Question for the CDC

I have a question for the CDC, who are considering advocating circumcision for all newborn infants, in an effort to reduce HIV infection (a flawed plan, as I argue here.)

1. How come the USA, in which the majority of men are circumcised, is rated 10th in the world for rates of HIV infection - whereas Europe and Japan, where men are generally not circumcised, have considerably LOWER rates of HIV infection?
   

Doesn't that just shoot the efficacy of this cruel and unnecessary procedure right out of the water?

CDC poised to advocate infant circumcision?

It was quack doctor John Harvey Kellogg who helped usher in America's era of neonatal circumcision. In his 1903 book Plain Facts for Old and Young, he advocated the removal of a child's foreskin as an effective remedy against the 'evils' of masturbation.

"A remedy for masturbation which is almost always successful in small boys is circumcision. The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment."

For decades afterwards, the routine circumcision of America infants went almost unchecked - with as many as 80% of children having their foreskins removed in the days following birth - all in the interests of 'hygiene' or 'aesthetics' or similarly discredited theories.

In fact, it wasn't until 1999 that the American Medical Association finally examined the issue - and rejected all the bunk 'science' that suggested circumcision was medically necessary or beneficial - stating:

“Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice.”

However, just like female circumcision in Africa and the Middle East (more accurately labeled 'genital mutilation') it was difficult to change the habits and prejudices of three generations of American parents. While routine circumcision dropped from 80% of all baby boys to just 60% - more than half of all newborns still had their foreskins unnecessarily removed.

But it did appear that the tide was changing - and that an increasing number of infants were being left intact just as God intended - until this week.

Because this week, the Center for Disease Control (CDC) in the United States considered advocating routine circumcision off all infant boys again - because studies in Africa suggested that circumcised men were 50% less likely to contract HIV than ones who were uncircumcised.

Dr. Peter Kilmarx, chief of epidemiology for the division of HIV/AIDS prevention at the CDC announced:

“We have a significant HIV epidemic in this country, and we really need to look carefully at any potential intervention that could be another tool in the toolbox we use to address the epidemic. 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 problems with Kilmarx's suggested campaign of circumcision? Where do I start?

Kilmarx has presented three studies conducted in Africa to indicate that men with a circumcised penis are 50% less likely to get infected by HIV - and advocates routine circumcision in American infants to carry those benefits over to the United States.

The problem is, America isn't Africa.

Here in the United States, our HIV 'epidemic' isn't on the same scale as in Africa. In some parts of Africa, up to 20% of the population can be infected. In the USA, the CDC estimate that just over a million Americans carry HIV (either diagnosed or undiagnosed.) That's 0.3% of the population. So already, an American's chance of encountering a person with HIV (much less having sex with them) is 66 times less than in Africa.

Secondly, America is a country with has reasonable sex education (no thanks to President Bush) and easy access to condoms. Condom use in Africa is practically unheard of. Therefore, Americans already have a far more effective way of preventing HIV infection through heterosexual intercourse than somebody in Africa does.

Thirdly, 67% of all men who are infected with HIV in the United States catch it through male-to-male sexual intercourse - and according to 15 studies, circumcision does nothing to protect either the 'bottom' (receptive) partner or the 'top' (giving) partner.

A further 17% of HIV infections are through injection drug use - another area in which circumcision has no applicable benefits.

And finally, the fastest growing group of heterosexuals being infected are women - and just like with receptive male-to-male sex, circumcision offers no benefits to reduce infection amongst that group.

Oh - not to mention that it will be at least 16 to 20 years before we can expect to see the 'benefits' of this campaign. In fact, the fastest growing demographic of people infected with HIV are actually in their thirties - so we'll actually have to wait three decades to see if Kilmarx's suggestions are really right.

So on paper Dr. Kilmarx's suggestions will (according to the CDC's 2006 figures) potentially prevent over 2,074 HIV infections when the 'new batch' of circumcised Americans become sexually active.

But it will still do nothing to prevent 33,106 other men, women and children getting infected - and will require over a million infants being circumcised - meaning over 48,216 kids will have to undergo a painful, brutal, unnecessary and dangerous procedure for the sake of preventing one hypothetical infection.

Of those 48,216 kids?

According to a 1996 study by Williams and Kapilla, between 2% and 10% of them will encounter complications arising from their circumcision. A 1999 study, examining 48 boys suffering from circumcision complications, witnessed 21% of them developing serious infections and one had to have his penis amputated entirely.

Does it really make statistical sense to butcher almost 50,000 kids for the sake of possibly preventing a single HIV infection twenty or thirty years in the future?

Of course not. It's just shameful that Dr. Kilmarx and the CDC are too blinded by science to see that fact for themselves.

Please do not circumcise your child!

(Data on US HIV and AIDS rates taken from the CDC factsheets.)
(Statistics of the three randomized African trials taken from InterScience)

Just a little snip...

As imminent fatherhood approaches, I have been exposed to the most terrifying aspect of living in America. Unsolicited parenting advice.

One of the most alarming pieces of 'advice' Tina and I have gotton regards what to do if our as-yet-unspecified 'bump' turns out to be a little boy. In America, the 'done thing' is to get your little fellow's 'little fellow' a snip as soon as he's fresh out of the womb.

Circumcision is still very common in America, even though the annual figures show it's declining in popularity since a high during the 1950s (when around 75% of all newborn boys would be circumcised.) It's pretty much a standard procedure at hospitals and parents have to 'opt out' of having a circumcision performed.

This is completely the opposite of how it is in England, where the National Health Service refuses to cover the costs of circumcision and parents have to specify they want the produce done and then pay for it out-of-pocket.

Why is circumcision so popular in America?

Well, the massive popularity of 'the snip' is fairly recent. In fact, up until 1900, only Jewish children tended to get the procedure done and most kids were left intact.

Around that time, however, a quack holistic doctor called John Harvey Kellogg started to gain a lot of popularity for his beliefs regarding sex and infant sexuality. He published a series of books lambasting the dangers of masturbation and sexuality, which he believed caused insanity, cancer, epilepsy and other medical issues.

Kellogg himself, despite being married for forty years, never once had intercourse with his wife. They had separate bedrooms and never produced children.

One of Kellogg's popular solutions to prevent young boys masturbating was 'the snip.' In his Treatment for Self-Abuse and Its Effects, he wrote:

"A remedy for masturbation which is almost always successful in small boys is circumcision. The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment. In females, the author has found the application of pure carbolic acid [phenol] to the clitoris an excellent means of allaying the abnormal excitement."

This belief tapped into America's puritanical streak and soon the operation was pretty much standard, with issues of 'hygiene' being given as the major reason why the procedure should be performed.

The Bunk Science Behind Circumcision

The myth that circumcision is 'more hygienic' is an ancient one. The ancient Egyptians and Jews made circumcision part of their religious rights, suggesting that it represented a 'blood pact' with God. This is because they lived in the desert, however, without easy access to soap and water.

In modern times, the idea that a circumcised penis is 'cleaner' than an uncircumcised one is ridiculous. True, the foreskin can provide a better breeding ground for bacteria, but a quick wash once a day leaves an unsnipped penis just as 'clean' as a snipped one.

In fact, the chances of an uncircumcised penis becoming infected are significantly lower than the chances of a botched circumcision leading to complications. It seems ridiculous that parents advocate a procedure with a higher chance of complication than what they're trying to prevent.

The Procedure Itself

Circumcision is almost always performed on extremely small children - most often within days of being born.

This is because it's an extremely invasive and hideously painful procedure. Since babies cry anyway, parents who let doctors circumcise their sons can pretend the anguished cries of agony are just standard 'baby bawling'.

However, that's not always the case. I had an American friend in elementary school who was unlucky enough to have the procedure performed when he was around ten years old. The actual operation itself was agonising and he was left wearing what amounted to a 'nappy' for days afterwards. Then, even after his scars had 'healed' his newly exposed manhood was ridiculously sensitive - meaning he spent the next three months hobbling around as if he'd been kicked in the testicles.

Complications

The American Medical Association issued a report in 1999 that stated unequivocally that they did not recommend the circumcision of infants. This is because the risks associated with circumcision far outweighed the perceived benefits.

Those 'benefits' are generally limited to two issues. Concerns that an uncircumcised penis can become infected (which are ridiculous, since from puberty onwards, the penis is almost certainly the body part that receives the most attention in the shower) and Phimosis, which is a medical condition in which the foreskin is too 'tight' to pull down over the head of the penis. Phimosis is generally overcome as soon as pubescent boys have access to the lingerie section of the Sear's catalogue.

The risks of circumcision, however, far outweigh the benefits. Because circumcision is such a regularly practiced medical procedure in North America, there are no shortage of horror stories resulting from botched surgeries. The most famous is probably Bruce Reimer, a Canadian boy who lost his entire penis during a botched circumcision and was raised as a girl as a result (eventually killing himself.)

Parents considering circumcising their son need to consider the ramifications of subjecting their newborn to an incredibly painful, totally unnecessary and potentially devastating medical procedure. Mommies and daddies are meant to love their children. Surely this means leaving them as God intended.