| Circumcision is the only surgery in history
ever advocated as a widespread means of preventing disease. In the
last fifty years, circumcision proponents in the medical profession
have promoted various claims. One medical claim for
circumcision is that it decreases the incidence of urinary tract
infection (UTI) in the first year of life.( 1) However,
the UTI studies this position is based on have been criticized by
other physicians, most notably by the American Academy of Pediatrics
(AAP). They concluded that the test designs and methods of these
studies may have “flaws.”( 2) A similar study found no
confirmed cases of UTI in intact male infants without urinary birth
defects.( 3) Furthermore, the UTI defense of circumcision is weak,
not just because the methods are flawed, but because the logic and
reasoning leading to the conclusion are flawed.
The UTI studies do not justify routine infant
circumcision for the following reasons:
- Even according to the questionable studies,
the overwhelming majority (96-99 percent) of intact male infants
do not get UTIs in the first year.( 4) It is not reasonable to
subject them to circumcision and the associated pain without
demonstrable benefit.
- The studies do not consider the potential
harm caused by circumcision. The rate of surgical complications is
reported to be from 0.2 to 38 percent.( 5) (The higher rate
included complications reported during the infants’ first year.)
There are at least twenty different complications including
hemorrhage, infection, surgical injury, and in rare cases,
death.( 6) Other harm includes loss of the foreskin and
behavioral consequences.( 7)
- Circumcision involves cutting off normal,
healthy, functioning tissue to prevent potential UTI problems in
the future. There is no disease or infection present at the time
of surgery. If we were to apply this principle in trying to
prevent other potential problems, then we would be pulling healthy
teeth to prevent cavities. Clearly, this principle is
irrational.
- UTI is treatable with antibiotics.( 8) If good
medical practice requires the least intrusive form of effective
treatment, then circumcision is not justified. Circumcision is a
radical surgical treatment.
- Females have a higher UTI rate than
males,( 9) yet no doctor advocates genital surgery to reduce
female UTI.
Most of these
arguments would be applicable to any claimed medical benefit.
Circumcision advocates can only make the dubious claim that an
unlikely or rare condition will be less likely to occur in the
circumcised male. This benefit is sufficient justification for many
people partly because circumcision is a surgical procedure that is
done on someone else. It is pertinent to ask: Would you
voluntarily submit to an unanesthetized surgical procedure on your
healthy genitals for this “benefit”? The answer is also evident from
the fact that intact male adults are not generally seeking to have
themselves circumcised. Upon closer inspection, it becomes clear
that the flawed reasoning of supposedly reputable studies has
contributed to the confusion on the circumcision issue.
Indeed, the medical community itself has
acknowledged that it has not maintained very high standards in its
published work. Researchers and authors Charles and Daphne Maurer
cite an editorial published in the Journal of the American
Medical Association:
In a study of 149 articles selected
at random from ten widely read and highly regarded medical
periodicals . . . less than 28% have sufficient statistical
support for drawn conclusions.( 10) Maurer and Maurer explain why so much “nonsense” is
published: (1) Experimental design and statistical analysis are not
typically taught in medical school; and (2) medical schools
discourage questioning of authorities.
Our science is affected by our cultural values.
Circumcision reflects a cultural value, and a principal method for
preserving cultural values is to disguise them as truths that are
based on scientific research. This “research” can then be used to
support medical practices. This explains the claimed medical
“benefits” of circumcision.
Blind acceptance of science and belief in
“objective” reality is imprudent. There is no such thing as
objective observation, because observations are made by people who
have inherent theories and expectations about how things should be.
Studies defending circumcision make this clear by ignoring vital
information (such as the functions of the foreskin) that conflicts
with observations, results, and conclusions.
Because it is unnecessary surgery, the burden of
proof in the circumcision debate rests with those who advocate it.
They must show that it is both safe and effective. Neither has been
demonstrated.
NOTES
(1) Wiswell, T., Smith, F., &
Bass, J., “Decreased Incidence of Urinary Tract Infections in
Circumcised Male Infants,” Pediatrics 75 (1985): 901-3;
Wiswell, T. et al., “Declining Frequency of Circumcision:
Implications for Changes in the Absolute Incidence and Male to
Female Sex Ratio of Urinary Tract Infection in Early Infancy,”
Pediatrics 79 (1987): 338-42.
(2) American Academy of Pediatrics,
“Report of the Task Force on Circumcision,” Pediatrics 84
(1989): 389.
(3)
Altschul, M., “Cultural Bias and the Urinary Tract Infection (UTI)
Circumcision Controversy,” The Truth Seeker, July/August
1989, 43-5.
(4)
Wiswell, Smith, & Bass, “Decreased Incidence,” 901-3; Wiswell et
al., “Declining Frequency,” 338-42.
(5) Kaplan, G., “Complications of
Circumcision,” Urological Clinics of North America 10 (1983):
543-9; Gee, W. & Ansell, J., “Neonatal Circumcision: A Ten Year
Overview with Comparison of the Gomco Clamp and the Plastibell
Device,” Pediatrics 58 (1976): 824-7.
(6) Kaweblum, Y. et al.,
“Circumcision Using the Mogen Clamp,” Clinical Pediatrics 23
(1984): 679-82.
(7)
Ritter, T., Say No To Circumcision (Aptos, CA: Hourglass,
1992): 12-1; Richards, M., Bernal, J., & Brackbill, Y., “Early
Behavioral Differences: Gender or Circumcision?” Developmental
Psychobiology 9 (1976): 89-95.
(8) Denniston, G., “First, Do No
Harm,” The Truth Seeker, July/August 1989, 35-8.
(9) Wiswell et al.,
“Declining Frequency,” 338-42.
(10) Maurer, D. & Maurer, C., The World of the
Newborn (New York: Basic Books, 1988), 240.
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