In the Feb. 6 issue, author-activist Lisa Braver Moss promoted non-circumcision of newborn boys as if circumcision was simply a matter of personal style rather than a valuable preventive health measure, as well as a Jewish religious covenant.
Recently both the American Academy of Pediatrics and the Centers for Disease Control and Prevention concluded that the medical benefits of newborn circumcision exceed the minor risks of the procedure. Published scientific evidence favoring circumcision has steadily increased, so that it is now overwhelming.
A circumcised newborn boy has multiple health advantages over his lifetime compared with one who has been left uncircumcised. Uncircumcised boys have a tenfold risk of severe urinary tract infections in the first year or two of life, often resulting in kidney damage. About 10 percent of uncircumcised boys will have to be circumcised anyway later in life, when the risks are appreciably greater than in newborns, because of inability to retract the foreskin (phimosis), as well as recurrent foreskin infections.
Probably the most significant factor in the movement to encourage universal circumcision is the finding that circumcision helps to prevent the acquisition of the human immunodeficiency virus that causes AIDS following heterosexual exposure. Over 25 million people, mostly in Africa, have died of HIV disease since it first appeared in the 1970s. It has been calculated that more than 5 million lives would be saved from HIV over the next few years by universal circumcision.
A number of African countries have national programs promoting adult as well as newborn circumcision. Data show that other sexually transmitted infections are also more likely to be contracted in the presence of the foreskin. The most significant of these is human papilloma virus, the causative agent of both penile cancer in men and cervical cancer in women.
The AAP and CDC statements emphasizing the value of newborn circumcision, as well as the continuing powerful accumulating data, have dealt a severe blow to the organized lay anti-circumcision groups. The largest are the misleadingly named NOCIRC (National Organization of Circumcision Information Resource Centers), with which Ms. Moss has been associated, and NOHARMM (National Organization to Halt Abuse and Routine Mutilation of Males). These groups, which largely began in the 1970s and reached their peak in the 1980 and ’90s, are now in disarray.
In the face of conclusive medical evidence favoring circumcision, their arguments are now limited to anecdotes and theoretical and claimed social advantages of the foreskin. Currently one hears less in the media about these groups, the main source of their previous support.
Comparing present anti-circumcision activity with previous interactions with these groups, it is my impression that their numbers have fallen significantly. Ms. Moss seems to be an exception, a holdout clinging tightly to her medically untenable anti-circumcision beliefs. She is addressing a small audience of receptive parents, particularly in trendy areas such as Berkeley and Marin.
The problem of educated parents choosing to leave their infant boys uncircumcised, thus placing them at greater health risks, is analogous to the increasing practice of non-immunization among parents with similar backgrounds. Indeed, in my experience parents who refuse circumcision are more likely to leave their children non-immunized and vice versa. The current outbreak of measles and pertussis illustrates the dangers of the non-immunized state. It is not only that non-immunized children are more likely to acquire these severe, sometimes deadly infectious diseases themselves, but that they can pass them on to other infants and young children not yet immunized.
Non-circumcision is a health risk to the boy himself, but does not represent the same degree of risks to others. The exception is STIs, particularly HIV and HPV, which are more likely to be transmitted by uncircumcised males.
Orthodox Jews perform circumcision-brit milah because it is a covenant with God; health is not a factor in the decision. In the case of non-Orthodox Jews and the general population, the rational reason to perform circumcision is the resulting medical benefits. So promoting non-circumcision among Jews is a double whammy.
When uncircumcised Jewish infants develop severe kidney infections — and I have seen several — one result is extreme parental guilt. It is analogous to the feelings of guilt in the parents of a non-immunized child who dies or suffers brain damage because of measles encephalitis.
Although Ms. Moss makes comments and recommendations on the most widely performed surgical procedure in the United States, she has had no medical training or experience. Her contentions are best characterized by the technical term known as mishegas.
Edgar Schoen, M.D, is a clinical professor of pediatrics (emeritus) at UCSF, former chief of pediatrics at Kaiser Permanente in Oakland, and a former chair of the American Academy of Pediatrics Task Force on Circumcision.
The CDC did *not* reach the conclusions described by Schoen!
They issued a DRAFT statement on circumcision a number of years back. But it received such intense criticism from the international medical community that it was never issued in final form.
As for the American Academy of Pediatrics, their 2102 policy statement made the explicit point that they did *not* recommend routine circumcision. Whatever claims they made in the statement about “benefits” and risks are also now no longer applicable, has this statement has surpassed its five year expiration deadline with no indication that the AAP plans to renew it.