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Swazi Observer Media meet in Jo’burg on male circumcisionBy Calsile Masilela COUNTRIES where more males are circumcised have a low HIV prevalence rate. [WRONG] Those with few circumcised men have a high HIV prevalence rate, particularly in Sub Saharan Africa. [WRONG] This was revealed during a media workshop on promoting male circumcision held in Johannesburg last week and organised by Media Institute of Southern Africa (MISA) head office in Namibia with the support of UNICEF, UNAIDS and UNFPA South Africa. MISA’s Reagan Malumo said they had embarked on programmes to train media practitioners with reporting skills on male circumcision. Misa has trained journalists on child reporting as well. The media needed to report positively on issues that affect people’s lives, adding that male circumcision had been added as one of the prevention methods in place to help reduce new HIV infections. [Brainwash the media and the public will follow.] They would like to stage awards for best reporting on male circumcision in the other Misa chapters. In Namibia, such awards are there already - to motivate journalists. UNICEF South Africa Communication for Development Specialist Adebayo Fayoyin said it was important that journalists be given the right information so they could write on topical issues with understanding. He said circumcised men have a significantly lower risk of becoming infected with the HIV [from women, according to certain studies, but not others] . ... |
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Casper Star-Tribune Judge rejects pleas for leniency, imposes 12-to-19-year sentenceFather of boy who died gets prisonBy WILLIAM BROWNING CASPER — Samuel Eugene McGehee shut his eyes in court Friday when his attorney played a recording of the police interrogation made the day his son died. The recording revealed the then 38-year-old McGehee sobbing uncontrollably hours after his 9-month-old son died of asphyxiation. The courtroom, with every aisle full, remained silent as the chilling sound of a father, struggling to catch his breath in the wake of a child’s death, piped out of the courtroom’s speakers. Authorities say McGehee wrapped the child’s head in a coat in an attempt to get him to take a nap on the afternoon of Nov. 15. ... Admits guilt
For another charge McGehee pleaded guilty to — felony child abuse dating back to 2008 — he received an additional two to four years in prison. That charge came about after McGehee attempted to circumcise another one of his children at home. He used a fillet knife to carry out the procedure, and the boy, 3 months old at the time, has undergone extensive reconstructive surgeries as a result. District Attorney Michael Blonigen asked for a 15- to 20-year sentence for the manslaughter charge and a three- to five-year sentence for the child abuse. “The lives of two young boys were forever changed before the age of 1,” the prosecutor told the court. “One lost his life, one was mutilated by his father.” ... Defense attorney Rob Oldham, though, painted a different picture of McGehee. ... Turning to the circumcision, Oldham said McGehee and his wife attempted to carry out the procedure at home because they were struggling financially, had deep religious convictions and were facing growing pressure from family members. ... Earlier story |
Court grants Gambia anti-female circumcision leaders bailBy Yankuba Jambang, Editor & Publisher, Senegambianews.com A magistrate’s court in Banjul has granted bail to the two leading campaigners against female circumcision in the Gambia on Wednesday. ... Dr. Isatou Touray, director of a non-governmental organization called GAMCOTRAP (The Gambia Committee Against Traditional Practices) and her assistant Mrs. Amie Bojang-Sissoho, were taken into police custody on October 11 for allegedly embezzling funds meant for the organization. Both have denied any wrong doing. ... Prosecutors say the two activists have diverted about 30,000 Euros from a Spanish NGO Yolacomba Solidaridad to personal use. But officials of the NGO in Spain have asked the government of President Yahya Jammeh to immediately release the women. |
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The Atlantic Lies, Damned Lies, and Medical ScienceMuch of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science. By David H. Freedman In 2001, rumors were circulating in Greek hospitals that surgery residents, eager to rack up scalpel time, were falsely diagnosing hapless Albanian immigrants with appendicitis. At the University of Ioannina medical school’s teaching hospital, a newly minted doctor named Athina Tatsioni was discussing the rumors with colleagues when a professor who had overheard asked her if she’d like to try to prove whether they were true—he seemed to be almost daring her. She accepted the challenge and, with the professor’s and other colleagues’ help, eventually produced a formal study showing that, for whatever reason, the appendices removed from patients with Albanian names in six Greek hospitals were more than three times as likely to be perfectly healthy as those removed from patients with Greek names. “It was hard to find a journal willing to publish it, but we did,” recalls Tatsioni. ... One of the researchers, a biostatistician named Georgia Salanti, fired up a laptop and projector and started to take the group through a study she and a few colleagues were completing that asked this question: were drug companies manipulating published research to make their drugs look good? Salanti ticked off data that seemed to indicate they were, but the other team members almost immediately started interrupting. One noted that Salanti’s study didn’t address the fact that drug-company research wasn’t measuring critically important “hard” outcomes for patients, such as survival versus death, and instead tended to measure “softer” outcomes, such as self-reported symptoms (“my chest doesn’t hurt as much today”). Another pointed out that Salanti’s study ignored the fact that when drug-company data seemed to show patients’ health improving, the data often failed to show that the drug was responsible, or that the improvement was more than marginal. Salanti remained poised, as if the grilling were par for the course, and gamely acknowledged that the suggestions were all good—but a single study can’t prove everything, she said. Just as I was getting the sense that the data in drug studies were endlessly malleable, Ioannidis, who had mostly been listening, delivered what felt like a coup de grâce: wasn’t it possible, he asked, that drug companies were carefully selecting the topics of their studies—for example, comparing their new drugs against those already known to be inferior to others on the market—so that they were ahead of the game even before the data juggling began? “Maybe sometimes it’s the questions that are biased, not the answers,” he said, flashing a friendly smile. Everyone nodded. Though the results of drug studies often make newspaper headlines, you have to wonder whether they prove anything at all. Indeed, given the breadth of the potential problems raised at the meeting, can any medical-research studies be trusted? ... “Randomized controlled trials,” which compare how one group responds to a treatment against how an identical group fares without the treatment, had long been considered nearly unshakable evidence, but they, too, ended up being wrong some of the time. “I realized even our gold-standard research had a lot of problems,” he says. Baffled, he started looking for the specific ways in which studies were going wrong. And before long he discovered that the range of errors being committed was astonishing: from what questions researchers posed, to how they set up the studies, to which patients they recruited for the studies, to which measurements they took, to how they analyzed the data, to how they presented their results, to how particular studies came to be published in medical journals. This array suggested a bigger, underlying dysfunction, and Ioannidis thought he knew what it was. “The studies were biased,” he says. “Sometimes they were overtly biased. Sometimes it was difficult to see the bias, but it was there.” Researchers headed into their studies wanting certain results—and, lo and behold, they were getting them. We think of the scientific process as being objective, rigorous, and even ruthless in separating out what is true from what we merely wish to be true, but in fact it’s easy to manipulate results, even unintentionally or unconsciously. “At every step in the process, there is room to distort results, a way to make a stronger claim or to select what is going to be concluded,” says Ioannidis. “There is an intellectual conflict of interest that pressures researchers to find whatever it is that is most likely to get them funded.” Perhaps only a minority of researchers were succumbing to this bias, but their distorted findings were having an outsize effect on published research. To get funding and tenured positions, and often merely to stay afloat, researchers have to get their work published in well-regarded journals, where rejection rates can climb above 90 percent. Not surprisingly, the studies that tend to make the grade are those with eye-catching findings. But while coming up with eye-catching theories is relatively easy, getting reality to bear them out is another matter. The great majority collapse under the weight of contradictory data when studied rigorously. Imagine, though, that five different research teams test an interesting theory that’s making the rounds, and four of the groups correctly prove the idea false, while the one less cautious group incorrectly “proves” it true through some combination of error, fluke, and clever selection of data. Guess whose findings your doctor ends up reading about in the journal, and you end up hearing about on the evening news? Researchers can sometimes win attention by refuting a prominent finding, which can help to at least raise doubts about results, but in general it is far more rewarding to add a new insight or exciting-sounding twist to existing research than to retest its basic premises—after all, simply re-proving someone else’s results is unlikely to get you published, and attempting to undermine the work of respected colleagues can have ugly professional repercussions. In the late 1990s, Ioannidis set up a base at the University of Ioannina. He pulled together his team, which remains largely intact today, and started chipping away at the problem in a series of papers that pointed out specific ways certain studies were getting misleading results. Other meta-researchers were also starting to spotlight disturbingly high rates of error in the medical literature. But Ioannidis wanted to get the big picture across, and to do so with solid data, clear reasoning, and good statistical analysis. The project dragged on, until finally he retreated to the tiny island of Sikinos in the Aegean Sea, where he drew inspiration from the relatively primitive surroundings and the intellectual traditions they recalled. “A pervasive theme of ancient Greek literature is that you need to pursue the truth, no matter what the truth might be,” he says. In 2005, he unleashed two papers that challenged the foundations of medical research. He chose to publish one paper, fittingly, in the online journal PLoS Medicine, which is committed to running any methodologically sound article without regard to how “interesting” the results may be. In the paper, Ioannidis laid out a detailed mathematical proof that, assuming modest levels of researcher bias, typically imperfect research techniques, and the well-known tendency to focus on exciting rather than highly plausible theories, researchers will come up with wrong findings most of the time. Simply put, if you’re attracted to ideas that have a good chance of being wrong, and if you’re motivated to prove them right, and if you have a little wiggle room in how you assemble the evidence, you’ll probably succeed in proving wrong theories right. His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do 25 percent of supposedly gold-standard randomized trials, and as much as 10 percent of the platinum-standard large randomized trials. The article spelled out his belief that researchers were frequently manipulating data analyses, chasing career-advancing findings rather than good science, and even using the peer-review process—in which journals ask researchers to help decide which studies to publish—to suppress opposing views. “You can question some of the details of John’s calculations, but it’s hard to argue that the essential ideas aren’t absolutely correct,” says Doug Altman, an Oxford University researcher who directs the Centre for Statistics in Medicine. Still, Ioannidis ... zoomed in on 49 of the most highly regarded research findings in medicine over the previous 13 years, as judged by the science community’s two standard measures: the papers had appeared in the journals most widely cited in research articles, and the 49 articles themselves were the most widely cited articles in these journals.... Of the 49 articles, 45 claimed to have uncovered effective interventions. Thirty-four of these claims had been retested, and 14 of these, or 41 percent, had been convincingly shown to be wrong or significantly exaggerated. If between a third and a half of the most acclaimed research in medicine was proving untrustworthy, the scope and impact of the problem were undeniable. ... even highly regarded researchers at prestigious institutions sometimes churn out attention-grabbing findings rather than findings likely to be right. But Ioannidis points out that obviously questionable findings cram the pages of top medical journals, not to mention the morning headlines. ... Of those 45 super-cited studies that Ioannidis focused on, 11 had never been retested. Perhaps worse, Ioannidis found that even when a research error is outed, it typically persists for years or even decades. He looked at three prominent health studies from the 1980s and 1990s that were each later soundly refuted, and discovered that researchers continued to cite the original results as correct more often than as flawed—in one case for at least 12 years after the results were discredited. |
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Birmingham Wired Black Country plastic surgeon struck off for sex actsA Black Country plastic surgeon has been struck off by the General Medical Council (GMC) for indecently assaulting six patients. Aivar Bracka denied the charges, but the GMC found his actions were sexually motivated, improper and inappropriate. Bracka, of Balmoral Road, Wordsley, was cleared of indecently assaulting five of his patients at Wolverhampton Crown Court last year. The General Medical Association then held its own investigation. It said he was opportunistic and had grossly abused his patients' trust. Its findings concluded that Bracka's conduct was "fundamentally incompatible with his continuing to be a registered medical practitioner". The GMC heard evidence that Bracka had performed inappropriate sex acts during a 13-year period with six young men in his care, including two boys aged under 18. Bracka told the GMC he had exposed himself to patients in limited circumstances but never to a juvenile. The offences took place between 1987 and 2000... Mr Bracka specialised in hypospadias repair and circumcision. In 2001, he co-authored a paper (Tucker SC, Cerqueiro J, Sterne GD, Bracka A. Circumcision: a refined technique and 5 year review. Ann R Coll Surg Engl. 2001; 83(2):121-5.) in which he described his technique for performing circumcisions "with the penis fully erect".
At his trial, Mr Bracka claimed hundreds of slides showing male genitalia recovered from his home were to help document all his patients on a "before and after" basis. |
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Tonight YouTube shafts risque Antwoord videoB Sameer Naik They became an overnight, worldwide internet sensation with their first video, Enter the Ninja, which went viral on YouTube with over a million views this year. Die Antwoord’s explicit lyrics and edgy approach won them respect from international artists such as Limp Bizkit and Lady Gaga, but now the hip-hop group from Cape Town, who’ve gained millions of fans worldwide through the internet, have another first – YouTube has banned their latest music video, Evil Boy, and removed it from the popular website. The new video single, which features explicit lyrics and a lavish screening of rubber dildos as the band rap about male circumcision, was removed within days of being uploaded for apparent “terms-of-use violations”. The three-member group, consisting of lead rapper Ninja, Yo-Landi Vi$$er and DJ Hi-Tek, teamed up with an 18-year-old Cape Town street child known only as Wanga for their new single, in which the youngster raps out against ritual male circumcision. The video has the young man rapping in Xhosa: “andifuni ngencanca yami incanca yami eyentombi qha” (I don’t want you to touch my penis, it’s for women only) against a |background of explicit images of male genitals. Ann Roberts, spokeswoman for Terraplane, the producers of Die Antwoord’s latest single, said that although the video had been temporarily removed, she expects it to be back up in a few days. “The video is of course very controversial. However, it will be back on YouTube as soon as the website puts an over-18 age restriction on the video,” said Roberts. ... Roberts said that despite the video being controversial, the producers had received only|a handful of complaints and were now busy working on a cleaner version of Evil Boy, which will soon make its debut on TV. ... “Wanga is an amazing young kid who is extremely smart. Die Antwoord gave Wanga an opportunity to tell his personal story, which in turn has made him much stronger,” said Roberts. ... “This video might be misunderstood by people as offensive, but there are children who die each year from ‘going to the bush’,” said Yo-Landi. ... |
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Freedom Newspaper (Gambia) Gambia Detains Head Of Anti Female Genital Mutilation Campaigners!Dr. Isatou Touray, And Amie Bojang Sissoho Charged With Theft? By Staff Reporter Bakary Gibba & Pa Nderry M’Bai Authorities in The Gambia have begun cracking down on women rights campaigners against Female Genital Mutilation. The Executive Director of The Gambia Committee Against Traditional Practices (GAMCOTRAP) Dr. Isatou Touray, and her Assistant Amie Bojang Sissoho were arrested on Monday by police for unexplained reasons, the Freedom Newspaper can report. ... Dr. Touray and Mrs. Sissoho are expected to reappear in court on Tuesday for plea taking. Sources said the detainees were alleged to have been charged with theft, but would not elaborate further on the main substance of the case. But prior to their arrest, Dr. Touray, who is known as a prominent anti FGM activist said she was being pursued by the state with people reporting her to the President. She said some people were "out to get her" with false accusations, but would not elaborate on the nature of the said accusations. She told delegates at a recent workshop that she was privy to the scheme that was hatched to get her arrested. Dr. Touray, and her fellow FGM campaigners have recorded a significant success in the area of FGM education in The Gambia. Many local circumcisers have laid down their tools—thanks to GAMCOTRAP’S grassroots education campaign against the deadly cultural practice. GAMCOTRAP’S efforts to discourage FGM in The Gambia has been greeted with strong opposition by some religious leaders—who openly advocate for female circumcision. One of them is the controversial State House Imam Alhagie Abdoulie Fatty, who told Freedom Radio in a recent interview that FGM is not being practiced in The Gambia as painted by local activists. Imam Fatty accuses FGM activists of blowing things out of proportion. He said Islam supports female circumcision.
“There is nothing wrong to circumcise our kids. Islam supports Female circumcision. Don’t mind the so called FGM activists. They are spreading wrong information about female circumcision. It is a cultural practice recognized by Islam A survey conducted by GAMCOTRAP says about 80 percent of The Gambian population practice FGM, but that figure had decline significantly thanks to educational awareness campaign spearheaded by the Organization. Those engage in the practice cite religious, and cultural reasons in support of FGM. But anti FGM campaigners disagree. They said the practice endangers the life of the girl child. For example, they argued that dozens of young girls are circumcised with one blade, and that in most cases the blade is never sterilized. This to some extent made the circumcised girls vulnerable to sexually transmitted diseases known as (STI), including HIV/Aids, the virus that causes aids. According to anti FGM activists, some of the circumcised kids died during the process. They said FGM violates the right of the girl child. They also opined that the practice undermines women’s sexual feelings. Up to the time of going to press Dr. Isatou Touray, and Amie Bojang Sissoho were still detained at the police head quarters in Banjul. They are expected to appear in court on Tuesday in Kanifing. They have not been accorded with the right to bail. |
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Mail & Guardian The blunt truth about new circumcision deviceBy Ilham Rawoot Circumcision is a touchy business. And writing about it has proven to be even touchier, especially when nobody wants to talk about it. When the KwaZulu-Natal health department decided to go ahead with using the TaraKLamp (a device that strikes me as the penile equivalent of a nail clipper) to circumcise men as part of an HIV-prevention project, a few questions arose. Firstly, why is the department using a device that has not been approved by the World Health Organisation and which some doctors have warned against citing the higher risk of complications involved compared with standard surgical procedure? On a deeper note, who is making money out of this device? Once the Mail & Guardian discovered it was being promoted by a company that didn’t have an office, and that no one had heard of before, we decided to dig a little bit. We found that no tender process was followed in obtaining the Malaysian-made device even though there are competing versions. We found that the Zambian man in charge of the company that has the local distribution rights had once been accused — mentioned in a Zambian high court judgement — of dealing in Mandrax, though he was never charged and protests his innocence. Surely the KZN health department should thank us for our hard work, for helping them make informed decisions that will help find the best option for South Africans. But that’s not what happened. Instead they called us “disingenuous” for asking for tender documents and expenditure values in relation to the TaraKLamp. Here’s KZN’s health spokesperson, Chris Maxon: “In the first instance; we wish state that we find it disingenuous for you to ask for these documents without providing reason. These are contract document that are kept to protect their authenticity. We therefore cannot release them with proper procedure being followed and, above all, to a person who is not honest about the reasons for requesting these.” Even when we explained that the reasons were quite simple — public money is used to pay for these devices and we have a right to know how much is spent and why it is going into the pocket that it is. Obvious, one might say. This wasn’t a good enough reason for them and they subsequently chose to ignore further requests for information. When we called the supplier to ask him questions he threatened to take us to court for defamation. We just want to understand things, really. If people are acting in good faith, then answering questions should be a simple and professional process. But that rarely happens. The TaraKLamp saga seems to carry some echoes of Virodene, the controversial Aids “cure” that caused a ruckus in the 90s. That case was marked by dodgy science and political meddling from former president Thabo Mbeki and the ANC. The drug was totally rejected by the scientific community. It seems we don’t learn from history. The decision to use the TaraKLamp seems similarly marked by closed doors and politicking, but the government doesn’t want to acknowledge that. They’d rather cover their ears when probed on new health methods, always wanting to be pioneers and highly advanced in the field, with no room for criticism. And, as with Virodene, it’s once again only the taxpayers and the men who may suffer complications under the device, that will pay the price.
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Die Antwoord to [?] bush circumcisionsThe band's newest member raps about his fears on 'getting cut'By GABISILE NDEBELE Controversial music group Die Antwoord are more than a just a trio of ''Zef" weirdos who spit and swear and wear pyjamas on stage. The three-member group consisting of lead rapper Ninja, Yo-Landi Vi$$er and DJ Hi-Tek, performed an hour-long show at the Bassline in Johannesburg on Saturday, and they've taken a new member under their wing - an 18-year-old street child known only as "Wanga". ... "I've known him since he was 13. Recently he told me that he was 'going to the bush' and explained to me what it was he was going to do there," said Ninja. "The laaitie sounded scared and told me that he would never be able to go to the townships as he would get beaten up, because he would be seen as a boy and not a man, as he had not been 'cut' (circumcised)," said Ninja. Ninja, 35, then advised Wanga not to go if he was scared, but rather to vent his feelings in a song explaining why he didn't want to go. Following that came their new single and a music video called Evil Boy , in which Wanga expresses his views on being circumcised. The video has the young man rapping in Xhosa: "andifuni ngencanca yami incanca yami eyentombi qha " (I don't want you to touch my penis, it' s for women only), against a background of e xplicit images of male genitals. "This video might be misunderstood by people as offensive, but there are children who die each year from 'going to the bush'. "That's the point we are trying to put across. Just in a different way, with an in-your-face effect," added Yo-Landi. ... |
Oy, vey!
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Ynet news Hundreds in north may undergo circumcision correctionsChief Rabbinate to hold hearing on rabbi from Haifa area suspected of not removing entire foreskin during brit ceremony. Following discovery, dozens of concerned parents contact experts to check if their children's circumcision was performed thoroughly. No concern for medical complications Kobi Nahshoni Israel's Chief Rabbinate suspects that a mohel (ritual circumciser) from the north performed hundreds of circumcisions in recent years that did not comply with Jewish Law. Some of the children circumcised by the rabbi have already undergone surgery to correct the brit, thus rendering it kosher. There is significant concern that others will be forced to undergo a similar procedure. Ynet learned that the mohel oversight committee instructed the rabbi not to conduct additional circumcisions until the Rabbinate's hearing on his case, expected to be held this week, is completed. According to the item published on ladaat.net, suspicions were aroused after a number of senior rabbis from the Haifa area were present at a brit milah performed by L. – a rabbi affiliated with the local Chabad – were surprised to find out that he did not remove the foreskin around the penis, as is required by halacha. The guest rabbis notified the Chief Rabbinate, and word spread throughout the community. Following these revelations, dozens of concerned parents contacted expert mohels to examine their children's circumcision. A number of circumcised children even had to undergo a surgical procedure under full anesthesia to correct the botched circumcision. Each such surgical procedure costs thousands of shekels. The said mohel is well-known and performs hundreds of circumcisions a year. Estimates are that the scandal will likely have implications for thousands of children. For instance, the Chief Rabbinate may decide to summon the circumcised children for an examination whether the circumcisions meet kosher standards. However, it is important to note that there is no concern of medical complications. The issue is a purely halachic and aesthetic one. Rabbi Moshe Weisberg, a member of the inter-ministerial committee of the Health Ministry and Religious Affairs ministry for oversight and training of mohels, told Ynet that he does not remember any such instance. "It can happen to anyone because no one is an angel, even if he is a mohel or a doctor," he explained. "But on such a scale? This is already in the realm of the abnormal." Weisberg added that a number of worried parents have already contacted him on the matter. In most cases, he ruled that though their sons' organ may look "weird," by his definition, it can be ruled retrospectively that the brit milah was kosher. However, in some cases, he recommended that the corrective surgery procedure be performed. "If it were my son, I wouldn't think twice," he said. Other mohels and doctors from the north have also performed the "corrections" on a number of children. 'Brit milah must be done performed in entirety'
N. said that he specifically chose L. to perform the brit milah because he heard that babies don't cry when he does the procedure. Now, three years later, he understands why. "Whenever I bathed the children, I saw there was something weird with him, but I didn't make a big deal about it," he added. "I told myself it could just be a difference between one child and the next. Only when my wife told me about the Rabbinate's investigation did the other shoe drop." Despite this, N. emphasized that the said mohel is "a God-fearing adherent," and that the botch, if there was one, was done innocently. Head of the Chief Rabbinate's brit milah department Rabbi Moshe Morsiano told Ynet, "There is no medical damage, but it is a halachic matter. Circumcision is a commandment and must be done in its entirety. There is concern here that this was not the case. This is a serious, well-known, and highly regarded man who apparently made a mistake." |
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Royal Australasian College of Physicians RACP resists endorsing circumcision CIRCUMCISION OF INFANT MALES... EXECUTIVE SUMMARYThe Paediatrics & Child Health Division, The Royal Australasian College of Physicians (RACP) has prepared this statement on circumcision of infant boys for doctors and to assist parents who are considering having this procedure undertaken on their male children. Circumcision of males has been undertaken for religious and cultural reasons for many thousands of years and it remains an important ritual in some religious and cultural groups. In Australia and New Zealand, the circumcision rate has fallen in recent years and it is estimated that currently 10-20% of newborn male infants are circumcised. [This estimate is far too high. It is nowhere as high as 20%, and in several states and New Zealand, well below 5%] Recently there has been renewed debate regarding both the potential health benefits and the ethical and human rights issues relating to infant male circumcision. Circumcision is generally a safe procedure but there are risks of minor complications and some rare but serious complications [including death]. The most important conditions where benefits may result from circumcision are recurrent urinary tract infections in children; and Human Immunodeficiency Virus (HIV) plus some other sexually transmitted infections in adults from populations with a high prevalence of these conditions; cancer of the penis in men with a history of phimosis, and cancer of the cervix in women whose partners engage in sexual practices known to increase the risk of Human Papilloma Virus (HPV) infection. The protection against Sexually Transmitted Infections (STIs) and HIV is less clear-cut in Australia and New Zealand than in high prevalence countries. Ethical and human rights concerns have been raised regarding elective infant male circumcision because it is recognised that the foreskin has a functional role, the operation is non-therapeutic and the infant is unable to consent. After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand. However it is reasonable for parents to weigh the benefits and risks of circumcision and to make the decision whether or not to circumcise their sons. [Clearly "routine" in the first sentence means "without medical indication" but the second sentence endorses just that.] When parents request a circumcision for their child the medical attendant is obliged to provide accurate unbiased and up to date information on the risks and benefits of the procedure. Parental choice should be respected. When the operation is to be performed it should be undertaken in a safe, child-friendly environment by an appropriately trained competent practitioner, capable of dealing with the complications, and using appropriate analgesia. ETHICAL CONSIDERATIONS OF NEONATAL CIRCUMCISIONSome of the risks of circumcision are low in frequency but high in impact (death, loss of penis); ... Evaluation of the significance of high-impact low-frequency risks is ethically contentious and variable between individuals. [Even so, it is striking that the RACP offers no estimate of of the probability of death.] Some are more risk averse than others. However, a statistical risk of death is not generally regarded as an absolute barrier. Most patients and most people in general accept the very low probability of death as a risk they are willing to take in pursuit of medical benefits, lifestyle, recreation, employment, and so on. [They accept that probability of death for themselves. We have no way of knowing that the newborn is willing to accept that possibility] The benefits of circumcision (or disadvantages of non-circumcision) are not readily assessable by doctors (unless they happen to belong to the same religious or social community as the parents), as they depend upon the role of circumcision within that community. [The benefits and risks of circumcision to the baby are not readily accessable by doctors or parents either, and therefore it would be advisable to err on the side of caution.] Doctors who have a conscientious objection to performing infant male circumcision should make this known and refer parents to another doctor. [But they don't have to find them one who'll do it.] (p15) The option of leaving circumcision until later, when the boy is old enough to make a decision for himself does need to be raised with parents and considered. This option has recently been recommended by the Royal Dutch Medical Association. [They went much further, saying "circumcision is not justifiable except on medical/therapeutic grounds."] The ethical merit of this option is that it seeks to respect the child’s physical integrity, and capacity for autonomy by leaving the options open for him to make his own autonomous choice in the future. (p15) A boy circumcised as an infant may deeply resent this when he grows older; he may want what he cannot have – not to have been circumcised. But it is also possible that a boy not circumcised as an infant (so that he can make his own decision later), may also deeply resent this. He may also want what he cannot now have – to have been circumcised as a baby. [These two outcomes are not ethically equivalent, and the chance of the former outcome is much greater than the latter.] (p16) [The RACP has resisted noisy lobbying by three circumcision-advocates, including Professor Brian Morris.] |
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