Circumcision: Pediatrician, lawyer sharply fault the AAP policy
Channel: Hugh7777
Date: 2013-03-26

In the latest Journal of Medical Ethics, Dr Robert Van Howe a paediatrician, and Steven Svoboda, a lawyer, severely criticise the methodology and ethics of the 2012 American Academy of Pediatrics circumcision policy.  They say the policy suffers from several troubling deficiencies, including "...the exclusion of important topics and discussions, an incomplete and apparently partisan excursion through the medical literature, improper analysis of the available information, poorly documented and often inaccurate presentation of relevant findings, and conclusions that are not supported by the evidence given."

Among the topics excluded: 
 The anatomy and function of the foreskin 
 The harm caused by its removal 
 Biomedical ethics 
 And human and children's rights 

The incomplete and partisan survey of literature includes: 
 The refusal to consider case reports, case series, ecological studies, reviews or opinions 
 The exclusion of studies finding detriments from circumcision
 Cost/benefit analyses that fail to find benefit being ignored 
 North American STD and HIV studies (which consistently fail to find circumcision benefit) not considered
 And, cherry-picking from within studies
 
The improper analysis includes: 
 Internally contradictory statements 
 Conclusions that do not follow from data 
 No risk/benefit analysis (either of circumcision or intactness) 
 And the AAP's move toward recommending circumcision in the US being based entirely on three African HIV studies
 
Poorly documented and inaccurate presentation: 
 They ignore findings against circumcision within studies they do cite 
 They get the numbers wrong, for example in their measure of the cancer risk 
 They ignore the availability of a vaccine to prevent HPV 
 They fail to apply cost/benefit to UTI, the only risk of early-onset where the child's opinion might reasonably be overridden.  
 They fail to consider the cost of me-atotomy, a very common surgery required after circumcision
 
And among conclusions not supported by evidence: 
 Their call for third-party payment while still consdiering circumcision to be "elective" 
 And the idea that doctors should be be brokers for the parents' culture. 

Accordingly, the critics say, the AAP should immediately retire its policy and replace it with one reflecting such critical concerns as the functions of the lost tissue, medical ethics and the importance of respecting non-consenting children's rights.