Announcement

Collapse
No announcement yet.

The Circumcision Debate: Beyond the Risks and Benefits. Andrew L. Freedman, MD. Pediatrics. May 2016 Issue--Early Release

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • The Circumcision Debate: Beyond the Risks and Benefits. Andrew L. Freedman, MD. Pediatrics. May 2016 Issue--Early Release

    Early release article for the AAP's May Issue of Pediatrics

    http://pediatrics.aappublications.or...type=HWCIT&ct=

  • #2
    The closing remarks of this piece seem to miss the whole point, I think.

    "I know it sounds naïve, but my challenge to all of us is to imagine a day we can peacefully live in a world in which not all penises have to look the same. "

    I think most intactivists would agree. Most are not arguing the adult men could not make the decision themselves. We, for the most part, live a world were adults are free to make decisions about other body modifications/tatooing and live peacefully together. I think the author and the AAP putting too much emphasis on parental rights and cultural factors rather than the autonomy for bodily integrity.

    Comment


    • #3
      FYI - This article is paywalled for me. If you have other choice bits to share, that's fine, but I'm certainly not paying to read AAP circumcision apologetics.
      Visit my restoration progress journal.

      Comment


      • #4
        [QUOTE=universitylad;n4700]The closing remarks of this piece seem to miss the whole point, I think.

        "I know it sounds naïve, but my challenge to all of us is to imagine a day we can peacefully live in a world in which not all penises have to look the same. "

        How a bout a world where all penises DO look the same.....INTACT! As nature intended.

        Comment


        • #5
          Originally posted by universitylad View Post
          The closing remarks of this piece seem to miss the whole point, I think.

          "I know it sounds naïve, but my challenge to all of us is to imagine a day we can peacefully live in a world in which not all penises have to look the same. "

          I think most intactivists would agree. Most are not arguing the adult men could not make the decision themselves. We, for the most part, live a world were adults are free to make decisions about other body modifications/tatooing and live peacefully together. I think the author and the AAP putting too much emphasis on parental rights and cultural factors rather than the autonomy for bodily integrity.
          I have not read the article, paywall, but if the author is trying to say why can't we live in peace with both RIC and intact together, he is selling bullshit. It is a common, and deceptive, tactic to avoid the real issue and instead talk about side issues.

          The way he should be saying this is more like, "Can't you people who are for the rights of the child to remain intact get off my back and let me amputate the most important part of the children's body for sexual feeling and function?"

          Regards

          Comment


          • #6
            Originally posted by parsecskin View Post
            How a bout a world where all penises DO look the same.....INTACT! As nature intended.
            But they don't look all the same! There is vast diversity among intact penises. Not sure "Andrew Freedman, MD" understands that though.
            Visit my restoration progress journal.

            Comment


            • #7
              I will post the article here if anyone wants to read it in full.
              ==========================================
              The Circumcision Debate: Beyond Benefits and Risks
              Andrew L. Freedman MD FAAP

              In 2007, following a flurry of reports describing a benefit of circumcision in the fight against HIV, the American Academy of Pediatrics reconvened the task force on circumcision to update its policy statement of 1999.(1) Rather than simply incorporating this new information, the committee chose to start from scratch and re-review the medical literature. The task force’s work culminated in a policy statement published in 2012, the centerpiece of which was the statement that “the health benefits of newborn male circumcision outweigh the risks.”(2) This formulation of the debate, “benefits versus risks” rather than “medical necessity, ” resulted in wide-ranging ramifications.

              To many, especially in the lay press, this was interpreted as moving the needle from a neutral stance, as the 1999 guidelines were viewed, to being pro circumcision.

              It was vigorously criticized by anti-circumcision activists, as well as many, primarily European, physicians and medical societies. Difficulties with this approach included the lack of a universally accepted metric to accurately measure or balance the risks and benefits. In particular, there was insufficient information about the actual incidence and burden of non-acute complications.

              In this issue, Sneppen and Thorup(4) use meticulous epidemiologic technique to assess the likelihood of needing a circumcision in a society in which the cultural norm is to preserve the prepuce. Work such as this, along with the subsequent avalanche of reports evaluating the risks and benefits, has helped to inform and animate the dialogue among physicians with a stake in the circumcision debate. But has this really helped to inform the public? Or are we just arguing among ourselves? What is often lost in the reporting on the American Academy of Pediatrics guidelines was the second half of the benefits/risk sentence, “the procedure’s benefits justify access to this procedure for families who choose it, ” and later “health benefits are not great enough to recommend routine circumcision.”

              What was the task force really saying? (2)

              To understand the recommendations, one has to acknowledge that when parents decide on circumcision, the health issues are only one small piece of the puzzle. In much of the world, newborn circumcision is not primarily a medical decision. Most circumcisions are done due to religious and cultural tradition. In the West, although parents may use the conflicting medical literature to buttress their own beliefs and desires, for the most part parents choose what they want for a wide variety of non-medical reasons.

              There can be no doubt that religion, culture, aesthetic preference, familial identity, and personal experience all factor into their decision. Few parents when really questioned are doing it solely to lower the risk of urinary tract infections or ulcerative sexually transmitted infections. Given the role of the phallus in our culture, it is not illegitimate to consider these realms of a person’s life in making this non-therapeutic, only partially medical decision. The task force was sensitive to the fact that as physicians, although we claim authority in the medical realm, we have no standing to judge on these other elements.

              The ethical standard used was “the best interest of the child, ” and in this setting the well-informed parent was felt to be the best proxy to pass this judgment. Protecting this option was not an idle concern at a time when there are serious efforts in both the United States and Europe to ban the procedure outright.

              These guidelines recognize that there will never be a simple single formula. Even if there was, we all often choose to ignore doing what may be beneficial or likewise choose to engage in risky activity depending on our immediate desires. In circumcision, what we have is a messy immeasurable choice that we leave to parents to process and decide for themselves rather than dictate to them. This may seem odd in a society in which circumcision is rarely sought, but makes perfect sense in the multicultural world in which many of us live.

              To the medical community, your efforts to improve our ability to accurately educate parents are needed. But we have to accept that there likely will never be a knockout punch that will end the debate. It is inconceivable that there will ever be a study whose results are so overwhelming as to mandate or abolish circumcision for everyone, overriding all deeply held religious and cultural beliefs.

              To the anti-circumcision activists, I would suggest that rather than directing an angry focus on the negative and the courts, your efforts would be better spent to educate and promote the prepuce positively, to win in the court of public opinion and to change the culture, so as to make having a foreskin be the “popular thing to do.”

              I know it sounds naïve, but my challenge to all of us is to imagine a day we can peacefully live in a world in which not all penises have to look the same.

              REFERENCES
              1. American Academy of Pediatrics.
              Circumcision Policy Statement. Task
              Force on Circumcision. Pediatrics.
              1999;103(3);686-693. Reaffi rmation
              published on 116(3);796
              2. American Academy of Pediatrics Task
              Force on Circumcision. Circumcision
              policy statement. Pediatrics.
              2012;130(3):585–586
              3. Blank S, Brady M, Buerk E, et al;
              American Academy of Pediatrics
              Task Force on Circumcision. Male
              circumcision. Pediatrics. 2012;130(3).
              Available at: www. pediatrics. org/ cgi/
              content/ full/ 130/ 3/ e756
              4. Sneppen I, Thorup J. Foreskin
              morbidity in uncircumcised males.
              Pediatrics. 2016;137(5):e201543402

              Downloaded from
              Department of Surgery, Cedars Sinai Medical Center, Los
              Angeles, California
              Former member American Academy of Pediatrics
              Task Force on Circumcision.
              Opinions expressed in these commentaries are
              those of the author and not necessarily those of the
              American Academy of Pediatrics or its Committees.
              DOI: 10.1542/peds.2016-0594
              Accepted for publication Feb 23, 2016
              Address correspondence to Andrew L. Freedman,
              MD, Department of Surgery, Cedars Sinai Medical
              Center, 8635 West Third St, Ste 1070, Los Angeles, CA
              90048. E-mail: [email protected]
              PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online,
              1098-4275).
              Copyright © 2016 by the American Academy of
              Pediatrics
              FINANCIAL DISCLOSURE: The author has indicated
              he has no fi nancial relationships relevant to this
              article to disclose.
              FUNDING: No external funding.
              POTENTIAL CONFLICT OF INTEREST: The author has
              indicated he has no potential confl icts of interest
              to disclose.
              COMPANION PAPER: A companion to this article
              can be found on online at www. pediatrics. org/ cgi/
              doi/ 10. 1542/ peds. 2015- 4340.
              PEDIATRICS Volume 137 , number 5 , May 2016 :e 20160594 COMMENTARY
              To cite: Freedman AL and FAAP M. The Circumcision
              Debate: Beyond Benefi ts and Risks. Pediatrics.
              2016;137(5):e20160594
              Downloaded from by guest on April 7, 2016
              Advanced Devices Inc.
              http://foreskin-restoration.info/
              Adhesi-Med Skin Safe Medical Adhesive
              Supercanister Tuggers
              Torpedo Tugging Weights

              Intaction - Understand the Harm, Change the World, Are You Ready?
              Join the I DID NOT CONSENT Army
              http://intaction.org/

              Comment


              • #8
                Sorry, I didn't realize was a paywalled article for some.

                "The ethical standard used was “the
                best interest of the child, ” and in this
                setting the well-informed parent was
                felt to be the best proxy to pass this
                judgment. Protecting this option was
                not an idle concern at a time when
                there are serious efforts in both the
                United States and Europe to ban the
                procedure outright. "... "This may seem odd
                in a society in which circumcision
                is rarely sought, but makes perfect
                sense in the multicultural world in
                which many of us live."

                This was sort of the same direction the AAP was going when they issued their statement on female genital cutting, but they were forced to retract it almost immediately. http://www.medscape.com/viewarticle/722840







                Comment


                • #9
                  The other thing I just noticed is that he is listed as
                  "Former member American Academy of Pediatrics
                  Task Force on Circumcision." I wonder what former member means. Did he stop being a member or resign? Or once their last policy statement was published is there no longer a Task Force on Circumcision until the AAP decides it needs to update its policy. Maybe its time to update it again.

                  Comment


                  • #10
                    Yikes. "Quisling" is a fair word for Dr. Freedman.
                    Visit my restoration progress journal.

                    Comment

                    Working...
                    X