LEAKED: AAP Press Script

Three things cannot be long hidden; the sun, the moon, and the truth. ~Buddha

Been wondering why the latest news reports on the latest AAP statement all sound similar to each other?

This is because the AAP planned a mass circumcision ad campaign in advance. The event was carefully synchronized with members of other American medical associations which harbor perpetrators of infant circumcision, such as ACOG, as well as circumcision "researchers," such as Aaron Tobian, who both helped write the new statement, as well as the "economical analysis" released a few days prior.

Well, judging from a leaked document, it looks like the media fallout in the wake of the release of their new statement was also carefully planned. It looks like AAP members who were to meet with reporters were given their lines to rehearse, so nothing is any kind of real answer, just canned propaganda party lines and scripted answers to scripted questions. We read in the AAP script only the questions which are to be asked and the answers which are to be given, it's almost Orwellian.

I'm going to post the script here all italics, adding my own commentary.

Circumcision Speaking Points

American Academy of Pediatrics

8/27/2012

August 2012

This information is intended to help AAP members prepare for media interviews. It is not for reproduction or distribution. (You should have been more careful.)

The AAP published the policy statement and technical report on male circumcision in the September 2012 issue of Pediatrics (published online Aug. 27). The report updates the previous recommendations made in 1999.

Highlights

1. Based on the Academy’s systematic and critical review of the scientific evidence (actually, carefully selected), male circumcision has been shown (by our own review) to have significant health benefits that outweigh the risks of the procedure. The (alleged) health benefits include:

a. lower risk of acquiring HIV, syphilis, human papillomavirus, and genital herpes (not all studies show this)

b. lower risk of cervical cancer in sexual partners, (based on select studies that show a correlation between intact partners and a "higher rate of HPV"; other research shows little to no difference, if not a trend in the OPPOSITE direction; HPV has been shown by some studies to be transmitted more easily by circumcised males.)

c. lower risk of penile cancer over a lifetime, (which, even if the research can be trusted [and it in and of itself is dubious], is already vanishingly rare; in America, according to the ACS, one in six men will develop prostate cancer; a man is more likely to get prostate cancer than penile cancer, yet there are no talks of excising the prostate in children)

What the American Cancer Society has to say about penile cancer:

In the past, circumcision has been suggested as a way to prevent penile cancer. This was based on studies that reported much lower penile cancer rates among circumcised men than among uncircumcised men. But in many of those studies, the protective effect of circumcision was no longer seen after factors like smegma and phimosis were taken into account. 

 

Most public health researchers believe that the risk of penile cancer is low among uncircumcised men without known risk factors living in the United States. Men who wish to lower their risk of penile cancer can do so by avoiding HPV infection and not smoking. Those who aren't circumcised can also lower their risk of penile cancer by practicing good hygiene. Most experts agree that circumcision should not be recommended solely as a way to prevent penile cancer.

d. lower risk of urinary tract infection in the first year of life. (the evidence for this has been shown to be methodologically flawed; even if it could be relied upon, UTIs are already quite rare in boys anyway, when compared to girls, and they're easily treatable with antibiotics; it makes no sense to be prescribing surgery to prevent an already rare and easily treatable condition)

*Note, other medical organizations in the world have evaluated the same evidence and have not come to the same conclusion as the AAP. The AAP is daring to defy the best medical authorities in the West, putting its credibility in jeopardy

2. Although the health benefits are not great enough to recommend routine circumcision for all newborn males, the benefits are enough to warrant access to the procedure for those families choosing it. It should be covered by insurance.

(Wow, all in the same breath. I want readers to consider this for a moment; while even the AAP admits the health benefits are not enough to recommend infant circumcision, it should still be an option for parents, and public coffers should pay for it. It raises the question; is it sound medical logic to be performing radical amputative surgery in healthy, non-consenting individuals on the basis of "potential medical benefits" instead of actual medical indication?)

3. Parents must ultimately decide whether newborn male circumcision is in the best interests of their child's health. Parents should discuss the risks and benefits with their pediatrician. They will need to weigh medical information in the context of their own religious, ethical and cultural beliefs. (As opposed to actual medical necessity? What other surgery works this way, in which religious and cultural beliefs take the place of medicine? What ethics are pediatricians who are more worried about appeasing parents, as opposed to the health and well-being of the child exercising?)

Without medical or clinical indication, can a doctor even be performing surgery on healthy, non-consenting individuals, let alone be soliciting the so-called "benefits" of it to parents and eliciting any kind of "decision?" Does not profiting from the performing of non-medical surgery on healthy, non-consenting individual constitute medical fraud?

The AAP appears to be trying to deliberately sanction blatant charlatanism.

Frequently Asked Questions

Q: What does the new policy recommend and how does it differ from the previous one?

A: The new policy is based on a thorough review of the available scientific evidence, which has shown clearer health benefits than had previously been understood. (FALSE: The new policy is based on selective "research," and not all the evidence was considered. The "health benefits" are not so clear, and the AAP is alone in considering them to "outweigh the risks." The AAP continues to maintain that they are not enough to endorse the practice of circumcision.) The most significant changes since 1999 are new studies that demonstrate a protective effect of circumcision against the acquisition of several sexually transmitted diseases, including HIV, genital herpes, human papilloma virus (the virus causing genital warts, cancer of the penis and cancer of the cervix) and syphilis. (...in promiscuous men in high-risk areas in Africa, and the so-called "studies" are of questionable value.)

The new policy states that the strength of the data is sufficient that the Academy advocates the procedure be covered by insurance. (...but not enough to recommend... Conflicting much?) The 1999 statement did not include such a recommendation. (This much is true.)

The new policy states that the scientific evidence indicates that the health benefits of newborn male circumcision outweigh the risks. (True. It does say that.) This is a stronger statement regarding the medical benefits of circumcision than was included in the 1999 statement, reflecting the scientific evidence that has emerged since then. (No, reflecting select data from three flawed "studies," and reflecting the financial and religious interests of its members.)

The recommendation that the final decision rests with the parents is the same as in the 1999 policy statement. (IE, the AAP continues to evade any responsibility for making a direct and forthright statement and placing it on naive parents who should consider the same "evidence" they could not use to endorse the procedure.) The new policy states that parents are entitled to factually correct and non-biased information about circumcision and must be allowed to weigh the health benefits and risks in light of their own cultural, religious, and personal preferences. (Cultural, religious, and, this time PERSONAL preference. As opposed to actual medical and/or clinical necessity? What other surgical procedure works in such a way? Without a medical or clinical condition that requires surgery, how is it parents should even be consulted on the matter? The only answer seems to be solicitation of a sales pitch. Again, the AAP appears to be advocating charlatanism.)

Finally, the new policy and technical report recommend the procedure should be performed by trained and competent providers, using sterile techniques and effective pain management. (A ridiculous red herring; all other surgical procedures performed on children should be performed by amateurs with rusty box cutters then?) The 1999 policy recommended analgesia, but the new policy includes greater detail regarding the need for sterile techniques and well-trained providers. (At the same time, we are supposed to believe circumcision is "a simple snip.")

Q: What led the AAP to revisit its policy on newborn male circumcision?

(Can we trust the following answer?)

A: It is standard practice for the AAP to revisit all of its policies on a regular basis. The previous policy statement on newborn male circumcision was first approved in 1999. It was revisited in 2005, but the depth and breadth of the HIV and STI studies at that time were not strong enough to warrant a revision, so the existing policy was reaffirmed. Since that time, new scientific knowledge has accumulated about the medical benefits of newborn circumcision. In order to maintain a current policy, it was important the scientific literature be reviewed and the policy updated. (Yes, I'm sure members at the AAP, ACOG etc. didn't all have the bejesus scared out of them by the recent developments in Cologne, Germany. Yes, I'm sure AAP members are all genuinely interested in preventing HIV in children who cannot even conceptualize sex. Yes, I'm sure there is simply no better way to prevent disease than by a procedure that happens to be a hefty stipend for AAP and ACOG members.)

Q: What has changed since the 1999 policy on newborn male circumcision was issued?

A: The primary known medical benefits of newborn circumcision in 1999 included a lower risk of urinary tract infection during the first year of life and a lower risk of penile cancer later in life. (The 1999 Task Force found that the bulk of the UTI studies were so methodologically flawed—by failing to control for confounding factors-such as breastfeeding—that no meaningful conclusions could be drawn from them. The 1999 AAP Task Force on Circumcision could not, therefore, recommend circumcision to reduce incidence of UTI [or any other disease].) The most significant changes since 1999 are new scientific studies that demonstrate a protective effect of circumcision against the acquisition of several sexually transmitted diseases, including HIV, genital herpes, human papilloma virus (the virus causing genital warts, cancer of the penis and cancer of the cervix) and syphilis. (...in promiscuous men in high-risk areas in Africa... And, again, a few select "studies" show this. Other medical organizations in Western medicine have evaluated the same "evidence" and found it lacking. The AAP, however, most members who profit from infant circumcision, is going tell them otherwise.)

Q. Is it true that rates of newborn circumcision have been decreasing and if so, why is that?

A: We don't know the true rate of newborn male circumcision in the U.S., but rates appear to have fallen slightly in the past 20 years. A growing number of state Medicaid programs have stopped paying for circumcision, thereby reducing access to the service. Some families may decide against the procedure because they are unable to pay out-of-pocket. More families may be choosing not to have a circumcision because of a sense that it is not medically necessary or due to their own religious, ethnic, cultural or esthetic beliefs.

Here is where it starts getting interesting; while the new AAP statement continues to say the "benefits aren't enough to recommend circumcision," it concerns itself with how many families are choosing to circumcise, which ones are not, why, and how to badger them with these benefits and force them to make "the right decision." Are they interested in mere disease prevention? Or in securing a customer base? There are other, more effective, less invasive ways to prevent every disease mentioned in their report. Are those not going to be talked about? Or is not circumcising simply not an option?

The data sources available are based on newborns who were circumcised in the hospital, and often do not reflect those who are circumcised in their communities by a religious practitioner (like a Mohel) or in a doctor's office. Because babies are discharged from the hospital sooner after birth than in the past, more circumcisions are probably performed in the clinic, and not reflected in hospital-based data.

You know what else we don't know from hospital data? The number of botches, revisions and complications that happen. Hospitals are not required to release that data, nor are mohels or other charlatans. The AAP does not seem to be interested in finding out either, and would rather believe the reported low numbers given by the CDC, another corrupt organization.

Q: What are the primary benefits of circumcision?

A:

• Lower risk of acquiring HIV, syphilis, human papillomavirus, and genital herpes

• Lower risk of cervical cancer in sexual partners

• Lower risk of penile cancer over a lifetime

• Lower risk of urinary tract infection in the first year of life

(All repeated from the top, all expected to be believed at face value.)

Q: How significant are these health benefits? (If asked for specific data. You can also refer reporters to the technical report to see the specific studies cited.)

Yes, only the "studies" that the AAP cites should be relied on. And, reporters too, will look beyond it to make sure the AAP did their homework.

HIV: The CDC estimates that 1.2 million people in the U.S. are living with HIV; about 50,000 Americans are newly infected with HIV each year. (How many of which are circumcised males? Any info on that?) The AAP technical report on circumcision cites 14 studies that found evidence circumcision is protective against heterosexually acquired HIV infection in men. (Did they look at studies that found little to no difference, if not a trend in the other direction? Here are some studies and reports that disagree with the "evidence" the AAP has reviewed...)

Genital Herpes: Approximately 16.2 percent of U.S. individuals aged 14 to 49 have herpes simplex virus type 2 (HSV2). Two large randomized trials in Africa found the incidence of HSV2 was 28% and 34% lower in circumcised men, and one study showed male circumcision protects female partners against HSV2 infection. (Did they look at other data? Let's analyze what we have here; the inverse is that HSV2 was still 72% and 66% in circumcised men. That's not too impressive. How do condoms and safe sex practices measure up?)

Human papillomavirus: HPV is among the most commonly occurring STIs in the U.S. and can lead to the development of cancers including cervical cancer. Two studies show a 30% to 40% reduction in risk of HPV infection among circumcised males. (Other studies show little to no difference, if not that HPV was easier transmitted by CIRCUMCISED men.)

Cervical cancer: Up to 12,000 new cases of cervical cancer are diagnosed in the U.S. annually. A study found a lower incidence of HPV infection in circumcised men (5.5%) compared to uncircumcised men (19.6%). In women whose partner had more than six lifetime sexual partners, male circumcision lowered her odds of cervical cancer significantly. (Conjecture upon conjecture; this is in conjunction with the assumption that intact men are transmitters of HPV; some studies show little to no difference, if not that HPV was more easily transmitted by circumcised males. At any rate, actual vaccines already exist for HPV, rendering circumcision a moot point.)

Penile cancer: Penile cancer is rare (0.58 cases per 100,000 individuals in 1993-2002) and rates appear to be declining in nations with both high and low circumcision rates. However, studies show an association between circumcision and a decreased likelihood of invasive penile cancer. (Come again? So evidence that shows no difference is ignored in lieu of the evidence that shows an "association," however flimsy it may be? Scroll up to read what the ACS has to say on penile cancer and circumcision.)

Syphilis: The total number of cases of syphilis reported to the CDC in 2010 was 45,834. The balance of evidence from several studies suggests male circumcision is protective against syphilis. (The bottom of the barrel gets thinner and thinner... Again, a "suggestion" obtained from selected evidence... Yes, so compelling... So a circumcised man can't get syphilis? How about a man wearing a condom?)

Urinary tract infection: The majority of UTIs in males occur in the first year of life. In children, UTIs usually necessitate a physician visit and may involve the possibility of an invasive procedure and hospitalization. (When and if they do happen. What is the incidence of UTIs in boys and girls? Are they fatal, or are they easily treated?) Infant boys who are circumcised have a lower risk of UTIs, with various studies showing a three-fold to a 10-fold reduction in risk. It is estimated that 7-14 out of 1,000 uncircumcised male infants will develop a UTI during the first year of life, compared with 1-2 infants among 1,000 circumcised male infants. (Based on WHAT evidence? And is circumcision really warranted in preventing an already rare, already easily treatable condition?)

Q: What are the risks of circumcision?

A: The risks of an adverse event during circumcision are very low when performed by an experienced practitioner using sterile technique. (Note the clarifier... Again, a red herring; surgery is always best when performed by a trained practitioner. The question is IS IT NECESSARY?) The most common (according to us) complications are minor and include bleeding, which responds to pressure, and minor skin infections. (Other common complications that are not included here are botched circumcisions which require correction later on, and meatal stenosis. Botches are so common that there are doctors that specialize in this field.) The best evidence (what we've selected) shows an incidence of circumcision-related complications of less than 1 percent, which is very low for a surgical procedure. (Too low.) More serious complications, like the removal of too much tissue or partial amputation of the penis are very, very rare, to the point that there were no good analytic studies in this area for the task force to review. (Absence of evidence is not evidence of absence. There have been an increasing number of lawsuits raised against mohels and physicians that have amputated more than just the foreskin of the penis. Here, we see one of the greatest problems with the new AAP statement; they claim "the benefits outweigh the risks," having no actual evidence to make this claim.) Circumcision can also cause pain, but this is easily addressed with the use of appropriate pain control methods during and after the procedure. (No news here; pain can be controlled in most any surgery. Most surgery is medically indicated, however...) The risks are much higher when the procedure is performed in older patients. (This is true of any surgery. Again, necessity and the ethic of performing non-necessary amputative surgery on a healthy, non-consenting individual is evaded...)

Q. What about the recent deaths of infants after ritual circumcision?

A. Isolated cases of morbidity and mortality after ritual circumcision have been reported in the U.S., and have been related to circumcisions that were not performed under sterile conditions. These cases and the practices that led to them have been limited to a specific group. (Circumcision doesn't kill... If you ignore all the deaths...) The AAP is clear: Any circumcision is an operative procedure that must be done under sterile conditions and with adequate pain control. These isolated cases are dwarfed by the number of circumcisions performed each year in this country under sterile conditions, and with a proven track record of safety. (Not discussed here: Deaths at the hands of professionals who performed the procedure under the most pristine conditions. Does the AAP have any data on this? What does the AAP know of deaths at hospitals? FACT: Hospitals are not required to release this information, and deaths due to circumcision are often covered up, or attributed to other causes, such as "hemorrhaging" or "septic shock." The AAP and it's members have a vested interest in helping suppress this data.)

Q: Isn't it true that the African studies that looked at the effect of circumcision on the acquisition of HIV can’t easily be generalized to the United States?

A: Africa has a higher prevalence of HIV, and more cases are attributable to heterosexual intercourse than in the U.S. (Not to mention the studies looked at promiscuous men where the custom is to have multiple sex partners in high risk areas in Africa.) Nevertheless, circumcision decreases the risk of heterosexual HIV by more than one-half. (The absolute reduction observed in these "studies" was 1.37%.) That still amounts to less than half as many new HIV cases due to heterosexual sex among circumcised men when compared to uncircumcised men, (promiscuous men in high risk areas in Africa) which is (might be) still beneficial for an incurable, life-threatening infection. A recent CDC study deemed that newborn male circumcision was an ultimately cost- saving HIV prevention intervention in the U.S. for all males, and of especial benefit to black and Hispanic males. (With absolutely no evidence to substantiate this claim, just pure extrapolation of the faulty African "research.")

Is the AAP prepared to explain, why HIV transmission is more prevalent in the US, where 80% of all males were circumcised from birth, and lower in Europe where circumcision is rare? Is it prepared to explain why HIV was found to be more prevalent in 10 out of 18 countries, according to USAID? More places where circumcision fails to prevent HIV here.

Q: It seems like the primary benefits of circumcision are related to the prevention of sexually transmitted diseases, so why perform the procedure on newborns, and why not wait until the male is of age and can decide for himself?

A: Behavioral health surveys show that most young males become sexually active before the age of majority, so by delaying circumcision until males reach the age of majority, they therefore would lose some of the protective benefit of circumcision. (In other words, we know what's best for all boys and men. All boys grow up to be promiscuous men, and they don't get a say in how they wish to protect themselves, nevermind that, even if the "evidence" were correct, condoms would still outperform circumcision.) According to the CDC, almost 40% of 9th grade males in 2011 reported already having had sexual intercourse. (Did it say how many were using condoms responsibly?) Also, they would not benefit from circumcision’s demonstrated protection against urinary tract infections during the first year of life. (A "benefit" they may not ever even need not want, considering the alternatives...) Just as importantly, circumcision in an older patient is more difficult and the complication rate is considerably higher. (Most surgery is; an older patient may never need to get circumcised, nor may he feel the "benefits" are important to him. NOTE: Earlier they said they didn't have any evidence.) The safest time to perform circumcision is during the newborn period. (Remember, they didn't evaluate any actual evidence to substantiate this claim, just assumed there wasn't any...)

Q. Is it ethical for parents to make this decision for their newborn son?

More importantly, without medical or clinical indication, can a doctor even be performing surgery in a healthy, non-consenting individual, much less be eliciting any kind of a "decision" from parents?

A. It is the responsibility of parents to make many important decisions for their children every day, including where they will live, what they will eat, how they will be educated, and decisions about health care. Male circumcision is one of those decisions. (I reiterate, without medical or clinical indication, can a doctor even be performing surgery in a healthy, non-consenting individual, much less be eliciting any kind of a "decision" from parents?) Parents, in consultation with their child’s pediatrician, need to consider the scientific evidence about the risks and benefits of the procedure (evidence that the AAP itself could not use to endorse the procedure?), and then need to weigh this with their own ethical and religious beliefs to make this decision. (How is it ethical to be cutting off part of the genitals of a perfectly healthy child? And what other surgery is based on religious beliefs and not medical or clinical indication? HINT: Circumcision is the only item on that list.)

Q. If the medical benefits outweigh the risks, why doesn’t the AAP recommend all newborn males be circumcised?

A: Families will bring their own religious, cultural and personal preferences into consideration in making this decision. (And doctors will oblige to perform surgery based on religious, cultural and personal preferences, as opposed to actual medical need...) Parents need to weigh the health benefits (which were not great enough for the AAP to recommend the practice?) and risks (which the AAP does not know of) in light of these considerations; the medical benefits alone may not outweigh other considerations for individual families. The data (we do not have) show that the procedure is best-tolerated during the newborn period, and accrues the most lifetime health benefits if done at this time. These benefits justify access to the procedure for those families that choose it and warrant third-party reimbursement of the procedure. (But not our recommendation? Really?) The Academy maintains that the cost of the procedure should not be a barrier. (To a procedure you cannot bring yourselves to recommend?)

Q: How does the AAP policy compare to the positions of other medical societies?

A: The American College of Obstetricians and Gynecologists (Note: WOMEN DOCTORS) has endorsed the 2012 AAP policy statement on circumcision. (WHY is the endorsement of a trade organization for WOMEN DOCTORS important to the AAP? Answer: Because they profit the most from the circumcision of children, who are not even in the purview of those professions.) The American Urological Association has recommendations very similar to those of the AAP. (They would; they too profit from the procedure.) The World Health Organization recommends circumcision as part of a comprehensive global HIV prevention strategy. (FALSE: The WHO recommends circumcision in promiscuous MEN in high risk areas in Africa. There is no global move to recommend circumcision anywhere else.)

Many of the medical society statements that have been characterized as opposing newborn circumcision do not really oppose newborn circumcision. They have concluded that the evidence does not justify a recommendation to routinely circumcise all newborn males. In reality, these statements do not differ significantly from the AAP policy. For example, the Royal Australasian College of Physicians has concluded that the evidence regarding the preventive effects of circumcision is not sufficient to recommend routine infant male circumcision, but that it is reasonable for parents to weigh the benefits and risks of the procedure and make a decision on behalf of their children. The Canadian Pediatric Society takes a similar stance. The British Medical Association recognizes significant disagreement with regard to the risks and benefits of circumcision and concludes that parents should be permitted to make a decision to circumcise as long both parents consent and have been provided with up-to-date written information about the risks of the procedure and the lack of consensus (???) in the medical profession regarding the procedure.

Almost, but not quite. Note the blatant self-contradiction; No respected medical board in the world recommends circumcision for infants, not even in the name of HIV prevention. They must all point to the risks, and they must all state that there is no convincing evidence that the benefits outweigh these risks. To do otherwise would be to take an unfounded position against the best medical authorities of the West, as it appears the AAP is doing now.

All respected medical boards say that there is not enough evidence to endorse the practice, even though they conclude that parents should "decide" based on this same "evidence." That is not "lack of consensus," that is actually quite consistent across the board. The AAP wants to paint a false picture of other medical organizations in the world.

The following paragraph is infuriating, because it is a blatant and deliberate lie.

On the other hand, the Royal Dutch Medical Association issued a statement in 2010 concluding that in light of the lack of convincing medical benefits, non-therapeutic circumcision of male minors conflicted with the child’s right to autonomy and physical integrity and that physicians should inform parents and caregivers seeking circumcision about the medical and psychological risks and the lack of convincing medical benefits. While this conclusion differs from the conclusions of the new AAP statement, it is important to recognize that the Dutch Medical Association statement does not include a comprehensive, systematic review of the scientific literature. (The author of these talking points means to say "like the AAP's.")

EXCUSE me? Just what are their conclusions based off of? Thin air?

The Dutch Medical Association is currently being notified by intactivists of what has been said here.

Q. Is circumcision child abuse? Recently a German court declared circumcision illegal. Does that ruling contradict the AAP’s policy?

Better phrased, "Is the forced circumcision of healthy, non-consenting minors, child abuse?"

A: Circumcision is a procedure with few risks and considerable health benefits. (Maybe. IS IT CHILD ABUSE to perform it in healthy, non-consenting minors.) Parents who make the decision in the best interests of their child’s health are within their child custody rights. (Without medical or clinical indication, can a doctor even be performing surgery in healthy, non-consenting individuals, much less be stoking a parent's bloated sense of entitlement?)

The German decision required medical necessity in order to legally circumcise a child. Doing so does not take the evidence of health benefits from the procedure into account. (The Germans have access to the same "evidence" the AAP does. When an act is an act of abuse, it doesn't matter that there may or may not be "health benefits." When a man rapes a woman, there is no assessment of the "medical benefits" of rape. The rights of the woman are violated regardless. For most other medical procedures, actually, medical necessity is required. Performing non-medical surgery on healthy, non-consenting individuals constitutes medical fraud. In children, it constitutes abuse, and the violation of basic human rights.) The Academy’s position is based on a comprehensive (no, selective) review of the scientific evidence. It is also important to remember that this was the opinion of one court responding to a single case of a boy who suffered heavy bleeding following a circumcision. The court ruling was effectively negated when Germany's lower house of parliament passed a resolution to protect the religious circumcision of infant boys. (UTTERLY FALSE: The resolution does not affect the court ruling, and there is actually now a case involving a rabbi there.)

Q. Why does the AAP support male circumcision but oppose female genital cutting?

A: The two procedures are not analogous. (Evidence for this is...?) Female genital cutting is mutilation. (Point blank. No female genital cutting "taskforce" ever came to this conclusion.) Female genital cutting is not circumcision. (Maybe a "ritual nick" is then?) The scientific evidence of female genital cutting indicates only harms and no health benefits. (What "taskforce" came to this conclusion? Is there a periodic "statement" released every so often? I'd like to see it. Actually, there is some evidence that female circumcision might actually be "beneficial." Not that the AAP wants to get involved in that again... Remember the Ritual Nick, Diekema.)

In male circumcision, the anatomy is different, and the procedure is different. (Again, what evidence was evaluated? What forms of female circumcision compared? The anatomy may be different, the procedure may be different, the principle violated THE SAME.) Male circumcision has been shown scientifically to provide benefits to the person being circumcised, and has a proven track record for safety. (Would the AAP endorse female circumcision would that the "evidence" were provided? Would that it could be performed "safely?" Is it really about "benefits" and "safety?" Because I can provide evidence for BOTH.)

Q: Does circumcision alter the sensation of the penis and decrease sexual pleasure?

A: This is a very difficult thing to study, but the data that exist do not suggest that circumcision alters sexual function or pleasure. (Well. At least the one's the AAP has considered anyway.) In studies done in Africa of adult males undergoing circumcision, a small number of men reported a diminished sexual experience, a small number reported an improved sexual experience, and most reported no change. (Are you going to tell us about the Sorrells' study? A study recently conducted in Denmark? Yes? No?)

Q: What questions should a parent ask of their doctor when discussing newborn circumcision?

A: Parents should ask: What is the benefit of circumcision and what is the risk? (How about "What are the alternatives to circumcision? What other ways exist of achieving the same "benefits?" Is there an STD circumcision prevents that a condom can't? What options exist for me if I don't want to mutilate my child's genitals?" Are AAP members prepared to answere these questions? Or is circumcision supposed to be the only option?) How do I select someone to perform a circumcision?  Parents should make sure that the procedure is performed by trained personnel under sterile conditions with adequate pain control measures during the procedure. (All other procedures, it's OK if an amateur does it...) Parents should think about their views about circumcision during the pregnancy, including finding out whether there is insurance coverage, in order to avoid a rushed decision after the baby is born. (WHY should parents think about their views about circumcision at all? Is the child going to be born sick? WHY should parents consider a procedure whose "benefits" the AAP could not use to endorse? Without any medical or clinical indication, can a doctor perform surgery on a healthy, non-consenting individual? Much less be eliciting any kind of a "decision" from parents? If he can't then why does "what his parents think" even matter? And why should insurance pay for non-medical surgery?)

Q: Is the AAP taking this stance simply because it allows members to make money from the procedure?

A: This issue is about access to health care, not profits. (I'm sure it's not about the money. It's not about self-serving agenda to legitimize a religious ritual for some of the AAP "taskforce" members either, what with the Cologne ruling and all...) The AAP recommends that insurance plans cover circumcision. Otherwise, some families who would choose circumcision would not be able to afford it. (Without medical or clinical indication, can doctors be performing surgery in healthy, non-consenting individuals, much less be giving parents any kind of a "choice?" Much less expect to be reimbursed by the public's coffers?)

The costs of a circumcision are paid by private insurance and Medicaid, with a small percentage funded by individuals. Rough estimates for the procedure average $165 out of pocket (within a range of $100 to $250.) However, these costs do not take into account hospital fees, supplies, and anesthesia. In the end, total costs can be upward of $1,750. (Multiply that by about 1.3 million a year. No, it's not about the money at all. Truly, it's just about healthcare and "access" to a non-medical surgical procedure you can't even bring yourselves to recommend.) It’s important to consider that choosing a circumcision later in life costs more and the procedure and anesthesia carries a greater health risk. (It is also important to remember that most surgery is the same way. It is important to remember that 80% of the world's men have intact organs, the overwhelming majority of males circumcised in the world are so because they were forcibly circumcised as infants for religious or cultural reasons; very few men in the world ever need circumcision, or ever choose it out of their own volition.)

Q. Who performs most circumcisions?

A: It depends on what part of the country one is in. It can be and it often is performed by obstetricians, pediatricians or family practitioners but could be done by nurse practitioners or nurse midwives. (A more straight and direct answer; the majority of circumcisions are performed by OB/GYNs who are members of ACOG, the trade union that gave the AAP their blessing. The rest are done by pediatricians, members of the AAP. Only a very tiny minority of circumcisions are performed by religious practitioners.)

I'm at a loss for words.

The AAP is morally and ethically bankrupt in more ways than one, not to mention outright self-serving and dishonest. The AAP couldn't be any less interested in the health and well-being of children.