Circumcision is not a big issue for me, though of course I'm aware that it's one of those parenting third rails, like breastfeeding and vaccination. I did a lot of reading about it before Ben was born, and the most I could muster was a mild bias against, based on a general principle of avoiding all non-crucial surgery. At the time, there was some not-extraordinarily-significant research supporting circumcision as plausibly prophylactic against certain STDs, and the combination of that, Andy's more-than-mild-but-not-very-strong bias for, and the extreme discomfort and embarrassment of a family friend who had to be circumcised for medical reasons in his 70s added up to a Yes. There's also in there somewhere, in a way I can't possibly justify, a weird little family-cultural / atheist-but-CYA adherence to the covenant. Or comfort in the tradition. Or notion of tribal belonging. Or something.
Anyway, like I said, it's not something I can work up a lot of strong feelings for or against, and it's one of those things, like whether you use a baby carrier or stroller, that I have a hard time understanding why some people are excited enough about to advocate publicly rather than simply decide for themselves. But I do feel strongly about this petition, strongly enough to have broken my own very sensible rule about not picking fights on Facebook.
Here's some of what Mothering says:
Based on flawed studies that ignore the risks and ethical concerns of infant circumcision, the CDC may recommend this unnecessary surgery for our baby boys. We know that safe sexual practices and abstinence – not circumcision – prevent sexually transmitted diseases. And we know that there is NO link between infant circumcision and better health.Mothering doesn't specify which studies it considers flawed and what those flaws might be. Unlike the CDC, it doesn't cite references. The CDC's fact sheet on male circumcision contains a useful paragraph, helpfully titled "Risks Associated with Male Circumcision," which includes no fewer than eight cites to studies that explicitly did not ignore the risks of the procedure. Mothering doesn't state its ethical objections, but I'm guessing they have something to do with the fact that an infant can't consent. And that's not something to dismiss out of hand, but we make decisions for our children every day, and that kind of ethical hairsplitting simply can't weigh heavily against substantive evidence (should there prove to be any) that performing the procedure would be a significant benefit to public health.
We will be delivering our petitions to CDC headquarters in April with the hopes of convincing them to make the right decision.
Mothering knows some stuff. Again, they don't cite references for how they know circumcision doesn't prevent transmission of STDs or how they know "there is NO link between infant circumcision and better health." And this kind of arrogant ignorance professing knowledge just honks me off. Take the claim that there's NO link between infant circumcision and "better" (as if that's even a meaningful or specific term) health: the American Medical Association says in this report, "there is little doubt that the uncircumcised infant is at higher risk for urinary tract infection." Smaller risk of UTIs = "better health"! But that's hardly the point, is it? The question isn't whether circumcision has any health benefits whatsoever (the most cursory review of current research makes it clear that it does); the question is whether the benefits are significant, whether they outweigh the risks and justify the costs. The ability to make that kind of essential distinction is only one of the reasons we trust the CDC before Mothering magazine to advise us about public health issues.
Mothering claims to want to convince the CDC to make the right decision. But to convince someone of something, you need to present an argument -- ideally with some evidence to back it up. A petition is not an argument. It's political pressure. It's a more or less polite way of ganging up. And I think we should all think very carefully about whether applying political pressure to the CDC is something we'd want to put our names to, or something we seriously think a group like the CDC should allow itself to be persuaded by.
It would be one thing if the petition advocated further specific study, if it made specific criticisms of the evidence, if it provided, in other words, an evidence-based argument to which it could then legitimately claim the CDC wasn't giving enough credence. But that's not what the petition advocates. Here's the text of the introduction:
No medical society in the world recommends male circumcision – yet newborn male circumcision is the most common surgical procedure in the U.S. This painful and risky procedure deprives more than a million boys each year of healthy, functional tissue – without their consent – while increasing medical costs by an average of $678 per baby.
The Centers for Disease Control (CDC) is developing public health recommendations for the U.S. on male circumcision that could ignore the serious risks of this non-therapeutic surgery. As the foremost expert on public health in our country, the CDC has a responsibility to share the truth about infant circumcision.
We need just a few more signatures to help us reach our 25,000 goal before the end of March. Sign our petition to the CDC below and demand a truthful statement on the risks and harms of newborn male circumcision.
So, if the CDC's recommendations don't ignore the risks of the procedure and do present a truthful assessment of said risks, but conclude that the benefits outweigh the risks, Intact America will support the recommendations?
Here's the text of the petition itself:
As the foremost expert on public health in our country, the Centers for Disease Control (CDC) has a responsibility to share the truth about public health issues that can affect millions of Americans.
Newborn male circumcision is the most common surgical procedure in the U.S. - yet this painful and unnecessary surgery carries serious risks, including hemorrhage, infection, surgical mishap, and death.
The role of circumcision in preventing sexually transmitted diseases (STDs) and other health claims has been investigated by public health researchers and remains highly debatable. Only safe sexual practices, such as the use of condoms and abstinence, can prevent STDs, including HIV/AIDS. Circumcision cannot be responsibly recommended as a way of preventing disease.
If the CDC chooses to promote newborn male circumcision, it is supporting a procedure called "non-therapeutic" by the American Medical Association - in favor of inconclusive and highly debatable research.Though Intact America makes no wild claims about what they know about circumcision, they throw the word "debatable" around as if it means "worthless." But they fail to mention what standard of proof they would find conclusive, and indeed fail to cite a single reference, most notably for their claims of the associated risks. They demand that the CDC admit the truth, implying of course that the CDC has failed to do so or is likely to fail to do so, but there is no evidence presented that suggests any kind of obfuscation or dishonesty.
I ask that the CDC not recommend circumcision as a means of preventing HIV/AIDS and formally recognize the risks and harms of the procedure and the right of every child to bodily integrity.
What I can't understand is, if they accept that the CDC is the foremost expert on public health in the US, that the CDC has a duty to present the truth to the American people, and that there is debatable evidence about whether routine circumcision is beneficial to the public health, why on earth they can't just get the hell out of the way and let the CDC examine the evidence and make its conclusions?
The evidence is debatable, so for pity's sake, let's debate it! Let's hear it, all of it, including what the CDC -- the acknowledged experts -- think we should do. Let's open our minds to the possibility that while there might not have been significant evidence to support recommending routine circumcision five years ago, or last year, perhaps there is now. And if there isn't this year, perhaps there will be five years from now. Let's keep asking the questions whose answers might save or improve lives, and let's listen to the people who can speak about those questions with informed intelligence before we start arguing with them. Let's not dig so deep into the trenches we make of our personal decisions that we can't occasionally climb out and take a look at what a new day's sun might have revealed.