ILLINOIS: AAP Will Not Publish Dissent

On his news feed, Hugh Young brings attention to the fact that the AAP is being very selective with the letters it is choosing to publish regarding its new policy statement.

The policy came out at midnight (ET) on August 27, 2012. In the following weeks, several letters have appeared, mainly critical of the policy (previously here, previously here and still here as of September 13, 0510 ET).

He writes, "But more hard-hitting letters, despite being fully referenced, have not appeared, and others have been added and removed in capricious ways."

He takes the liberty to publish letters that were up for several days, but have since been removed. (The unpublished letters are viewable here and here.)

Strangely enough, while they won't publish dissenting letters from intactivists, despite being fully referenced, they will publish Brian Morris praising the new AAP policy statement and tooting his own horn. (See Morris' "Welcome" of the new policy here.)

EDIT:
On a different medium, Brian Morris' tone on the new AAP policy statement was different, showing disappointment in the fact that the AAP stopped short of recommending infant circumcision. On this Patch article, Morris comments:

"The AAP's policy is not strong enough. The benefits exceed risks by over 100 to 1 just from number-crunching. But if the severity of the perils of not circumcising are compared with the trivial nature of the risks, then the benefits would be something like a million to 1 in favor. The ridiculous nonsense by the anti-circs stands condemned. This includes fallacious claims that circumcision is detrimental to sex. High quality research findings prove such propaganda to be absurd. In fact sex is better for a circumcised man. And women prefer circumcised lovers.
~Brian Morris
8:59 pm on Saturday, September 1, 2012

The "nonsense" stands condemned by WHOM? And just what are the "high quality research findings" he is talking about? "Women prefer circumcised lovers" WHERE? And why does it matter here, where we are talking about the circumcision of newborns?

While Brian "welcomes" the new AAP statement on Pediatrics, on September the 7th, he doesn't seem too enthused on Patch a few days earlier.

On my blog I will publish a letter I wrote in response to Brian Morris' piece praising the AAP, which I'm sure will never get published. In response to Brian Morris' letter titled "New Circumcision Policy Welcomed,"I wrote the following:

Re:New Circumcision Policy Welcomed

 In its simplest reduction, this appears to be yet another instance of Brian Morris taking the opportunity to promote circumcision, mostly by quoting mostly himself. [1], [2], [3], [4], [5]

At first glance, it would appear as if this post was collectively written by the authors that appear. But upon further inspection, it looks like whoever responds with an e-letter such as this one can include other authors at will, resulting in what looks like a letter written by a collective. Are the other authors aware that Brian Morris is including them as co-authors? Or is Brian Morris seeking to bolster his own credibility?

Brian Morris quotes some authors selectively, but this appears to be a tactic to insert claims which are backed by works written none other than himself.

For example: "We congratulate the AAP Task Force on Circumcision for concluding that "the health benefits of newborn male circumcision outweigh the risks. [6]" Excluded is the fact that the AAP has maintained its previous stance, which states that the benefits are not great enough to recommend infant circumcision.

Then we have: "While the Task Force considered evidence up until early 2010, further evidence of the benefits of circumcision has accumulated since then.[1]"

He says: "Meta-analyses indicate circumcision provides 73% protection against HIV in men who exclusively practice insertive intercourse with men,[7] lowers risk of oncogenic human papillomavirus (HPV) infection by 57%,7[8] and that phimosis, balanitis and smegma increase penile cancer risk by 12-, 4- and 3-fold, respectively.[2]"

Here, he takes advantage of other meta-analyses [7, 8] to include his own [2]. 

He follows this by yet another claim that can only be backed by none other than himself: "While the Task Force noted the importance of circumcising newborns in protecting the vulnerable pediatric kidney from common bacterial infections during infancy, protection against urinary tract infections continues over the lifetime.[1]"

And yet another: "An analysis of all conditions that circumcision protects against found benefits exceed risks by a substantial margin, generating a number needed to treat value of two.[1]"

These claims do not correlate with reality. The claimed detriments of having a foreskin are simply not observable in developed countries where circumcision is rare, including Australia, Brian Morris' own country of origin.

Morris continues: "While it is true that 'the procedure has the least surgical risk and the greatest accumulated health benefits if performed during the newborn period' and that 'newborn males who are not circumcised at birth are much less likely to elect circumcision in adolescence or early adulthood',[6] other substantial barriers have been identified should circumcision be delayed.[3]  Arguments by circumcision opponents have been refuted,[4] as has a policy statement on infant male circumcision in Australia.[5]"

The first reference is the AAP policy statement [6], but the last three references are all none other than himself. [3,4,5]

Perhaps he feels circumcision opponents have been refuted [4], and that he has single-handedly trumped the Royal Australasian College of Physicians [5], but so far, the RACP has ignored Morris and their policy statement remains un-withdrawn.

Morris concludes: "We support the AAP recommendations, including better training, universal access, provision of accurate unbiased information to parents, use of effective anesthesia, and third party reimbursement."

Given the rest of this article, Morris' usage of "we" in this statement seems to serve the illusion that he speaks for a number of authors, when in reality, he may be speaking for none other than himself.

I could have just as easily included a number of authors that I believe support my arguments in the form for this e-letter, but I have chosen on the side of integrity and I speak for none other than myself. 

I do not hesitate to declare my conflict of interests, as readers can see for themselves. However, readers must know that Brian Morris has competing interests that he is failing to declare here.

Brian Morris is the most vocal circumcision promoter in Australia, [9] and he uses regular scare tactics in an attempt to frighten parents into circumcising their children.[10] He neither holds degrees in surgery, urology, pediatrics, nor epidemiology, and his field of study is only remotely related to medicine (he is a molecular biologist and professor of molecular medical sciences).[11] He is in no way an authority on circumcision, much less male genitalia, child care, nor disease prevention. Yet, Morris is constantly producing publications for parents compelling them to circumcise their children,[12] and for women compelling them to stigmatize intact males,[13,14] and he is a prolific publisher of "studies" and "appraisals" of circumcision, which are mostly, as he does here, quoting himself. [1,2,3,4,5] Brian Morris often repeats inconclusive or flawed circumcision "research," and is constantly antagonizing the RACP calling for it to instate "mandatory circumcision" for all males in Australia.[5]

Morris belongs, or once belonged to Gilgal Society, his name appearing alongside their logo in numerous publications that promote circumcision.[12, 13, 14] Aside from many pro-circumcision tracts, Gilgal Society has published circumcision-based erotica, and the founder, Vernon Quaintance, was caught with many hours of child pornography.[15, 16] Morris has since tried to sever ties with Gilgal Society,[17] but he, and numerous others who have tried to abandon Gilgal Society, have come together to form the so-called “Circumcision Foundation of Australia.” [18]

Brian Morris also runs a website which he uses to promote circumcision.[19] Morris' website links to the following recommended websites and groups[20] (8 of which are sites that eroticize circumcised penises and circumcision itself, and 7 that sell devices to perform circumcisions[34][35][36][37][38][39]):

The Gilgal Society[21]

 Circlist (German)[22]

 Circlist (Yahoo Asian)[23]

 Erotic Male Circumcision[24]

 Circumcised Kids[25]

 Circumcision Fetish[26]

 SCARandACORN[27]

 Teen Circ[28]

 Cutting Club[29]

 Beschnittene Gay Boys[30]

 Misc. Kids[31]

 Misc. Kids Health[32]

 Misc. Kids Pregnancy[33]

Readers need to be made aware that Brian Morris is not the objective, impartial, dispassionate observer he leads on to believe. As someone who neither holds degrees in surgery, urology, pediatrics, nor epidemiology, and his field of study is only remotely related to medicine (he is a molecular biologist and professor of molecular medical sciences),[11] Morris is not any kind of authority on circumcision, much less male genitalia, child care, nor disease prevention. Furthermore, Brian Morris is known to be a prolific advocate of circumcision, particularly the circumcision of healthy, non-consenting infants. His lack of academic qualification and his known special interests raise the question of how he feels his word is of any value to the American Academy of Pediatrics, and how it adds any to their policy statement.

Readers may say that I am engaging in ad-hominem, but this accusation is unwarranted. Where a source seeks to convince by a claim of authority or by personal observation, identification of undeclared conflicts of interest are not ad hominem;  it is generally well-accepted that an "authority" needs to be objective and impartial, and that an audience can only evaluate information from a source if they know about conflicts of interest that may affect the objectivity of the source. Identification of a conflict of interest is appropriate, and concealment of a conflict of interest is a problem.

I feel it necessary to identify Morris’ undeclared conflicts, as these affect his objectivity as a source. As a known, avid circumcision promoter, and as someone who holds no degrees in pediatrics, let alone surgery, urology, and epidemiology, I feel Brian Morris’ words of congratulation are inappropriate to appear in the publication of a known medical organization whose purview is the health and well-being of children. The American Academy of Pediatrics ought to distance itself from Brian Morris if they would like to preserve any semblance of credibility.

References:

1. Morris BJ, Wodak AD, Mindel A, Schrieber L, Duggan KA, Dilly A, Willcourt RJ, Cooper DA, Lumbers ER, Russell CT, Leeder SR. Infant male circumcision: An evidence-based policy statement. Open J Prevent Med. 2012;2:79-82.

2. Morris BJ, Gray RH, Castellsague X, Bosch FX, Halperin DT, Waskett JH, Hankins CA. The strong protection afforded by circumcision against cancer of the penis. (Invited Review). Adv Urol. 2011(Article ID 812368):1-21.

3. Morris BJ, Waskett JH, Banerjee J, Wamai RG, Tobian AAR, Gray RH, Bailis SA, Bailey RC, Klausner JD, Willcourt RJ, Halperin DT, Wiswell TE, Mindel A. A 'snip' in time: what is the best age to circumcise? BMC Pediatr. 2012;12:20.

4. Morris BJ, Bailey RC, Klausner JD, Leibowitzd A, Wamai RG, Waskett JH, Banerjee J, Halperin DT, Zoloth L, Weiss HA, Hankins CA. A critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries. AIDS Care. 2012:Mar 28 [Epub ahead of print].

5. Morris BJ, Wodak AD, Mindel A, Schrieber L, Duggan KA, Dilly A, Willcourt RJ, Cooper DA. The 2010 Royal Australasian College of Physicians' policy statement 'Circumcision of infant males' is seriously flawed. Intern Med J. 2012;42:822-828.

6. American Academy of Pediatrics. Circumcision policy statement. Task Force on Circumcision. Pediatrics. 2012;130:e756-e785.

7. Wiysonge CS, Kongnyuy EJ, Shey M, Muula AS, Navti OB, Akl EA, Lo YR. Male circumcision for prevention of homosexual acquisition of HIV in men. Cochrane Database Syst Rev. 2011;6:CD007496.

8. Albero G, Castellsagu? X, Giuliano AR, Bosch FX. Male circumcision and genital human papillomavirus: A systematic review and meta-analysis. Sex Transm Dis. 2012;39:104-113.

9. "Sunday Night Circumcision". http://www.youtube.com/watch?v=7yDvL4hNny4#t=1m18s. Retrieved 2011-03-06. Archive: http://www.youtube.com/watch?v=gdGbXdEo93U

10. Morris, Brian J. (2010). "Why Medical Bodies and Others Should Not Advise That Circumcision Should be Delayed Until the Boy Can Make the Decision for Himself". circinfo.net. http://www.circinfo.net/circumcision_why_you_should_not_delay.html. Retrieved 2011-03-07. Archive: File:Circinfo why-you-should-not-delay.pdf

11. Morris, Brian J. (2010-03-04). "Professor Brian Morris". The University of Sydney.. Head of Discipline. http://sydney.edu.au/medicine/genetic/staff/profiles/bmorris.php. Retrieved 2011-03-07.

12. Morris, Brian; Quaintance, Vernon (2007). Vernon Quaintance. ed. Circumcision: A guide for parents. London, England: Gilgal Society. http://www.circinfo.net/pdfs/GFP-ENAU.pdf. Retrieved 2011-03-06. Archive: File:Gilgal Parents-Guide.pdf

13. Morris, Brian (2007). Vernon Quaintance. ed. Sex and circumcision: What every woman needs to know.. London, England: Gilgal Society. http://www.circinfo.net/pdfs/GFW-EN%200712-1.pdf. Archive: File:Gilgal For Women leaflet.pdf

14. "Guide For Women". http://web.archive.org/web/20110518085430/http://www.circinfo.net/. Retrieved 2011-05-81.

15. "Croydon circumcision campaigner caught with child porn videos". Croydon Advertiser. 2012-04-21. http://www.thisiscroydontoday.co.uk/Croydon-circumcision-campaigner-caught-child-porn/story-15866127-detail/story.html. Retrieved 2012-04-22. Archive 2012-04-21: http://circleaks.org/images/2/27/Www.thisiscroydontoday.co.uk-Croydon-circumcision-campaigner-caught-child-porn-s.pdf

16. Kay, Richard (2012-04-25). "Sex scandal rocks Order of the Knights". MailOnline (GlamEntertainment). http://www.dailymail.co.uk/news/article-2134978/David-Cameron-son-PM-wife-Samantha-unveil-church-tribute-son-Ivan.html. Retrieved 2012-04-26. Archive (2012-04-27): http://circleaks.org/images/6/66/Quaintance-disrupts-the-church%28malta%29.pdf

17. Young, Hugh. "Intactivism News". Circumstitions. http://www.circumstitions.com/news/news45.html#vernon2. Retrieved 2012-04-27.

18. http://www.circumcisionaustralia.org/

19. Morris, Brian J. (2010). "About the Author - Professor Brian J. Morris". circinfo.net. http://www.circinfo.net/about_the_author_professor_brian_j_morris.html. Retrieved 2011-03-07. Archive: File:Circinfo about-the-author.pdf

20. Morris, Brian J. (2007-08-29). "Circumcision Websites & Online Discussion Groups". circinfo.net. http://circleaks.org/images/3/31/Web.archive.org-web-20070829145507-circinfo.net-circumcision_websites_online_discussion_groups.html-1.pdf. Retrieved 2011-03-06. Archive: http://web.archive.org/web/20070829145507/circinfo.net/circumcision_websites_online_discussion_groups.html

21. Quaintance, Vernon. "The Gilgal Society". The Gilgal Society. http://www.gilgalsoc.org/. Retrieved 2011-03-07. Archive: File:Gilgalsoc mainpage.pdf

22. "Circlist". Circlist. http://www.circlist.hasibubu.de.

23. "Asian-pro-circumcision". Yahoo. http://groups.yahoo.com/group/asian_circlist/.

24. "Erotic Male Circumcision". Yahoo. http://groups.yahoo.com/group/eroticmalecircumcision/.

25. http://groups.yahoo.com/group/circumcisedkids/

26. Morris, Brian J. (2007-08-29). "Circumcision Websites & Online Discussion Groups". circinfo.net. http://circleaks.org/images/3/31/Web.archive.org-web-20070829145507-circinfo.net-circumcision_websites_online_discussion_groups.html-1.pdf. Retrieved 2011-03-06. Archive: http://web.archive.org/web/20070829145507/circinfo.net/circumcision_websites_online_discussion_groups.html

27. "SCARandACORN: Interseted in the subject of circumcision, particularly those with personal experience. Against the tide of anti-circumcision.". Yahoo. http://groups.yahoo.com/group/SCARandACORN/.

28. "Teen Circumcision". Yahoo. http://groups.yahoo.com/group/teen_circ_/.

29. "The Cutting Club". EuroCirc. http://www.eurocirc.org/cuttingclub.

30. "BeschnitteneGayBoys • Circumcised guys do it better!!". Yahoo. http://groups.yahoo.com/group/BeschnitteneGayBoys/.

31. "Usenet Newsgroup: misc.kids". http://groups.google.com/group/misc.kids/topics?pli=1.

32. "Usenet Newsgroup: misc.kids.health". http://groups.google.com/group/misc.kids.health/topics?lnk=srg.

33. "Usenet Newsgroup: misc.kids.pregnancy". http://groups.google.com/group/misc.kids.pregnancy/topics?lnk=srg.

34. "Tara Klamp". Tara Klamp. http://www.taraklamp.com/. Retrieved 2011-03-06.

35. "Find Supplies". http://www.findsupplies.com/.

36. "Smart Klamp". http://www.smartklamp.com/.

37. "Weihai Zhenxi Medical". http://www.zhenxi-korea.com/.

38. "Circ-Ring International". http://www.zhenxi-europe.com/.

39. "Cutting Ring". http://www.cutting-ring.com/.