American Academy of Pediatrics 2012 Policy
In 2012, the Academy of Pediatrics (AAP) reviewed the many current claims of benefit for circumcision and published a position statement that concluded that “the health benefits outweigh the risks.” However, in this same statement, they admitted no less than four times that the rates of complication, morbidity, and mortality are unknown.[172, p. e772, e775]
Indeed, in a follow-up editorial published in Pediatrics, in May 2016, Andrew Freedman, a member of the AAP’s 2012 Circumcision Task Force, referring to the literature review his committee undertook, conceded that “[d]ifficulties with this approach included the lack of a universally accepted metric to accurately measure or balance the risks and benefits. In particular, there was insufficient information about the actual incidence and burden of non-acute complications.”
It is astonishing that, given such an admission, a leading professional organization would declare any net benefit for an amputative procedure upon children, a failing for which the AAP has been soundly – and rightfully – criticized.
A possible explanation is found in Freedman’s further admissions:
- that the practice is “cultural” and “non-therapeutic,”
- that “for the most part, parents [in ‘the West’] choose what they want for a wide variety of nonmedical reasons,” including “religion, culture, [parental] aesthetic preference, familial identity [i.e. to make the son match father or brothers], and personal experience,” and
- that part of the goal of the task force was to protect the parental option to circumcise a child for any such reasons, irrespective of medical factors.
Tellingly, Freedman also states that while, as physicians, “we claim authority in the medical realm, we have no standing to judge on these other [cultural] elements” – though, as he himself admitted (above), that is exactly what the Task Force did.
The tortuous 150-year-old history of spurious protective or curative claims for male circumcision has involved scores of ‘diseases’ as diverse as bedwetting, hip dysplasia, and tuberculosis. Because of this history, the many individual claims have often been packaged together to create the illusion that benefits, even if individually minor, at least provide cumulative protection. Medical professionals striving for modern evidence-based (and ethical) medical practices, however, could fairly conclude that many of the current benefit claims for circumcision are, indeed, window dressing to disguise ‘cultural brokerage’, rather than good science.
172. American Academy of Pediatrics, Task Force on Circumcision. Male circumcision. Pediatrics 2012;130:e756-e785.
173. Freedman AL. The circumcision debate: beyond benefits and risks. Pediatrics. 2016;137(5). Epub 2016 Apr 6.
174. Frisch M, Aigrain Y, Barauskas V, Bjarnason R, Boddy SA, Czauderna P, et al. Cultural bias in the AAP’s 2012 Technical Report and Policy Statement on male circumcision. Pediatrics. 2013;131(4):796-800.
175. Svoboda JS. Circumcision–a Victorian relic lacking ethical, medical, or legal justification. Am J Bioeth. 2003;3(2):52-4.