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.
Showing posts with label herpes. Show all posts
Showing posts with label herpes. Show all posts
Thursday, November 5, 2009
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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