adequately.

The last paragraph offers the logical fallacy of appeal to antiquity, and offers a disingenuous reference to the Ethical and Religious Directives for Catholic Health Care Services.

As pointed out by Guggie Daily in her blog, it is true only in that the Ethical and Religious Directives doesn't mention infant circumcision as a separate topic at all in the entire document. The statement made by Trihealth seems to imply it's not prohibited, versus not being mentioned directly.

Furthermore, here is what the Ethical and Religious Directives for Catholic Health Care Services does say, regarding situations where non-consenting minors are being signed up for non-therapeutic experiments with risks:

"31. No one should be the subject of medical or genetic experimentation, even if it is therapeutic, unless the person or surrogate first has given free and informed consent. In instances of nontherapeutic experimentation, the surrogate can give this consent only if the experiment entails no significant risk to the person’s well-being. Moreover, the greater the person’s incompetency and vulnerability, the greater the reasons must be to perform any medical experimentation, especially nontherapeutic."

"51. Nontherapeutic experiments on a living embryo or fetus are not permitted, even with the consent of the parents. Therapeutic experiments are permitted for a proportionate reason with the free and informed consent of the parents or, if the father cannot be contacted, at least of the mother. Medical research that will not harm the life or physical integrity of an unborn child is permitted with parental consent."

The directive doesn't explicitly have a statement on non-therapeutic circumcision of infants, male nor female. In fact, since nothing is said about female infant circumcision, if we are to follow the logic of the above conflicting statement, female circumcision, and perhaps other non-therapeutic surgery is approved as well.

At any rate, the related statements clearly show that non-therapeutic circumcision experimentation on baby boys is prohibited, but Catholic hospitals should already know this. There's certainly no confusion when it comes to Catholic teaching on unnecessary medical procedures, forced medical procedures and amputations.

The U.S. Conference of Catholic Bishops asserts:

"All persons served by Catholic health care have the right and duty to protect and preserve their bodily and functional integrity. The functional integrity of the person may be sacrificed to maintain the health or life of the person when no other morally permissible means is available. (Ethical and Religious Directives for Catholic Health Care Services (Fifth Edition, 2009), n. 29.)

The Catechism of the Catholic Church states:

"Except when performed for strictly therapeutic medical reasons, directly intended amputations, mutilations and sterilizations performed on innocent persons are against moral law." (CCC, n. 2297)

What is infant circumcision?

Or, more appropriately, what is the foreskin?

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 not "extra skin." The foreskin is normal, natural, healthy, functioning tissue, with which all boys are born; it is as intrinsic to male genitalia as labia are to female genitalia.

Circumcision is the surgical removal of the foreskin from the penis, which leaves the glans, or head of the penis, permanently exposed. After circumcision, the head of the penis, and surrounding mucosal tissue, dries out and becomes tough and calloused in a process called "keratinization." The appearance and mechanics of the penis are changed for the rest of a man's life.

What is the medical definition of amputation?

The Free Dictionary by Farlex gives the following definition:

"Amputation is the intentional surgical removal of a limb or body part. It is performed to remove diseased tissue or relieve pain."

Even the medical definition of amputation clearly states that removal of a body part is done to address disease and relieve pain, neither of which are present in a healthy newborns. As the very premise of this so-called "study" concedes, circumcision causes pain, which the "researchers" no longer deny, and which they are set to measure by deliberately causing it.

Unless there is a medical or clinical indication, the circumcision of a healthy, non-consenting individual 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.

For any surgical procedure, including surgery to modify the genitals, medical ethics requires both necessity and informed consent, both of which cannot be present in healthy, non-consenting newborns. Without medical or clinical indication, doctors have absolutely no business performing surgery in healthy, non-consenting individual, much less be eliciting any kind of "decision" or "participation" from parents.

This "experiment" on human babies in in direct violation of Catholic teaching and ethical health care directives. Trihealth's statement is complete hogwash. 

Closing Statements

Imagine if you will, a "study" that sets out to see what the "least painful" method of female circumcision. Which one causes the least bleeding. Which one causes "less complications." Which one results in less need for revisional surgery later on. Imagine a "study" whose stated purpose implies causing deliberate pain in baby girls. Imagine one of the factors the "study" sets out to measure is whether or not the parents have been satisfied. Would it ever fly?

Would it be called "progress" if so-called "researchers" found a way to perform infant female circumcision in a way that was "bloodless?" "Painless?" "With little to no risk?"

I'm reminded of a 1959 American researcher, W. G. Rathmann MD, who invented a clamp for female circumcision, as a cure for frigidity. At the least he wasn't targeting infants.

Rathmann Clamp for female circumcision

Rathmann clamp in action - clamping the clitoral hood, the female equivalent of the male foreskin

The trend of opinion on routine male circumcision is overwhelmingly negative in industrialized nations. No respected medical board recommends circumcision for infants. All of them, including the AAP in their last statement, say that the "benefits" are not sufficient.

It must be asked how it is that parents are being asked to consider the self-same "benefits" that couldn't convince a single respected medical organization, and somehow come up with a more reasonable conclusion, and how it is doctors are expected to comply a "decision" that goes against the best medical authorities in the West.

It must be asked, WHY are "researchers" conducting "experiments" on a procedure no medical organization recommends, on healthy, non-consenting minors?

Without medical or clinical indication, how is it doctors are performing surgery on healthy, non-consenting minors? How it they're even letting parents make any kind of "choice?" Let alone "volunteer" their children for an experiment to "measure the pain" of a non-therapeutic, non-medical surgical procedure no respected medical organization can bring itself to recommend?

Is it conscionable that an "experiment" involving a procedure that no medical organization in the world can bring itself to recommend in healthy, non-consenting minors is being conducted?

Is it conscionable that "researchers" are conducting an experiment whose very premise admits that the newborns will be deliberately made to experience pain?

And, can it be conscionable that a device that is known for circumcision mishaps (its manufacturer was put out of business by countless lawsuits raised against them) is being tested?

Who in the world approved this experiment? What was running through their minds?

Would an experiment to see "what is the least painful method of female circumcision" ever be aproved in this way?

The only good that can come out of this "research study" is that nobody will be able to pretend that infants cannot feel pain anymore. They say that they are trying to determine which method results in LESS pain and LESS blood loss, in other words, admitting that there is pain and blood loss involved no matter how it's done.

Further Details:
The study itself can be viewed here, and here.

Principal Investigator: Mounira Habli, MD
http://www.cincinnatichildrens.org/bio/h/mounira-habli/        
mounira_habli@trihealth.com

(The principal investigator appears to be wearing a Muslim head covering. No conflict of interest there...)

Contact: Michaela Eschenbacher, MPH
http://www.linkedin.com/in/michaelaeschenbacher   
michaela_eschenbacher@trihealth.com  


Contact: Rachel Sinkey, MD
http://www.trihealth.com/discover-trihealth/education/trihealth-obstetrics-and-gynecology-residency/list-of-current-residents/      
rachel_sinkey@trihealth.com

Sponsors and Collaborators
TriHealth Inc.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01726036


Related Posts:

Circumcision Botches and the Elephant in the Room

The Ghost of Mogen

AAP: Around the Bush and Closer to Nowhere

The Circumcision Blame Game

Politically Correct Research: When Science, Morals and Political Agendas Collide

Other takes on the matter:
Guggie Daly

Related Links:

Intact America Press Release

WLWT Coverage

WCPO Coverage

CNN: Circumcision study halted due to trauma

Another Mohel Botches a Bris

Whenever a botched circumcision case makes the news, and people start talking about it, either in the commentary section (when news outlets are actually brave enough to allow them), or parenting forums, or on Facebook, there is always somebody who says something along the lines of:

"This wouldn't have happened if it were performed by a mohel. Mohels are jacks of their trade who do circumcisions for a living."

Actually, mohels are often put on pedestals in more ways than one.

A Jewish bris performed by a mohel is better than a hospital circumcision performed by a doctor for a myriad of reasons. Here are some that I've heard:

• Mohels are more experienced, so your son is sure not to suffer a botched job
• Mohels take less time than doctors(some claim less than 10 seconds), shortening the painful procedure
• Mohels don't use pain medication (this is supposed to be a good thing, in spite of the facts)
• Mohels do their work outside of the hospital, in a religious setting, giving "meaning" to circumcision, making it more "holistic" ("holistic" taking on an entirely different meaning here)

There are other reasons, but these seem to be the main ones.

Now, there have been quite a few documented cases of mohels botching a bris, and being taken to court for it. (For example, here and here.)

But whenever I bring these up, strings and straws are grasped for, here and there, and Jewish circumcision advocates begin to list off alibis of why these are "special cases," and why mohels continue to be the best circumcision performers.

Among these are:

• The child had a pre-existing condition; not the mohel's fault (when a child is found later on to be a hemophiliac, have a heart condition and other ailments)
• The child had a particularly strange-shaped penis to work with; the case is an exception
• The botch was a result of clamp malfunction; mohel is not at fault
• The botch was performed by an inexperienced mohel; not a representative case

It's interesting to hear Jewish advocates of circumcision clarify that the bris has to be performed by a "trained and qualified mohel."

Thus, the reasons why Jewish circumcision performed by a mohel in a bris milah ritual are an ever moving target, and Jewish circumcision and its officiators remain sacrosanct.

Parents Usually Not Forthcoming
One of the reasons why very few botched circumcision jobs make the news is because parents, both Jewish and non-Jewish alike, are complicit in keeping the botched circumcision job and its perpetrator secret.

What parent wants to admit that their child has been permanently disfigured because they decided to agree to a medically unnecessary procedure?

In the case of Jewish parents, who wants to admit that what is perhaps the most precious of Jewish mitzvot is the cause of their child's disfigurement, and in worse cases, death?

As an example, when investigators were querying the Jewish families whose babies were infected with herpes, they would not name names. People in these communities were also unwilling to help find the perpetrator. The preservation of a cherished tradition that people have emotional attachment to is more important.

Circumcisors, Jewish and non-Jewish have reputations to protect. Gentile parents have peace of mind to preserve. Jewish parents have the added burden of protecting their own, and not giving away a holy man who performs the sacred ritual of bris milah. Thus, silence is perpetuated, and parents are complicit in keeping this silence.

That is, until now.

Circumcision Lawsuits
Recent years have seen a series of lawsuits against circumcisors, mohels and doctors, sometimes people who are both, for circumcision mishaps, which indicates that there are parents who are deciding to no longer keep silent about what has happened to their sons.

In a very recent case, a judge approved a $4.6 million settlement on a behalf of a boy who lost the head of his penis in a botched circumcision attempt. The doctor who performed the circumcision used a Mogen clamp, a device notorious for glans amputations, even when used by professionals. So notorious is the Mogen clamp for glans amputations that the company that makes this device went out of business, because it couldn't afford the $11 million dollar lawsuit filed against it, after a mohel severed the end of another baby's glans using one of their clamps

The peculiar thing about Mogen is that up until the very end, they claimed that injury was impossible with the use of their clamp, "when used properly," even after other glans amputations were reported. The injury behind a prior lawsuit at Fulton County Superior Court had already put Mogen on notice about the danger of the device. In a different case, at South Fulton Medical Center, another law suit was won in 2009. In that case, a child lost a third of his glans, and the plaintiffs were awarded 2.3 million dollars.

And, just this month, another mohel was taken to court by parents in Queens. The rabbi told the parents he did an "acceptable job" that was "performed appropriately" and "within the standard of care and skill required of Jewish mohelim and circumcisers." He also allegedly told the parents that calling a doctor wasn't necessary, even though it was obvious that something had gone wrong with the bris. The parents claim that the delay in medical treatment resulted in greater permanent damage to his son, resulting in the necessity for corrective surgery with general anesthesia; the boy may need more operations in the future.

Of course there will be those who claim that this would never happen if the circumcision were "properly performed."

To which I would retort that female circumcision does not result in complications "when properly performed" by the right shaman priestess either.

The self-serving, ad hoc special pleading is astounding.

Interesting note; Jewish groups are challenging a New York law that says mohels have to warn parents of the risks, and have them sign a consent form before proceeding. Does this mean that Jewish parents AREN'T being told of the risk of glans ablations, herpes infections and death?

Hopefully more parents, Jewish and non-Jewish, will find the courage to bring the botched circumcisions of their sons to light.

Related Posts:

Circumcision Botches and the Elephant in the Room 

The Ghost of Mogen 

Mohels Spreading Herpes: New York Looks the Other Way 

New York: Oral Mohel Tests Positive for Herpes 

Circumcision Indicted in Yet Another Death: Rabbis and Mohels are "Upset"

Herpes Circumcision Babies: Another One? Geez!

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

New University of California Logo: Circumcision Clamp?

When I first saw it I couldn't believe it. I thought it had to be some kind of joke. I first laid eyes on it on my Facebook news feed, when a friend decided to post a funny story about it. Some people think it looks like one of those animated "now loading" computer icons.

I thought, "You've got to be kidding me! Really?"

I decided to Google it, and sure enough, there it was.

What's disconcerting to me is that the logo looks like a circumcision device, the closest one I could think of is the Mogen clamp. (Mogen went out of business because they couldn't afford the million dollar lawsuits as a result of the botched circumcisions it was responsible for.)

It looks like a circumcision clamp with the letter "C" on it, which I know stands for California, but I couldn't help associating it with the word "circumcision."

Which raises a few questions in my head.

Is this seriously for real?

If so, what were the creators thinking?

What was on their minds?

I'd like to know who is responsible for this disgusting imagery.

If this is real, the University of California needs to get rid of this logo at once.

That is, unless it wants to be known as the "University of Circumcision..."

The Ghost of Mogen

Advocates of circumcision always minimize circumcision to "just a little snip with little to no risks." They always say "there are no risks, and if there are, they're worth it." When you present them examples of circumcisions gone wrong, they will always say "Oh, well that's just a once in a million case. Circumcision mishaps don't ever happen when a professional does it." Well, in this blog post I'm going to talk about a very real risk that circumcision advocates may not tell you about. The following circumcision mishap is one that is so common that there have already been numerous court cases; glans amputation.

In a very recent case, a judge approved a $4.6 million settlement on a behalf of a boy who lost the head of his penis in a botched circumcision attempt. The doctor who performed the circumcision used a Mogen clamp, a device notorious for glans amputations, even when used by professionals. So notorious is the Mogen clamp for glans amputations that the company that makes this device went out of business last year, because it couldn't afford the $11 million dollar lawsuit filed against it, after a mohel severed the end of another baby's glans using one of their clamps. A year after Mogen goes out of business, we are still hearing of the damage their clamp is causing.

The peculiar thing about Mogen is that until the very end, they claimed that injury was impossible with the use of their clamp, even after other glans amputations were reported. The injury behind a prior lawsuit at Fulton County Superior Court had already put Mogen on notice about the danger of the device. In a different case, at South Fulton Medical Center, another law suit was won in 2009. In that case, a child lost a third of his glans, and the plaintiffs were awarded 2.3 million dollars.

I'm afraid that this may not be the last we hear of Mogen glans amputations yet. Despite going out of business in America, and despite its notoriety for glans amputations, Mogen clamps are being used in a pilot project to have male children circumcised at birth under the pretext of HIV prevention in Kenya. They are currently being used in Rwanda to circumcise newborns under the pretext of "HIV prevention." In light of the fact that newborn children aren't at risk for sexually transmitted HIV, and in light of the fact that there are already better, more effective, less invasive modes of prevention, how is taking this risk conscionable?

Until the next apparition of  Mogen's ghost... *sigh*

UPDATE (added 7/28/2011):
It utterly infuriates me that the WHO has been effectively pissing in our mouths and calling it rain... "Circumcision would only be offered to consenting adults," they promised. Well why in the hell have they approved circumcision devices for infant male circumcision? Given what I presnt above, why have they approved MOGEN of all torture devices? What in the world are these people THINKING??? GEEZ. Pisses me off.

Letter to Editors at the Vancouver Sun

OK, so Neil Pollock, a Jewish mohel and child circumcisor by trade, notorious for plugging his business whenever, wherever he can, takes advantage of  yet another situation. In response to Sharon Kirkey's article "Circumcision best left to prepubescence," he, aided by well-known circumcision czar Edgar Schoen (he goes by "Ed" now, just so you know... ain't it cute?), plugs circumcision and his own business, YET AGAIN. You can read the article, which basically reads like an informercial, right here:

http://www.vancouversun.com/health/skinny+circumcision/4599446/story.html

I took it upon myself to write a letter to the editors at the Vancouver Sun myself. Here it is:

To whom it may concern,

This is in response to Neil Pollock's shameless self promotion, and his support by Edgar (AKA "Ed") Schoen. Before anybody takes what Pollock and Schoen say seriously, there are some conflicts of interest that readers of the Vancouver Sun should know about.

First, Neil Pollock is a surgeon from Vancouver, Canada, whose sole livelihood comes from performing infant circumcision and vasectomy.[1] He charges $455.00 Canadian for circumcising children under 2 months of age,[2] and if his website is correct, he performs 2,500 annually, which means he grosses $1,137,500 Canadian on infant circumcision alone. Pollock is also a mohel by trade,[1][3] which suggests that aside from his livelihood, circumcision is of cultural and religious importance to him. Edgar Schoen also once made a living from circumcision, and has been a long-standing vocal advocate of circumcision for years. Pollock and Schoen are also both Jewish, where circumcision is a religious ritual central to their religious and cultural identities. Mentioning these men's religious affiliation is important, because belonging to a religious group where circumcision is a religious requirement is at odds with presenting anything disparaging about it; it predisposes people to presenting only that which puts circumcision in a positive light.[4]

Neil Pollock dispenses misleading, or outright untrue information. On his website, he sells his circumcision technique as "a new approach" that "has recently been developed."[5] Pollock's website uses language that suggests that he uses state-of-the-art techniques and equipment that no other surgeon possesses, by warning against others who try to "emulate" him.[6] Closer inspection reveals that Pollock isn't doing anything "new"; his website reveals that he uses the Mogen technique, which involves the Mogen clamp. The Mogen clamp was invented in 1954,[7] but it is actually one of many successors to the much older, traditional barzel device.[8]

Here are some things Neil Pollock may not tell parents about Mogen. On his website, and on this article, he insists that without experience, which he boasts for having, the methods and techniques he uses could be "potentially dangerous," however the Mogen clamp has been notorious for glans amputations, even among experienced conductors of circumcision.[9] Mogen went out of business after losing a 10.8 million dollar law suit, after a mohel severed the end of a baby's glans using one of their clamps. Mogen claimed that injury was impossible with its use. The injury behind a prior lawsuit in Fulton County Superior Court had already put Mogen on notice about the danger of the device. In a different case, at South Fulton Medical Center, another law suit was won in 2009. In that case, a child lost a third of his glans, and the plaintiffs were awarded 2.3 million dollars. [10]

Many of the "benefits" that Pollock tries to highlight are dubious, or are based on debunked information. For example, when he talks about the lining of the inside of the foreskin, and how the cells "trap the virus but are unable to destroy it," this was one of the original hypotheses that was used to run the circumcision trials in Africa. The specific name for these cells are the Langerhans cells, and deWitte actually found in his study that the Langerhans cells are not only impossible to eliminate, because they are found all over the body, but they actually secrete a substance called Langerin, which actually destroys the HIV virus.[11]

The langerhans hypothesis has been long forgotten, and researchers have tried to sell the lie that "Circumcision reduces the risk of HIV because it's harder for the virus to get through the keratinized glans." But other studies have found no difference between the keratinization of the inner and outer aspects of the adult male foreskin. Keratin layers alone are unlikely to explain why uncircumcised men are at higher risk for HIV infection. [12] Additionally, "No difference can be clearly visualized between the inner and outer foreskin."[13] As of yet, circumcision "researchers" have yet to explain the mechanism whereby circumcision prevents HIV transmission. The repeated studies are all based on disproven hypotheses, bringing their validity into question.

Pollock and Schoen say that STDs are more likely in uncircumcised men, but this does not reflect reality, where STD transmission rates are higher in North America, where the majority of the men are circumcised (approx. 80% according to Edgar Schoen), than they are in countries in Europe, where circumcision is rare. They also fail to mention studies that show circumcision makes no difference in HIV transmission [14] or that it actually has the opposite effect, increasing infection, especially to female partners [15]. They mention HPV transmission, but not that there are already vaccines for them. They say that penile cancer is "almost exclusive" to uncircumcised men, but they do not talk about the rate, which is something like 1 in 100,000 of men who smoke with poor hygiene practices.[16] Prostate cancer is more common in men; 1 in 6 North Americans will develop prostate cancer. [17] Using Pollock and Schoen's logic, removing prostates at birth is more urgent than male circumcision.

They briefly mention that "Sexual pleasure and power are not significantly affected by circumcision," but they will not mention that the foreskin is more sensitive than the most sensitive part of the circumcised penis. Sorrells shows that circumcision reduces sensitivity by a factor of 4. [18]

Regarding UTIs, it is common knowledge that whether boys are circumcised or not, girls are 10 times more likely to develop UTIs. UTIs are already quite rare in boys, and are as easily treatable with antibiotics in boys, as they are in girls. It makes no sense to amputate part of a child's genitals to prevent a disease that is already quite rare, and already easily treated. Neil Pollock and Edgar Schoen point out Tom Wiswell's work, but they will not mention that all of it has been thoroughly discredited.[19][20]

Neil Pollock talks about phimosis, but nothing is mentioned about the frequency of occurence of this condition, much less about how often circumcision is actually indicated, even when the condition develops. He talks about circumcision promoting hygiene, but surgery is not needed to promote hygiene. An uncircumcised male child needs no more care than an uncircumcised female child. It is true that men in old age are often unable to clean themselves, and somebody else must do it for them, but the same applies to women in old age.

The rest of the article is basically self promotion. Unless it is medically or clinically indicated, doctors have no business performing elective, non-medical surgery on healthy, non-consenting minors, much less pander to a parent's sense of entitlement.

Neil Pollock is a professional mohel and child circumcisor and in this article, he is merely promoting his trade. Schoen did his share of circumcisions as well, and he is a very vocal advocate for circumcision. According to a MEDLINE search, Edgar Schoen has been published 20 times in the medical literature on the subject of circumcision. In addition to reaping, or having reaped profit from the procedure they are promoting, Neil Pollock and Edgar Schoen are both Jewish. I feel this is important to mention, because circumcision is an important ritual and religious commandment. Although physicians may act with what they consider to be sound medical judgement, some physicians may be influenced also by nonmedical consideration. The cultural background of many Jewish circumcision advocates predisposes them to view circumcision in a positive light, to welcome evidence that the most particular and problematic religious custom of their people is medically beneficial, and to dismiss arguments to the contrary.[21] Please do not conflate my assessment of potential bias and conflicts of interest with anti-Semitism. These are conflicts of interest that put the objectivity of the information presented in question, and it is the responsibility of the Vancouver Sun to publish them so that the public can make a better assessment of the information presented by these men.

In closing, it needs to be mentioned that Edgar Schoen is a well-known circumcision evangelist that has been rejected wherever he goes.[22]

Yours truly,

Joseph Lewis


References:
1."About Dr. Pollock". http://www.pollockclinics.com/circumcision/circumcision-drpollock.html. Retrieved 2011-04-08.
2. "Arranging a Circumcision". http://www.pollockclinics.com/circumcision/circumcision-arrange.html. Retrieved 2011-04-08.
3. Owens, Anne Marie (2001-01-22). "Like father, like son". National Post, The. http://www.pollockclinics.com/circumcision/npost.htm. Retrieved 2011-04-08.
4. Siegfried et al. "Male circumcision for prevention of heterosexual acquisition of HIV in men." Cochrane Library 3 (2003)
5. "Parents' Guide to Circumcision". http://www.pollockclinics.com/circumcision/circumcision-guide.html. Retrieved 2011-04-08.
6. "Pollock Clinics Infant Circumcision". 2011-04-08. http://www.pollockclinics.com/circumcision/circumcision-index.html. Retrieved 2011-04-08.
7. "Use of the Mogen clamp for neonatal circumcision". http://www.circumcisionquotes.com/rdr5.html. Retrieved 2011-04-08.
8. "Methods of circumcision". circumstitions.com. 2011-04-08. http://www.circumstitions.com/methods.html#barzel. Retrieved 2011-04-08.
9. (April/May 2002). "Pain During Mogen or PlastiBell Circumcision". Journal of Perinatology 22 (3): 214-218. http://www.nature.com/jp/journal/v22/n3/full/7210653a.html. Retrieved 2011-04-08.
10. Tagami, Ty (2010-07-19). "Atlanta lawyer wins $11 million lawsuit for family in botched circumcision". The Atlanta Journal-Constitution. http://www.ajc.com/news/nation-world/atlanta-lawyer-wins-11-573890.html. Retrieved 2011-04-08.
11. deWitte et al. "Langerin is a natural barrier to HIV-1 transmission by Langerhans cells". Nature Medicine http://www.circumcisionandhiv.com/files/de_Witte_2007.pdf Retrieved 2011-4-14
12. Dinh et al. "HIV-1 Interactions and Infection in Adult Male Foreskin Explant Cultures". http://retroconference.org/2009/PDFs/502.pdf Retreived 2011-4-14
13. Dinh et al. "Keratinization of the adult male foreskin and implications for male circumcision." http://www.ncbi.nlm.nih.gov/pubmed/20098294 Retreived 2011-4-14
14. Westercamp, M; Bailey RC, Bukusi EA, Montandon M, Kwena Z, et al. (2010). "Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs". PLoS ONE 5 (12). Template:Hide in print. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015552.
15. Wawer MJ, Makumbi F, Kigozi G, et al. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. Lancet 2009;374:229 ?37.
16. Wallerstein E (February 1985). "Circumcision. The uniquely American medical enigma". Urol. Clin. North Am. 12 (1): 123?32. PMID 3883617
17. ACS "What are the key statistics about prostate cancer?" http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics Retreived 2011-4-14
18. Sorrels et. al "Fine-touch pressure thresholds in the adult penis" http://www.nocirc.org/touch-test/bju_6685.pdf Retreived 2011-4-14
19. AAP Task Force on Circumcision. Circumcision Policy Statement. Pediatrics 1999;103(3):686-693.
20. Van Howe RS. Effect of confounding in the association between circumcision status and urinary tract infection. J Infect 2005;51(1):59-68.
21. Glick, Leonard (2005). ""This Little Operation", Jewish American Physicians and Twentieth-Century Circumcisoin Advocacy". Marked in Your Flesh. New York, New York: Oxford University Press. pp. 183-184. ISBN 0-19-517674-X.
22 .G Hill, J V Geisheker (2006) "Edgar Schoen does not represent the North American view of male circumcision". Retrieved 2011-04-08. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083089/

Afterthought...
I was in a hurry, otherwise I would have also included the following:

Pollock promises a "virtually painless" circumcision,[1] but this claim assumes the methods he boasts in using are actually effective. On his website, it says that the pain control methods used are Tylenol, sugar,[2][3] a topical cream, and a local anaesthetic injection called a dorsal penile ring block. The topical anaesthetic only serves to numb the area to lessen the pain of the injection, but studies have shown that a dorsal penile ring block is not always effective in stopping the pain of circumcision.[4][5] During the circumcision, the child is given sugar pacifiers to "reduce his pain perceptions", but in at least one study, data shows that giving sugar to a child doesn't help to reduce the perception of pain in the child.[6] Post-operative pain and the pain the child must endure during recovery is hardly, if ever, addressed.

Pollock advertizes that it takes him "only 30 seconds" to perform circumcision, but this doesn't take into account the fact that the child must first have topical anaesthetic applied, and then be given the dorsal penile ring block for which there is a 10 minute waiting period for the injection to take effect. In the FAQ page, it is admitted that "although the circumcision takes under 30 seconds, we require you to be in our office for one hour and fifteen minutes in total so that we can carefully review with you all post procedure care and answer any of your questions."

In closing, Neil Pollock is just doing what any other merchant does to promote his business. It must be emphasized that Neil Pollock was first and foremost a mohel, and that he, Edgar Schoen and other circumcision advocates were circumcising children long before the current HIV hype. Pollock is not interested in facts, he is interested in promoting his own trade and absolving his own religious practices. Pollock will never admit the truths about circumcision because it would be devastating to his livelihood, devastating to his faith, and devastating to his own personal identity. The fact that he is a Jewish mohel, and that his livelihood depends on the circumcision of children bring this man's objectivity into question.

"It's hard to get a man to understand something when his livelihood depends on his not understanding..."
~Upton Sinclair

References:
1. "Pollock Clinics Infant Circumcision". 2011-04-08. http://www.pollockclinics.com/circumcision/circumcision-index.html. Retrieved 2011-04-08.
2. "Parents' Guide to Circumcision". http://www.pollockclinics.com/circumcision/circumcision-guide.html. Retrieved 2011-04-08.
3. "Before the Circumcision". 2011-04-08. http://www.pollockclinics.com/circumcision/circumcision-before.html. Retrieved 2011-04-08.
4. Taeusch, H William; Alma M Martinez, J Colin Partridge, Susan Sniderman, Jennifer Armstrong-Wells, Elena Fuentes-Afflick (April/May 2002). "Pain During Mogen or PlastiBell Circumcision". Journal of Perinatology 22 (3): 214-218. http://www.nature.com/jp/journal/v22/n3/full/7210653a.html. Retrieved 2011-04-08.
5. Williamson, Paul S.; Nolan Donovan Evans (August 1986). "Neonatal Cortisol Response to Circumcision with Anesthesia". Clinical Pediatrics 25 (8): 412-416. http://cpj.sagepub.com/content/25/8/412.abstract. Retrieved 2011-04-08.
6. Slater, Rebeccah; Laura Cornelissen, Lorenzo Fabrizi, Debbie Patten, Jan Yoxen, Alan Worley, Stewart Boyd, Judith Meek, Prof Maria Fitzgerald (2010-10-09). "Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial". Lancet, The 376 (9748): 1225-1232. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961303-7/ Retrieved 2011-04-08.