An Open Letter to Monica Robins, Senior Health Correspondent, WKYC

http://www.wkyc.com/mb/news/local/cleveland/group-of-men-protest-circumcision/328106212#

Dear Ms. Robins,

I am writing to express my disappointment in your coverage of the protest in Cleveland by Bloodstained Men against non-therapeutic genital cutting or circumcision ("Group of Men Protest Circumcision," October 1, 2016, WKYC.com). I realize that you are limited probably to mere seconds or minutes on broadcast TV news, yet the tenor of your coverage (particularly as it reads in transcript form on the station's website) was exceedingly superficial, biased and, at best, dismissive of these protesters. And while I applaud you for at least covering this story, I believe that you missed an opportunity to do what a reporter ought to do, including presenting both sides of the story in an objective and balanced way. Instead, you simply recycled sound bytes and long discredited misinformation on the efficacy and legitimacy of infant circumcision as a prophylaxis against diseases such as urinary tract infections and STIs, all of which can be prevented or treated with non-invasive means. Your viewers and the public deserve far better, especially from a Senior Health Correspondent.

To address the main points of your story:

You stated, "Most circumcisions are performed on newborn boys and have been practiced for religious, cultural, and ethic traditions for thousands of years."

In fact, the majority of the world's male population is intact. The United States is one of the small minority of modern industrialized nations in which infant circumcision is performed routinely. Currently, over half of all newborn males in the United States are subjected to it: over one million annually at a cost of hundreds of millions of dollars to consumers - and to tax-payers, as well, in those states that permit Medicaid funding to be used for this medically unnecessary (by the AAP's own admission) surgery. From a health- and medical standpoint, your statement that circumcision has been practiced as a tradition for thousands of years has absolutely no bearing on this topic, otherwise your station should have sent its religion- or cultural reporter to cover this demonstration. Yet, at the same time, your statement seems intended to confer legitimacy on this practice by virtue of its deep historical roots and longevity. I would remind you, however, that female genital mutilation, slavery, and the legal subordination of women - to name only three religious, cultural, and ethnic practices - likewise have been practiced for thousands of years. That does not make these practices valid nor ethical.

As we know, the United States is not thousands of years of old and routine infant circumcision is not in the cultural, religious, or ethnic traditions of the vast majority of people living in the United States. Your viewers might therefore have been better served by a more detailed history - or even any history - of how circumcision came to be commonly practiced here in contrast to most of the rest of the world. That would allow them to judge this surgery in its proper context. To wit:

During the 19th century, circumcision was promoted as an effective remedy for a host of ailments including, but not limited to, rheumatism, epilepsy, asthma, skin cancer, insanity, and venereal disease. However, it was as a remedy for "masturbatory insanity," which was believed to result from masturbation or "self-abuse," that circumcision was most widely promoted by its supporters. Incidentally, one of its most passionate Victorian advocates, none other than John Harvey Kellogg, the co-creator of Corn Flakes, also advocated putting carbolic acid on girls' clitorises for the same purpose: that is, to decrease sexual sensation and thus to inhibit masturbation. Because it was widely pushed by its supporters both outside of and within the medical profession, infant male circumcision increasingly came to be accepted as normal and routine by a credulous public, even as the medical (and sexually-repressive) justifications for circumcision were debunked, one after the other. And because, until about a generation ago, circumcision was seldom questioned, routine infant circumcision metamorphosed from pure pseudoscience to a cultural norm, all while masquerading as a valid medical procedure. It persists to this day as the proverbial cure in search of a disease. These are the historical, pseudo-scientific and cultural roots of routine infant circumcision as it is practiced in the United States.

Added to this are the determined efforts by an entrenched and financially interested pro-circumcision lobby. Circumcision, it should be noted, is a $400 million per year industry for OBGYNs and pediatricians. The stolen foreskins ("stolen," since an infant cannot consent to his own circumcision) are then often used by biotech corporations in the manufacture of everything from replacement skin for burn victims to "beauty cream" products. Circumcision, then, is big business (estimated by some at upwards of a billion dollars) and now generates a huge revenue stream for those who participate in it. This, too, is why circumcision persists in the United States today. Your viewers deserve to have been informed of this, as well.

You stated, "The American Academy of Pediatrics found the health benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision. The decision should be made by parents."

The AAP's latest position statement (from 2012) has been roundly criticized by numerous professional medical organization both in the United States and in Europe, and specifically because of the manifest cultural bias which led the AAP task-force members to come to their conclusion. Indeed, one of the lead authors of the AAP's revised policy statement, Andrew Freedman, MD, FAAP, has recently conceded in a published statement that when the AAP task force on circumcision alluded to its "benefits," it was referring not strictly to "health benefits" but to the cultural and "aesthetic" "benefits" of circumcision as well. It is not surprising, therefore, that the AAP's 2012 statement on infant circumcision was criticized for its cultural bias. In a commentary signed by about 40 physicians and published in the Journal Pediatrics (the journal of the American Academy of Pediatrics, March 18th, 2013), entitled "Cultural Bias in the AAP's 2012 Technical Report and Policy Statement on Male Circumcision," the authors write: "Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada and Australia." The authors of this commentary conclude, "There is a growing consensus among physicians, including those in the United States, that physicians should discourage parents from circumcising their healthy infant boys because nontherapeutic circumcision of underage boys in Western societies has no compelling health benefits, causes postoperative pain, can have serious long-term consequences, constitutes a violation of the United Nations' Declaration of the Rights of the Child, and conflicts with the Hippocratic oath: primum non nocere: First, do no harm."

The AAP's conclusion that the "benefits" of infant circumcision "outweigh the risks" has also been criticized by a group of psychologists who wrote to the CDC, after the latter issued a draft of updated recommendations in support of circumcision based on the AAP's position statement. The authors of this letter noted not only the numerous methodological errors behind the AAP's position statement, but "the troubling fact . . . that the CDC completely ignored the psychological effects of genital cutting on male children." Among the conclusions of these psychologists was that "circumcision causes significant psychological harm in children and adolescents" and that "by encouraging circumcision, medical professionals are shaming [intact] boys' bodies."

So, aside from the AAP, whose members have a financial interest in perpetuating infant circumcision, where does the rest of the medical community actually stand on this question? Your viewers deserve to know. This is what the Royal Dutch Medical Association (KNMG) has to say: "[N]on-therapeutic circumcision of male minors is a violation of children's rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications - bleeding, infection, urethral stricture, and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence." This is what the Canadian Paediatric Society has to say about it: "The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns." Here's what the Royal Australasian College of Physicians has to say: "After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand." In fact, there is not a single professional medical organization on Earth that recommends routine infant circumcision. Every research arm of every major medical organization ever tasked with assessing infant circumcision has found insufficient evidence to warrant recommending it. That holds even for its most ardent defender in the U.S. - the American Academy of Pediatrics. As you have noted, The AAP's own position statement on circumcision is that ". . . existing scientific evidence is not sufficient to recommend routine circumcision [my emphasis]." The AAP's position statement goes on to say that "because the procedure is not essential to a child's current well-being, we recommend that the decision to circumcise is one best made by parents in consultation with their pediatrician taking into account what is in the best interests of the child, including medical, religious, cultural, and ethnic traditions [my emphasis]." As is obvious, the AAP's position statement professes to represent not exclusively medical best practices but instead adopts a position in support of what it concedes is not a medically necessary but rather is essentially a cultural practice. Again, I would remind you that to argue on behalf of circumcision on the basis of "religious, cultural, and ethnic traditions" not only is not appropriate on the part of a medical organization but these are the very same justifications that have been used and continue to be used to defend the practice of female genital mutilation.

Nary a mention of the significant and growing opposition to circumcision within the medical community itself, as opposed merely to the opposition among human rights groups such as Bloodstained Men, was made by you in your report. Yet this, too, is information with which your viewers should have been provided. Indeed, when reporting on this topic, the countervailing weight of the medical opinion in opposition to the AAP's tepid but unmistakable endorsement of infant circumcision is information that is required of any legitimate news outlet by the principle of fair and balanced reporting. Your failure to include it thus conveyed the erroneous impression that Bloodstained Men is out of step with medical opinion and, therefore, a "fringe" group. It is not. Its tactics may be "fringe," but on the question of the ethics and validity of nonconsensual infant circumcision, Bloodstained Men stands foursquare within the majority of world opinion.

I observed above that your story merely recycled long discredited sound bytes and misinformation regarding the risks and efficacy of infant circumcision when you stated, "Risks include bleeding, swelling, and botched procedures. Benefits include prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted diseases including HIV." Let's look into the purported benefits of circumcision a little more deeply.

A reduction in the risk of penile cancer is one oft-cited benefit, and one you mentioned yourself. Yet the American Cancer Society itself has written that "circumcision is not of value in preventing cancer of the penis." In fact, penile cancer is so rare that a male is more likely to develop breast cancer than penile cancer yet, curiously, infant boys' breast buds are not routinely amputated along with their foreskins. Another claim is that circumcision can reduce the risk of the adult male or his sexual partner's contracting an STD or the human papilloma virus (HPV). But not only are there far more effective measures that can be taken to prevent these, such as the use of condoms and the administration of the HPV vaccine, but these measures do not sacrifice a functionally important part of the male genitalia. (It is also unethical and irresponsible to imply that one need not use a condom simply because one has been circumcised.) Still another medical justification for circumcision is that it reduces the risk of an infant's getting a urinary tract infection (UTI), but girls are ten times as likely as boys to develop UTIs and, when they do, girls are routinely administered antibiotics as a remedy. Why is genital surgery indicated prophylactically in boys to lessen the risk of developing a UTI while the far less invasive and far less risky intervention of administering antibiotics is employed to treat UTIs in girls? Given that UTIs are far more common among females than males, the "cost-benfit" justification for male circumcision becomes even weaker. As for its role in reducing the risks of contracting HIV, this medical myth comes primarily from two African studies that purported to demonstrate the efficacy of prophylactic circumcision. Yet these studies have been roundly criticized for their methodological errors as well as for their hyperbolic claims as to the reduction in HIV transmission rates. What these studies reported as a 60% reduction was in fact a relative reduction as opposed to an absolute reduction. The actual reduction in the rate of transmission was found to be in the neighborhood of one and a half percent.

In sum, there is a veritable mountain of peer-reviewed research and authoritative medical opinion that not only does not support infant circumcision but positively condemns it. Yet you chose in your coverage to omit this fact entirely and that is why I say that your reporting here was biased and superficial and that your viewers were not well served by it.

I commend you for encouraging parents to do their "homework" and to seek information from "reputable sources" but I am bewildered by your own failure to do the same in preparing this story. I would also urge your viewers, if they seek information from their OBGYN or pediatrician about infant circumcision, to ask them why men in Europe, where circumcision is rare, have lower rates of STIs, including HIV, than men in the United States, where circumcision is common. They should also ask their OBGYN or pediatrician to describe and explain both the anatomical and histological structures of the male prepuce. Likewise, parents should ask their OBGYN or pediatrician to explain the centrality of the male prepuce to male sexual sensation and response, as well its functional role during intercourse. And they should ask about the fact that women partners of men who have undergone circumcision (either volitionally, or who have been subjected to it without their consent, as most of us have) frequently report problems with intercourse including painful intercourse. In this regard, parents may also wish to ask their OBGYN or pediatrician why the AAP did not look at a single study on the long-term effects of circumcision on male genital function and sensation when it revised its position on circumcision. Finally, parents should ask their OBGYN or pediatrician about the normal development of the penis and at what age the prepuce (or foreskin) naturally detaches from the glans (to which it is fused at birth) and at what age it is appropriate to retract the prepuce in the course of performing normal hygiene. If their OBGYN or pediatrician cannot answer any and all of these questions to their satisfaction, they may wish to take their medical consumer business elsewhere. At the very least, if their OBGYN or pediatrician cannot demonstrate a basic knowledge of the structure and function of the male prepuce, parents should be deeply skeptical about the wisdom of allowing her or him to amputate it from their child's body.

A final word. In your report on this demonstration and the position of Bloodstained Men, you made no mention whatsoever of the ethics of this invasive, traumatizing, painful, medically unnecessary, controversial and increasingly discredited surgery. Your only oblique references to this aspect of the subject were the observation that Bloodstained Men considers male genital cutting "cruel" and your quotation by Mr. Guiremand of Bloodstained Men that nonconsensual circumcision "violates the right of someone to have control over [his] own body." I find it troubling that you did not pursue this line of inquiry in your report. After all, it is precisely the ethical dimension of nonconsensual circumcision that is at the very heart of the movement to eradicate it. In this respect, the movement to end non-therapeutic male genital cutting is no different than its sister movement to end non-therapeutic female genital cutting. Thus, not only from the standpoint of balanced medical reportage but from the standpoint of serving the public interest by highlighting the ethical dimension of a medically unnecessary and nonconsensual yet routine amputation, you missed an important opportunity. I would urge you, therefore, to look into this topic further and see what medical ethicists such as Brian Earp, physicians such as Morten Frisch and Adrienne Carmack, and legal scholars such as Peter Adler have to say about it. I hope that you will follow up with more detailed, more balanced, and more enlightening coverage of this topic for your viewers in the near future.