| In the last fifty years,
circumcision advocates 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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