What a terrific way to begin 2010 that to see medical doctors call on the American Academy of Pediatrics to replace its so-called "neutral" policy on newborn male circumcision with an affirmative statement on the clear benefits of this procedure to the male, his partners, and society as a whole.
That's the focus of an article and editorial in the January 2010 issue of the Archives of Pediatric and Adolescent Medicine. Here are some excerpts from Fran Lowry's story in Medscape Medical News:
“During the past 4 years, substantial new data have been published on the health benefits of circumcision,” write Aaron A. R. Tobian, MD, from Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues. “While the historical evidence strongly suggests that male circumcision reduces urinary tract infections and penile inflammatory disorders in infants, we reviewed the more recent evidence with regard to effects on sexually transmitted infections (STIs) in adulthood.”
"To evaluate the effect of circumcision on HIV prevention, the researchers analyzed 3 randomized controlled trials of more than 10,000 men from South Africa, Kenya, and Uganda.
The trials enrolled HIV-negative men to circumcision on enrollment or after 21 to 24 months, and all 3 trials demonstrated that male circumcision significantly decreased male heterosexual HIV acquisition by 53% to 60%, despite differences in age eligibility criteria, urban or rural settings, and surgical procedure.
"Because of this new evidence, the World Health Organization (WHO), together with the Joint United Nations Program on HIV/AIDS (UNAIDS), recommended that male circumcision be provided as an important intervention to reduce heterosexually acquired HIV in men, the study authors report.
"The trials also found that male circumcision decreased herpes simplex virus type 2 (HSV-2) acquisition by 28% to 34% and the prevalence of human papillomavirus (HPV) by 32% to 35% in men.
"Among female partners of circumcised men, bacterial vaginosis was reduced by 40% and Trichomonas vaginalis infection was reduced by 48%, the study authors write.
"The study authors note that the rates of neonatal circumcision complications are between 0.2% and 0.6% of operations performed. The most common complications are bleeding and local infection, which are controlled with pressure and wound care or antibiotics. Other complications, such as phimosis and concealed penis, adhesions, fistula, meatitis, meatal stenosis, and injury to the glans, are extremely rare.
"They add that there was no evidence of change in sexual behavior after circumcision in the African randomized controlled trials. “Thus, there are risks to neonatal circumcision, but serious long-term complications are extremely rare,” the study authors write.
“The rare short-term risks of neonatal circumcision need to be weighed against the potential benefits accrued in infancy and childhood (eg, reduction of urinary tract infections), the longer-term benefits that may accrue in adolescence and adulthood (eg, reduced risks of HIV, HSV-2, and HPV), as well as possible benefits to female sexual partners of circumcised men (eg, reduced bacterial vaginosis and trichomonas),” Dr. Tobian and colleagues write.
"Medicaid does not cover the cost of male circumcision in 16 states, and the lack of coverage particularly affects disadvantaged minorities, who have the highest risk for HIV and sexually transmitted diseases. “These socioeconomically disadvantaged groups could benefit most if Medicaid covered the costs of neonatal circumcision. Thus, the AAP’s policy has important implications for the health of disadvantaged minorities,” they write.
"They conclude that it is time for the AAP policy to fully reflect current data.
"In an accompanying editorial, Michael T. Brady, MD, from Nationwide Children’s Hospital in Columbus, Ohio, writes that the study authors have provided a very objective review of the available data. Although the 3 randomized trials were performed in Africa, “it is clear that circumcision does offer health benefits, even in the United States,” he notes.
"The current evidence on the health benefits of circumcision is adequate enough to include circumcision in medical coverage provided by Medicaid or commercial insurance providers, Dr. Brady points out. “This is particularly relevant since over the past decade many state Medicaid programs have discontinued payment for circumcision.”
Showing posts with label AAP. Show all posts
Showing posts with label AAP. Show all posts
Tuesday, January 5, 2010
Thursday, December 10, 2009
2009 Turning Point: Momentum to Circumcise Grows Worldwide
As the year 2009 draws to a close, history may judge this year as the "turning point" in the movement to achieve universal circumcision -- a world in which the foreskin no longer poses a health threat to a male, his partners, or society as a whole.
Aided by one medical study after another this year, more governments than ever have embraced the goal of 100% male circumcision, knowing that this simple health procedure can reduce the risk of HIV by 60% and dramatically curb the spread of STDs, HPVs, cancers, and other ailments that afflict society.
When the data is finally collected for the year 2009, it will show that more males world-wide are circumcised now than ever before in world history. To be circumcised is not only the "norm" in the USA, it has become the desired norm across the world simply because "the cut" is healthy.
Even in those countries where governments have been reluctant to embrace circumcision (i.e., many European countries), the populace as a whole is joining the circumcision movement. Men are opting for the cut, and parents are wisely choosing to circumcise their sons at birth, knowing this is the safest, most reliable, and inexpensive way to protect their boy for life.
We have also seen a growing appreciation of the value of circumcision in Asia and the Indian subcontinent. I would bet, once the data is in, that more Japanese, more Indians, more Chinese are circumcised than ever before -- joining their counterparts in Korea, Philippines, and Indonesia who are already clean-cut. The best news on that front this year have been reports that Chinese health officials may encourage universal circumcision in the near future. The world's largest country could set a powerful example if it would promote newborn circumcision as an important health measure.
The year 2009 also saw the growing hysteria of the anti-circumcision fanatics, as they try to pressure governments to ignore the medical science and to scare parents against this life-preserving procedure. In my view, the fanaticism of these groups only marginalizes them among the mainstream. That is certainly true in the USA where, despite millions of anti-circ dollars spent on lies and mischaracterizations, I have no doubt that more baby boys were circumcised this year than last year.
Just ask the normal person on the street here in the Midwest about circumcision and the answer is always the same. "Of course. It's the healthy thing to do." -- a statement usually coupled with "Yeah, it prevents AIDs." The latter is not quite accurate -- it reduces the risk of AIDs -- but the public is getting the basic message.
Even those who may be confused on the issue because of anti-circ propaganda usually return to the basics. "It's cleaner. It's easier." -- with the variation "If it was so bad, why does everyone do it?" They do it because, deep down, nobody really wants a filthy foreskin that can cause so much medical havoc.
If 2009 becomes the turning point in the medical goal of achieving universal circumcision, there is still one disappointment which can be remedied in the remaining weeks of this year. Where is the American Academy of Pediatrics? Where is the CDC, Centers for Disease Control? We began the year with hope that -- based on medical science alone -- the AAP and CDC would declare that every male should be circumcised. While insiders say they want to do this because they know it is medically right, pressure from the anti-circs have delayed action. Nothing would complete 2009 more as the "Year of Circumcision" than a strong backbone at the AAP and CDC and a year-end statement encouraging ("voluntarily") the circumcision of males!
So what do you think? Do you agree that, in general, this has been a terrific year for circumcision? I welcome your thoughts.
Aided by one medical study after another this year, more governments than ever have embraced the goal of 100% male circumcision, knowing that this simple health procedure can reduce the risk of HIV by 60% and dramatically curb the spread of STDs, HPVs, cancers, and other ailments that afflict society.
When the data is finally collected for the year 2009, it will show that more males world-wide are circumcised now than ever before in world history. To be circumcised is not only the "norm" in the USA, it has become the desired norm across the world simply because "the cut" is healthy.
Even in those countries where governments have been reluctant to embrace circumcision (i.e., many European countries), the populace as a whole is joining the circumcision movement. Men are opting for the cut, and parents are wisely choosing to circumcise their sons at birth, knowing this is the safest, most reliable, and inexpensive way to protect their boy for life.
We have also seen a growing appreciation of the value of circumcision in Asia and the Indian subcontinent. I would bet, once the data is in, that more Japanese, more Indians, more Chinese are circumcised than ever before -- joining their counterparts in Korea, Philippines, and Indonesia who are already clean-cut. The best news on that front this year have been reports that Chinese health officials may encourage universal circumcision in the near future. The world's largest country could set a powerful example if it would promote newborn circumcision as an important health measure.
The year 2009 also saw the growing hysteria of the anti-circumcision fanatics, as they try to pressure governments to ignore the medical science and to scare parents against this life-preserving procedure. In my view, the fanaticism of these groups only marginalizes them among the mainstream. That is certainly true in the USA where, despite millions of anti-circ dollars spent on lies and mischaracterizations, I have no doubt that more baby boys were circumcised this year than last year.
Just ask the normal person on the street here in the Midwest about circumcision and the answer is always the same. "Of course. It's the healthy thing to do." -- a statement usually coupled with "Yeah, it prevents AIDs." The latter is not quite accurate -- it reduces the risk of AIDs -- but the public is getting the basic message.
Even those who may be confused on the issue because of anti-circ propaganda usually return to the basics. "It's cleaner. It's easier." -- with the variation "If it was so bad, why does everyone do it?" They do it because, deep down, nobody really wants a filthy foreskin that can cause so much medical havoc.
If 2009 becomes the turning point in the medical goal of achieving universal circumcision, there is still one disappointment which can be remedied in the remaining weeks of this year. Where is the American Academy of Pediatrics? Where is the CDC, Centers for Disease Control? We began the year with hope that -- based on medical science alone -- the AAP and CDC would declare that every male should be circumcised. While insiders say they want to do this because they know it is medically right, pressure from the anti-circs have delayed action. Nothing would complete 2009 more as the "Year of Circumcision" than a strong backbone at the AAP and CDC and a year-end statement encouraging ("voluntarily") the circumcision of males!
So what do you think? Do you agree that, in general, this has been a terrific year for circumcision? I welcome your thoughts.
Tuesday, November 17, 2009
Africans Show America How to Implement Universal Circumcision
While the Centers for Disease Control (CDC) and the American Academy of Pediatrics, to say nothing of the U.S. government, dithers over whether to do the obvious -- embrace universal circumcision of all males -- African nations are showing western nations exactly the way to do it.
The latest news comes out of Kenya, which hopes to achieve 100% foreskin-free country by 2013. Under a news article just issued by IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs, the Kenyan government is doing exactly what the United States government ought to do.
The article is headlined: "The Million Man Cut." And that, of course, expresses the goal -- to circumcise one million uncircumcised males by 2013. According to this article, the circumcision rate in Kenya is good -- around 85%. But it's not high enough to provide the societal protection that circumcision gives. At least 1.2 million foreskins are still amongst them, foreskins that serve as portals for HIV, STDs, HPV, herpes, and other preventable diseases.
Here are excerpts from the news article. Don't you think it's time for the USA to learn the lesson from Africa?
"KISUMU, 17 November 2009 (PlusNews) - The Kenyan government is expanding services to meet the growing demand for voluntary medical male circumcision after the launch of a national campaign a year ago.
"We believe the launch of a rapid results initiative to scale up what we are already offering will help meet the demand; our target is an ambitious one to see to it that at least 1.1 million of the uncircumcised men in this country get the cut by the end of five years," said Jackson Kioko, director of medical services in western Nyanza Province.
Results of three random trials in South Africa, Kenya and Uganda in 2005 and 2006 demonstrated that medical male circumcision reduced the risk of HIV infection among men by up to 60 percent. According to the Kenya AIDS Indicator Survey 2007, 85 percent of Kenyan men are circumcised; HIV prevalence is higher by three-to-five times in uncircumcised men.
There are about 1.2 million uncircumcised men between the ages of 15 and 49 in Kenya, most of whom live in Nyanza Province, where fewer than 50 percent of men are circumcised. Since the launch of the national campaign in November 2008, an estimated 40,000 men have been circumcised and 124 sites opened and equipped with facilities and personnel to offer the service. The government has trained 700 health workers in the province to offer the services in various health facilities. "The trained health workers will ensure people who demand these services get them in a safe and timely manner and the training of others is ongoing across the various provinces within the country," Kioko added.
The government also plans to roll out mobile medical circumcision. "We do not want people to opt out simply because the services are not near them and we are making arrangements that we go to them rather than them coming to us," Kioko said. "We will, in the near future, offer infant medical circumcision; this has the potential to help people in time before their sexual debut."
The latest news comes out of Kenya, which hopes to achieve 100% foreskin-free country by 2013. Under a news article just issued by IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs, the Kenyan government is doing exactly what the United States government ought to do.
The article is headlined: "The Million Man Cut." And that, of course, expresses the goal -- to circumcise one million uncircumcised males by 2013. According to this article, the circumcision rate in Kenya is good -- around 85%. But it's not high enough to provide the societal protection that circumcision gives. At least 1.2 million foreskins are still amongst them, foreskins that serve as portals for HIV, STDs, HPV, herpes, and other preventable diseases.
Here are excerpts from the news article. Don't you think it's time for the USA to learn the lesson from Africa?
"KISUMU, 17 November 2009 (PlusNews) - The Kenyan government is expanding services to meet the growing demand for voluntary medical male circumcision after the launch of a national campaign a year ago.
"We believe the launch of a rapid results initiative to scale up what we are already offering will help meet the demand; our target is an ambitious one to see to it that at least 1.1 million of the uncircumcised men in this country get the cut by the end of five years," said Jackson Kioko, director of medical services in western Nyanza Province.
Results of three random trials in South Africa, Kenya and Uganda in 2005 and 2006 demonstrated that medical male circumcision reduced the risk of HIV infection among men by up to 60 percent. According to the Kenya AIDS Indicator Survey 2007, 85 percent of Kenyan men are circumcised; HIV prevalence is higher by three-to-five times in uncircumcised men.
There are about 1.2 million uncircumcised men between the ages of 15 and 49 in Kenya, most of whom live in Nyanza Province, where fewer than 50 percent of men are circumcised. Since the launch of the national campaign in November 2008, an estimated 40,000 men have been circumcised and 124 sites opened and equipped with facilities and personnel to offer the service. The government has trained 700 health workers in the province to offer the services in various health facilities. "The trained health workers will ensure people who demand these services get them in a safe and timely manner and the training of others is ongoing across the various provinces within the country," Kioko added.
The government also plans to roll out mobile medical circumcision. "We do not want people to opt out simply because the services are not near them and we are making arrangements that we go to them rather than them coming to us," Kioko said. "We will, in the near future, offer infant medical circumcision; this has the potential to help people in time before their sexual debut."
Thursday, November 5, 2009
New Study: Circumcision Reduces Herpes & HPV in Males
How long must we wait for the Centers for Disease Control and the American Academy of Pediatrics to take account of the growing body of medical evidence that points in only one direction -- every boy should be circumcised to protect himself, his partners, and society as a whole.
This week, still another study in the New England Journal of Medicine confirms that male circumcision reduces a male's chance of getting genital herpes and HPV.
After years of such evidence, it's amazing that the CDC and AAP feel so threatened by a small group of anti-circumcision fanatics that they appear to be back-pedaling on doing what is medically right. I will never understand why the foreskin fetishists go to such extremes, but eventually even the docs at the CDC and AAP will yield to medical science and declare what most of us know is true: circumcision is good for every boy!
For more evidence of that, read the full Reuters story, as reported in the Vancouver Times Colonist:
Circumcision protects men from genital herpes and a virus that causes genital warts and cancer but it does not appear to guard against syphilis, U.S. and Ugandan researchers said on Wednesday.
The report in the New England Journal of Medicine adds to the debate over whether men — and newborn boys — should be circumcised to protect their health and perhaps the health of their future sexual partners.
The findings from two trials in Uganda build on related research showing that circumcision cuts a man's risk of HIV infection through heterosexual intercourse by more than 50 per cent, said Anthony Fauci of the National Institutes of Health in the United States, which funded the study.
They also come at a time when circumcision rates are declining in places like the United States even as evidence mounts that the practice can provide important health benefits.
"Medically supervised adult male circumcision is a scientifically proven method for reducing a man's risk of acquiring HIV infection through heterosexual intercourse," he said.
"This new research provides compelling evidence that circumcision can provide some protection against genital herpes and human papillomavirus infections as well."
The human papillomavirus, or HPV, is the most common sexually transmitted infection in the world. It causes cervical cancer, which kills 300,000 women globally every year.
The team, which also included researchers from Johns Hopkins University in the United States and Makerere University in Uganda, conducted two parallel clinical trials to analyse the impact of male circumcision as a public health tool.
The combined results of the studies looking at more than 3,000 men showed circumcision reduced the risk of herpes by 25 per cent and of HPV by one third. HPV also causes anal and penile cancers.
Circumcision also appeared to reduce the odds of genital warts but had no effect on the incidence of syphilis, the researchers added.
The study highlights the potential of using circumcision to protect people most at risk of the infections in the developing world, especially Africa, where HIV and HPV are widespread.
"Efforts to scale-up male circumcision could have tremendous benefit," said David Serwadda of Makerere University in Uganda, who worked on the study.
Since 2007, circumcision has been promoted by the World Health Organization and the United Nations Program on HIV/AIDS as a way to reduce the risk of AIDS in areas where heterosexual transmission is high.
When done in children, the operation reduces the chance of urinary tract infections and phimosis, a problem with the foreskin.
This week, still another study in the New England Journal of Medicine confirms that male circumcision reduces a male's chance of getting genital herpes and HPV.
After years of such evidence, it's amazing that the CDC and AAP feel so threatened by a small group of anti-circumcision fanatics that they appear to be back-pedaling on doing what is medically right. I will never understand why the foreskin fetishists go to such extremes, but eventually even the docs at the CDC and AAP will yield to medical science and declare what most of us know is true: circumcision is good for every boy!
For more evidence of that, read the full Reuters story, as reported in the Vancouver Times Colonist:
Circumcision protects men from genital herpes and a virus that causes genital warts and cancer but it does not appear to guard against syphilis, U.S. and Ugandan researchers said on Wednesday.
The report in the New England Journal of Medicine adds to the debate over whether men — and newborn boys — should be circumcised to protect their health and perhaps the health of their future sexual partners.
The findings from two trials in Uganda build on related research showing that circumcision cuts a man's risk of HIV infection through heterosexual intercourse by more than 50 per cent, said Anthony Fauci of the National Institutes of Health in the United States, which funded the study.
They also come at a time when circumcision rates are declining in places like the United States even as evidence mounts that the practice can provide important health benefits.
"Medically supervised adult male circumcision is a scientifically proven method for reducing a man's risk of acquiring HIV infection through heterosexual intercourse," he said.
"This new research provides compelling evidence that circumcision can provide some protection against genital herpes and human papillomavirus infections as well."
The human papillomavirus, or HPV, is the most common sexually transmitted infection in the world. It causes cervical cancer, which kills 300,000 women globally every year.
The team, which also included researchers from Johns Hopkins University in the United States and Makerere University in Uganda, conducted two parallel clinical trials to analyse the impact of male circumcision as a public health tool.
The combined results of the studies looking at more than 3,000 men showed circumcision reduced the risk of herpes by 25 per cent and of HPV by one third. HPV also causes anal and penile cancers.
Circumcision also appeared to reduce the odds of genital warts but had no effect on the incidence of syphilis, the researchers added.
The study highlights the potential of using circumcision to protect people most at risk of the infections in the developing world, especially Africa, where HIV and HPV are widespread.
"Efforts to scale-up male circumcision could have tremendous benefit," said David Serwadda of Makerere University in Uganda, who worked on the study.
Since 2007, circumcision has been promoted by the World Health Organization and the United Nations Program on HIV/AIDS as a way to reduce the risk of AIDS in areas where heterosexual transmission is high.
When done in children, the operation reduces the chance of urinary tract infections and phimosis, a problem with the foreskin.
Sunday, August 23, 2009
US Health Officials Closer to Pushing Universal Circumcision
Good news out of the NY Times today. The US Centers for Disease Control (CDC) appears closer than ever to recommending that every male in America be circumcised, preferably at birth. This, of course, is the logical outcome of all the studies over the last decade that demonstrate conclusively that circumcision has a positive health benefit on not only the circumcised male but also his partners and society as a whole.
The story published this Sunday quotes Dr. Peter Kilmarx, the CDC's chief of epidemiology, as saying, "What we’ve heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks.” The CDC is expected to make its recommendation public by the end of the year, although anti-circ foreskin lovers are waging an all-out effort to save the foreskin through a misleading campaign of lies and innuendoes.
The Times reporter also notes that "circumcision will be discussed this week at the C.D.C.’s National H.I.V. Prevention Conference in Atlanta, which will be attended by thousands of health professionals and H.I.V. service providers."
The United States was once a truly clean-cut country but circumcision rates have fallen because the American Academy of Pediatrics abandoned its pro-circ position in favor of "neutrality." That caused some insurance companies and state Medicaid programs to abandon payment for newborn circumcision.
But as the Times reporter noted, "The academy is revising its guidelines, however, and is likely to do away with the neutral tone in favor of a more encouraging policy stating that circumcision has health benefits even beyond H.I.V. prevention, like reducing urinary tract infections for baby boys, said Dr. Michael Brady, a consultant to the American Academy of Pediatrics."
"He said the academy would probably stop short of recommending routine surgery, however. 'We do have evidence to suggest there are health benefits, and families should be given an opportunity to know what they are,' he said."
Curiously, it's the CDC that is taking the lead to return America to a fully circumcised clean-cut status, while the AAP -- if Dr. Brady is correct -- seems more reluctant to just say what most baby docs know is true: a clean circumcised penis is the healthy choice.
You can read the full NY Times article at http://www.nytimes.com/2009/08/24/health/policy/24circumcision.html?hp
The story published this Sunday quotes Dr. Peter Kilmarx, the CDC's chief of epidemiology, as saying, "What we’ve heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks.” The CDC is expected to make its recommendation public by the end of the year, although anti-circ foreskin lovers are waging an all-out effort to save the foreskin through a misleading campaign of lies and innuendoes.
The Times reporter also notes that "circumcision will be discussed this week at the C.D.C.’s National H.I.V. Prevention Conference in Atlanta, which will be attended by thousands of health professionals and H.I.V. service providers."
The United States was once a truly clean-cut country but circumcision rates have fallen because the American Academy of Pediatrics abandoned its pro-circ position in favor of "neutrality." That caused some insurance companies and state Medicaid programs to abandon payment for newborn circumcision.
But as the Times reporter noted, "The academy is revising its guidelines, however, and is likely to do away with the neutral tone in favor of a more encouraging policy stating that circumcision has health benefits even beyond H.I.V. prevention, like reducing urinary tract infections for baby boys, said Dr. Michael Brady, a consultant to the American Academy of Pediatrics."
"He said the academy would probably stop short of recommending routine surgery, however. 'We do have evidence to suggest there are health benefits, and families should be given an opportunity to know what they are,' he said."
Curiously, it's the CDC that is taking the lead to return America to a fully circumcised clean-cut status, while the AAP -- if Dr. Brady is correct -- seems more reluctant to just say what most baby docs know is true: a clean circumcised penis is the healthy choice.
You can read the full NY Times article at http://www.nytimes.com/2009/08/24/health/policy/24circumcision.html?hp
Sunday, July 26, 2009
Universal Circumcision Reduces HIV Dramatically
Did you catch this latest gem of a story? The Phillipines, where universal circumcision is practiced and encouraged, has one of the lowest HIV rates in the world.
A story from ABS/CBN News is worth a moment:
"Dr. Catherine Hankins, chief scientific adviser to UNAIDS, has praised the Philippines for having one of the lowest HIV/AIDS prevalence rates in the Asia-Pacific, which she attributed to the country's practice of almost universal male circumcision." [my emphasis].
"One of the major reasons for the Philippines' low HIV prevalence rate is the fact that it practices almost universal male circumcision. We know that male circumcision protects against HIV partially, about a 60 percent reduction for men and eventually that means Filipino women are less likely to encounter men who are HIV positive so they have lower rates of HIV," Hankins, chief scientific adviser to UNAIDS, told abs-cbnNEWS.com.
"The Philippines, in adopting male circumcision despite the fact that it is primarily a Roman Catholic country has meant a better control of the epidemic."
"She said various studies have shown the benefits of male circumcision including lower rates of urinary tract infections in male infants who are circumcised; lower risk of penile cancer and lower prevalence of some sexually transmitted infections such as human papillomavirus (HPV) and herpes simplex virus type 2 (HSV-2)."
Now we've known this medical evidence for some time now, but what is interesting is that the Phillipines is a perfect "case study" of what happens when every male is clean-cut. Of course, there is some HIV & STDs & HPV, but the cultural desire to be circumcised has greatly cut the rates of those awful diseases there. In the Philippines to be "supot" or "pisot" (meaning uncircumcised) is not only unhealthy but it's also socially unacceptable. Indeed, to call someone supot or pisot is a great insult, meaning not only are they uncircumcised but they are dirty, unclean, and child-like.
I hope Dr. Hankins has talked to the US Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP) so that they, like the World Health Organization (WHO) and UNAIDS, can forcefully call for universal circumcision in America.
A story from ABS/CBN News is worth a moment:
"Dr. Catherine Hankins, chief scientific adviser to UNAIDS, has praised the Philippines for having one of the lowest HIV/AIDS prevalence rates in the Asia-Pacific, which she attributed to the country's practice of almost universal male circumcision." [my emphasis].
"One of the major reasons for the Philippines' low HIV prevalence rate is the fact that it practices almost universal male circumcision. We know that male circumcision protects against HIV partially, about a 60 percent reduction for men and eventually that means Filipino women are less likely to encounter men who are HIV positive so they have lower rates of HIV," Hankins, chief scientific adviser to UNAIDS, told abs-cbnNEWS.com.
"The Philippines, in adopting male circumcision despite the fact that it is primarily a Roman Catholic country has meant a better control of the epidemic."
"She said various studies have shown the benefits of male circumcision including lower rates of urinary tract infections in male infants who are circumcised; lower risk of penile cancer and lower prevalence of some sexually transmitted infections such as human papillomavirus (HPV) and herpes simplex virus type 2 (HSV-2)."
Now we've known this medical evidence for some time now, but what is interesting is that the Phillipines is a perfect "case study" of what happens when every male is clean-cut. Of course, there is some HIV & STDs & HPV, but the cultural desire to be circumcised has greatly cut the rates of those awful diseases there. In the Philippines to be "supot" or "pisot" (meaning uncircumcised) is not only unhealthy but it's also socially unacceptable. Indeed, to call someone supot or pisot is a great insult, meaning not only are they uncircumcised but they are dirty, unclean, and child-like.
I hope Dr. Hankins has talked to the US Centers for Disease Control (CDC) and the American Academy of Pediatrics (AAP) so that they, like the World Health Organization (WHO) and UNAIDS, can forcefully call for universal circumcision in America.
Saturday, April 25, 2009
American Academy of Pediatrics Statement on Circumcision We Hope to See
Somewhere circulating within the emails of the American Academy of Pediatrics' Task Force on Circumcision, there is a draft proposal updating the AAP's 1999 "neutral" stance on circumcision in light of the growing medical evidence in favor of male circumcision. You can call this a fictional wish-list, but we hope the AAP has the guts to issue a report something like this:
After a comprehensive review of the latest medical and scientific evidence, the American Academy of Pediatrics concludes that all males should be circumcised, preferably at birth, as a matter of both personal medical well-being and general public health to protect themselves, their future sexual partners, and society as a whole from a number of debilitating, life-threatening, and costly diseases.
In 1999, the AAP declared that “scientific evidence demonstrates potential medical benefits of newborn male circumcision,” but we cautioned that “these data are not sufficient to recommend routine neonatal circumcision.” This position, reaffirmed in 2005, understandably left parents of newborn males in a quandary. While the medical benefits of circumcision were established, such as a substantial reduction in urinary tract infection, the evidence was not then compelling to recommend that every male be circumcised. Parents were left to draw their own conclusions, which meant that social, familial, and other non-medical concerns often took priority over health care in the decision-making process.
With substantial new scientific evidence over the last four years, the AAP now recommends that all newborn males be circumcised, and we encourage all public and private health insurers and medical providers to cover, promote, and establish efficacious ways to achieve universal male circumcision. We endorse routine neonatal circumcision, with all the appropriate analgesics to alleviate pain, and we recommend that all males, regardless of age, be circumcised. Circumcision not only confers life-long benefits on the male, but it also protects his female partners and society as a whole.
Among its other benefits, circumcision reduces a male’s chance of acquiring HIV by at least 50 percent, reduces his risk of acquiring HPV by 35 percent and spreading HPV to his female partners, reduces his chances of contracting Herpes Simplex Virus Type II by 28 percent, and reduces the likelihood of causing cervical cancer in his female partners. The AAP does not assert that circumcision eliminates these painful and costly medical scourges, but it will significantly reduce them. These health benefits to males and females far outweigh any risks posed by circumcision, and to suggest otherwise is to engage in a head-in-the-sand approach to science for political and non-medical reasons.
We recognize that the decision to circumcise children lies with the parent, so, consequently, just as with AAP-recommended vaccinations, an option not to circumcise must be made available. But the AAP concludes that sound science dictates the goal of universal male circumcision, regardless of the race, nationality, religion, age, or economic status of the male. A requirement by schools that all boys be circumcised before puberty is recommended, subject to exception for religious or deeply-held objection, or a rare medical necessity. But like the eradication of polio and measles through a policy of universal vaccination, the public health benefits of circumcision are best conferred when adopted by all.
This position in no way impugns the decision of many parents in recent years that left their sons uncircumcised. The decision not to circumcise was perfectly understandable, particularly in the context of the AAP’s former position. But medical science advances, and health care requirements must change with that evidence. Boys left uncircumcised, particularly as they become sexually active, increase their own risks and those with whom they are intimate. That is why the AAP encourages both public and private health insurers and health providers to establish cost-effective options to circumcise both young and older males. And we encourage parents of uncircumcised boys to take advantage of those options as quickly as possible.
Finally, we believe that the evidence for universal male circumcision is so compelling that the United States Government, through the Surgeon General, the Public Health Service, the Centers for Disease Control, Centers for Medicare & Medicaid Services, and all other relevant agencies, needs to engage in a public information campaign and improve affordable access to circumcision for all American males of every age. Under the leadership of the World Health Organization, many other governments have taken such a pro-active lead. The American Academy of Pediatrics urges the U.S. Government to do the same. A country with the greatest medical scientists, practitioners, and institutions should once again take the lead on this critical public health mission.
"DRAFT DRAFT DRAFT"
Task Force on Circumcision
American Academy of Pediatrics
Benefits of Male Circumcision Outweigh Risks
A Call to Universal Circumcision
Executive Summary
After a comprehensive review of the latest medical and scientific evidence, the American Academy of Pediatrics concludes that all males should be circumcised, preferably at birth, as a matter of both personal medical well-being and general public health to protect themselves, their future sexual partners, and society as a whole from a number of debilitating, life-threatening, and costly diseases.
In 1999, the AAP declared that “scientific evidence demonstrates potential medical benefits of newborn male circumcision,” but we cautioned that “these data are not sufficient to recommend routine neonatal circumcision.” This position, reaffirmed in 2005, understandably left parents of newborn males in a quandary. While the medical benefits of circumcision were established, such as a substantial reduction in urinary tract infection, the evidence was not then compelling to recommend that every male be circumcised. Parents were left to draw their own conclusions, which meant that social, familial, and other non-medical concerns often took priority over health care in the decision-making process.
With substantial new scientific evidence over the last four years, the AAP now recommends that all newborn males be circumcised, and we encourage all public and private health insurers and medical providers to cover, promote, and establish efficacious ways to achieve universal male circumcision. We endorse routine neonatal circumcision, with all the appropriate analgesics to alleviate pain, and we recommend that all males, regardless of age, be circumcised. Circumcision not only confers life-long benefits on the male, but it also protects his female partners and society as a whole.
Among its other benefits, circumcision reduces a male’s chance of acquiring HIV by at least 50 percent, reduces his risk of acquiring HPV by 35 percent and spreading HPV to his female partners, reduces his chances of contracting Herpes Simplex Virus Type II by 28 percent, and reduces the likelihood of causing cervical cancer in his female partners. The AAP does not assert that circumcision eliminates these painful and costly medical scourges, but it will significantly reduce them. These health benefits to males and females far outweigh any risks posed by circumcision, and to suggest otherwise is to engage in a head-in-the-sand approach to science for political and non-medical reasons.
We recognize that the decision to circumcise children lies with the parent, so, consequently, just as with AAP-recommended vaccinations, an option not to circumcise must be made available. But the AAP concludes that sound science dictates the goal of universal male circumcision, regardless of the race, nationality, religion, age, or economic status of the male. A requirement by schools that all boys be circumcised before puberty is recommended, subject to exception for religious or deeply-held objection, or a rare medical necessity. But like the eradication of polio and measles through a policy of universal vaccination, the public health benefits of circumcision are best conferred when adopted by all.
This position in no way impugns the decision of many parents in recent years that left their sons uncircumcised. The decision not to circumcise was perfectly understandable, particularly in the context of the AAP’s former position. But medical science advances, and health care requirements must change with that evidence. Boys left uncircumcised, particularly as they become sexually active, increase their own risks and those with whom they are intimate. That is why the AAP encourages both public and private health insurers and health providers to establish cost-effective options to circumcise both young and older males. And we encourage parents of uncircumcised boys to take advantage of those options as quickly as possible.
Finally, we believe that the evidence for universal male circumcision is so compelling that the United States Government, through the Surgeon General, the Public Health Service, the Centers for Disease Control, Centers for Medicare & Medicaid Services, and all other relevant agencies, needs to engage in a public information campaign and improve affordable access to circumcision for all American males of every age. Under the leadership of the World Health Organization, many other governments have taken such a pro-active lead. The American Academy of Pediatrics urges the U.S. Government to do the same. A country with the greatest medical scientists, practitioners, and institutions should once again take the lead on this critical public health mission.
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