Letter to Editors at the Vancouver Sun

OK, so Neil Pollock, a Jewish mohel and child circumcisor by trade, notorious for plugging his business whenever, wherever he can, takes advantage of  yet another situation. In response to Sharon Kirkey's article "Circumcision best left to prepubescence," he, aided by well-known circumcision czar Edgar Schoen (he goes by "Ed" now, just so you know... ain't it cute?), plugs circumcision and his own business, YET AGAIN. You can read the article, which basically reads like an informercial, right here:

http://www.vancouversun.com/health/skinny+circumcision/4599446/story.html

I took it upon myself to write a letter to the editors at the Vancouver Sun myself. Here it is:

To whom it may concern,

This is in response to Neil Pollock's shameless self promotion, and his support by Edgar (AKA "Ed") Schoen. Before anybody takes what Pollock and Schoen say seriously, there are some conflicts of interest that readers of the Vancouver Sun should know about.

First, Neil Pollock is a surgeon from Vancouver, Canada, whose sole livelihood comes from performing infant circumcision and vasectomy.[1] He charges $455.00 Canadian for circumcising children under 2 months of age,[2] and if his website is correct, he performs 2,500 annually, which means he grosses $1,137,500 Canadian on infant circumcision alone. Pollock is also a mohel by trade,[1][3] which suggests that aside from his livelihood, circumcision is of cultural and religious importance to him. Edgar Schoen also once made a living from circumcision, and has been a long-standing vocal advocate of circumcision for years. Pollock and Schoen are also both Jewish, where circumcision is a religious ritual central to their religious and cultural identities. Mentioning these men's religious affiliation is important, because belonging to a religious group where circumcision is a religious requirement is at odds with presenting anything disparaging about it; it predisposes people to presenting only that which puts circumcision in a positive light.[4]

Neil Pollock dispenses misleading, or outright untrue information. On his website, he sells his circumcision technique as "a new approach" that "has recently been developed."[5] Pollock's website uses language that suggests that he uses state-of-the-art techniques and equipment that no other surgeon possesses, by warning against others who try to "emulate" him.[6] Closer inspection reveals that Pollock isn't doing anything "new"; his website reveals that he uses the Mogen technique, which involves the Mogen clamp. The Mogen clamp was invented in 1954,[7] but it is actually one of many successors to the much older, traditional barzel device.[8]

Here are some things Neil Pollock may not tell parents about Mogen. On his website, and on this article, he insists that without experience, which he boasts for having, the methods and techniques he uses could be "potentially dangerous," however the Mogen clamp has been notorious for glans amputations, even among experienced conductors of circumcision.[9] Mogen went out of business after losing a 10.8 million dollar law suit, after a mohel severed the end of a baby's glans using one of their clamps. Mogen claimed that injury was impossible with its use. The injury behind a prior lawsuit in Fulton County Superior Court had already put Mogen on notice about the danger of the device. In a different case, at South Fulton Medical Center, another law suit was won in 2009. In that case, a child lost a third of his glans, and the plaintiffs were awarded 2.3 million dollars. [10]

Many of the "benefits" that Pollock tries to highlight are dubious, or are based on debunked information. For example, when he talks about the lining of the inside of the foreskin, and how the cells "trap the virus but are unable to destroy it," this was one of the original hypotheses that was used to run the circumcision trials in Africa. The specific name for these cells are the Langerhans cells, and deWitte actually found in his study that the Langerhans cells are not only impossible to eliminate, because they are found all over the body, but they actually secrete a substance called Langerin, which actually destroys the HIV virus.[11]

The langerhans hypothesis has been long forgotten, and researchers have tried to sell the lie that "Circumcision reduces the risk of HIV because it's harder for the virus to get through the keratinized glans." But other studies have found no difference between the keratinization of the inner and outer aspects of the adult male foreskin. Keratin layers alone are unlikely to explain why uncircumcised men are at higher risk for HIV infection. [12] Additionally, "No difference can be clearly visualized between the inner and outer foreskin."[13] As of yet, circumcision "researchers" have yet to explain the mechanism whereby circumcision prevents HIV transmission. The repeated studies are all based on disproven hypotheses, bringing their validity into question.

Pollock and Schoen say that STDs are more likely in uncircumcised men, but this does not reflect reality, where STD transmission rates are higher in North America, where the majority of the men are circumcised (approx. 80% according to Edgar Schoen), than they are in countries in Europe, where circumcision is rare. They also fail to mention studies that show circumcision makes no difference in HIV transmission [14] or that it actually has the opposite effect, increasing infection, especially to female partners [15]. They mention HPV transmission, but not that there are already vaccines for them. They say that penile cancer is "almost exclusive" to uncircumcised men, but they do not talk about the rate, which is something like 1 in 100,000 of men who smoke with poor hygiene practices.[16] Prostate cancer is more common in men; 1 in 6 North Americans will develop prostate cancer. [17] Using Pollock and Schoen's logic, removing prostates at birth is more urgent than male circumcision.

They briefly mention that "Sexual pleasure and power are not significantly affected by circumcision," but they will not mention that the foreskin is more sensitive than the most sensitive part of the circumcised penis. Sorrells shows that circumcision reduces sensitivity by a factor of 4. [18]

Regarding UTIs, it is common knowledge that whether boys are circumcised or not, girls are 10 times more likely to develop UTIs. UTIs are already quite rare in boys, and are as easily treatable with antibiotics in boys, as they are in girls. It makes no sense to amputate part of a child's genitals to prevent a disease that is already quite rare, and already easily treated. Neil Pollock and Edgar Schoen point out Tom Wiswell's work, but they will not mention that all of it has been thoroughly discredited.[19][20]

Neil Pollock talks about phimosis, but nothing is mentioned about the frequency of occurence of this condition, much less about how often circumcision is actually indicated, even when the condition develops. He talks about circumcision promoting hygiene, but surgery is not needed to promote hygiene. An uncircumcised male child needs no more care than an uncircumcised female child. It is true that men in old age are often unable to clean themselves, and somebody else must do it for them, but the same applies to women in old age.

The rest of the article is basically self promotion. Unless it is medically or clinically indicated, doctors have no business performing elective, non-medical surgery on healthy, non-consenting minors, much less pander to a parent's sense of entitlement.

Neil Pollock is a professional mohel and child circumcisor and in this article, he is merely promoting his trade. Schoen did his share of circumcisions as well, and he is a very vocal advocate for circumcision. According to a MEDLINE search, Edgar Schoen has been published 20 times in the medical literature on the subject of circumcision. In addition to reaping, or having reaped profit from the procedure they are promoting, Neil Pollock and Edgar Schoen are both Jewish. I feel this is important to mention, because circumcision is an important ritual and religious commandment. Although physicians may act with what they consider to be sound medical judgement, some physicians may be influenced also by nonmedical consideration. The cultural background of many Jewish circumcision advocates predisposes them to view circumcision in a positive light, to welcome evidence that the most particular and problematic religious custom of their people is medically beneficial, and to dismiss arguments to the contrary.[21] Please do not conflate my assessment of potential bias and conflicts of interest with anti-Semitism. These are conflicts of interest that put the objectivity of the information presented in question, and it is the responsibility of the Vancouver Sun to publish them so that the public can make a better assessment of the information presented by these men.

In closing, it needs to be mentioned that Edgar Schoen is a well-known circumcision evangelist that has been rejected wherever he goes.[22]

Yours truly,

Joseph Lewis


References:
1."About Dr. Pollock". http://www.pollockclinics.com/circumcision/circumcision-drpollock.html. Retrieved 2011-04-08.
2. "Arranging a Circumcision". http://www.pollockclinics.com/circumcision/circumcision-arrange.html. Retrieved 2011-04-08.
3. Owens, Anne Marie (2001-01-22). "Like father, like son". National Post, The. http://www.pollockclinics.com/circumcision/npost.htm. Retrieved 2011-04-08.
4. Siegfried et al. "Male circumcision for prevention of heterosexual acquisition of HIV in men." Cochrane Library 3 (2003)
5. "Parents' Guide to Circumcision". http://www.pollockclinics.com/circumcision/circumcision-guide.html. Retrieved 2011-04-08.
6. "Pollock Clinics Infant Circumcision". 2011-04-08. http://www.pollockclinics.com/circumcision/circumcision-index.html. Retrieved 2011-04-08.
7. "Use of the Mogen clamp for neonatal circumcision". http://www.circumcisionquotes.com/rdr5.html. Retrieved 2011-04-08.
8. "Methods of circumcision". circumstitions.com. 2011-04-08. http://www.circumstitions.com/methods.html#barzel. Retrieved 2011-04-08.
9. (April/May 2002). "Pain During Mogen or PlastiBell Circumcision". Journal of Perinatology 22 (3): 214-218. http://www.nature.com/jp/journal/v22/n3/full/7210653a.html. Retrieved 2011-04-08.
10. Tagami, Ty (2010-07-19). "Atlanta lawyer wins $11 million lawsuit for family in botched circumcision". The Atlanta Journal-Constitution. http://www.ajc.com/news/nation-world/atlanta-lawyer-wins-11-573890.html. Retrieved 2011-04-08.
11. deWitte et al. "Langerin is a natural barrier to HIV-1 transmission by Langerhans cells". Nature Medicine http://www.circumcisionandhiv.com/files/de_Witte_2007.pdf Retrieved 2011-4-14
12. Dinh et al. "HIV-1 Interactions and Infection in Adult Male Foreskin Explant Cultures". http://retroconference.org/2009/PDFs/502.pdf Retreived 2011-4-14
13. Dinh et al. "Keratinization of the adult male foreskin and implications for male circumcision." http://www.ncbi.nlm.nih.gov/pubmed/20098294 Retreived 2011-4-14
14. Westercamp, M; Bailey RC, Bukusi EA, Montandon M, Kwena Z, et al. (2010). "Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs". PLoS ONE 5 (12). Template:Hide in print. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0015552.
15. Wawer MJ, Makumbi F, Kigozi G, et al. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. Lancet 2009;374:229 ?37.
16. Wallerstein E (February 1985). "Circumcision. The uniquely American medical enigma". Urol. Clin. North Am. 12 (1): 123?32. PMID 3883617
17. ACS "What are the key statistics about prostate cancer?" http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics Retreived 2011-4-14
18. Sorrels et. al "Fine-touch pressure thresholds in the adult penis" http://www.nocirc.org/touch-test/bju_6685.pdf Retreived 2011-4-14
19. AAP Task Force on Circumcision. Circumcision Policy Statement. Pediatrics 1999;103(3):686-693.
20. Van Howe RS. Effect of confounding in the association between circumcision status and urinary tract infection. J Infect 2005;51(1):59-68.
21. Glick, Leonard (2005). ""This Little Operation", Jewish American Physicians and Twentieth-Century Circumcisoin Advocacy". Marked in Your Flesh. New York, New York: Oxford University Press. pp. 183-184. ISBN 0-19-517674-X.
22 .G Hill, J V Geisheker (2006) "Edgar Schoen does not represent the North American view of male circumcision". Retrieved 2011-04-08. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2083089/

Afterthought...
I was in a hurry, otherwise I would have also included the following:

Pollock promises a "virtually painless" circumcision,[1] but this claim assumes the methods he boasts in using are actually effective. On his website, it says that the pain control methods used are Tylenol, sugar,[2][3] a topical cream, and a local anaesthetic injection called a dorsal penile ring block. The topical anaesthetic only serves to numb the area to lessen the pain of the injection, but studies have shown that a dorsal penile ring block is not always effective in stopping the pain of circumcision.[4][5] During the circumcision, the child is given sugar pacifiers to "reduce his pain perceptions", but in at least one study, data shows that giving sugar to a child doesn't help to reduce the perception of pain in the child.[6] Post-operative pain and the pain the child must endure during recovery is hardly, if ever, addressed.

Pollock advertizes that it takes him "only 30 seconds" to perform circumcision, but this doesn't take into account the fact that the child must first have topical anaesthetic applied, and then be given the dorsal penile ring block for which there is a 10 minute waiting period for the injection to take effect. In the FAQ page, it is admitted that "although the circumcision takes under 30 seconds, we require you to be in our office for one hour and fifteen minutes in total so that we can carefully review with you all post procedure care and answer any of your questions."

In closing, Neil Pollock is just doing what any other merchant does to promote his business. It must be emphasized that Neil Pollock was first and foremost a mohel, and that he, Edgar Schoen and other circumcision advocates were circumcising children long before the current HIV hype. Pollock is not interested in facts, he is interested in promoting his own trade and absolving his own religious practices. Pollock will never admit the truths about circumcision because it would be devastating to his livelihood, devastating to his faith, and devastating to his own personal identity. The fact that he is a Jewish mohel, and that his livelihood depends on the circumcision of children bring this man's objectivity into question.

"It's hard to get a man to understand something when his livelihood depends on his not understanding..."
~Upton Sinclair

References:
1. "Pollock Clinics Infant Circumcision". 2011-04-08. http://www.pollockclinics.com/circumcision/circumcision-index.html. Retrieved 2011-04-08.
2. "Parents' Guide to Circumcision". http://www.pollockclinics.com/circumcision/circumcision-guide.html. Retrieved 2011-04-08.
3. "Before the Circumcision". 2011-04-08. http://www.pollockclinics.com/circumcision/circumcision-before.html. Retrieved 2011-04-08.
4. Taeusch, H William; Alma M Martinez, J Colin Partridge, Susan Sniderman, Jennifer Armstrong-Wells, Elena Fuentes-Afflick (April/May 2002). "Pain During Mogen or PlastiBell Circumcision". Journal of Perinatology 22 (3): 214-218. http://www.nature.com/jp/journal/v22/n3/full/7210653a.html. Retrieved 2011-04-08.
5. Williamson, Paul S.; Nolan Donovan Evans (August 1986). "Neonatal Cortisol Response to Circumcision with Anesthesia". Clinical Pediatrics 25 (8): 412-416. http://cpj.sagepub.com/content/25/8/412.abstract. Retrieved 2011-04-08.
6. Slater, Rebeccah; Laura Cornelissen, Lorenzo Fabrizi, Debbie Patten, Jan Yoxen, Alan Worley, Stewart Boyd, Judith Meek, Prof Maria Fitzgerald (2010-10-09). "Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial". Lancet, The 376 (9748): 1225-1232. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961303-7/ Retrieved 2011-04-08.

Circumcision KILLS

"It's hard to get a man to understand something, when his livelihood depends on his not understanding."
~Upton Sinclair

Circumcision advocates will always tell you that infant circumcision carries "little to no risk," and if there are any risks, they're "worth it." Few will ever take the time to tell you about what these risks are; that you go through with circumcising your child is more important. Sign here, we'll talk later. But for many parents, knowledge of the risks comes too late, when they have to face an agonizing ordeal they were never warned about by knife-happy doctors, because of an operation that ironically was supposed to "prevent" problems to begin with. I'm going to present some risks that your doctor will minimize, if he decides to even tell you about them at all.

Infection
Infection is a risk that comes with any surgery. As long as anyone is causing an intentional wound, it opens up a person's body to infection. But here's the trick; circumcision is elective, non-medical surgery that is completely unnecessary in an already perfectly healthy child. It makes no sense to operate a child, to purposefully increase his chances for infection, in order to prevent conditions for which there are already better prevention options and/or effective treatment should the condition occur at all.

Circumcision particularly increases a boy's chances for Methicillin-resistant Staphylococcus aureus (MRSA) infection. In 2009, at the beginning of the year, an inspection of  Beth Deaconess Hospital revealed that 19 newborns had gotten infected with MRSA, 15 of which were boys who were infected through their circumcision wounds. You can read more details about this here:
http://www.boston.com/news/health/articles/2009/04/11/state_details_safety_lapses_at_beth_israel/?page=2

This study reveals that the risk for UTIs is higher particularly in traditional circumcisions performed by Jewish mohels.
http://adc.bmj.com/content/early/2008/10/06/adc.2008.144063.abstract?rss=1

This is telling because I have often heard it said that circumcisions performed by mohels are "better" because circumcisions are all that mohels do for a living.

Let's see... "reduce the risk" of infection in a child by putting him increasing his chances FOR infection by causing a deliberate wound... I'm still trying to see the sense in this...

Too Much Skin Removed
In my personal opinion, ANY skin removed is "too much skin removed." A child is always born with just the right amount of skin, because the foreskin is standard equipment. The foreskin isn't any more "extra" than the labia or clitoral hood are "extra." "Too much skin removed" refers to more skin removed than desired. When too much skin is excised from a boy's penis, he will have painful erections when he grows up, because there is not enough skin to accomodate the shaft of the penis.The skin may stretch to accomodate the shaft as the boy grows, but if it fails to, the shaft of the penis becomes bent out of shape due to the restrictive conditions in which it is placed. As a man, the child may have an erection that bends forward or to the side. Hairy skin may be pulled up onto the shaft, creating what looks like a hairy shaft.

For examples of penises with too much skin removed, please visit the following link.
WARNING: Pictures of penises, particularly grotesque penises, ahead. Not for the squeamish:
http://circumstitions.com/Restric/Botched7ex.html

Partial or Full Ablation
Let's be honest with ourselves; any which way you're trying to slice it, circumcision is ALWAYS partial ablation of the penis. You're cutting part of a child's penis off, and there is simply no way around that. What "partial or full ablation" means is partial or full ablation of what is supposed to remain after a circumcision, which is a shaft and a bare glans. Circumcising a child will put him at risk for partial or full ablation of the glans, and/or the penis itself. This happens even with professional "jacks of their trade," so it is a mistake to believe that "this can never happen with an experienced professional."

In the study in the following link, a child lost approximately 10% of his glans carried out by two experienced physicians.
http://www.nature.com/jp/journal/v22/n3/full/7210653a.html

The procedure in the above example was carried out using a Mogen clamp, a device notorious for glans amputations, despite its promise that "no injury to the glans is possible."

In 2007, another boy at Sarah Bush Hospital, Mattoon, IL lost his glans to circumcision with a Mogen clamp:
http://circumstitions.com/news/News26.html#mattoon

And yet another at South Fulton Medical Center, Atlanta, GA lost a third of his glans, putting Mogen on notice about the danger of the device :
http://www.ajc.com/news/nation-world/atlanta-lawyer-wins-11-573890.html

Finally, a boy in New York lost his glans during a bris to a Mohel who tried to circumcise him using a Mogen clamp.
http://www.ajc.com/news/nation-world/atlanta-lawyer-wins-11-573890.html

http://www.law.com/jsp/article.jsp?id=1202464033969&Atlanta_Lawyer_Takes_on_Botched_Circumcision_Claims_Nationwide&slreturn=1&hbxlogin=1

Mogen was sued for $2.3 million in the Atlanta case, and for $10.8 million in the Florida case, putting the company out of business. (According to AJC, there had been another law suit against Mogen for $7.5 million in a 2007 Massachusetts lawsuit.)

The moral of the story is, it doesn't matter who performs the circumcision, and no matter what tools he uses; there is ALWAYS a risk, even when a so-called "pro" does it.

Death
Finally, the circumcision of a healthy, non-consenting infant can result in death. Circumcisors will either downplay this risk, if they decide to even mention it at all. It's hard to get concrete estimates on how many children die every year as a result of this unnecessary surgery. Hospitals and circumcising physicians have revenue and a reputation to protect, so many choose not to disclose this information. In other cases, doctors lie and attribute the death to something else, say "septic shock," "hemmorage" or "cardiac arrest."

As an example, last year, a mother blogged in great detail about the birth and death of her son. He had been born with a pre-existing heart problem, and so the boy's circumcision was delayed. Though many tried  to dissuade her from circumcising her child who was already in a delicate condition on her blog, she ignored the warnings and insisted she was going to have her son circumcised come what may. On her blog she spelled out in detail how her son's condition was improving, and how her physicians kept insisting that "the time to circumcise was now."

Not too long afteward, the mother posts on her blog, asking for prayers because, as expected, her son was in critical condition. They couldn't stop the bleeding and the boy was dying. 7 hours passed, and it finally dawns on physicians that the boy needs stitches to stop the bleeding, but a little too late. The boy dies, but the mother insists that her physicians "confirm" that the child's death had all to do with his pre-existing condition, and not at all with the fact that the child bled through his circumcision wound. The mother has since taken down that part of her blog. She announced that her son's body would be cremated. Did the boy die because of his condition or because of circumcision? Now nobody will ever know.

In the UK, another boy, Amitai Moshe, goes into cardiac arrest immediately after his bris. The verdict of his inquest a few years later? Amitai Moshe died of "natural causes," and the fact that he started having breathing problems and started bleeding through his nose and mouth had absolutely nothing to do with the fact that he was ritually circumcised just minutes before.

Read the shameless story here:
http://www.times-series.co.uk/news/4588885.Baby_died_of__natural_causes__after_circumcision/

There have been a few attempts to calculate how many boys die a year due to circumcision, each with different results. Estimating from available hospital records, numbers as far as over 200 boys a year have been given. In a latest study, the number was 117 boys a year.
http://mensstudies.metapress.com/content/b64n267w47m333x0/

Any number given today though, has limitations for the reasons given. Hospitals aren't obliged to release this information, and circumcisers often attribute the death to something else. There are incentives for withholding data and mislabeling circumcision deaths; releasing the death information on elective, non-medical procedure means risking lawsuits. Reputations get ruined, and the revenue accrued for circumcisions (1.3 million boys get circumcised a year in the US) is lost.

In a recent case, a settlement was reached this week for $230,000, for the death of South Dakota Native American infant, Eric Dickson Keefe, who bled to death from a circumcision in 2008.
http://www.icgi.org/2011/04/230000-circumcision-wrongful-death-lawsuit-settles/

For more on death from circumcision, visit:
http://www.cirp.org/library/death/
http://circumstitions.com/death.html

In Closing
All surgeries carry risks for sure. But are they worth it, especially for elective, non-medical cosmetic surgery? Surgery that is supposed to "minimize the risks" for conditions that are already rare, easily treatable and/or easily preventable by other, more effective, less invasive means? If there is no medical condition that indicates surgery, can a physician even be performing circumcision in healthy, non-consenting infants, let alone allow parents to make any kind of "choice?" It is an American disgrace that parents have dig around for information, because those who are paid to be trustworthy dispensers of medical advice do not/cannot/will not provide it.

Circumcision and UTI

"Circumcision prevents UTIs," I am told. "It's better when a mohel does it," I am told.

http://www.circumcisionandhiv.com/2011/04/imaj-a-costly-covenant-ritual-circumcision-and-urinary-tract-infection.html

As far as I'm aware, UTIs are much more common in girls than they are in boys, whether the boys have been circumcised or not. They're already quite rare in boys, and they're already quite easily treatable with antibiotics.

It boggles the mind how having newer, better treatment and prevention methods for a disease, people cling to older, radical surgery as "prevention." It's simply illogical how instead of trying to look for ways to make a surgical procedure absolete, "researchers" grope for ways to keep it around.

Oh when will this madness end?