The Circumcision Decision: Who Made You The Decider?

By Nina Cohen © 2012

An open letter of response to Norine Dworkin-McDaniel's essay Circumcision Decision which won the 2012 Third Annual Two Kinds of People Essay Contest.

Photograph by Danelle Frisbie, Genital Integrity Awareness Week 2012, Washington D.C. 

Dear Norine,

Your sexual preference for circumcised penises aside, the genitals you chose to have cosmetically, functionally, permanently and surgically altered belong to your son. He may grow up to have preferences different from yours. His future lovers may have preferences different from yours. Your husband's preference differed from yours. As a woman who has been fortunate to have both intact and circumcised lovers, I can assure you that my preferences differ from yours.

Key men in my life would also beg to differ; my partner thanked his mother for "letting him keep" his foreskin. My brother wishes that our parents had told the doctor to leave his alone. It pains me to think about how different his introduction to life outside the womb was from mine, and how I got to keep the body I was born with, but he did not. Circumcised boys will never know what it's like to have a whole sex organ. They will never experience the full range of pleasure they were meant to have, and are likely to lose sensation as they age. Countries with lower rates of circumcision have lower rates of ED. The sensitive glans, meant to be an internal organ and protected by the foreskin, grows calloused from years of rubbing against fabric, and the most sensitive areas of the penis, such as the frenulum, are amputated in circumcision.

As for wanting your son to fit in, a significant percentage of parents are now choosing to "bring their whole baby home," which means many of your son's peers will be au naturale. The stigma around having one's whole penis is fading - as well it should! Why should human bodies in their natural form garner distaste?

As for sexual health (which should be a non-issue for babies and little boys) I recommend that you examine the studies that show that the incidence of sexually transmitted infections is lower in circumcised men. The statistical methodology is flawed. In fact, the rates of HIV infection are higher in the United States, where more sexually active men are cut than in similarly developed regions where intact men are the majority, such as in Europe.

Again, you are neither the person whose penis is being forever diminished by your choice, nor are you a "special someone" who will ever engage in sexual activity with said penis. You are mother to the boy, not "owner." You are not a doctor making a necessary medical decision; no major health organization recommends routine infant circumcision. So why should your preference to have your son's penis surgically tailored to suit you be prioritized?

Personally, I feel truly blessed to have been born a girl in America, not a boy, such that the choice to keep my body intact as nature intended was not taken away from me by parents who felt it was their right to do so. Should I happen to want my prepuce ("clitoral hood") amputated I would want to be able to make that decision for myself, as an autonomous adult.

After all, one can always make the choice to remove healthy skin for personal reasons; whereas your son cannot choose to have himself un-circumcised should he wish to have his foreskin back. At best, he could choose foreskin restoration, a process by which the remaining skin is expanded to cover the glans. Hundreds of thousands of men are restoring, though they will never truly get back what was taken from them against their will.

Furthermore, as an adult, I could be fully anesthetized prior to surgery, as well as have effective pain relief during the recovery period. Infants are not afforded this option, as it is too dangerous to properly medicate them, and local numbing agents neither suffice to fully block the pain of circumcision, nor are they consistently used on neonates. Moreover, the recovery period is spent in diapers, where the fresh surgical wound is in frequent contact with urine and feces.

I suspect that if you were to witness a circumcision (YouTube makes such things possible for all to see) the baby's cries of pain as the foreskin is ripped and clamped and cut from the glans will likely ring in your ears for some time. In young boys, the foreskin is not yet retractable, and must be severed from the glans in a manner similar to peeling fingernails away from the nail bed. Currently, I cannot hear a baby cry without flashing back to the screams of the baby boy I watched on video, as he lay strapped spread-eagled to a Circumstraint while a doctor calmly amputated the most sensitive part of his body. How the doctor could ignore the baby's obvious agony and continue with the unnecessary surgery is beyond me. The baby went from uttering heartrending shrieks to an abrupt and eery silence. Studies show that cortisol levels skyrocket in infants traumatized in this manner, followed by their systems going into shock. They withdraw physiologically to escape the unbearable pain. Some vomit and defecate; sometimes their stomachs are pumped so the surgery can proceed. Many babies have trouble breastfeeding following circumcision. Some suffer "botched" circumcisions which require corrective surgery, or worse: some die. Why we Americans think this is "normal" is beyond me.

There are profound reasons so many of the responses to your essay are intensely negative and emotional. One of the phrases invoked by those of us who fight for the rights of girls and boys (and ultimately the men those boys will one day be) to keep their genitals intact is "Circumcision: the more you know, the more you are against it." Also favored is "His body, His choice."

For dedicated advocates of universal human rights - and most especially children's rights - there is no middle ground when these rights are at stake. In routine infant circumcision the rights of newborn males to bodily integrity are violated by parents who mean well but do not see the whole picture, as well as by a medical establishment that profits from needless penile-reduction surgery on healthy intact infants.

Please do not let prejudice and parental power blind you to the sacrifice of erogenous flesh you mandate for the man your baby will one day become when you "choose circumcision" for a son. Please let him keep the body he was born with. If all were right in the world, gratuitous genital surgery would not be a "choice" parents could inflict upon their children. To cut a male infant would be as illegal is it is to cut a female infant.

It has been against federal law to cut the genitals of girls in any way, for any reason, in the United States since the 1996 FGM law went into effect (March 30, 1997). Why are male infants undeserving of similar protection, bodily autonomy and genital integrity? What is so wrong with the bodies of baby boys that amputative surgery on their healthy penises is culturally acceptable?

Babies come into this world perfect and trusting and intact. They want comfort, safety, pleasure - not fear, separation and pain. They need nurturing in loving arms and at the breasts of their mothers - not excruciating, terrifying genital surgery at the hands of callous strangers who know full well that circumcision is medically unnecessary. Circumcision is elective surgery chosen by the parents of unwitting patients - not the patients themselves, who are too young to speak for or defend themselves.

In the hope that a more empathic perspective will dawn, I urge all of us to reread Circumcision Decision with "girl" and "daughter" in place of "boy" and "son" - with the organ known as "foreskin" replaced with "clitoral hood," and with clitorises in place of penises. We protect one, why do we chop up the other?

Imagine a father telling a mother, in no uncertain terms, after all other propaganda has failed because there is no true rationale for elective genital surgery on an intact and healthy infant: "Trust me, Sweetie - if you ever want a guy to go down on our daughter, cut off the skin around her clit. She and her future boyfriends will thank us."


Cohen is a Jewish performer and teacher who grew up in Ithaca, NY, and moved to Austin, TX for the arts scene and the sunshine. When she's not at the piano or on the stage, she puts time and energy into saving babies through her work with Intact Austin.

Intact men's shirt from Made By Momma




~~~~

The Plastibell Lie

By Robin Vaughn-Bortolus © 2012

After four days of labor to bring my sweet son into the world, he arrived perfect.

I was exhausted when a nurse came in and said that it was time for him to be circumcised. I had been preparing for my sons arrival for months. I had read everything I could to try and make sure that I made informed decisions on his behalf. I chose breastfeeding, no vaccines at birth, etc. I really thought I had covered ALL the things I would need to be prepared for.

But there I was faced with a procedure that I had failed to educate myself on: circumcision.

I told the nurse that I was not okay with my son being cut. She informed me that this hospital used a no-cut device called a Plastibell. She said that it was a pain free method for my son. It was in that moment that I made a decision on his behalf that I regret, and will regret, for the rest of my life. I signed off on the procedure.

I knew that I wasn't okay with a scalpel, knife, etc., being used on my newborn -- but here was a great cut-free, pain-free alternative, right? I could not have been more wrong.

When my son was brought back to me he was crying in such a way that shattered my heart. I knew in that instant that I had made a terrible mistake. It was only after getting home that I looked up the Plastibell method and discovered the terrible truth behind it. I was horrified at my ignorance.

Two weeks later my son had his check up and the physician told me that the Plastibell procedure had not been performed correctly - that my son's foreskin was still "to long." Without so much as asking my permission my son's doctor had his nurse begin to gather the necessary instruments to "fix the problem."

In that moment, I informed the doctor that my son was fine as he was and that we would NOT be "fixing" anything. He did not approve and we were forced to find another doctor. I failed my son when I signed those permission papers in the first place, but I refused to damage him further.

I can never take back what I subjected my son to by allowing him to altered. But hopefully by sharing this I can encourage other parents to be more informed than I was, and to not fall for the Plastibell lie.

To learn more about the Plastibell method of circumcision, that many parents are told is 'cut-free' 'blood-free' and 'pain-free' please see: Plastibell Infant Circumcision.

Hear from other parents whose sons were circumcised before they had accurate information or support at I Circumcised My Son: Healing From Regret and Keeping Future Sons Intact.

Resources on intact care and circumcision are gathered at Are You Fully Informed? and the library at Saving Our Sons.

Happy Pi Day!

Happy Pi Day!

Official Pi Day commentary: PiDay.org

Learn more on #i2 Pi Day topics at IntactNetwork.org/research or via the starting off resources at Are You Fully Informed?

*******

Circumcision Does Not Prevent Prostate Cancer

By Danelle Frisbie © 2012

Male Anatomy

1. Bladder
2. Seminal vesicle
3. Prostate
4. Pubic bone
5. Erectile tissue
6. Urethra
7. Vas deferens
8. Epididymis
9. Glans
10. Prepuce ('Foreskin')
11. Testis
12. Rete testis
13. Efferent ductules
14. Seminiferous tubules
15. Anus

The prepuce, or 'foreskin,' is an organ located on the outside of the penis or clitoris and is present from birth in all mammals on earth. The prostate is a gland located deep inside the male pelvis at the base of the penis which surrounds the neck of the bladder. The two are located no where near each other and have little bearing on one another, except for the fact that both play important roles in male sexuality.

In reference to these two organs, an article published today by Reuters titled, Circumcision tied to lower prostate cancer risk, reports that "circumcised men may have a slightly lower risk of developing prostate cancer than those who still have their foreskin..." The article goes on to discuss research by Jonathan L. Wright who states that he, "Would not go out and advocate for widespread circumcision to prevent prostate cancer. We see an association, but it doesn't prove causality." (1)

As cringe worthy as some parts of the article are, it is a good thing that Wright notes the difference between correlation and causality because we know the two often have nothing to do with one another. For those not familiar with the difference: imagine for a moment the cities you know that host a lot of churches. We'll say City A has 100 churches, City B has 50 churches, and City C has just one church. We know (thanks to the fields of criminology and sociology) that City A also has the highest rate of aggravated crime, City B has much less, and City C sees almost no crime recorded in the local police log. Does this mean that building churches increases crime? If we tear those 100 churches down, will we see a decrease in City A's crime rate? Of course not. Because there are other variables at play, and the two are merely correlated. There are no direct causalities between a church and aggravated crime. In fact, the two are about as related as the foreskin and prostate cancer.

But, we've been here before - toying with the fairy tale of prostate cancer and foreskins. We've had a long list of illnesses (both real and imagined) that we've blamed on the foreskin -- masturbation, 'promiscuity,' epilepsy, convulsions, seizures, 'sin,' blindness, deafness, cancer, sexually transmitted illnesses (STIs) of various kinds, women's health issues, HIV... and now we are back to cancer again.

In their 1996 letter to the American Academy of Pediatrics, Drs. Heath and Shingleton (VPs on The American Cancer Society's board) stated that, "Perpetuating the mistaken belief that circumcision prevents cancer is inappropriate."

Not surprisingly, in their current review of risk factors for prostate cancer, The American Cancer Society does not list being intact among factors. Included are such things as age, ethnicity, family history, diet, obesity, and smoking.

In addition, The American Cancer Society makes this statement on early detection of prostate cancer and treatment:

Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. The American Cancer Society believes that men should not be tested without learning about what we know and don’t know about the risks and possible benefits of testing and treatment. The only test that can fully confirm the diagnosis of prostate cancer is a biopsy, the removal of small pieces of the prostate for microscopic examination. However, prior to a biopsy, less invasive testing can be conducted. [...] Screening men who are older or in poor health in order to find early prostate cancer is less likely to help them live longer. This is because most prostate cancers are slow-growing, and men who are older or sicker are likely to die from other causes before their prostate cancer grows enough to cause problems. (2)

Despite The American Cancer Society's position, those who are invested in pro-cutting measures today would assert that we should forgo early detection of prostate cancer via biopsy because it is 'too invasive,' but instead conduct an even more invasive and life-long, altering surgical procedure by amputating the prepuce organ from all healthy males. Is there logic in doing so? If there is any to be found, we would surely see it played out in statistics of prostate cancer between male populations that are circumcised at birth vs. those who are not.

Yet in reality, we find just the opposite to be true.

The World Health Organization's International Agency for Research on Cancer presented the 2008 findings of incidence and mortality of prostate cancer. Statistics clearly show that rates of prostate cancer are highest in nations with the highest populations of adult circumcised men, and rates of prostate cancer are consistently lowest in nations where male circumcision is unheard of. (3)

Diagram One shows the incidence of prostate cancer (red) and mortality rate of those inflicted with prostate dancer (blue). Keep in mind that North America has one of the highest populations of adult men who were circumcised at birth.

Diagram Two shows the age-standardized incidence of prostate cancer per 100,000 men across the globe. Again, we see that the highest prevalence of prostate cancer exists in nations that also have the highest number of adult circumcised males. The lowest rates of prostate cancer are found in nations where men are almost exclusively intact.

In fact, if we didn't know better [remember correlation versus causation] we'd venture to guess that being intact serves as protection from prostate cancer! We know very little at this point within the fields of human sexuality, health, and urology about the immunological protection that is achieved by the sub-preputial (within the prepuce) flora, immunoglobulins and lytic secretions coming from within the human male body. Physicians and researchers alike have suggested that these protective properties may lend explanation to the fact that we consistently find results as those portrayed in the graphs above - men who keep their full and functioning prepuce (which serves, in part, as an immunological organ) tend to see less, not more, genital related illnesses and infection of all kinds. (4, 5, 6).

What was first debunked in the 1940s after Abraham Ravich (7) invented the mythological notion that the foreskin was to blame for prostate and cervical cancers, seems to have resurfaced in pro-cutting circles today. Maybe enough time has past that we will not recall the roots of these tall tales and will tragically fall victim to them again... And maybe enough money (unnecessary surgeries, the sale of foreskins for research and cosmetics, job opportunities) will incite even the well researched professional to cut healthy organs from healthy human beings. But in the midst of the mess, one thing is for certain: circumcision does not protect against prostate cancer.

While discussing the subject among advocates today, Kira Dawn remarked, "It never ceases to amaze me how much money and time is spent by 'researchers' hell-bent on proving that a normal human body part is the biggest threat known to mankind." Much in agreement and bewildered at today's headlines, Australian native, James Mac, noted, "These increasingly desperate and hysterical claims will only hasten the demise of forced circumcision." Let's hope that he is correct. It's high time for Americans to wise up and and put an end to such laughable nonsense.


References

1) Reuters' "Circumcision tied to lower cancer rates" at: http://www.reuters.com/article/2012/03/12/us-circumcision-cancer-idUSBRE82B08G20120312?feedType=RSS

2) American Cancer Society: Prostate Cancer at: http://www.cancer.org/Cancer/ProstateCancer/MoreInformation/ProstateCancerEarlyDetection/prostate-cancer-early-detection-toc

3) World Health Organization International Agency for Research on Cancer: Globocan 2008 at: http://globocan.iarc.fr/factsheets/cancers/prostate.asp

4) Bowen JM, Tobin N, Simpson RB, Ley WB & Ansari MM. Effects of washing on the bacterial flora of the stallion's penis. Journal of Reproductive Fertility, 1982; 32:41-45.

5) Fleiss, Paul M. & Hodges, Frederick M. (2002). What Your Doctor May Not Tell You About Circumcision. Warner Books, New York.

6) Wallerstein, Edward (1980). Circumcision: An American Health Fallacy. Springer Publishing Company, New York.

7) Ravich, Abraham. “The Relationship of Circumcision to Cancer of the Prostate” Journal of Urology, Vol. 48, 1942:298‑299.

Related reading in addition to above references:

1) Gollaher, David, L. (2000). Circumcision: A History of the World's Most Controversial Surgery. Basic Books, New York.

2) Ritter, Thomas & Denniston, George (2002). Doctors Re-examine Circumcision. Third Millennium Publishing Company, Seattle, WA.

3) Romberg, Rosemary, The Painful Dilemma, Chapter 14: The Question of Prostate Cancer at: http://circumcisionthepainfuldilemma.wordpress.com/table-of-contents/chapter-14/

4) Circumcision Information Research Pages: Penile Cancer at: http://www.cirp.org/library/disease/cancer/

5) Joseph Lewis' Latest Pro-Circumcision Canard: 'Circumcision Prevents Prostate Cancer'.

6) Hugh, of Circumstitions.org response: http://www.circumstitions.com/news/news44.html#prostate

~~~~

Ben Affleck and Jennifer Garner Welcome Healthy, Whole Baby Boy

We don't dive into the celeb gossip too often here at SOS, but when Ben Affleck and Jennifer Garner announced they welcomed baby boy, Samuel, to the family yesterday (Feb 27), it was cause for a few high-fives as this is one Hollywood babe who will likely be keeping all his parts.

Having grown up intact, Affleck has discussed circumcision briefly in interviews in the past, saying that he "hates it." But his son is sure to love him for keeping him happy, healthy and whole!

Samuel Garner Affleck joins his two older sisters, Violet (6) and Seraphina (3) in the Affleck Garner family.

Above: Jon Stewart (Comedy Central) prop; Sept 2006

Below: Video clip below starts at minute 4:40

Medicaid Response Letter to Circumcision Coverage

What follows is a response to the document, Medicare, Medicaid, Children's Health Insurance Programs: Transparency Reports and Reporting of Physician Ownership or Investment Interests, written by a Mothering.com member, and shared with the SOS community.

The deadline for submissions on this particular matter is February 17, 2012. However, this form can be used and modified for a number of letter-writing purposes addressing Medicaid and their current funding (with tax payer dollars) to cover infant circumcision in the United States.

If you would like to submit a response on this matter, you can do so from any nation in the world:

(1) Copy/paste the text below into a document of your own to save, or download the letter here:

http://www.4shared.com/office/eVb3mSuY/CMS-2011-0191_17February2012.html

(2) Go to the Regulations.gov submission page:

http://www.regulations.gov/#!submitComment;D=CMS-2011-0191-0001

(3) Complete the required fields (Country, State or Province, Postal Code and Category) and as many optional fields you would like to. Click browse under '3. UPLOAD FILE(S)' to upload the saved document from your harddisk. Click 'Submit'.

If using this form letter for other Medicaid writing purposes, alter as necessary.

See also: Are YOU Paying for Circumcision?

Response to “Medicare, Medicaid, Children's Health Insurance Programs: Transparency Reports and Reporting of Physician Ownership or Investment Interests” [regulations.gov Docket No. CMS-2011-0191, FR Doc No: 2011-32244]

Thank you for the opportunity to provide feedback to “Medicare, Medicaid, Children's Health Insurance Programs: Transparency Reports and Reporting of Physician Ownership or Investment Interests” [regulations.gov Docket No. CMS-2011-0191, FR Doc No: 2011-32244]. This response document shall briefly address the important role that increased transparency and public awareness of financial relationships between drug and device manufacturers and certain health care providers has to play in safeguarding patients against government agencies regulatory failures; in filling information gaps on exculpatory consent forms regarding the use of foreskin and other healthy tissue excised from minors; and the need for greater transparency to help safeguard patients from the potential clinical bias of physicians and teaching hospitals in receipt of NIH research funding.

Medicaid and Circumcision

Circumcision of male minors, in the absence of a clear and present immediate medical indication, is a controversial practice within the medical profession (KNMG 2010; Smith 2011), with doubts having been raised in the professional literature about whether it is even lawful to circumcise, and to allow the circumcision, of healthy boys at the expense of Medicaid (Adler 2011). Despite this, more than 1.14 million circumcision procedures were performed on male infants in U.S. hospitals in the year 2009 (AHRQ 2011), with hospitals in states in which Medicaid continues to cover circumcision of male minors in the absence of a clear and present immediate medical indication, having circumcision rates higher than states where it does not (CDC 2011). Thus at the outset, a stipend from the state acts as an incentive for physicians to subject minors to a controversial medical procedure, in the absence of a clear and present immediate medical indication, and one that will continue to dilute other government expenditures and initiatives aimed at improving child and infant health (HHS 2011a).

FDA, Circumcision Devices and Regulatory Failure

In 2000, the Food and Drug Administration [FDA] issued a public health notice about safety concerns regarding Gomco [and Gomco-type] circumcision clamps and Mogen [and Mogen-type] circumcision clamps, having received approximately 20 injury reports a year between 1996-2000 including lacerations, hemorrhaging, penile amputation and urethral damage (FDA 2000).

As of September 2011, the FDA has received a further 139 reports of problems related to circumcision clamps, including 51 injuries, twenty-one of those which were related to Mogen-type clamps, all but one of which involved injuries (Hennessy-Fiske 2011).

Despite this, the FDA has yet to issue a recall on any circumcision devices, and many physicians and teaching hospitals continue to use Gomco- and Mogen-type circumcision clamps (Hennessy-Fiske 2011).

On the 13 December 2011, the OIG published a report critical of the FDA's failure to oversee states inspections of food facilities (OIG 2011a), suggesting the possibility that more systemic problems exist within the agency, impacting it's ability to perform it's basic regulatory functions.

Increased transparency and public awareness of financial relationships between drug and device manufacturers and certain health care providers thus has an important role to play in safeguarding patients against government agencies regulatory failure, and one that must take precedence over drug and device manufacturers professed concern for increased regulatory and administrative 'burden'.

Foreskin-derived Medical and Cosmetic Products and the Informed Consent of Donors

Foreskins excised from minors in the absence of a clear and present immediate medical indication, almost invariably present in a normal healthy state, and as such their excision and preservation contributes little to the study of the pathology of disease. Further, the most promising advances in the field of cellular regeneration research, are to be found in cell lines derived from adult sources including dental pulp cells (Authur et al 2008), uterine cells (Bock 2011) and bone marrow cells (Wada et al 2011); and diagnostic and therapeutic application of patient-derived cells (HHS 2011b; Pasca et al 2011), rather than cell lines derived from the excised healthy foreskins of minors.

Products derived from foreskins excised en masse from minors in the absence of clear and present immediate medical indications, are frequently utilised in the commercial medical product, and more especially cosmetics industries (Advanced Healing 2011; Ballantyne 2009; LifeCell 2012; Organogenesis 2011; Pitman 2008; SkinMedica 2011). As observed by the U.S. Department of Health and Human Services Office of Human Research Protections, “Changing technology in the field of genomics has dramatically increased the amount and nature of information about individuals that can be obtained from their DNA” (OHRP 2011). Valid concerns therefore exist for the future privacy of children whose healthy tissues are likely to be acquired by commercial interests in the cosmetic and medical product industries - and may be retained indefinitely - due to presently unforeseeable technological advances in the field of genomics.

Doubts exist about the appropriateness of utilising products derived from foreskin and other healthy tissue excised from minors, in the cosmetic and medical product industries, on the basis of exculpatory consent forms signed by parents and legal guardians of minors, and whether it is appropriate for parents and legal guardians to give explicit consent for these purposes.

The provision of information to parents on circumcision consent forms about the storage, transfer, processing, sale or any other use of excised healthy foreskins is unstudied. However, a survey conducted by Schaefer et al (2011) of consent forms from U.S. in vitro fertilization clinics and the provision of information to egg donors of the potential for embryonic research using donated eggs, concluded that “egg donors in the United States, including some who may have a moral objection to research and stem cell research, are not being informed that embryos created with their donated eggs may in fact be used for these purposes”, suggesting the possibility that incomplete information is also being provided to parents about the use of foreskin and other healthy tissue excised from minors. Similarly, information about the original source of human skins cells used in cosmetic and medical products, is ominously absent from the websites of some manufacturers who utilise foreskin-derived ingredients in their products (LifeCell 2012; SkinMedica 2011).

Increased transparency and public awareness of financial relationships between drug and device manufacturers and certain health care providers thus has an important role to play in filling information gaps on exculpatory consent forms regarding the use of foreskin and other healthy tissue excised from minors, and one that must take precedence over drug and device manufacturers professed concern for increased regulatory and administrative 'burden'.

Safeguarding Patients from the Potential for Clinic Bias Resulting from NIH Research Funding

In 2011, the Department of Health and Human Services Office of Inspector General [OIG] published a series of audit reports revealing that throughout the fiscal years 2000-2010, institutes under the aegis of the National Institutes of Health [NIH], did not comply with the time and amount requirements specified in appropriations statutes, in awarding federal contracts to commercial partners, committing the federal government to tens of millions of dollars of expenditure ahead of appropriation of funds from Congress. Specific examples involving the National Institute of Allergy and Infectious Diseases [NIAID] include Contract N01-AI-15416 with the University of California at San Francisco (OIG 2011b), Contract N01-AI-3-0052 with Avecia Biologics Limited (OIG 2011c), Contract HHSN266-2006-00015C with NexBio, Inc. (OIG 2011d) and Contract HHSN272-2008-00013C with the EMMES Corporation (OIG 2011e).

During this time, federal agencies also funded and sponsored research conducted abroad, that would be unlikely to receive ethical approval to be conducted in the United States, incorporating the excision of healthy tissue from subjects in the absence of a clear and present immediate medical indication . Specific examples include NIAIDs sponsorship and funding of ClinicalTrials.gov registered trials NCT00059371 and NCT00425984 (Bailey et al 2007; Gray et al 2007). Consent forms for these trials failed to include then known information, from the professional medical literature, about the importance to mens sexual health of the foreskin and other tissues removed by circumcision (Taylor et al 1996).

Of concern, is that the results of the above trials are increasingly being used to justify the en masse circumcision of male minors in the absence of clear and present immediate medical indications, both in the United States and abroad, and in the former instance, at the expense of Medicaid (CDC 2011; Kim 2011).

To help inform patients of potential clinical bias of physicians in receipt of NIH research funding, it is imperative that the proposed publicly accessible, centralised website be expanded to include NIH grants awarded to physicians and teaching hospitals. This could be accomplished with minimal burden by cross-referencing the names of physicians and teaching hospitals with grant information already available through sources such as ClinicalTrials.gov.

Conclusion and Action Required

Increased transparency and public awareness of financial relationships between drug and device manufacturers and certain health care providers has an important role to play in safeguarding patients against government agencies regulatory failure, and one that must take precedence over drug and device manufacturers professed concern for increased regulatory and administrative 'burden'.

Increased transparency and public awareness of financial relationships between drug and device manufacturers and certain health care providers has an important role to play in filling information gaps on exculpatory consents forms regarding the use of foreskin and other healthy tissue excised from minors, and one that must take precedence over drug and device manufacturers professed concern for increased regulatory and administrative 'burden'.

To help inform patients of potential clinical bias of physicians in receipt of NIH research funding, it is imperative that the proposed publicly accessible, centralised website be expanded to include NIH grants awarded to physicians and teaching hospitals. This could be accomplished with minimal burden by cross-referencing the names of physicians and teaching hospitals with grant information already available through sources such as ClinicalTrials.gov.

References

Adler P W (2011) Is it lawful to use Medicaid to pay for circumcision? J Law Med. 2011;19(2):335-53 Abstract available at http://sites.thomsonreuters.com.au/journals/2011/11/28/journal-of-law-and-medicine-update-december-2011/ Accessed: 2012-01-08 Archived by WebCite at http://www.webcitation.org/64YPGfMLo

Advanced Healing (2011) Dermagraph Active Living Cells Overview Link http://www.dermagraft.com/about/overview/ Accessed: 2012-01-16. Archived by WebCite at http://www.webcitation.org/64jhakjim

AHRQ (2011) Hospital Stays for Children, 2009. HCUP Statistical Brief #118 prepared by Yu, H. (RAND Corporation), Wier, L.M. (Thomson Reuters), and Elixhauser, A. (AHRQ) August 2011. Agency for Healthcare Research and Quality, Rockville, MD Full-text available at http://www.hcup-us.ahrq.gov/reports/statbriefs/sb118.jsp

Arthur A, Rychkov G, Shi S, Koblar SA, Gronthos S (2008) Adult human dental pulp stem cells differentiate toward functionally active neurons under appropriate environmental cues in Stem Cells. 2008 Jul;26(7):1787-95. Epub 2008 May 22 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18499892

Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, Williams CF, Campbell RT, Ndinya-Achola JO (2007) Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet369(9562),643–656 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17321310

Ballantyne, C (2009) A Cut above the Rest?: Wrinkle Treatment Uses Babies' Foreskins Scientific American 12 February 2009 [Epub] Full-text available at http://www.scientificamerican.com/article.cfm?id=a-cut-above-the-rest-wrin Accessed: 2012-01-18. Archived by WebCite at http://www.webcitation.org/64mLMhvCA

Bock, R (2011) Uterine stem cells used to treat diabetes in mice NIH News Full-text available at http://www.nih.gov/news/health/aug2011/nichd-30.htm Archived by WebCite at http://www.webcitation.org/64jhMI7v9

CDC (2011) Trends in In-Hospital Newborn Male Circumcision - United States 1999-2010 Prepared by Xinjian Zhang, PhD, Sanjyot Shinde, PhD, Peter H Kilmarx, MD, Robert T Chen, MD, Div of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Shanna Cox, MSPH, Lee Warner, PhD, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; Maria Owings, PhD, Div of Healthcare Statistics, National Center for Health Statistics; Charbel El Bcheraoui, PhD, EIS Officer, CDC. Morbidity and Mortality Weekly Report (MMWR) Full-text available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a4.htm?s_cid=mm6034a4_w

FDA (2000) Potential for Injury from Circumcision Clamps Food and Drug Administration Full-text available at http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealthNotifications/ucm062279.htm

Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, Kiwanuka N, Moulton LH, Chaudhary MA, Chen MZ, Sewankambo NK, Wabwire-Mangen F, Bacon MC, Williams CF, Opendi P, Reynolds SJ, Laeyendecker O, Quinn TC, Wawer MJ (2007) Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet369(9562),657–666 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17321311

Hennessy-Fiske, Molly (2011) Injuries linked to circumcision clamps. Los Angeles Times 26 October 2011http://www.latimes.com/health/la-he-circumcision-20110926,0,4367816.story Accessed: 2012-02-12. Archived by WebCite at http://www.webcitation.org/65PYUIZ0D

HHS (2011a) Obama Administration awards nearly $300 million to states for enrolling eligible children in health coverage HHS Newsroom December 28, 2011 Full-text available at http://www.hhs.gov/news/press/2011pres/12/20111228a.html

HHS (2011b) Scientists Rejuvenate Cells From Elderly Department of Health and Human Services Health Highlights 1 November 2011 Full-text available at http://www.healthfinder.gov/news/newsstory.aspx?Docid=658486

Kim, A (2011) Botswana’s Infant Circumcision Campaign in PRI's The World Article archived at http://liveweb.archive.org/http://www.theworld.org/2011/10/botswana-infant-circumcision-campaign/ Retrieved 11 October 2011

KNMG (2010) Non-theraputic circumcision of male minors Royal Dutch Medical Association Full-text available at http://knmg.artsennet.nl/web/file?uuid=579e836d-ea83-410f-9889-feb7eda87cd5&owner=a8a9ce0e-f42b-47a5-960e-be08025b7b04&contentid=77976

LifeCell (2012) AlloDerm Tissue Matrix defined Full-text available at http://www.lifecell.com/alloderm-regenerative-tissue-matrix/95/ Accessed: 2012-01-18. Archived by WebCite at http://www.webcitation.org/64mqrqxmQ

OHRP (2011) Regulatory Changes in ANPRM Comparison of Existing Rules with Some of the Changes Being Considered Office of Human Research Protections website Full-text available at http://www.hhs.gov/ohrp/humansubjects/anprmchangetable.html Accessed: 2012-01-16. Archived by WebCite at http://www.webcitation.org/64jh4cWek

OIG (2011a) Vulnerabilities in FDA's Oversight of State Food Facility Inspections (OEI-02-09-00430) Health and Human Services Office of Inspector General website 13 December 2011 Full-text available athttp://oig.hhs.gov/oei/reports/oei-02-09-00430.pdf

OIG (2011b) Appropriations Funding for National Institute of Allergy and Infectious Diseases Contract N01-AI-15416 With the University of California at San Francisco Audit (A-03-10-03120) on the Health and Human Services Office of Inspector General website 10 July 2011 Available athttp://oig.hhs.gov/oas/reports/region3/31003120.pdf

OIG (2011c)Appropriations Funding for National Institute of Allergy and Infectious Diseases Contract N01-AI-3-0052 With Avecia Biologics Limited (A-03-10-03117) Health and Human Services Office of Inspector General website 21 September 2011 Full-text available at http://oig.hhs.gov/oas/reports/region3/31003117.pdf

OIG (2011d) Appropriations Funding for National Institute of Allergy and Infectious Diseases Contract HHSN266-2006-00015C With NexBio, Inc. (A-03-10-03119) Health and Human Services Office of Inspector General website 21 September 2011 Full-text available at http://oig.hhs.gov/oas/reports/region3/31003119.pdf

OIG (2011e) Appropriations Funding for National Institute of Allergy and Infectious Diseases Contract HHSN272-2008-00013C with the EMMES Corporation (A-03-10-03115) Health and Human Services Office of Inspector General website 31 October 2011 Full-text available athttp://oig.hhs.gov/oas/reports/region3/31003115.pdf

Organogenesis (2011) Apligraf: How Is It Made? Linkhttp://www.apligraf.com/professional/what_is_apligraf/how_is_it_made/ Accessed: 2012-01-16. Archived by WebCite at http://www.webcitation.org/64jhpT91Q

Pasca SP, Portmann T, Voineagu I, Yazawa M, Shcheglovitov A, Pasca AM, Cord B, Palmer TD, Chikahisa S, Nishino S, Bernstein JA, Hallmayer J, Geschwind DH, Dolmetsch RE (2011) Using iPSC-derived neurons to uncover cellular phenotypes associated with Timothy syndrome Nat Med. 2011 Nov 27;17(12):1657-62. doi: 10.1038/nm.2576 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22120178

Pitman, S (2008) Babies’ foreskin dubbed as new anti-aging treatment Cosmetic Design Full-text available athttp://www.cosmeticsdesign.com/Formulation-Science/Babies-foreskin-dubbed-as-new-anti-aging-treatmentAccessed: 2012-01-16. Archived by WebCite at http://www.webcitation.org/64ji8mqbP

SkinMedica (2011) Key Ingredients Link http://www.skinmedica.com/skin-care-products/skin-rejuvenation/tns-recovery-complex#tab2 Accessed: 2012-01-16. Archived by WebCite at http://www.webcitation.org/64jiK7Gdx

Schaefer GO, Sinaii N, Grady C (2011) Informing egg donors of the potential for embryonic research: a survey of consent forms from U.S. in vitro fertilization clinics Fertil Steril. 2011 Dec 22. [Epub ahead of print] Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22196714

Smith JF (2011) The professional imperative for obstetrician-gynecologists to discontinue newborn male circumcision Am J Perinatol. 2011 Feb;28(2):125-8. Epub 2010 Aug 10 Abstract available athttp://www.ncbi.nlm.nih.gov/pubmed?term=20700861

Taylor, J.P., A.P. Lockwood and A.J.Taylor The prepuce: Specialized mucosa of the penis and its loss to circumcision Journal of Urology (1996), 77, 291-295 Abstract available athttp://www.ncbi.nlm.nih.gov/pubmed?term=8800902

Wada N, Bartold PM, Gronthos S (2011) Human foreskin fibroblasts exert immunomodulatory properties by a different mechanism to bone marrow stromal/stem cells Stem Cells Dev. 2011 Apr;20(4):647-59. Epub 2010 Oct 12 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed?term=20712449

Tshirt from the Made By Momma intact shop

~~~~

Deceived

By Christina King © 2012
Dedicated to parents whose boys were circumcised at birth. 

Moms and dads of circumcised boys, this is for you:

It's easy to forget that you were deceived too.

When your son was born, you held him in your arms,

You fell instantly in love, and wished to do no harm.

The doctor came in and asked, "Do you want to circumcise?"

He told you it was for the best and fed you many lies.

"It won't get infected." He promised. "He won't get teased."

"It's cleaner." He insisted. "Intact, he'd be displeased!"

"It's a decision you must make as parents," the doctor explains.

"Do it now while you can. Babies feel little pain."

"If you don't do it now, he'll grow up to have it done."

"It's very painful for adults. Today is best in the long run."

You only wanted good for your perfect baby boy.

You hadn't the slightest idea what they would destroy.

He called it a mere flap of skin, and promised 'just a snip.'

If you had known the truth, you'd never have allowed it.

The foreskin - 15 inches square, now gone.

The soft ridges of the frenar band...

Over 20,000 nerve endings lost,

More than the surface of his hand.

Several feet of blood vessels

Are forever lost,

And this is far from all

He'll discover was the cost.

Truth eventually did find its way to you,

And you are horrified by what you found.

"What have I done to my baby?" You ask...

But in such remorse you'll drown.

So know this:

It takes a strong person to admit to something wrong.

This lets you begin to heal, even though it may take long.

You can't change the past, but you can make the future bright!

And if we all stand up together, we can make it right.

So don't blame yourself,

As the healing starts,

For listening to a doc

Who should've had your son's interest at heart.

Let him know that you are sorry, and explain.

It's okay to cry. It's okay to grieve.

You wanted the very best for him!

But instead you were deceived.

~ Christina King

~~~~

If you are the parent of a son who was circumcised at a time when you did not have accurate or complete information upon which to base your decision, you are not alone. There are many parents today electing to keep future sons, or grandsons, intact, and striving to openly share with others so that their own sons' loss is not in vain. Hear others' stories at I Circumcised My Son: Healing From Regret or visit the Keeping Future Sons Intact page today. If you would like to connect with someone personally, write to us anytime at SavingSons@gmail.com We are happy to listen or help.

Christina King serves as a gentle educator for parents and co-director at Intact Iowa and Intact Des Moines, while mothering her own children, and busily growing baby #3 - who, whether boy or girl, will remain perfectly intact as s/he enters this world.