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article imageUS Pediatricians say circumcision benefits outweigh the risks

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By Darren Weir     Aug 27, 2012 in Health
The American Academy of Pediatrics (AAP) is now saying the health benefits of circumcision outweigh any risks from the procedure and even suggested it be covered by insurance.
WebMD says the AAP has issued a new policy statement that tells parents to consider all the medical information available along with their ethical, cultural and religious beliefs when deciding whether to remove the foreskin on their newborn sons.
But the pediatricians have stopped short of recommending the surgery for every infant.
WebMD quotes Dr. Arleen Leibowitz from the University of California, Los Angeles, who wasn't involved in drafting the policy saying, “This is obviously a personal decision that families make. This is an important step that the academy clarifies where the scientific evidence is and that they do evaluate that the benefits are much stronger than we had previously realized.”
The American College of Obstetricians and Gynecologists is also endorsing the policy and would be the most likely physicians to discuss the option with new parents. Medicaid programs in several states may have to rethink their recent decision to stop paying for routine circumcision procedures.
The AAP points to recent studies from Africa and Europe and a study published last week in the Archives of Pediatrics and Adolescent Medicine, that suggest circumcision cuts the rate of transmission of STDs including; HIV, Herpes, and HPV (human papillomavirus). The evidence also suggests a reduction in urinary tract infections, especially for infants, a lower risk for cancer of the penis and reducing the risk of cervical cancer in their female sex partners. But the New York Times reports that circumcision does not appear to reduce HIV transmission among men who have sex with other men, and that two studies found that circumcision actually increases the risk of HIV. infection among sexually active men and women.
Anti-circumcision group, Intact America, says most of the research being referenced, is done on adult men in Africa. ABC news Australia quotes the group's executive director, Georganne Chapin, saying, "The task force has failed to consider the large body of evidence from the developed world that shows no medical benefits for the practice, and has given short shrift, if not dismissed out of hand, the serious ethical problems inherent in doctors removing healthy body parts from children who cannot consent."
Dr Douglas Diekema, who served on the task force that drafted the policy and a Seattle pediatric bioethicist, says they considered the ethical issues, including the pain involved and whether parents have the right to make the decision without the child's consent. He tells ABC, "There is no decision you can make that doesn't potentially put a child at risk. If you choose to circumcise, there is a risk he'll grow up to be a man who wishes he wasn't circumcised." And he adds that waiting until the child is older and can make his own decision, would lose many of the early benefits and would result in more surgical risks.
Diekema says the policy is very clear though on the issue of pain. "We were unanimously agreed that it's inappropriate to do this procedure without adequate pain control. That, in many ways, is one of the biggest ethical issues."
The New York Times says significant complications are believed to occur in about one out of every 500 procedures. But surgical mistakes can result in permanent damage or even amputation of parts of the penis. The Times says that one estimate suggests about 117 boys die each year from the procedure.
The issue has political implications as well. The NY Times reports that after an uproar from Jewish and Muslim groups, a German government ethics committee last week overruled a court decision that made the procedure illegal. The Professional Association of Pediatricians in Germany is calling the government decision, “a scandal.”
In nearby Austria, state-run hospitals have been told to stop performing circumcisions. And Denmark has commissioned a study to make sure doctors are following the law and are present during religious circumcision rituals.
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