# routine neonatal circ. : no scientific basis.

> Written by RS on 13. August 1999 at 23:23:14:

> In Reply to: Re: Gross Misnomer of written by Gerald N. Weiss,M.D. on 05. August 1999 at 02:23:58:

> Hello Gerald,

> I`m glad you wrote to the public FORUM.

> >>This forum is primarily intended for unbiased research, to revise our understanding of the ancient tradition of routine circumcision from the perspective of modern medicine. (This means, early monitoring and prevention when possible, accurate diagnosis previous to treatment, information and education).

> >>Robin Stuart

> >I heartily endorse this attitude and commend Robin for his outstanding work which
> >serves to elaborate so well the COMPLICATIONS of those who have not been fortunate
> >enough to have been PROPHYLACTICALLY circumcised neonatally.

> I completely distance myself from this conclusion. My
> suggested modern methods of PREVENTION (which you answered
> to above) have nothing to do with "PROPHYLACTIC" circumcision.

> The modern medical attitude and the conclusion of my study is
> that children must be checked and these conditions prevented.

> I can only think that you have been involved for too long
> with the anti - pro circumcision debate.

> To move with the modern world it is necessary to free yourself
> from this irrelevant and closed minded question which suggests
> only two alternatives: routine circumcision or nothing at all.

> ___________________________________

> >The 1999 AAP Task Force Report
> >conclusion only adds to the confusion:
> > Although the relative risk of UTI (Urinary Tract Infection) in uncircumcised
> > male infants is increased from 4- to as much as 10-fold during the first year of
> > life, the absolute risk of developing a UTI in an uncircumcised male infant is low
> > (at most, ~1%).
> >Compounding a scientific cost analysis is data availability and manner of
> >presentation. The Report acknowledges the greater frequency of STD, AIDS and
> >penile cancer in the uncircumcised.

> Rather than just repeating the confusion how about clearing
> it up .... Do the problems you are talking about among the
> uncircumcised occur in 1% or in 0.1% of the population?

> In debate.html, I repeat information from Vernon Quaintance
> who hosts your pages, and gave me permission to quote him.

> ... "UTIs happen 10% more in uncircumcised boys."
> Are we talking about a difference between 1 in 600 and 1 in 6,000?

> ... "Its AIDS, penis cancer etc. all added together."
> How often do these complaints actually occur?? Do these occur more than 1% of the time?

> .... "Parents should be aware of the danger."
> Even if its 1% I would agree, but then isn't it even more important to inform them that...

> Phimosis occurs in 8.8% when flaccid, most pro circers will
> easily accept 10% when erect. Consider in Britain where
> checking is not performed: population 70 million - 1 million
> a year - 2,740 a day - 1,370 men - 10% of this means that
> approximately 137 boys a day arrive at puberty and start
> their path to manhood with an anatomical inhibition.

> Surely if care for children is foremost in your thinking it
> would be appropriate to help make our culture aware that
> these common conditions can be checked for and to help
> educating about any and all of the many different options
> there are on prevention and treatment.

> Isn't it time to think about practical obvious necessities?
> You can continue your arguments about circumcising every
> child or none for further centuries once these common actual
> problems have been resolved.

> My question to the anti and pro circ. activists concerns
> the priority of helping children in a practical way. ----
> Is "checking for individual problems" a middle ground which
> may resolve a number though not all of your differences?
> and then if we could all pull together, maybe the internet
> community could also help a number of children.

> ___________________

> THE FOLLOWING SEEMS A VERY GOOD "APOLOGY" TO THE ANTI CIRC. GROUPS -
> (though have you ever heard of abstracts and short summary versions?)

> >As a retired surgeon I
> >can speak with experience and more objective critical analysis. As late as the 1980s,
> >when serving in the US military, neonatal circumcision was not even listed as a
> >surgical procedure. It was performed but not recorded as �surgery on our Report
> >of Operations. Even to this day, this attitude may be reinforced by current
> >malpractice insurance companies. Pediatricians and Family Practitioners,
> >approved as qualified and performing circumcisions in the first year of a child�s life
> >may do so with no special increase in rates. However, if performed after the first
> >year of life, circumcision falls in the category of major surgery and thus premium
> >rates increase!
> > It is recognized that the majority of American neonatal procedures of this
> >type are done by nurses, medical students, physician assistants, interns or residents
> >who have little or no surgical expertise, training and often no supervision. The most
> >common neonate and male surgery is often performed by non-surgeons!! There is
> > an explanation.
> > In the United States of America our country was founded on the distinct
> >separation of State and Church. Following this direction, surgeons as a group
> >attributed the procedure to the Hebrew ritual. As the advantage of the secular
> >prophylactic surgical measure reached a height, prompted by military conflicts and
> >scientific confirmations (Weiss, GN and Harter, AW, Circumcision: Frankly
> >Speaking, 1998, Wiser Publications, Fort Collins, CO), neonatal circumcision
> >became a norm for 80% to 90% of newborns during mid century in the U.S. The
> >simplicity and safety of a surgical procedure, not basically considered surgery but
> >ritual, was enhanced with new metal and plastic gadgetry. The Gomco Clamp and
> >Plastibell devices for neonatal circumcision substituted for the trained surgeons�
> >hands. Hebrew Mohels (i.e., ritual circumcisers), who for centuries were guided by
> >compassion and procedural speed for the eight day old Jewish infant, were rigidly
> >trained for the delicate procedure. They were relegated to the ritual category.
> >Others meantime were to be assured of a safe circumcision, by virtue of technology,
> >even though the operators lacked or had minimal training. Surgeons of the time felt
> >the common and important procedure to be in a ritual and safe category. As for
> >safety of those in the non-ritual group, it depended more on technological safeguards
> >than on trained operators.
> >the rare complications can be attributed to those inexperienced operators.

> My comment (from a letter last week) "the pro circers. of this
> world have devised and designed any number of clever simple
> efficient methods of performing a full circumcision, and these
> have simply flooded the market, ... it would not suprise me if
> the last time anyone did any research into partials was some
> Jewish Mohel, before Christ, (partial circ was the original
> Jewish cut)"

> I would like to know if this is true: Are you aware of any
> research on partial circumcision? --- Have you ever performed
> one yourself?

> Are you suggesting that neonatal circumcision in the USA is
> a question of the cost?

> ___________________________________

> >An E-mail message received from a medical student in Germany this past
> >month illustrates the point:
> > �Congratulations on your research on circumcision! I find it really deplorable that
> > this uncomplicated but thus so beneficial operation is losing population so rapidly
> > in our days. I am a 24 year old medical student from Germany and I have spent 18
> > years of my life with a foreskin...and with it with a great many problems. I am
> > circumcised now and more than happy about it. I wish circumcision was the norm
> > here in Germany, because it is - as you might know - very unpopular here. In my
> > med school here circumcision is not even taught. Wish you all the best for your
> > research,

> I am not suprised that "In my med school here circumcision is
> not even taught." However the importance of this anecdote
> cannot be overlooked - This potential doctor suggests a
> routine procedure ("I wish circumcision was the norm") on
> account of his personal experiences. We see very clearly
> here how personal prejudice on this subject can influence
> medical opinion and practice.

> BTW I would bet that he had frenulum breve ... a condition
> which the German checks overlook ...

> ____________________________________________________________

> > In the meantime, the AAP 1999 Task Force conclusion is justified:
> > �Existing scientific evidence demonstrates potential medical benefits of newborn
> > male circumcision; however, these data are not sufficient to recommend routine
> > neonatal circumcision.�
> > Long term scientific research will confirm the evidence of hygienic, aesthetic,
> >health preventive and perhaps sociologic aspects of neonatal circumcision.

> I have responded to this in private mail, please get on with
> doing the necessary research instead of speculating on what
> this may show in advance. ... It is fully illogical to put
> the results of any research before doing the research.

> ____________________________________________________

> >AGAIN, Robin and others are to be congratulated on revealing the degree of COMPLICATIONS and
> >outright misery and discomfort so many males suffer as a result of penile problems
> >related to phimosis, paraphimosis and an entity few physicians are even aware of-- frenulum
> >brevae. Continue your signal, outstanding and promising studies. I intent to learn with
> >you and contribute as my 50+ years of surgical experience has taught me.
> > With best wishes for continued success of this project, GN Weiss, MD

> Thank you for your good wishes, and I respect your life long
> committment in this field. However if you want to join or
> support this research project it will be necessary for you to
> chuck overboard any opinions or preconceptions which cannot be
> proved.

> Please search for and find fault in my study!!! ...

> If you cannot criticise any of the thinking on my site, or answer
> my criticism of your letters then it is never too late for a
> change of opinion and consider: someone in your position with
> your contacts could really help make the breakthrough on this
> century long debate.

> yours sincerely
> Robin Stuart

> BTW your referal to a gross misnomer in terminology was
> unexplained, however I am against both routine circumcision
> and neonatal circumcision in the present so called civilised
> world.

> I must comment on your referal to "frenulum brevae" ... As VQ
> said some 3 years ago: anyone using the name frenulum breve
> would be copying my terminology. I in fact copied the current
> word and spelling used by German Urologists.

> To suddenly bring a change in terminology at this point without
> any explanation of why you want to use this new confusing
> spelling would be irresponsible, so I hope this was merely a
> typing mistake.

> Answers:

> - Re: neonatal circ. : a realistic perspective Gerald N. Weiss, M.D. 31.8.99 (1)
>   - Re: Lucky bulls and your silly neonatal ideas RS 18.9.99 (0)

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