Nordic countries may finally ban circumcision.

[ddt]

Yes, by all means, it's quite factual and understandable.

Thanks. I'll await one or two more reactions before I submit my reaction to the CMAJ.

Link to the paper

My (draft) reaction:

The authors conclude from their study that uncircumcised boys have a higher risk for urinary tract infection than circumcised boys. However, the study is fatally flawed and does not support this conclusion.

The authors have selected their test subjects from those boys that were referred to their hospital by primary and secondary health care providers, specifically with the request for a catheter urine culture. The test subjects are therefore not representative of the general population; at best, they are representative of those boys whom their physicians already suspect of having a urinary tract infection.

The collection of test subjects thus exhibits a selection bias compared to the general population, and thus no conclusions with respect to the general population can be drawn. The remarks in the "Strengths and limitations" section do nothing to substantially address this fundamental bias. Only a randomly drawn, representative, and sufficiently large sample of the general population can address the question of the comparison of UTI incidence between circumcised and uncircumcised.

Provided the sample is representative of all boys referred to the hospital with the request for catheter urine culture, conclusions can be drawn, however, with respect to the treatment of urinary tract infections.

1) First and second line physicians are better able to identify urinary tract infections and distinguish them from other conditions with uncircumcised boys than with circumcised boys: 1 in 4 uncircumcised boys referred to the Children's Hospital with the suspicion of a UTI actually have one, while only 1 in 20 circumcised boys have one. Thus, with circumcised boys, 5 times the effort has to be spent to identify one UTI.

2) Thus, circumcision leads to waste of the limited funds of Medicare Canada, i.e., public funds paid by the taxpayer, which has to pay for the catheter urine culture, the tests and the time of third line specialists.

 

[The Big Dog]

No, banning something you see as child abuse or a human rights violation is not authoritarian.



Except that wasn't his argument. It was inflammatory rhetoric, but it was just part of much longer are substantial posts that addressed your points.

Your anti-European bias, on the other hand, was not. It was your attempt to paint a false either-or scenario.

Wait, disagreeing with the proposed legislation in Europe shows an anti-European bias? Nonsense.

Not only is this completely inaccurate, I note that you have not deemed it worthy to call out posters on an anti-American bias.

But you are also providing excuses for this: "mutilate all boys fan club."

 

[Darat]

DDT, something I didn't see mentioned I wonder if because professionals "know" that intact boys are more likely to have UTIs they would be more likely to send an intact boy for further investigation?

 

[Darat]

Wait, disagreeing with the proposed legislation in Europe shows an anti-European bias? Nonsense.

Not only is this completely inaccurate, I note that you have not deemed it worthy to call out posters on an anti-American bias.

But you are also providing excuses for this: "mutilate all boys fan club."

Well it does since there is no" European" proposal.

 

[The Big Dog]

Well it does since there is no" European" proposal.

I was not the one who brought up the bizarre "anti-European" slur in the first place.

You may wish to view my question through the lens of just how incredulous I was at the very suggestion.

 

[The Norseman]

Yeah, let's minimize the medical conditions avoided by neonatal circumcision.

The issue is, and always has been, that, when there are both benefits and drawbacks to a medical procedure, the decision to perfom the procedure lies with the party whom the law invests with the power of making such decisions. In the case of minor individuals, said party is the parents or legal guardian of the minor, not the minor themself. What circumcision opponents are attempting to argue is that circumcision is somehow unique in that suddenly the government has a compelling interest to intervene and curtail the rights that it has granted to the proxies of minor individuals to make decisions about said minors in the way the proxies see fit. In other words, circumcision opponents are making a special pleading against circumcision, which, in light of the fact that they consider their position to be the rational one, should in fact not be accepted.

If the medical conditions avoided by neonatal circumcision were so prominent, there would be an entirely different tack to the issue. The evidence just really isn't there for the benefits to outweigh the major drawbacks.

Secondly, the point is that the law does not allow the parents/guardians to have carte blanche when it comes to what may be done to or with their minor children and never has. There always is a point where society says, "here's a line which must be held against such and such for what we believe as to be the betterment of humanity as a whole". Sometimes this doesn't address the issue and can end up being burdensome or more harmful. In this case, I fully agree with the position that regular neonatal circumcision is overall a net harm to the people that it happens to; the benefits are minimal compared to the problems that occur.

 

[The Big Dog]

If the medical conditions avoided by neonatal circumcision were so prominent, there would be an entirely different tack to the issue. The evidence just really isn't there for the benefits to outweigh the major drawbacks.

Secondly, the point is that the law does not allow the parents/guardians to have carte blanche when it comes to what may be done to or with their minor children and never has. There always is a point where society says, "here's a line which must be held against such and such for what we believe as to be the betterment of humanity as a whole". Sometimes this doesn't address the issue and can end up being burdensome or more harmful. In this case, I fully agree with the position that regular neonatal circumcision is overall a net harm to the people that it happens to; the benefits are minimal compared to the problems that occur.

That would not seem to remotely justify banning a parents' right to choose circumcision in connection with their medical doctor's advice.

According to a systematic and critical review of the scientific literature, the health benefits of circumcision include lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis. Circumcision also lowers the risk of penile cancer over a lifetime; reduces the risk of cervical cancer in sexual partners, and lowers the risk of urinary tract infections in the first year of life.

- See more at: http://www.aap.org/en-us/about-the-...on=ERROR:+No+local+token#sthash.ttsWkuJS.dpuf

 

[Darat]

That would not seem to remotely justify banning a parents' right to choose circumcision in connection with their medical doctor's advice.

According to a systematic and critical review of the scientific literature, the health benefits of circumcision include lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis. Circumcision also lowers the risk of penile cancer over a lifetime; reduces the risk of cervical cancer in sexual partners, and lowers the risk of urinary tract infections in the first year of life.

- See more at: http://www.aap.org/en-us/about-the-...on=ERROR:+No+local+token#sthash.ttsWkuJS.dpuf

You must have missed this bit from your linked to article:

...snip...

but the benefits are not great enough to recommend routine circumcision for all newborn boys,

...snip...

 

[ddt]

DDT, something I didn't see mentioned I wonder if because professionals "know" that intact boys are more likely to have UTIs they would be more likely to send an intact boy for further investigation?

The question of selection of boys by first and second line is an interesting one, and I haven't seen it addressed in the paper. But your idea that intact boys would be more likely to be sent to the hospital for a catheter urine culture is belied by the fact that around 25% of the intact boys referred turned out to actually have a UTI, but only 5% of the circumcised boys. So, in fact, it's the reverse: they're more likely to send a circumcised boy on basis of (vague) symptoms to the hospital.

ETA: and we still don't know why, despite the touted advantage on prevention of UTIs by a factor 10 by circumcision, the USA still has the same UTI incidence as European countries.

 

[The Big Dog]

You must have missed this bit from your linked to article:

Not Darat, I did not miss that AT ALL.

In fact my post directly incorporated the actual recommendation made in the press release, and the accompanying reports.

Here it is again:

That would not seem to remotely justify banning a parents' right to choose circumcision in connection with their medical doctor's advice.

 

[Darat]

Sorry I just reread your post and I still can't see where you quoted the statement that "...but the benefits are not great enough to recommend routine circumcision for all newborn boys, ...snip..."

Perhaps you thought you had included it?

 

[Squeegee Beckenheim]

That would not seem to remotely justify banning a parents' right to choose circumcision in connection with their medical doctor's advice.

That's a straw man. Nobody is suggesting that circumcision for medical reasons be banned.

 

[The Big Dog]

That's a straw man. Nobody is suggesting that circumcision for medical reasons be banned.

Actually, it is not a straw man, because I have yet to hear what "medical reasons" justify the procedure, nor how is going to be the final authority nor who intends to enforce the standard.

Case in point, the AAP has found "medical reasons" sufficient, others perhaps not.

 

[Safe-Keeper]

Actually, it is not a straw man, because I have yet to hear what "medical reasons" justify the procedure

Of course. How could we not think of that. Obviously if we don't list the specific medical issues we don't really mean what we say.

 

[The Big Dog]

Sorry I just reread your post and I still can't see where you quoted the statement that "...but the benefits are not great enough to recommend routine circumcision for all newborn boys, ...snip..."

Perhaps you thought you had included it?

Actually Darat, I was specifically responding to a post that claimed that the medical advantages were not sufficient, and I included a link to the article.

Further, your "quoting" of the release gives the misleading impression that I was misquoting the link, which is not true.

I quoted what I felt was appropriate and provided a link. Therefore, whether I quoted it or not, I provided the exact resource necessary for anyone to make their own decisions regarding it.

Edited by jhunter1163: 

Edited for Rule 12.

 

[zooterkin]

Sorry I just reread your post and I still can't see where you quoted the statement that "...but the benefits are not great enough to recommend routine circumcision for all newborn boys, ...snip..."

Perhaps you thought you had included it?

I see what you did there...

 

[Squeegee Beckenheim]

Actually, it is not a straw man, because I have yet to hear what "medical reasons" justify the procedure, nor how is going to be the final authority nor who intends to enforce the standard.

Neither of these things affect your statement being a straw man.

Case in point, the AAP has found "medical reasons" sufficient, others perhaps not.

Actually, no. As the link you provided yourself states, the AAP does not recommend routine neonatal circumcision.

 

[Darat]

Actually Darat, I was specifically responding to a post that claimed that the medical advantages were not sufficient, and I included a link to the article.

Further, your "quoting" of the release gives the misleading impression that I was misquoting the link, which is not true.

I quoted what I felt was appropriate and provided a link. Therefore, whether I quoted it or not, I provided the exact resource necessary for anyone to make their own decisions regarding it.

...snip...

Ah so you didn't quote the part that said "..but the benefits are not great enough to recommend routine circumcision for all newborn boys...snip" - thought I hadn't missed the primary recommendation from the article you linked to.

It would seem to be strange that you choose to use a report that is at odds with your wish for there to be routine genital mutilation of boys in the USA.

 

[jdp]

Actually, it is not a straw man, because I have yet to hear what "medical reasons" justify the procedure, nor how is going to be the final authority nor who intends to enforce the standard.

Case in point, the AAP has found "medical reasons" sufficient, others perhaps not.

And it's these others, specifically the Nordic countries of Europe, who find that there is no medical reason to offer neonatal circumcision routinely and more over absent therapeutic need, it should be banned. So the relavent medical association in the specific coutnry has come to a conclusion and based on that conclusion made a policy recommmendation. What exactly is the problem?

 

[luchog]

Actually, it is not a straw man, because I have yet to hear what "medical reasons" justify the procedure, nor how is going to be the final authority nor who intends to enforce the standard.

In fact, that has been specified in this thread multiple times. Your refusal to acknowledge and address the posts that present those medical reasons makes your continual assertion that it doesn't exist disingenuous at best. I notice that there have been several studies posted multiple times refuting your assertions, which you've consistently failed to even acknowledge, let alone address.

There are several clear medical scenarios that justify circumcision. They are very rare, and as such not justification for routine infant circumcision and the risks it entails. You have yet to provide support for such, the few actual studies you've linked to being either clearly and fatally flawed, or do not actually say what you claim they do. You've also not presented a single argument in favour of infant circumcision that does not apply equally well to milder forms of FGM, yet you hypocritically insist there's a difference.

Do you have any actual, peer-reviewed, replicated science to present to support your position, or just opinion articles and junk science?