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Copyright 2018 by Trish Causey.
One of my favorite quotes waxes poetically, “Dissension is the highest form of patriotism”. While usually (and wrongly) attributed to Thomas Jefferson, the message of mutiny apropos is still a valuable lesson in not allowing the government to hoodwink the public with unwarranted policies, particularly in regard to health.
CDC & CIRCUMCISION
In August 2018, the Centers for Disease Control and Prevention (CDC) released their long-awaited rebuttal to their 2014 “Recommendations for Providers Counseling Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, Sexually Transmitted Infections, and other Health Outcomes,” which included the document’s new title, “Summary of Public Comments and CDC Responses to Public Comments for Information for Providers Counseling Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV infection, Sexually Transmitted Infections, and other Health Outcomes”.
The CDC’s documents listing their ridiculous responses to the public comments as well as their laughable peer review rounds can be found here, with the full .PDF of public response rebuttals located here.
The CDC’s stance is to encourage doctors to recommend intact men and teens get circumcised, even if they have absolutely no problem with their foreskin. This means doctors are now being encouraged by a federal agency to offer unsolicited medical advice and recommend an unnecessary medical amputation of a healthy, functioning organ of a man’s body. It is important to note that recommending unnecessary medical procedures, much less soliciting non-therapeutic medical intervention, is generally considered a violation of medical ethics.
Here is an example of the impact of the CDC’s statement: if an intact man went to his doctor for a sore throat, the doctor could recommend circumcision for no reason.
Conversely, if the intact man went to his doctor and requested an appendectomy even though there were no problem with his appendix, the doctor would refuse on the basis that there is no cause to remove a healthy organ that is functioning properly. In fact, there is no confirmed function of the appendix – no one is sure what it actually does; but no one has ever suggested baby boys or adult men get their appendix cut out in order to prevent appendicitis. The irony is that the male foreskin has 16 known functions, from protecting the urethra and the glans to intense sexual pleasure and triggering the ejaculation reflex.
To begin, the CDC noted that the public comments largely fell into two categories: (a) the CDC’s review methods were inadequate, and (b) the “CDC is untrustworthy, shameful, distrustful, etc.” (Page 1) Throughout the document, many of the CDC’s responses begin with “The CDC recommendations are based on a comprehensive evaluation of scientific data on the health risks and benefits of medical male circumcision.” This means the CDC did not conduct a clinical trial to assess the validity of a pro-circumcision stance for intact men and teens. Nor did the CDC include studies that have shown circumcision has no benefit, such as the study conducted by the United States Navy; or data proving the function of the foreskin or the harm caused by circumcision, such as any of the Taylor studies; or studies showing that foreskin creates superior sexual satisfaction for a man’s partners, such as in the O’Hara studies.
An RCT is a randomized controlled trial, which is a scientific, clinical experiment intended to prevent bias when examining a potential medicine or treatment. The CDC relied on various cherry-picked RCT’s that supported their prejudicial preference toward circumcision, which is the antithesis of the scientific method. For instance, on Page 2, the CDC notes that 537 public responses were concerned that the CDC did not include studies that proved male circumcision has no benefits along with 397 comments concerned with the CDC making its recommendation based on previous studies that showed a bias toward the medical industry’s prevalence toward routine circumcision.
In Round 1 of the peer review of the original statement, Reviewer #3 splendidly took the CDC to task for its ragtag approach in assembling the information for this statement. While I highly suggest every intactivist read this 230-page Round 1 if for no other reason than Reviewer #3’s comments, Reviewer #3 calls out the CDC from the onset and pulls no punches:
[T]he most remarkable thing is that the CDC is recommending clinicians and health care providers relay information that is counterfactual, incomplete, and biased to medical decision makers. In essence, they are deliberately encouraging health care providers to misinform their patients and thus commit medical malpractice.
The go-to reasons for circumcision of neonates generally revolve around the myths of preventing urinary tract infections (UTI’s), hygiene, penile cancer, and HIV/AIDS transmission. Urinary tract infections are caused by bacteria, which means a simple antibiotic can remedy that pretty quickly. Any fear of smelly smegma can be alleviated with a quick shower each day, sans soap under the foreskin; normal, healthy smegma is necessary for penis health and has no bad odor or color. Penile cancer is one of the most rare cancers and occurs much less frequently than breast or ovarian cancers. HIV/AIDS is most commonly spread between intravenous drug users and sexually-active adults not babies. Therefore, the neonatal pro-circumcision myths are now busted.
The main reasons quoted by the CDC for recommending circumcision of adult males concern the transmission of HIV, other sexually-transmitted illnesses, and other health issues. As stated above, the most common method of giving or getting HIV/AIDS is through 1) shared needles due to intravenous drug use and 2) unprotected sex between men. I cannot fathom how circumcising a man helps him not use dirty needles; and other than total abstinence, condom use is still the best means to prevent transmitting or contracting a sexual disease – and that includes HIV/AIDS.
In 2013, renown pediatrician Dr. Robert Van Howe published a paper in ISRN Urology, writing:
In studies of general populations, there is no clear or consistent positive impact of circumcision on the risk of individual sexually transmitted infections. Consequently, the prevention of sexually transmitted infections cannot rationally be interpreted as a benefit of circumcision, and any policy of circumcision for the general population to prevent sexually transmitted infections is not supported by the evidence in the medical literature.
BUT WAIT…. THERE’S MORE….
On Pages 17 and 18 of the public response rebuttal, the CDC spews some of the most ludicrous anti-scientific pro-circumcision drivel I have ever seen. After working so hard to justify their recommendation of cutting adult men, the CDC thoroughly backpedals into incompetence to avoid addressing some of the public’s informed and common-sense comments.
For the 260 public comments that concerned actual counseling procedures (Page 16), section “d.” public comment suggested to “[c]ounsel patients on proper care of intact foreskin…”, to which the CDC replied that this type of health counseling was “outside the scope of the recommendation statement”. (Page 17) I was gobsmacked. Outside the scope? A 30-page governmental document is filled with justifications for cutting off a man’s foreskin, but saying, “Shower everyday” is somehow outside the scope of the CDC’s health knowledge? Just as “antibiotics” is outside the scope of treating a UTI? Just as “Use a condom” is outside the scope of safe-sex? Maybe my tax-dollars are outside the scope of how I want to spend my money if fabricating reasons to convince intact men to get circumcised is more important than sharing basic, proven health techniques with the public.
Section “e.” of this same rebuttal posed the novel idea that “Counseling guidelines should include benefits of foreskin” when counseling parents and adult men. (Page 18) The CDC’s answer gave suggestions for speaking to parents, noting that “some men enjoy the sensation of foreskin”; and to the adult men, the CDC writes, “adult men who undergo circumcision experience minimal or no change in sexual satisfaction or function.” THIS IS A BOLD-FACE LIE.
I can attest that men absolutely do experience a change in sexual satisfaction. I have heard from a number of men who got circumcised as an adult and hated the result because sex no longer feels good. I feature several of these men and their stories in my book, INTACT: Men As They Were Born to Be.
How can you remove an organ that has 16 known functions and expect there not to be a change in function? “Functioning” is actually all the foreskin does. The foreskin functions to protect the urethra. The foreskin functions to protect the glans. The foreskin functions to make masturbation and sex incredibly enjoyable for the man. The foreskin functions to make sex more enjoyable for a man’s partner. The foreskin functions to keep a woman’ vaginal fluid inside the vagina so that sex is not painful. A man’s foreskin works 24/7/365. A man’s foreskin never sleeps.
Adding insult to injury, the CDC goes on to say, “There is a lack of evidence available from rigorous, well-designed scientific studies demonstrating the health benefits of an intact foreskin”. Obviously, the CDC did not look for the studies conducted by the U.S. Navy, the O’Hara’s, or any of the Taylor studies. Nor did the CDC consider that every boy in the world is born with foreskin and the majority of men in the world are intact. These might be clues that foreskin is normal and has some benefits.
In the United States, most neonatal circumcisions are perpetrated by OBGYN’s and pediatricians. In 1999, the American Academy of Pediatrics (AAP) had declared circumcision to be unnecessary. The importance of this stance cannot be understated because the AAP has incredible influence over the standard of care doctors provide their young, vulnerable patients. By 2012, however, the AAP had done a 180-degree turn on their position, saying, “Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns.”
Ah. There it is. Money.
With over a million circumcisions done each year in the United States, neonatal circumcision is a bit of a cash-cow for OBGYN’s and pediatricians; neonatal circumcision costs between $250 and $500. However, the growing success of intactivism over the past 20 years has yielded a noticeable increase in baby boys being left intact after birth. According to IntactAmerica, the circumcision rate in the United States has dropped to 55%, down from over 90% in the 1970s. This – combined with the immigration of intact men from non-cutting cultures – i.e., everywhere else in the world – indicates that the number of intact men in the country is actually increasing.
Adult circumcision can easily cost $600 to $1,000 just for the urologist’s fee, and that does not include the fees incurred by the surgical center, the anesthesiologist, follow-up doctor visits, and pain meds (lots and lots of pain meds). Overall, adult male circumcision can cost between $1,500 to $3,200 and may not be covered by a man’s insurance. So you can see why doctors might want to encourage healthy men to get cut even when there is no indication that circumcision is medically necessary.
This begs the question if money is a motivating factor in why the CDC has taken up a position as being pro-circumcision for intact men and teens. If the CDC’s position convinces the growing numbers of intact males to get circumcised as teens or adults, this could become lucrative for urologists and other would-be cutters looking to earn extra cash. There’s no telling how many Big Pharma and medical supply companies might be greasing the wheel of the pro-circumcision upsurge at the CDC. Regardless of whose money is talking, rest assured that the public is listening.
When disseminating information to the American public, the CDC refers to several laws, such as the Information Quality Act (2000), and several departments within the government designated to assure the standards by which governmental agencies establish official statements for the American people. Statements are usually defined as either ISA: Influential Scientific Assessment, or HISA: Highly Influential Scientific Assessment. (Source)
The CDC’s endeavor to promote circumcision to American intact males was determined to be so important in its potential impact that is was categorized as HISA, a Highly Influential Scientific Assessment. Therefore, the CDC recognizes that encouraging doctors to give unwanted and unsolicited counseling about circumcision to otherwise healthy men and teens could have a significant effect on their lives and bodies.
Without overstating the severity of the CDC’s pro-circumcision statement, the inference of a pro-circumcision recommendation from a federal agency implies that circumcision of post-pubescent American males is on its way to becoming federal health policy. As an American, as a parent, and as tax-payer, I will not sit by while this happens. Basic, well-known health practices of daily hygiene, safe-sex, and antibiotics should not be “outside the scope” of America’s foremost health authority; nor should a governmental agency encourage doctors to violate medical ethics and offer unneeded medical procedures to healthy men.
Perhaps dissension is the best activism when the government wants to engrave its opinion in your flesh.
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