An Open-Minded Pediatrician and Me – Part 2
In my last post, I told you about my conversation with a self-described “open-minded” pediatrician at the annual convention of the American Academy of Pediatrics. I was as distressed by his seeming ability to consider the circumcision question as a simple matter of “point of view,” as I was with the magnitude of pain and harm he had caused, and the fact that thousands of boys and men were living with the consequences. I did, however, know what he meant when he said that for him to stop performing circumcisions would be “complicated.”
If this doctor stops now, what will he tell the repeat “customers,” young parents asking him to circumcise their second or third son? What will he tell his colleagues?
If he stops, what will he tell the boys he cut who later learn that he – indeed – did put down the knife?
If he stops, and one day a young man in the small community where he practices sues him for injuries, or for lack of consent (the statute of limitations on a malpractice claim typically re-opens for a time when an individual turns 18), what defense will he offer?
On the other hand, if he doesn’t stop, how will this doctor live with his conscience – or with the consciousness that made him come to talk with us? What will he do if he botches terribly a surgery, and a baby loses half of his penis, or dies, after he knew he should stop circumcising, but didn’t?
Since the AAP conference, I’ve lost hours of sleep pondering this conversation, unable to imagine the magnitude of the suffering – one or two babies a day, week after week, month after month, year after year, strapped down and mutilated – caused by this man who took an oath to do no harm. I went online and learned that the small northeastern city where he practices has only 16,000 people. This means – again, if his numbers are correct – he has circumcised pretty much every male under the age of 25 in the community and the surrounding area.
Except his own son, that is. And by the way, what does he tell his intact son?
Let’s say your postman one day stopped by to tell you that he’d touched the genitals of all the neighborhood children, and all the children in his son’s school (though not his own child), as well as the children in the surrounding towns, over the past 25 years; and then he told you he wanted to know your point of view about that. You’d reach for the phone, and call the police.
Yet there I was, in this huge exhibit hall in Boston, standing under the bright lights of the infant formula, baby lotion, and drug companies, talking politely with a man who had cut the penises of 5000-6000 babies, but was “open-minded” and wanted to understand Intact America’s point of view.
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The Intact America Blog 
Given the lack of medical necessity for rc and the possibility of a fatal outcome, one is reminded of something John Kerry once said a few decades ago in a somewhat different context; namely, who wants to be the last one to die for a mistake?
As a physician who has worked around other medical professionals while they discuss circumcision, I have noticed how the whole idea of infant circumcision is just considered a ‘normal’ part of the day. Everyone just discusses it like it is no big deal. If I try to bring up what should be obvious (torture, mutilation, human rights, etc.), everyone gets really uncomfortable and glares at me like I just rained on their happy parade. Then I am the problem! As Voltaire said, “Familiarity accommodates any barbarity.”
In South Africa many young boys die and are mentally destabilizedeach year because of peer pressured circumcisions it’s a criminal act against humanity
I think yes, you should persuade and persuade doctors like him to stop unnecessarily circumcision surgery.
I think, sure he had known the ’10 Reasons Why You Should Stop Circumcising Baby Boys’ before he approached your booth. At least since 24 years ago. If he is a good doctor, he even has known the role and functions of foreskin and the incridible human body with the all parts since he got the doctor title.
If you think about 10 reasons to stop circumcising baby boys, sure he just think ‘1 Reason Why I Shouldn’t Stop Circumcising Baby Boys’. And the reason is ……….. Money.
I hope you will be successful to persuade him to stop circumcision baby boys and then even help in your campaign.
I live in Atlanta GA and have Kaiser Permanente as my HMO. I’ve interviewed the Glenlake pediatricians about their position on circumcision.
One doc, male, said he does it because parents ask. Another doctor, who I had high hopes for because she was fresh out of medical school, said it was cultural but she did not like doing them. She volunteered she circumcised her own son (I don’t think she meant literally.)
When pregnant with my son, I considered Georgetown Pediatrics in Dunwoody. It was close and convenient and they have a large staff of doctors – I figured I’d bond with someone there when I got to know them.
My pre-birth visit with the new patient counselor was dismal. She told me that “all the mothers are nervous about the circumcision” but “not to worry because their doctors were all very good at it.” Obviously that was not the practice for me. But I’m not having much luck bonding with the Kaiser Permanente pediatricians either.
I would hope that young interns, residents and doctors in training would challenge their professors for complete anatomic instruction, including foreskin. And challenge the procedure. And refuse. And advocate.
The “Put Down the Knife” campaign is right on board. Doctors are accountable for their actions. A person can learn and grow. That position is defensable. What is not defensable is to stubbornly hold on out of fear.
If the doc in question happens to read this post, I reach out to you to take a leadership role starting here and now to end mindless circumcision generation to generation.
I hope you will “Put down the knife”, and with your personal knowledge of what pediatricians experience in making this transition help us craft a strategy other physicians can follow.
Thank-you Georganne for this blog and your leadership.
Hi all. So thankful for this blog. Maybe understanding the logic behind an idea isn’t enough. Maybe there has to be some kind of enlightenment to go along with understanding the logic to make one internalize the idea. This happened to me. In graduate school, the topic of male circumcision came up alongside female circumcision in a couple of philosophy classes. I got the idea. I thought about it. Then I thought about it no more. It wasn’t until I was in my recovery room after giving birth to my son and heard another baby boy being wheeled back from his circumcision that I became instantly enlightened on the reality of circumcision. I was not a first time mother and was very used to all kinds of crying sounds. THIS crying sound was otherworldly, like nothing I’d heard before. My heart was pounding out of my chest. That baby was experiencing full blown trauma. It was THEN that I understood. So, perhaps we need to reach a bit deeper and help people move beyond the logical arguments when getting across to people. What tools can we use to enlighten? Videos? Photos? What else?
It’s a violent sexual crime and should be treated as such …. if a culture does not stand against it the culture is doomed to violence, perversion, disease, death, famine and war …….
it’s no wonder that violent crime rates soar in cultures that engage in that infidelity
Monday, October 17, 2011How bad is the African HIV Circumcision research?
The research did not prove life-long protection only partial episodic protection (relative to the trial conditions for only 18months).
The trials also did not reflect not real world settings, and therefore how can they be applicable to real world settings.
Rarely reported or emphasised, A significant number of circumcised men in the study became infected with HIV.
The participants were not randomly selected, but selected themselves, creating a potential bias or distortion in the generalisability of the results to any general population.
The participants were paid adult male volunteers who wanted to be circumcised and therefore had a bias in favour of it, and could possibly have been in favour of circumcision because they were high risk candidates who had unprotected sex (no condoms) with multiple sex partners, and were looking for a way to maintain high risk behaviours.
Therefore as the participants were not randomly selected, and were a potentially biased self-selected sample of the population, the results cannot be extrapolated to general populations outside of this population sub-group. (Van Howe & Storms, 2011)
Inadequate Controls: Participants in the trials were not treated equally with the circumcised group given more education about healing from surgery, advised to not resume sex for 6 to 8 weeks and therefore, abstained from sex longer, and participants were given greater time and emphasis about wearing condoms during the period of healing from surgery.
No control was undertaken to examine possible non-sexual blood exposures by participants. No control was undertaken for dry sex as practised by some african cultures.
No control for the sex (gender) of partners, and no control for anal intercourse. (Van Howe & Storms, 2011)
Unexplained and disrtorting the statistics was the finding that in the first three months of the Kenyan trial, five men became HIV-positive who reported no sexual activity in the period before the seroconversion (0.73/100 person-years, 95%CI=0.30-1.76). (Van Howe & Storms, 2011)Data suggests a percentage of infections were from non-sexual exposures, with 23 infected men reporting no sexual contact without a condom. No explanations or investigations undertaken for non-sexual exposures to HIV infections. (Van Howe & Storms, 2011)
The African HIV Trial researchers were all pro-circumcision and with a history of activism in the area.
Nearly 10 times as many participants dropped out of the clinical studies 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.
No long term follow-up possible with all subjects circumcised at end of trial.
Researchers used speculative hypotheses to explain trial findings, such as Langeran present in the foreskin cells are targeted by HIV, whereas later research found Langeran cells actually kill HIV. (Van Howe & Storms, 2011)
The studies had such high numbers of participants leading to an overpowering of the statistical analysis, inflating the results. (Van Howe & Storms, 2011)
French demographer Garenne criticised the findings by demonstrating that interventions with a near 50% clinical trial efficacy had very little population effect.
At best the research findings are only valid for adult circumcision volunteers, and populations with high prevalence of HIV, not babies or low prevalence nations. At worst the research is so floored the findings only have validity within similar research conditions and virtually zero validity for real world situations.
Comparisons with vaccinations are invalid. Most vaccinations are administered orally, dermally or via injection and not surgery removing healthy tissue. Those that are vaccinated are virtually fully protected, and those that come within proximity, whereas circumcision only partially protects the male for a period of 18months, does not protect female or male partners, with evidence of increased infections in female partners od circumcised males, does not protect against blood exposures, or injecting users, does not protect against male to male sex. A very poor vaccine indeed.
The conclusions to circumcise baby boys does not follow from the experiment which was tested on male adult volunteers for a period of 18 months.
The research does not explain how many circumcised populations have higher HIV infections than non-circmcised populations.
Yay for Intact getting a blog! I can foresee already, with just these first posts, that it’s going to be hard for me to read.
Thank you for what you do.
I am so glad I didn’t circumcise my boys (4 and 20 months). I have received numerous derogatory remarks from family members about being a heathen hippie. Of course, these comments are coming from people who need to justify their own circumcisions and the circumcisions of their sons. I believe, however, my boys will thank me when they are older. It’s a blessing that I live in Chicago and we have large immigrant population (Mexican, Indian, Asian and Eastern European) that don’t mutilate their boys, so I’m pretty sure my boys will fit right in with their peers and not worry about the “showers” in school or whatever other silly justifications they have come up with rationalize their behavior towards their sons.
I grew up in the UK when the circumcision rate was about 50%. No-one got teased in the showers. We looked, of course we did, but no-one got teased. BOys are far more concerned about size in the showers than whether they are cut or normal.
Marlene, my older son was born at Illinois Masonic Medical Center in Chicago in 1987 and is intact. When he was 13 he thanked me for not having him circumcised, and he gave me a big hug. Yes, your boys will be grateful to have been allowed to keep everything they were born with.
I think this doctor was really looking for a moral sanction from IA approving his actions. When he said he was “open-minded” I think he really hoped that IA was “open-minded” and would understand and accept his actions and tell him all was ok.
Just like when a Catholic goes to confession, confesses his/her sins, asks for forgiveness, but has no intention of repenting. Similar to buying an insurance policy just in case.
Chris Maurer
Chris, I think you hit the nail on the head. That fits with my experience of the man. If so, he did not, to put it very mildly, leave with our blessings.
As I read this, I couldn’t help but remember these words about being “open-minded,” which is how this pediatrician described himself. (See: http://www.faktoider.nu/openmind_eng.html)
[Practical gentlemen] have a number of bitterly sarcastical comments on persons whose minds are so open that their brains fall out.
Max Radin (1937)
Here are some even older variants, but without the brain (so to speak): “Their minds are so open that nothing stays in” (1932), “a mind so ‘open’ that almost anything can blow through it without leaving a trace” (1928) or “a mind so open that it had nothing in it at all” (1908).
Thanks for all your hard work.
I need some information.
How do I go about combating the argument that circumcision diminishes the incident of contracting HIV?
Have there been unbiased studies proving or disproving this procedure strictly for prevention?
Lashlee, I just try to share my thought to you.
Studies were done by humans, humans do studies because they still need to learn many things. Yes there are so many studies in medical world, because medical world still need to learn many many things about human body and the life. But unfortunatelly, humans can do wrong. They still can do wrong in many things, including when doing studies. The results of the studies can differ from one study to another, from a study in one place and in another place, and also from time to time.
Now about ‘circumcision diminishes the incident of contracting HIV?’, I think I also ever heard studies about that, but there were also studies with the opposite result, because the skin of circumcised penis will be thinner when erection happen so sexually more prone to wounds, the way of HIV transmision.
Actually you don’t need to confuse about that kind of studies or about the pro and the controversies, just believe the designer of human body, God. God knows much much, and much more than all humans in this world about human body and the life. God knows what are the bests for human body and the life. And God has designed foreskin for all men. Just take care and do well to all parts of our body, so we all can be healthy and may enjoy our life to the fullest.
I simply respond to those claims by stating that it’s not possible that circumcising infants reduces HIV because babies do not have sex. The person I’m talking to (including doctors) is usually stunned by that comment. The discussion then becomes focused about adult circumcision being more complicated. My response to that is: “What you’re saying is that the adult has to be treated humanely.” Said this to a pediatrician at a health fair and she had a startled look on her face and said: “That’s true.” End of discussion.
The key in this debate is to reframe the issue away from the medical “studies” (except of course for those that support our position) and focus on ethics, morality, and common sense.
I sometimes say, “you can prevent a lot of diseases by cutting off body parts. If you removed baby girls’ breast buds, they would never get breast cancer. But we don’t do that because it would be unethical.”
Circumcision does not prevent HIV. The U.S. has the highest rate of circumcision for first world countries and the highest rate of HIV. The 3 African based studies were poorly done with many flaws and biases. Many of the men became HIV positive without sexual contact or with constant use of condoms. It is more likely being spread by unsterile needles through the medical system. Even those poorly done studies, which were stopped early thereby overestimating any benefits, only showed maybe an absolute risk reduction of about 1%. This is VERY SMALL benefit, which likely is no benefit over time if the men were followed. Condoms prevent HIV acquisition; treating infected people with ART’s helps prevent transmission and cure HIV; abstinence prevents HIV; avoiding injections with non-sterile needles prevents HIV. Circumcision in infants has NEVER been studied linking it to prevention of HIV. Circumcision has been studied in gay men multiple times and has NOT been shown to decrease HIV transmission/acquisition.
There is an enormous of amount of cultural transference among physicians who promote this irrational, unethical and harmful practice. In Canada, there are only a handful of physicians willing to perform non-therapeutic circumcisions and they certainly perform the lion’s share. I’m willing to bet that virtually all of these physicians are themselves circumcised, a cycle of cruelty that stems from an inexcusable ignorance of the normal sexual function of the prepuce. Non-therapeutic amputation of healthy genital tissue from powerless children is a disgrace to our profession and it violates the most sacred principles of medical ethics. Male genital mutilation will not stop until national medical associations, as well as individual physicians, pull their heads out of the sand and speak out against this shameful practice. Put down the scalpels. Primum non nocere.
Dr. Christopher L. Guest MD,FRCPC
Barrie, Ontario, Canada
Christopher, you have said something that others inside your profession need to hear often, plainly and loudly. Those few words that you’ve used say it all.
Dr. Guest:
Thank you for sharing this succinct and powerful statement!
Dr. Guest, Thanks for posting. This movement needs many more physicians speaking out for children.
I think you contradicted yourself. You make two claims. Circumcising can be explained by: 1. Stems from ignorance (suggests a training or educational reason). 2.The vast majority of physicians are circumcised (suggesting a psychological reason).
If #1 is true, then I would expect the ratio of physicians performing circumcisions to mirror the ratio for all men of the same age group, but clearly this is not the case if #2 is true. Could you shed some more light on your observations?
Dan- I’m not following your logic here. I don’t see any contradictions. I think Dr. Guest was saying that he thinks the majority of circumcising physicians are themselves circumcised. He did not say that the majority of physicians are circumcised (they may be). Also, correlations do not always translate as absolute rules, for example- we know that most child sexual abusers were themselves sexually abused as children. But the vast majority of children who are sexually abused do not become sexual abusers in adulthood. The fact that many circumcised physicians do not do circumcisions is not in conflict with the idea that the few remaining circumcising physicians in Canada are most likely circumcised and have an emotional stake in perpetuating the practice.
Dan,
I don’t think the vast majority of physicians in Canada are circumcised, which is likely very different than the current demographic trend in the U.S.A. There are, however, a few Canadian physicians who perform an enormous number of circumcisions such as Dr. Neil Pollack in Vancouver, whose website claims, with great relish, that he has performed over 30,000 circumcisions. It is deeply disturbing that otherwise thoughtful and caring physicians cannot appreciate the ethical problem of strapping down a powerless infant and cutting off the most heavily innervated part of the penis, for no reasonable medical benefit and in clear contradiction to the recommendations of the Canadian Paediatric Society. This type of prolific genital cutting requires considerable psychological transference on the part of the offending physician, as well as a shameful degree of indifference among the rest of the medical community for not condemning this practice.
I do believe there is a generalized ignorance among circumcised (and intact) physicians with regards to the sexual/sensory and mechanical functions of the prepuce, as well as a lack of the historical understanding of how this religious blood ritual became “medicalized” during the Victorian era. This is a deeply embarrassing and disgraceful chapter in the history of our profession and many physicians are unwilling to take responsibility by properly educating the public and speaking out against non-therapeutic circumcision. I am NOT one of those physicians.
Georganne- I once met a doctor (female) who proudly claimed to have circumcised over 5000 babies….(“and the only ones I felt bad about were the Jews, because I was taking the money away from the mohel.”) In this blog post I made an illustration depicting just what 5000 people looks like… caution: it might make you lose a little more sleep.
http://thefrontporchswing.blogspot.com/2010/03/todays-genital-integrity-post-is-going.html
Sarah – thank you so much for posting the link to your blog piece, and to the video. I hope all the readers of this blog will also look at the video. Georganne
Sarah, what a wonderful blog. I wish it were, somehow, available for all in the medical community to read. One would hope that those who promote and perpetuate this barbaric custom would be shamed into ceasing.
Thank you Howard! I did just post a link to it on the AMA’s facebook page in a thread about the AMA voting to support resistance to any local legislation banning circumcision.
> If this doctor stops now, what will he tell the repeat “customers”
That’s a thought I’ve had for a while now, specifically about the AAP. Let’s say that at some point they decide to recommend *against* it? Wouldn’t this leave them and other pediatricians open to litigation for saying it was a legit procedure in the past? How does the American medical system get out of this business without suffering massive losses, both through litigation and via lost reputation? It’s clear that the powers at be in the AAP aren’t ready to abandon it, but I hope that eventually they might be. But will they be ‘locked in’ forever? Will they feel forced to continue to say that it is at least ‘ok’ just to save their own necks? And if so, what can be done about that?
Craig, that’s a good point. And, that’s the AAP’s problem. Of course it sort of becomes our problem when we ask them tor change. However, I’m sure that other treatments have been deprecated in the past. The fall-back position for the AAP is much like what we tell parents who circumcised your first boy, but is thinking about not cutting their second, “New studies have shown that circumcision has less benefit than previously believed.”
It is the same as stopping routine tonsillectomies. “We used to think this was a good thing to do. Now we do not. We have now stopped.”
Yes, I’m sure female circumcision is simply “point of view.”
It’s all relative I’m sure.
The Bottom Line
The foreskin is not a birth defect. Neither is it a congenital deformity or genital 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.
Doctors have absolutely no business performing surgery on healthy, non-consenting individuals, much less stoking a parent’s sense of entitlement.
Joseph – in your interesting, well-expressed post, you mentioned a 6th finger as something that’s a deformity [and therefore it IS okay to remomve it from an unconsenting child].
Well, hear this. 14 years ago a man wanting to discuss circ. contacted me. He told me that he was very upset over being circumcised when a helpless infant. It was a long, heartbreaking and all-round difficult-to-listen-to story. Among other things, he couldn’t forgive his mother.
One particular thing: he was born with a 6th finger on one hand. While one Jewish doctor circumcised him, another doctor, the circumciser’s brother, simultaneously cut that little 6th finger off. He knows this because he obtained (with some difficulty) his medical records from the hospital.
This man told me that he objected not only to the foreskin removal but also to the removal of that extra finger. He said it belonged to him and nobody else. Who’s to say he wouldn’t have enjoyed being a little different.
Update: This man is now certifiably mentally ill. He has been in and out of psychiatric units for years. He has made one suicide attempt; he is on and off various psychiatric drugs. Lots of other things I could tell you about him but there’s no point; I know you all get the picture. Thank you.
Bettie,
Sorry if in any way my expression came off as saying that “it is OK to remove a 6th finger from a non-consenting child.”
The reason that part is in there, is because in the arguments I encounter as an intactivist, the fallacy of comparing the foreskin, which is healthy and normal, to a 6th finger, which is actually a genetic anomaly, often comes up.
A similar one is comparing the presence of the foreskin to a cleft, or intersexed organs.
I completely understand the argument of self-autonomy, especially when it comes to intersexed organs.
The fact is though, that while these quirks are genetic anomalies that may actually present parents and doctors with a dilemma (the issue of intersexed organs is becoming more and more understood), the foreskin is nowhere near comparable.
The foreskin is not this rare hidden trait that should shock doctors and parents when it presents itself; the foreskin is standard equipment found in every male child at birth.
It is being born *without* the foreskin that is the rare and notable phenomenon. In the past, this condition, known as “aposthia,” or “lipodermos” was seen as a medical condition by the Greeks, and methods of treating this ailment are documented in ancient Greek medical records.
Is a 6th finger a real medical problem in need of correction? I think that question is up for debate. The foreskin, however, is an intrinsic part of the human penis, and there is simply no room.
Georganne, We have is email address, right? Why not forward him these blogs.
Well, it isn’t complicated. Instead it is profitable. Not stopping buys a yacht, Stopping does not. And that, Marilyn, is the crux of it.
Perhaps parents should pay to leave the kid as nature intended, too.
That was not a serious suggestion 🙂
Let’s hope every doctor is as sensitive and ethical as you are, Tim!
Wow, Georganne, what a powerful piece! I’ve pondered these same issues. Years ago, I thought that when everyone was educated, circumcision would quickly come to an end…Easy. Not so! Not only do people cling to personal, cultural, and religious preferences, not to the mention the money that’s being made, once they are complicit it, becomes all the more difficult. In a circumcising society, not many are not complicit. Still, with all this to counter, people are hearing our message. That doctor will never circumcise another boy without thinking about you or your question about how much money he’s made amputating foreskins!
I think he is much mistaken. Stopping would not be complicated.
“At the time I performed your surgery I felt I was doing the right thing. Since then I have learned enough to know that this practice should stop. So I have stopped.”
There is nothing complicated about that. It shows responsibility.