Newest circ study - now benefits outweigh risks?

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smsturner's picture
Joined: 05/11/09
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Newest circ study - now benefits outweigh risks?

I found this super interesting.
I thought the definite trend was going against male circumcision all the around, with some states even threatening to ban the procedure altogether. The American Association of Pediatrics used to say it wasn't beneficial enough to do, but now the AAP is saying the benefits outweigh the risks.

from a medical standpoint, circumcision?s benefits in reducing risk of disease outweigh its small risks, said Dr. Freedman, a pediatric urologist in Los Angeles.

Recent research bolstering evidence that circumcision reduces chances of infection with HIV and other sexually spread diseases, urinary tract infections and penis cancer influenced the academy to update its 13-year-old policy.

Its old stance said potential medical benefits were not sufficient to warrant recommending routinely circumcising newborn boys. The new one says, ?The benefits of newborn male circumcision justify access to this procedure for those families who choose it.? The academy also says pain relief stronger than a sugar-coated pacifier is essential, usually an injection to numb the area.

Read more: Pediatricians: Benefits of circumcision outweigh risks - Washington Times

Pediatricians: Benefits of circumcision outweigh risks - Washington Times

Is there a debunking to this? Do we agree?

Spacers's picture
Joined: 12/29/03
Posts: 4100

Bull****. This is about money. They've lost income because parents aren't paying out-of-pocket for it and insurance is no longer covering it. There's nothing new here, and there's certainly not anything substantial enough to justify circumcising tens of thousands of baby boys every year. HIV and other sexually transmitted diseases can be prevented by using a condom and staying within a monogamous relationship with someone you know to be disease-free. Urinary tract infections can often be prevented with good hygiene, aren't usually life-threatening, and don't generally even require antibiotics to treat. Penile cancer affects, at most, about 1500 men per year with about 300 deaths; those statistics include other male organ cancers so it's hard to be able to pinpoint an exact number. Even assuming they're all penile cancer, that's 0.001% of the male population affected and 0.0002% death rate. Breast cancer affects for more women & results in far more deaths but no one suggests removing all girls' breasts at puberty to prevent that disease.

GloriaInTX's picture
Joined: 07/29/08
Posts: 4116

"Spacers" wrote:

This is about money.

You're right. It is about money.

Meantime, a recent study projected that declining U.S. circumcision rates could add more than $4 billion in health care costs in coming years because of increased illness and infections.

AlyssaEimers's picture
Joined: 08/22/06
Posts: 6560

Ooo. I saw this this morning and wondered if it would show up here. I remember the last very heated debate about this.

Thankfully as a mother of three girls I have not delt with this. I am thinking I probably would have let DH decided though because I do not have strong feelings about it one way or the other.

smsturner's picture
Joined: 05/11/09
Posts: 1303

Honestly, I'm not terribly swayed either way. I just thought the study was interesting.

"Spacers" wrote:

HIV and other sexually transmitted diseases can be prevented by using a condom and staying within a monogamous relationship with someone you know to be disease-free. ....... Breast cancer affects for more women & results in far more deaths but no one suggests removing all girls' breasts at puberty to prevent that disease.

A couple of thoughts...
Girls breasts seem far more useful in the long run.
Another point I would definitely argue is that while we would LOVE for all of our sons to be super smart about every sexual encounter they have, the reality is that all of them aren't. If there was even a small likelihood it would prevent a life threatening disease like HIV, I would consider that a benefit, even if I wouldn't consider it a main deciding factor.
If they came out with a vaccine for AIDS, I don't think any of us would tell our sons not to get it just because they should be being smart about sex anyway.

Spacers's picture
Joined: 12/29/03
Posts: 4100

"GloriaInTX" wrote:

You're right. It is about money.

Please show me where the few hundred cases of penile cancer add up to $4 billion. The rest of what they're claiming is mostly preventable, or easily & cheaply treated. There's no link to that particular study, nor a name for me to Google it on my own, but I'll bet they've probably assumed that a certain percentage of those uncirc'd boys will get HIV. Personally, I hope that this next generation will be the one to finally learn the lesson of safer sex practices, and also that a vaccine will be developed for HIV.

Another thing, penile cancer is usually associated with HPV so increasing access to that vaccine to adolescent boys would probably help more than circumcision.

GloriaInTX's picture
Joined: 07/29/08
Posts: 4116

"Spacers" wrote:

Please show me where the few hundred cases of penile cancer add up to $4 billion. The rest of what they're claiming is mostly preventable, or easily & cheaply treated. There's no link to that particular study, nor a name for me to Google it on my own, but I'll bet they've probably assumed that a certain percentage of those uncirc'd boys will get HIV. Personally, I hope that this next generation will be the one to finally learn the lesson of safer sex practices, and also that a vaccine will be developed for HIV.

Another thing, penile cancer is usually associated with HPV so increasing access to that vaccine to adolescent boys would probably help more than circumcision.

For the study, Tobian and his team used computer simulations to estimate how much added health care costs would stem from U.S. circumcision rates dropping to only 10 percent of U.S. newborn males - about 4 million males, which is similar to the European. They found over a lifetime, such circumcision rates would tack on an extra $407 in costs per man and $43 per woman.

Specifically, the researchers calculated that if circumcision rates were to dip to 10 percent, there would be a 212 percent increase in cases of male urinary tract infections and a 12 percent increase in HIV infections in men, along with a 29 percent rise in HPV infections and a 20-percent rise in herpes infections.

Women would also be at greater risk, the researchers said, with a reported 51 percent increases in the infection bacterial vaginosis, an 18-percent rise in high-risk HPV infections and a 12.9 percent rise in low-risk HPV.

In total, that's $4.4 billion in avoidable health care costs, say the researchers. As is, the 20-year decline in rates have already contributed to upwards of $2 billion in added costs. They also note that 18 states have already abolished Medicaid coverage for male circumcisions, considering it an optional procedure.

"Although there are multiple factors that contribute to a nation's MC rate, it is likely that reductions in insurance coverage play a role in lowered MC rates," the authors wrote. "Thus, the financial and health implications of policies that affect MC are substantial."

The findings were published in the August 20 issue of the Archives of Pediatrics and Adolescent Medicine.

In an accompanying editorial published in the same journal, Dr. Arleen A. Leibowitz and Katherine Desmond, health policy researchers at the University of California, Los Angeles, write based on the evidence, "It is now time for the federal Medicaid program to consider reclassifying MC from an 'optional' service to one that all state Medicaid plans will cover for those parents who choose the procedure for their newborn sons."

http://www.cbsnews.com/8301-504763_162-57497265-10391704/declining-circumcision-rates-may-add-$4-billion-in-u.s-health-care-costs-researchers-say/

http://archpedi.jamanetwork.com/article.aspx?articleid=1352167

wlillie's picture
Joined: 09/17/07
Posts: 1796

"Spacers" wrote:

Bull****. This is about money. They've lost income because parents aren't paying out-of-pocket for it and insurance is no longer covering it. There's nothing new here, and there's certainly not anything substantial enough to justify circumcising tens of thousands of baby boys every year. HIV and other sexually transmitted diseases can be prevented by using a condom and staying within a monogamous relationship with someone you know to be disease-free. Urinary tract infections can often be prevented with good hygiene, aren't usually life-threatening, and don't generally even require antibiotics to treat. Penile cancer affects, at most, about 1500 men per year with about 300 deaths; those statistics include other male organ cancers so it's hard to be able to pinpoint an exact number. Even assuming they're all penile cancer, that's 0.001% of the male population affected and 0.0002% death rate. Breast cancer affects for more women & results in far more deaths but no one suggests removing all girls' breasts at puberty to prevent that disease.

How's that working out for our country now?

I'm glad they are finally admitting it should be a parent's choice. They aren't recommending routine, just that intactivists back off and insurance cover it.

Spacers's picture
Joined: 12/29/03
Posts: 4100

Damn! I had a brilliant reply all typed out & pg.org kicked me off! :evil: Long story short, the statistics just don't match up to the claims of the pro-circ lobby. Check out the "prevalance of circumcision" rates for countries and "HIV rates" for the same countries. Some of the countries with the highest rates of circumcision have the highest rates of HIV. And many of the countries with the lowest circ rates also have the lowest HIV rates. I had a list but it's lost now.

Nevada now has the lowest circ rate in the U.S. at 12%. Why are we not seeing an epidemic of UTIs in boys in that state? Five of the 13 Canadian provinces have a circ rate lower than 10% and those provinces also have the lowest HIV rates in Canada. And I can't find anything about an epidemic of non-circ-related UTIs in Canada, either.

AlyssaEimers's picture
Joined: 08/22/06
Posts: 6560

Just to clarify, do you think circumcision should be illegal?

GloriaInTX's picture
Joined: 07/29/08
Posts: 4116

I guess its all a big conspiracy. Since WHO says the same thing.

There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. Three randomized controlled trials have shown that male circumcision provided by well trained health professionals in properly equipped settings is safe. WHO/UNAIDS recommendations emphasize that male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence.

Male circumcision provides only partial protection, and therefore should be only one element of a comprehensive HIV prevention package which includes: the provision of HIV testing and counseling services; treatment for sexually transmitted infections; the promotion of safer sex practices; the provision of male and female condoms and promotion of their correct and consistent use.

WHO | World Health Organization

smsturner's picture
Joined: 05/11/09
Posts: 1303

"wlillie" wrote:

I'm glad they are finally admitting it should be a parent's choice. They aren't recommending routine, just that intactivists back off and insurance cover it.

ME TOO. I think that's exactly what it should stay. Insurance covered, but totally a choice.

"GloriaInTX" wrote:

I guess its all a big conspiracy. Since WHO says the same thing.

WHO | World Health Organization

60%!!!?? wow that's HUGE! i didn't realize it was that big.
I'm leaning toward having a condom surgically sewn on to my next son at birth, if i have one. Seems like the only way to guarantee they are smart... lol

Joined: 12/10/05
Posts: 1681

"Spacers" wrote:

HIV and other sexually transmitted diseases can be prevented by using a condom and staying within a monogamous relationship with someone you know to be disease-free.

The key word is "can"... Because they aren't, especially in the teen/young adult demographic.

I'm glad to see recognition of the benefits and that they make mention of the proper use of analgesic.

Spacers's picture
Joined: 12/29/03
Posts: 4100

To the "parents choice" people, how do you sync that with the fact that circ rates in this country DROPPED pretty dramatically (in some places from over 90% to less than 20%) when insurance stopped covering it? If people cared enough do it, wanted to make that choice for their sons, don't you think they would care enough to pay for it? I mean, what's $200 when it's your son's future health at issue?

And yes, I would love for circumcision to be illegal. Every child has the right to bodily integrity, no matter his parents' income or religion or whatever. Cutting off his body parts should be *his* decision, no one else's.

AlyssaEimers's picture
Joined: 08/22/06
Posts: 6560

"Spacers" wrote:

To the "parents choice" people, how do you sync that with the fact that circ rates in this country DROPPED pretty dramatically (in some places from over 90% to less than 20%) when insurance stopped covering it? If people cared enough do it, wanted to make that choice for their sons, don't you think they would care enough to pay for it? I mean, what's $200 when it's your son's future health at issue?

So if you care so much about getting birth control, why don't you pay for it instead of making it law that insurance companies and employers pay for it? Birth control is no more medically necessary than circumcision.

Joined: 12/10/05
Posts: 1681

"Spacers" wrote:

To the "parents choice" people, how do you sync that with the fact that circ rates in this country DROPPED pretty dramatically (in some places from over 90% to less than 20%) when insurance stopped covering it? If people cared enough do it, wanted to make that choice for their sons, don't you think they would care enough to pay for it? I mean, what's $200 when it's your son's future health at issue?

And yes, I would love for circumcision to be illegal. Every child has the right to bodily integrity, no matter his parents' income or religion or whatever. Cutting off his body parts should be *his* decision, no one else's.

I cared enough to pay for it. And I appreciate having that option. It would also be nice if it was covered, but I'm not going to complain.

I think the decrease in rates also has to do with people having difficulty finding a doctor to do it, since the billing is different (at least in Canada). Around here there are a handful of docs who will do it for their own patients and one doc who takes referrals (and is super busy with circ appts).

mom3girls's picture
Joined: 01/09/07
Posts: 1535

We were prepared to pay for our son's, we were pleasantly surprised when they paid for it (even though they only paid for half) It was something that was very important to my husband. My pediatrician felt like it was important too (he only has 10% of patients that do circ) due to my family history of serious UTI and kidney infections. I think parents need to make choices for their children in cooperation with their doctors and other people need to stay out of it

smsturner's picture
Joined: 05/11/09
Posts: 1303

I let my husband decide for my son. I supported that he had him circ'd. We would have paid, but didn't. As a medical procedure that could have benefits, I think it should be covered. I think there should be pamphlets of information and full disclosure made to the parent about the method, analgesic, benefits and risks, and then it should be the parent's choice.

And yes, I would love for circumcision to be illegal. Every child has the right to bodily integrity, no matter his parents' income or religion or whatever. Cutting off his body parts should be *his* decision, no one else's.

A couple things, I asked my husband what he thought of that when we had our son. He said he would definitely have wanted it, and was happy it was done when he couldn't remember it, and before he ended up high school where others saw. If it was his choice, I'm imagining that would be after 18, when he had the money, and that would have been later than he would have wanted it.

The other, I'm curious what you think of ear piercing for infants...should that be illegal too? It seems to fall under the same category.

GloriaInTX's picture
Joined: 07/29/08
Posts: 4116

Circumcision is not required for Christians, though my opinion is that God originally put it in place for health reasons. I find it very interesting though that we have found out all this time later that there was a reason that God told them to circumcise on the eighth day. It doesn't make as big a difference now since babies get vitamin K shots.

In Genesis 17:12, God was very specific in His command that Abraham circumcise newborn males on the eighth day. But why the eighth day? In 1935, professor H. Dam proposed the name “vitamin K” for the factor in foods that helped prevent hemorrhaging in baby chicks. We now realize that vitamin K is responsible for the production (by the liver) of the element known as prothrombin. If vitamin K is deficient, there will be a prothrombin deficiency and hemorrhaging may occur.

Interestingly, it is only on the fifth through the seventh days of the newborn male’s life that vitamin K(produced by bacteria within the intestinal tract) is present in appropriate quantities. Vitamin K coupled with prothrombin—causes blood coagulation, which is important in any surgical procedure. Holt and McIntosh, in their classic work, Holt Pediatrics, observed that a newborn infant has
...peculiar susceptibility to bleeding between the second and fifth days of life.... Hemorrhages at this time, though often inconsequential, are sometimes extensive; they may produce serious damage to internal organs, especially to the brain, and cause death from shock and exsanguination (1953, pp. 125-126).

Obviously, then, if vitamin K is not produced in sufficient quantities until days five through seven, it would be wise to postpone any surgery until some time after that. But why did God specify day eight?

On the eighth day after birth, the amount of prothrombin present actually is elevated above 100 percent of normal, and is the only day in the male’s life in which this will be the case under normal con-ditions. If surgery is to be performed, day eight is the perfect day to do it. Vitamin K and prothrombin levels are at their peak.

http://www.theoric.org/trinityfrench/raybarnett/Apol_06A/35R1%20FaithReasonCollection/crcumcsn.pdf

Spacers's picture
Joined: 12/29/03
Posts: 4100

"smsturner" wrote:

The other, I'm curious what you think of ear piercing for infants...should that be illegal too? It seems to fall under the same category.

Yep, ear piercing should also be illegal under the same bodily integrity argument. Until a child is old enough to understand the consequences (pain, risk of infection, etc.) and still want to do it, it's not OK.

"AlyssaEimers" wrote:

So if you care so much about getting birth control, why don't you pay for it instead of making it law that insurance companies and employers pay for it? Birth control is no more medically necessary than circumcision.

The law says that insurers need to provide all women with free preventive care services, and birth control is a preventive medicine. And yes, for a very long time I paid for it out-of-pocket (or got it for free at Planned Parenthood) because I didn't have insurance or it wasn't covered by my crappy policy and I didn't want to risk an unintended pregnancy with less effective methods.

"mom3girls" wrote:

We were prepared to pay for our son's, we were pleasantly surprised when they paid for it (even though they only paid for half) It was something that was very important to my husband. My pediatrician felt like it was important too (he only has 10% of patients that do circ) due to my family history of serious UTI and kidney infections. I think parents need to make choices for their children in cooperation with their doctors and other people need to stay out of it

In your case, where the evidence of family history makes a good argument in favor of circumcision, then it would be a prudent medical procedure and, as such, should be covered by insurance. For most people, it's not and shouldn't be.

AlyssaEimers's picture
Joined: 08/22/06
Posts: 6560

"Spacers" wrote:

then it would be a prudent medical procedure and, as such, should be covered by insurance. For most people, it's not and shouldn't be.

So how can a prudent medical procedure be illegal?

It still baffles me that you think a baby that happens to reside inside the womb has no rights whatsoever, not even the right to live. But once that baby exits the womb something magical happens that makes it so the mother has no right to decide how her child is raised or make medical decisions for the baby, and the baby has complete rights.

Joined: 08/17/04
Posts: 2226

Meh...I've been pro circ for awhile and would have had one done if either or both of my kids were boys. I'm all about choice so I'm cool if you don't circ. It's still really common around here to circ and insurance covers it.

ClairesMommy's picture
Joined: 08/15/06
Posts: 2299

I'd be surprised if any Canadian province covers circ. Any Canadian ladies have circ covered? We don't in AB. It's $200 and is not covered by extended benefits like Blue Cross. But we have comparably a very low circ rate compared to the States. I wonder why that is. Duh. Probably because it's not insured Wink Just kidding. I seriously would like to know what big difference there is between us and the US. Does the US have a higher population (relatively) of Jews and Muslims? I would think so. What about Europeans? I'm British and I know that no male in my family, including my son and my brother's 3 boys being all born in Canada, are circ'ed. Brits just don't really do it. Is or was there a bigger medical push, so to speak, in the US to circ? Maybe Canadians are more of a 'it's not necessary' approach. IDK. Interesting.

Jules's picture
Joined: 10/03/01
Posts: 797

It does make you stop and wonder as you read the study. The recommendations appear to be based on three large-scale trials in Africa within the past decade. These found that circumcised heterosexual men were up to 60 percent less likely to become infected with HIV than uncircumcised men.

Some of the language within the new circ study seems pretty wishy-washy. I'm not overly comfortable when study authors have vested interested, especially financial gain.

It reminds me a bit of the U.S. Preventive Services Task Force recommendations on breast cancer screening -- "against routine screening mammography" for women in their 40s.

Without screening, 3.5 out of every 1,000 women ages 40 to 49 will die of breast cancer in the next 10 years; regular mammography can reduce that number to 3. The panel calculated that to save one life among women in this age group, 1,900 women must be screened annually for 10 years. The other 1,899 women will receive no benefit from mammography over that period, though they will field 1,330 call-backs for reassessment and 665 breast biopsies, and eight of them will be diagnosed with cancers whose prognosis will not be altered by detection via mammogram -- either because they would never become dangerous or because they are so aggressive that there's little to be done.

They American Congress of Obstetricians and Gynecologists criticized the task force recommendations and continued to call for annual or biennial mammograms for women in their 40s. By continuing the present system, a lot of money comes into the very group that rejected more slack screening

Could this be another example where money is the bottom line?