Thursday, March 31, 2011

Circumcision & poor health outcomes in 1st world nations

There is much evidence that infant circumcision contributes to poorer health outcomes in first world nations.

Health Outcomes in Children

Firstly, A recent Australian (2009) research found that present day Australian Children had far superior health outcomes to when routine infant circumcision was common, read as follows:

"The health of Australia’s children continues to improve, according to the latest report on child health from the Australian Institute of Health and Welfare, A Picture of Australia's Children 2009. During the period 1986-2006 there was a dramatic decline in infant and child deaths (which fell by half), improved survival in cases of cancer, and a reduction in the incidence of asthma.
These are significant findings, given that the period 1986 to 2006 witnessed a huge decline in the incidence of circumcision, from about 40 per cent of boys in the early 1980s to about 10 per cent in 2006. It is thus good empirical proof that “lack of circumcision” does not increase child health problems. Even more significantly, it is a decisive refutation of “scientific” predictions by Terry Russell, Brian Morris and other diehard promoters of routine circumcision that the fall in the circumcision rate would lead to an explosion of genito-urinary problems in boys and an ever-increasing death toll from urinary tract and bladder infections. No such problems are identified in this report, which does not even mention any health problems affecting the genito-urinary area.
On the contrary, the halving of the death rate among infants and children suggests that leaving the foreskin in place could even have significantly improved child health outcomes and contributed to the decline in infant and child mortality. It is, after all, quite illogical to claim that a boy with wound on his penis is somehow healthier than a boy who has not been injured there. As the British child health expert N.R.C. Roberton points out, “it is fundamentally illogical that mutilating someone might be beneficial.” *
Problems identified by the AIHW report include an increasing incidence or diabetes and obesity, more, tooth decay, too much television, not enough vegetables, and persistent poor health among indigenous Australians. It is hard to see how even a fanatic like Brian Morris could blame “lack of circumcision” for children not eating their vegetables.
The Australian Institute of Health and Welfare is the Australian Government’s premier health research foundation.
The full report and press release can be downloaded from the AIHW website.
N.R.C. Roberton, “Care of the Normal Term Newborn Baby,” in Textbook of Neonatology, eds. Janet M. Rennie, N.R.C. Roberton, 3rd edn. (Edinburgh: Churchill Livingston, 1999), 378-379.


When we look at longecity of first world nations an interesting story emerges.  Longevity is universally recognised as one of the most important signs of the health of an individual and the individuals of a nation, if we look at Americans (Circumcision Culture) Longevity which is 78yrs, you would expect it to be higher than similar nations that do not practice Circumcision, but in fact the opposite is true. Countries that do not circumcise have much higher longevity.  Japan’s  Longevity is 81.4yrs, Sweden’s Longevity is 80.6 yrs, Switzerlands Longevity is 80.6years. In fact most of Europe which does not Circumcise has higher longevity than the USA. Even within the USA it has been reported in Press that American Latino's who generally dont circumcise are the longest lived USA citizens. Therefore it is very clear that Infant Circumcision fails 1st world nations on the health measure of Longevity.

Infant Mortality

Infant mortality is another measure of public health, and the USA (The largest circumcising 1st world nation) does very poorly again compared to its no-circ peers, with much higher infant mortality than the EU nations & Japan.  The USA infant mortality rate is 6.4 deaths per live births, versus Sweden 2.8 deaths per live births  at and Japan at 3.2 deaths per live births. Again most of non-circumcising Europe has lower infant mortality than the USA.  Infant Circumcision has failed the first world circumcising nation of USA on the health measure of Infant Mortality.

UN Child Well-Being Measure
Infant circumcision has also failed circumcising America on a UN measure of child-well being:

United Nations measure of child well being = look at the table below:
1. Netherlands
2. Sweden
3. Denmark
4. Finland
5. Spain
6. Switzerland
7. Norway
8. Italy
9. Republic of Ireland
10. Belgium
11. Germany
12. Canada
13. Greece
14. Poland
15. Czech Republic
16. France
17. Portugal
18. Austria
19. Hungary
20. United States**
The 19 Nations ahead of the USA** are all non-circumcising nations.  From this evidence alone it appears than circumcising infants makes zero contribution to child well-being.  This data would suggests there are other factors far more important than circumcision which are involved in child well-being, and that infant circumcision has zero contribution to child well-being.

Sexually Transmitted Infections is another measure of Public Health where infant circumcision has failed the Circumcision USA when compared to Non-Circumcision nations of Europe.  The USA has 6 times the HIV infections than No-Circ Germany & 3 times the HIV infections than no-circ Holland.  .  The USA has 2.7 times the Syphillus infections than than no-circ Holland. .  The USA has 33 times the Gonnoreah infections than than no-circ Holland.  .  The USA has 19 times the Chlamydia infections than No-Circ  Holland.  Infant Circumcision has failed the USA on the health measure of STI Infection rates.

Penile Cancer

Another claim by Circumcision proponents is that circumcison prevents penile cancer. Denmark which doesnt circumcise its male infants has lower penile cancer rates than the USA which does. This epidemiological finding suggests there are more important factors than circumcision to preventing penile cancer. Another fail for infant circumcision.

In medical epidemiology we often look to world's best health outcomes, identify the resasons/practices which contribute, and often label this as the gold standard medical practice.  Europe & Japan which dont circumcise their male infants, have healthier infants, boys, and men, than the USA which does circumcise its infants.  On these 5 measures alone Non-Circumcision of infants would be considered Gold Standard Medical practice, and it could be said that Infant Circumcision as a public health measure is one big monumental failure in the first world medicine nation of the USA.

In summary, At the very least, and against its own claims "that infant circumcision provides health benefits", infant circumcision has failed the first world nation of America, and Non-Circumcision Cultures do better. If anything one could speculate that the data indicates a correlation with the very opposite (infant circumcision causes poorer health outcomes in first world nations).  However, much further detailed and more expensive research would be required to determine the validity of the correlation between infant circumcision and poorer health outcomes in first world nations.  Non-Circumcising nations would have zero motivation to allocate limited health resources to do this research, and circumcision nations would be averse to devoting limited health resources to find out that their religious & cultural medical practice is actually harmful to male health. In essence as is the case now, it is a grass-roots movement in first world nations like America where ordinary people through education and a willingness to go against cultural norms, and by protecting one baby at a time from infant circumcision, that will eventually see the practice abolished in all first world nations.

The World Health Organisation 2007 is the source of Longevity and Infant Mortality data.  Advocates for youth is the source of STI data:

Tuesday, March 22, 2011

Why does the foreskin become more impt as men age?

Direct Sexual Nerve stimulation and its response becomes more important for men as they age because sex hormone levels of testosterone gradually diminish and vascular circulation becomes less efficient. Robbing men of 20,000 pleasure nerves and anatomical pleasure structures like the frenar band and frenulum deprives them of much needed nerve stimulation as they age.  The loss of testosterone and vascular efficeincy can be in part compensated by direct stimulation of pleasure nerves, if these are lost to circumcision then men are deprived of this potential sexual compensation.

Friday, March 18, 2011

Why does infant circumcision still exist?

Culture is the one word that encapsulates why this practice still exists.  Culture covering the whole spectrum of social life including: religion, community, tribal practices, belief systems, Scientific values, Cultural Myth making, Cultural taboos, & Cultural shaming practice.  These cultural reasons are reinforced by the practice iteslf which has components of trauma, pain and anxiety, which can manifest as obsessiveness in individuals. Look at the obsessive lengths people go to, including scientists and medico's to promote the practice.
1Culture Non-Religious = In this instance we have a cultural set of beliefs and practices, including institutions, high profile individuals from media to medicine, Friends, Family, & Community leaders who are Saying "circumcision is good and that natural anatomy (the foreskin) is bad."  Very difficult issue to deal with but predominantly extensive education is required, and a variety of persuasion strategies from predominantly gentle coaxing & education, to "rarely as a last resort" aggressive shaming tactics (Giving the Pro-Circers a smell and taste of their own medicine), Knowing your audience is important, in which persuasion strategy to use.
Cultural Belief Systems = "The foreskin is of no value, it is a useless flap of skin."  "Circumcision is a harmless procedure and the baby won’t feel a thing."  The new one: "Circumcision is like a surgical vaccine, and circumcision is the only way I can achieve these health benefits for my child."  While clearly false with strong evidence that disputes these cultural beliefs, many people still believe these strongly contested circumcision myths. The answer here, is to challenge these beliefs with education, such as healthiest longest lived people with lowest STI's/HIV are non-circumcision people.
2.       Obedience to Medical Authority = Medical personal have an esteemed position in most cultures and strongly influence people.  "If my doctor says I need to do it, then it must be right."  Some people have been bought up to defer to medical authority, and that the Doctor always knows best.  Doctors are human beings and are susceptible to personal bias, prejudice, errors, false beliefs, greed, ignorance, incompetence, medical negligence, unethical behaviour, and cultural conditioning.  In many ways doctors can be cultural ambassadors.  This belief in the infallibility of the medical profession needs to be challenged with opinions from the world-wide consesus of respected medical authorities that recommend against infant circumcision.
3.      Cultural Religious obligation = This is the most difficult one to deal with.  Ultimately it is from within the religious community that change needs to occur.  Some Jews have created an alternate ceremony that does not involve circumcision (Brit Shalom). Even a small minority of muslims are rejecting the practice.  Respect and dignity is required here no matter how much or how strongly we disagree.  When we go too hard on religion we usually get a severe backlash, however, I believe Scofield's San Francisco legislation proposal is a great way to highlight the ethical and legal issues of infant circumcision, and its connotations for religious circumcision.  Dont fall for or buy the anti-semetic tag, refer to the increasing numbers of Jews and Jewish groups that are anti-circumcision as well.
4.      Tribalism = The father who says “ I want him to look like me” is not really thinking about his son at this very moment, but instead his own need for his son to belong to the no-foreskin tribe.  Take a deep breath, and slowly educate and persuade.  What the father is not thinking about and needs to be reminded of, is that circumcision is harmful, there are risks in the procedure, the foreskin is functional anatomy and it is a human rights violation of his son. Tribalism constructs its own social reality and can be deconstructed and reconstructed to a higher moral level of functioning, particularly as we know more and know better.
5.       6.       Investment in the procedure = Some parents, having already circumcised feel very invested and defensive about the procedure, very difficult to change or persuade in this case, all of the above suggestions apply.     Many in the medical profession who have circumcised 100's if not 1,000's of babies are also very invested in the procedure and also very defensive.  Not easy to persuade here.
7. Scientific research = "The research from Africa says that circumcision will prevent males from getting HIV." This false belief arises out of the supposed infallibility of Scientific Research.  WE need to educate that All scientific research is culturally value laden, and not infallible.  The researcher can interpret data, & emphasise what he/she wants to find or publish, & ommisions can made of what the researcher doesnt want known about his/her research.  Again education is critical here.  Hints when discussing African Research = The research did not prove life-long protection only partial episodic protection. It is not absolute risk reduction only relative risk reduction.  A significant number of circumcised men in the study became infected with HIV, Participants were not treated equally with the circumcised group given more education about healing from surgery, abstained from sex longer, and were given greater time and emphasis about wearing condoms during the period of healing from surgery.  Nearly 10 times as many participants dropped out of the study as were infected, with HIV status unknown. The studies were ended early exagerrating effects. The vast majority of participants in the study were HIV free, therefore, why was no attempt made by researchers to identify the 100% condom users and compare these to the circumcised group, Was 100% condom use more effective than circumcision = Most probably yes!! but researchers did not want to find this and report it.  In another study, Women who had sex with circumcised men were 50% more likely to become infected with HIV.  The reseach is valid only for adult circumcision volunteers, and populations with high prevalence of HIV, not babies or low prevalence nations. Demographic studies in Africa have found many circumcised populations have higher HIV infection rates than non-cirumcised populations.  The USA which circumcises has much higher HIV than western Europe which doesnt circumcise. The strong message here needs to be safe sex and condoms can only prevent HIV, and a false belief in the protection of circumcision places men and women at greater risk of infection.

There are many other reasons and I would invite comments and discussion on the blog.

Tuesday, March 15, 2011

Busting Circumcision Myths: Babies Sleep through Circumcision

Having watched the recent interview with Lloyd Schofiled (SF MGM Bill) where CNN;s Kelly stated (In trying to minimize the harms of the procedure) "Some babies sleep through their circumcision........." Since millions of people hear this sort of bullshit......I thought this pro-circ myth needs to be challenged once again.

Firstly why does such a myth even exist? One reason is that it probably developed to give some comfort to the Parents, particularly the mother who has just given birth, because the truth that the baby screamed in agony gasping for breath, would probably cause too much stress to the mother.  Another reason is to perpetuate the practice. Possibly another is self-protection by the medical profession?

The truth is that the studies that have examined pain response have found that babies feel severe and intense pain.  One study was stopped early once the severity of pain in circumcised babies was recognised. Taddio's studies found circumcised babies demonstrated greater pain behaviours at 6 month immunisations, and another study found even with the use of EMLA topical anaesthetic cream, circumcised babies had elevated cortisol levels (the human stress hormone).  So the truth is that  babies feel intense & severe pain during circumcision, and that if babies lose consciousness it is not that they are sleeping but that they have a traumatic shock or dissociative unconsciousness.

Lets bust the myth that babies sleep through circumcision.

Sunday, March 13, 2011

Do Pro-Circumcision Propagandists suffer from a Form of Stokholm Syndrome?

There is much evidence that infant circumcision is a traumatic and painful experience causing loss and deprivation, yet we find some or even many males that have been circumcised endlessly and obsessively promoting infant circumcision.  Why is this so?

One explanation may be a form of Stokholm Syndrome (SS). SS refers to a paradoxical psychological phenomenon wherein hostages express adulation and have positive feelings towards their captors that appear irrational in light of the danger or risk endured by the victims, essentially mistaking a lack of abuse from their captors as an act of kindness (Wikipedia).  The captors often feel traumatised by their experience and yet identify with their traumatisers, particularly if they survive unharmed or even experince a form of kindness or even attachment.  In a sense they feel that their traumtisers have spared them death and given them life.  The key psychological ingredients are helplessness, severity of trauma and intensity of emotional involvement.

In the case of infant circumcision, the baby is totally helpless, the circumcison is traumatic and painful, and hopefully in most cases the infant ends up experiencing an intense loving close relationship with the caregivers that made the choice to traumatise them.  The circumcised then not only attach to their parents but identify with their parents customs & practices, and then defend them even though they were severely harmed and deprived by the experience.  Trauma resides in the primitive areas of the brain, predominantly the Limbic system, one expression of this trauma memory is anxiety, which can become an obsession looking for a cause.  Hence the endless pro-circumcision propaganda.!!!! Though in many cases with a deeper understanding and awareness of the cause of the trauma, circumcision trauma's may turn into an obsession to end routine infant circumcision, a cause for good and ending harm, instead of pro-circ's need to forever perpetuate it.