Joseph4GI: June 2015

Thursday, June 11, 2015

FLORIDA: Joe DiMaggio Children's Hospital Complicit in Medical Fraud, Child Abuse?

In my last post regarding this case, I posted about the details an anonymous user leaked on Facebook, which revealed that the child in this case is scheduled to be circumcised on Thursday, June 11 (THAT'S TODAY) at Joe DiMaggio Children's Hospital by one Gary Birken, MD.

The release of this information has gone viral, and Joe DiMaggio Children's Hospital has heard an earful (or perhaps, more appropriately, "seen a screenful?") from hundreds, if not thousands, on their Facebook page, prompting the following response:

Joe DiMaggio Children's Hospital (JDCH) calls itself "[A] pillar in the South Florida Community and an advocate for many causes, always working for the benefit of its patients, while providing quality service and care." They further state that they "[C]an't and will not discuss specifics in this forum due to HIPAA guidelines."

It appears here that JDCH is expressing concern for upholding its reputation, supposedly touting a concern for the confidentiality of their patients. The problem with this confidentiality is that it could be hiding something sinister; if there is nothing wrong with the child in question, could he rightly be called a "patient?"

The comments have not stopped, prompting a second response from them:

Again we see similar lines, if not in more stronger tones, that they are concerned for preserving their reputation. They seem to be concerned that the hospital and their doctors are being "defamed," and that their work is being "minimized." Their wording is interesting, seeing as "minimizing" what is transpiring at their hospital is precisely what they intend to do.

The peculiarity to be noted here is that they reiterate that HIPAA laws prevent them from speaking about any medical case, and yet they still manage to disclose that "the child in question is not a patient at Joe DiMaggio Children's Hospital or any Memorial Helathcare System facility or of Dr. Gary Birken."

Intactivists, and others, are watching closely and taking note of the chain of events surrounding this case.

Lie after lie...

JDCH appears to be concerned with tarnishing its reputation, but I'm afraid if the facts are what they are, this does not bode well for them. As if their involvement in this case weren't enough, a relative of the child has posted a screenshot of the child's pre-surgical assessment, dated 6/4/2015 (first visit), publicly on Facebook, catching the spokespeople at JDCH in a bold-faced lie.

As if denying that this child were a patient at JDCH weren't enough, if one reads the pre-surgical assessment, one can see the deliberate fraud, lies and fabrication taking place.

The father, of course "reports" frequent urine trapping and ballooning of the child's foreskin, and supposedly notes "erythmia (redness) of distill foreskin." The review mentions "penile pain, ballooning of the foreskin and foreskin not retractable," and further down, it reiterates "Foreskin reduces approximately 30 percent. Mild foreskin inflammation. Urine noted under foreskin."

What the father and the doctor are trying to note as "problems" should raise red flags to the learned reader.

Ballooning is a normal stage of development at this child's age; it’s one of the ways the balanopreputial lamina are naturally stretched and desquamated.

There can be several causes to redness (erythema) or inflammation, from too much soap or improper rinsing, to a mild irritation, to rubbing, to balanitis; all of those causes are usually easily treatable and are not indications for surgery. The doctor notes "penile pain," and that the child's foreskin is "not retractable." Why is this doctor trying to retract this child's foreskin? Is he not aware that non-retractability is normal for a child this age? What is the cause of this child's pain? Could it be that the child's foreskin is being forcibly retracted by the doctor or the child's caretakers? (Read about forcible retraction in a previous post.)

Why does the doctor seem more concerned in finding an alibi for performing surgery on this child than genuinely interested in finding the source of the pain? For what other inflammation of the body is surgical removal the first course of action, and not attempts to treat it by conventional means?

The doctor notes “urine noted under foreskin”, as if this were some kind of pathological symptom. The fact is that the foreskin traps moisture. This is normal, as every male in the world who has a foreskin maintains a certain moisture between the foreskin and the glans; it’s how mucosal tissues work. To try to make this into a pathological condition is like saying that moisture inside the mouth is indication of improper hygiene. Do doctors note urine in the labia as a "problem" too?

The assessment says the child's penis is "Normal. Uncircumcised."

The assessment and plan concludes:
“Discussed pros and cons, RCA in detail with father and aunt as relatives to elective circumcision. They have asked that we proceed.”

Here we can clearly see that the doctor refers to the circumcision to be performed on this child as "elective." There is an absence of a clear medical indication, and thus a recommendation that the child should be circumcised to alleviate any medical problem. Instead, the doctor discusses "the pros and cons.. to elective circumcision."

In other words, it is clear that the procedure is not medically necessary. The child has no condition requiring the procedure. It is clear that the doctor wants to wash his hands over the procedure and pawn any responsibility on the child's guardians who "elected" it.

It’s clear from the form that the circumcision is not necessary, that the circumcision would be purely elective, that it would happen solely because the parents gave their go-ahead, and that the doctor wants this to be evident, presumably so that he stands blame-free in any case.

Readers note; there is no other surgery that a doctor is obliged to perform on a healthy, non-consenting child because his *parents* want it done. Surgery in children usually requires a strong medical indication, or a need to correct a problem.

If surgery is not medically indicated in this child, if the procedure is purely elective and being performed to appease the whims of the father, then the doctor cannot be expected to be reimbursed by Medicaid. Should Medicaid cover this procedure, this doctor would clearly be engaging in medical fraud, and JDCH would be complicit in facilitating it.

The plot gets thicker...

It appears this assessment was sent as an attachment to another doctor:

Note where it says "Diagnoses:" "Foreskin problem, "Redundant prepuce and phimosis"

What "foreskin problems" were there? To someone who views the circumcised penis as "normal," isn't the prepuce "redundant" at any length? What assessments were performed by Dr. Birken to verify that the child actually has "phimosis" and his genitals aren't merely presenting natural stages of development?

I will leave it up to the reader to decide what s/he thinks is going on.

Doctor to File Complaint Against Joe DiMaggio Children's Hospital

On a previous post, I noted that one Dr. John Trainer MD had publicly posted the following on JDCH's Facebook Page:

"Simply an observation: the surgeon who would perform an elective surgery on a four-year-old, over the objection of his mother, and the objection of the four-year-old, has committed a gross breach of medical ethics.

If your hospital is complicent in the mutilation of Chase Hironimus, know that I will be filing an ethical complaint with the Florida Board of Medicine the next day."

Well, it appears as though a local paper has picked it up. (Read the article here.)

I must say, it is interesting to read about this man's background:

"John Trainer, M.D., is a family doctor in Jacksonville. He has circumcised children and taught other doctors how to perform circumcisions. His own son is circumcised.

But during the past few months, as he's followed the case of 4-year-old Chase Hironimus..., Trainer reexamined his own position on the surgery and has come to believe that routine infant circumcision is a violation of medical ethics and that Chase's case is particularly egregious because the mother's consent was forced under duress."

I suppose that even it is a tragedy that this happening in our nation, I should be grateful that there are some doctors who are coming around.

I will paste more excerpts from this article here:

From a physician's point of view, Trainer told New Times, "it's absolutely mind-boggling this would be considered as real consent." Of the doctor rumored to be scheduled to perform a circumcision on Chase — Gary Birken — Trainer said, "it is incumbent on him" to be "aware that this is a dramatic case, an unusual case.

"Where this this galls me the most," Trainer says, "is that if we are physicians and ethical and called on to police our profession," and the doctor here "either knew or should have known" — that's the phrasing commonly used in ethical standards — "that consent was tainted," and if he proceeds in this particular case, "at the very least his ethics need to be challenged."

Furthermore, he said, pediatric surgery ethics require that a doctor make the child aware of what is happening and consider the child's opinion in elective surgeries. Court documents asserted that Chase was scared of and does not want the procedure...

It's also, he says, "the only procedure an obstetrician will do on a man — and with absolutely no follow-up. They'll never see that penis again — no follow-up. This is unheard-of with any other procedure."

Asked if he faced any career risks by preemptively speaking out against a doctor or hospital, Trainer said, "I am on the Board of Directors of Baptist Primary Care, a leader in a consortium of 150 providers — the largest and most trusted health-care system in Northeast Florida. If I suffer backlash for speaking out, I am OK with that. Actually, my Facebook page is blowing up with people commending me for being courageous. I don't really feel that brave."

Doctors Opposing Circumcision Lays Down the Law

In other news, organization Doctors Opposing Circumcision has sent the following letter to JDCH.

I'll let readers read it and make of it what they want for themselves:

One thing is for sure; whoever lays hands on this child had better get ready.

Muslim child about to be circumcised. One can be sure

nobody "convinced" him of anything, money is not

enough to comfort this child who knows what is coming

As a 4-year-old, the child may have to be restrained.

Here is a picture of a 4-year-old being forcibly circumcised

in Turkey. Boys in Muslim traditions are circumcised at later ages.

Joe DiMaggio Children's Hospital; did you seriously allow this to happen in your facilities today?

Have you failed this child?

Some "pillar" you are.

I close with my mission statement:

Mission Statement
The foreskin is not a birth defect. Neither is it a congenital deformity or genetic anomaly akin to a 6th finger or a cleft. Neither is it a medical condition like a ruptured appendix or diseased gall bladder. Neither is it a dead part of the body, like the umbilical cord, hair, or fingernails.

The foreskin is not "extra skin." The foreskin is normal, natural, healthy, functioning tissue, present in all males at birth; it is as intrinsic to male genitalia as labia are to female genitalia.

Unless there is a medical or clinical indication, the circumcision of a healthy, non-consenting individuals is a deliberate wound; it is the destruction of normal, healthy tissue, the permanent disfigurement of normal, healthy organs, and by very definition, infant genital mutilation, and a violation of the most basic of human rights.

Without medical or clinical indication, doctors have absolutely no business performing surgery in healthy, non-consenting individuals, much less be eliciting any kind of "decision" from parents, and much less expect to be reimbursed by public coffers.

Genital mutilation, whether it be wrapped in culture, religion or “research” is still genital mutilation.

It is mistaken, the belief that the right amount of “science” can be used to legitimize the deliberate violation of basic human rights.

Previous Posts:
FLORIDA UPDATE: Father Intent on Circumcising 4-yo Son Seeks to Legally Paralyze Mother

FLORIDA UPDATE: Mother in Circumcision Dispute Fails to Appear in Court - Judge Orders Her Arrest

FLORIDA: Belligerent Judge Seeks the Circumcision of a 4 Year Old

FLORIDA UPDATE: 4-yo Circumcision Case Goes Federal

FLORIDA CIRCUMCISION SAGA: Mother Arrested, Child Nabbed

FLORIDA UPDATE: Court Battle Slated for Monday - Father Objects to British TV Coverage

A Word Of Prayer for Chase

FLORIDA: What Happened Today As Per Intact America

FLORIDA CIRCUMCISION SAGA: Withdrawal of Motion and Notice of Voluntary Dismissal Filed

FLORIDA CIRCUMCISION SAGA: Insult to Injury

FLORIDA CIRCUMCISION SAGA: It's Not Over Yet

FLORIDA BULLETIN: Circumcision Scheduled for 4-yo - Anonymous User Discloses Details

Phony Phimosis: How American Doctors Get Away With Medical Fraud

Wednesday, June 10, 2015

Phony Phimosis: How American Doctors Get Away With Medical Fraud

I'm writing this post touched off by recent case in Florida, where a father is trying to veil his compulsive desire to have his 4-year-old son circumcised in a pseudo-medical allegation that the child is suffering some kind of problem.

According an earlier The Sun Sentinel article:

"[The father] has said he decided to pursue the circumcision in December 2013 when the boy was 3, after he said he noticed his son was urinating on his leg. The father on Friday said the boy's pediatrician had diagnosed a condition called phimosis, which prevents retraction of the foreskin."

Sharp readers who have been keeping up with this case should note a major inconsistency in this chronicle of events; namely that the father had invoked a legal contract where both parents had agreed to circumcise the child in question, which was signed by both the boy's mother and himself more than three years ago. This alone should demonstrate that the father had the intention of circumcising the boy three years ago, before the child would have been diagnosed with any "problem," not to mention his quip that he wanted to have his child circumcised "because it's the normal thing to do."

As it turns out, another physician who testified on behalf of the mother, and who had himself diagnosed the child directly, said that the child was just fine and that there was no medical reason why the boy had to be circumcised. This prompted the separate debate as to whether the circumcision of a healthy, non-consenting minor were "medically beneficial" or not, leading to the preceding judge to rule, according to his own analysis, that it was. (The judge is no doctor, and even the American Academy of Pediatrics refrains from issuing a recommendation for the circumcision of healthy children based on the current body of evidence.)

The judge ruled that the boy should be circumcised as outlined in the legal parental agreement signed three years ago, not because the boy had any pressing need to be circumcised, but because, based on his own (non-medical) judgement, he himself thought that circumcising a healthy, non-consenting 4-year-old was "medically beneficial."

So what was the father intending with his son-peeing-on-leg story?

I think a good look at the facts makes it obvious.

Those who have been keeping their eye on circumcision, circumcision advocates and their alibis, will no doubt be aware that the diagnosis of "phimosis" is far too commonly given as a pretext to circumcise an older child. Circumcision is also marketed as prophylaxis for "phimosis" by those who advocate or have to gain from performing the procedure.

But what is phimosis?

Who gets it?

What causes it?

How common is it?

When and if it is necessary, what treatment options are available?

When is a situation not "phimosis" but a normal stage in development?

I'm writing this blog post to answer these questions and more.

The Facts

What is phimosis?

The word "phimosis" originates from the Greek word phimos (φῑμός) which means "muzzle". "Phimosis" is a vague term used to describe any situation where, in intact males, the foreskin cannot be retracted to reveal the glans, or the head of the penis. The term may also refer to clitoral phimosis in women, whereby the clitoral hood cannot be retracted, limiting exposure of the glans clitoridis.

What are the normal stages of development?

At Birth
Typically, when a baby boy is born, the prepuce is long with a narrow tip.(1)(2) Retraction is not possible in the majority of infants because the narrow tip will not pass over the glans penis. Moreover, it is normal for the inner mucosal surface of the prepuce to be fused with the underlying mucosal surface of the glans, or head of the penis,(1)(2)(4)(5) by means of a membrane called synechia, also known as the balano-preputial membrane or balano-preputial lamina,(1) further preventing retraction. This attachment forms early in fetal development and provides a protective cocoon for the delicate developing glans.(6) It is normal for the foreskin to be non-retractable in infancy and early childhood.(6)

Retraction of the Foreskin
In normal development, the foreskin usually separates from the glans and becomes retractable with age.(4) As the infant matures into a boy and the boy into a man, the tip of the prepuce becomes wider, and the shaft of the penis grows, making the tip of the prepuce appear shorter. The membrane that bonds the inner surface of the prepuce with the glans penis spontaneously disintegrates and releases the prepuce to separate from the glans. The prepuce spontaneously becomes retractable.

In order for retraction to occur, the foreskin must have separated from the glans and the opening of the foreskin must have widened to allow it to slip back over the glans. Throughout childhood and adolescence, there is a release of hormones. As hormone levels rise, the fiber-dense tissue of the prepuce is replaced with a more elastic tissue. A boy will begin to explore his genitals as he grows, and as time passes, the elastic tissue will allow the opening of the foreskin to widen. This can happen at any age but it is not common in young boys.

The amount of time it takes for a boy's foreskin to become fully retractable varies from boy to boy; this process can take many years for some boys, and yet minutes for others. In some boys, the foreskin may not be retractable until after puberty.(7)(8)(9) This is an entirely normal stage of development and should not be diagnosed as any kind of "problem."

When Does Retraction Happen?
According to the experience of doctors and researchers in cultures where circumcision is uncommon, retraction happens at varying ages, and a non-retractable foreskin rarely requires treatment. Observations from doctors in Denmark, and Japan and other countries indicate that spontaneous loosening usually occurs with increasing maturity.(7)(8)(9)(10)(11)(12)

Non-retractability is considered normal for males up to and including adolescence. The process whereby the foreskin and glans gradually separate may not be complete until the age of 17.(4) A Danish survey (2005) reported that average age of first foreskin retraction is 10.4 years.(13) Marques et al (2005) reported that 99% of boys can retract their foreskins by age 14.(12)(14)(15)(16) One may expect 50% of 10-year-old boys; 90% of 16-year-old boys; and 98-99% of 18 year-old males to have a fully retractable foreskin. Treatment is seldom necessary.

A 1999 study by Cold and Taylor shows that at 6 to 7 years, approximately 60% of the boys had natural adhesions. At 10-11 years, close to 50% of the boys still had adhesions. At 14-15, approximately only 10% of the boys had adhesions. As they approach the age of 17, only a very small percentage of boys will have adhesions. That means that, left uncircumcised, most boys will be able to retract their foreskin before they are 17 years old.

Foreskin Retraction as Observed in Children in Other Countries
Jakob Øster, a Danish physician who conducted school examinations, reported his findings on the examination of school-boys in Denmark, where circumcision is rare.(7) Øster (1968) found that the incidence of fusion of the foreskin with the glans penis steadily declines with increasing age and foreskin retractability increases with age.(7)

Kayaba et al. (1996) also investigated the development of foreskin retraction in boys from age 0 to age 15.5, and they also reported increasing retractability with increasing age. Kayaba et al. reported that about only 42% of boys aged 8-10 have fully retractile foreskin, but the percentage increases to 62.9% in boys aged 11-15.(8) Imamura (1997) reported that 77% of boys aged 11-15 had retractile foreskin.

Thorvaldsen and Meyhoff (2005) conducted a survey of 4000 young men in Denmark. They report that the mean age of first foreskin retraction is 10.4 years in Denmark.(13) Non-retractile foreskin is the more common condition until about 10-11 years of age.

Current medical literature indicates that the foreskin is non-retractable in the majority of males until they begin to approach puberty. Until a boy begins to reach sexual maturity, non-retractability of the foreskin is a normal part of growing up.

When is "phimosis" a problem?
Given the empirical facts stated above, it is already mistaken to assume that just because the foreskin cannot be retracted to reveal the head of the penis, a male has some sort of pathological condition. As evidenced by the facts given above, the great majority of male children who have anatomically correct genitals will have foreskins that cannot be retracted, and it is a mistake to assume that all children undergo this transitory "illness" where they can't retract their foreskins, akin to the mumps, measles or chicken pox. Girls do not begin to menstruate until the onset of puberty, and they are not considered to be suffering any sort of medical condition until then.

Non-retractability of the foreskin may pose a problem if it continues well past puberty. Typically the foreskin has dilated to allow retraction as a result of the release of hormones. In a small percentage of males, the production of these hormones is insufficient, and the foreskin fails to dilate, resulting in a condition known as "preputial stenosis," or, a narrow foreskin. This condition may make hygiene and sexual intercourse difficult, if not impossible, but not always. In older men that have bad hygiene habits and who smoke regularly, having a non-retractile foreskin can increase the chances of developing penile cancer.

There is another reason why the foreskin may not be retractable in a male, and that is because he has suffered an infection with balanitis xerotica obliterans, or BXO for short. In this case, the tip of the foreskin is scarred and indurated, and has the histological features of a pathological infection. The foreskin of a male who has suffered an infection with BXO will have developed a fibrotic ring, which makes retraction difficult or impossible. It is this pathologically induced non-retractability which can be correctly termed "phimosis." To differentiate normal stages of development, and even the physiological state of a foreskin which has failed to dilate as a result of lack of hormones, from pathologically-caused non-retractability, doctors have invented the term "true phimosis." It is non-retractability caused by pathological infection with BXO that can be considered an actual problem.

Can phimosis be cured?
It is estimated that 2% of males go their entire lives without their foreskins ever becoming retractable. How this condition can be treated will depend on what the actual problem is. The physiological condition where a foreskin has failed to dilate as the result of a lack of hormones, otherwise known as "preputial stenosis," tends to respond to steroid cream therapy, coupled with stretching exercises and/or stretching devices.

Non-retractability as a result of a BXO infection, however is different, as this is caused by a resulting fibrotic ring at the end of the foreskin, which is scarification that may or may not respond to steroid cream treatment or stretching exercises. It is non-retractability caused by BXO infection that can be genuinely considered a problem which may call for corrective surgery.

It should be noted that non-retractability of the foreskin as a result of BXO infection occurs in less than 1% of males. Additionally, it should be noted that even when a case of "true phimosis" may require surgical correction, it does not always entail a complete removal of the prepuce. There are procedures that can correct phimosis which can preserve the foreskin and its functions. Surgical methods range from the complete removal of the foreskin (circumcision) to more minor operations to relieve foreskin tightness, such as a "dorsal slit" (AKA "superincision") a "ventral slit" (AKA "subterincision") and "preputioplasty."

If treatment should be necessary, it should not be done until after puberty and the male can weigh the therapeutic options and give informed consent.(9)

How should a genuine case of phimosis be diagnosed?
In order to correctly determine that there is a real problem occurring in a male, a learned doctor will begin by ruling a few things out.

If, for example, a child hasn't reached puberty yet, and because non-retractability is common for this age group, the doctor should consider that the child may be experiencing normal stages of development.

If, for example, a child hasn't reached puberty yet, but he was able retract his foreskin previously, it may be probable that the child may have experienced an infection with BXO.

If, for example, an adult male who has already gone through puberty still has a non-retractile foreskin, the doctor needs to determine if this is a physiological problem caused by a lack of hormones (preputial stenosis), or if it is a pathological problem as a result of infection with BXO (AKA "true phimosis").

Because non-retractibility of the foreskin can be both a normal stage of development, and a pathological problem, it can be very easy for doctors to make an inadvertent, or even deliberate misdiagnosis. Particularly in countries like the United States, where circumcision is a perceived norm, and doctors may not be educated in the differences between normal stages of development and phimosis as a pathological condition, it can be very easy for doctors to say that a child is suffering a condition that may require surgical correction, where in fact, there is actually none.

For a correct diagnosis, a doctor who is knowledgeable about the difference between normal stages of development and non-retractability caused by BXO infection will correctly have the male analyzed for signs of lesions of BXO. Then, and only then, can a doctor properly make the diagnosis that a male child is suffering a medical problem, and that the child may need surgery to correct the problem.

Because non-retractability in adult males is rare, and "true phimosis" (pathologically induced non-retractability) even more rare, there is a high probability that a diagnosis for "phimosis" is actually false, especially in children, where non-retractability of the foreskin is a part of normal development.

Iatrogenically Induced Problems
Problems with the retraction of the foreskin may either be the result of a lack of hormones, the result of an infection with BXO, or, they could be iatrogenically induced. (E.g. actually caused by the doctor himself.)

It has been widely recognized by the medical profession for most of the 20th century that normal male infants have foreskins which are incompletely separated from the epithelium of the glans.(17) The foreskin cannot be retracted without tearing the fusion and adhesions which are commonly present between the inner foreskin and the glans penis in normal stages of development.

In English-language medicine, there is an absence of proper knowledge of the foreskin and its development in the medical curriculum. According to McGregor et al (2005), physicians often have difficulties distinguishing between this normal, natural state of the penis in neonates and pre-pubecent boys and pathological phimosis caused by BXO.(17)(18) Spilsbury et al (2003) suggest that doctors may be likely to confuse the aforementioned conditions with pathological phimosis.(19)

Unaware of the harmless nature of the normal, natural state of the penis in neonates, and the presence of adhesions in infants and pre-pubecent boys, and unaware that this can be damaging, doctors have been known to forcibly attempt to retract the foreskin in healthy, developing children, just to see if it retracts, tearing natural adhesions and/or ripping the foreskin in the process. Furthermore, they have been known to erroneously instruct parents that a child's foreskin needs to be retracted in order to "clean under it," arguing that they will develop infections otherwise.(20)

Premature, forcible retraction of the foreskin is an extremely painful, serious, and potentially permanent injury(17). It can damage the glans and mucous inner tissue of the foreskin. Forcibly retracting a child could result in iatrogenically induced phimosis, where the raw, open wounds of ripped adhesions could heal and fuse together, or where a forcibly dilated foreskin could develop scarification, resulting in a fibrotic ring similar to the one caused by BXO infection. Additionally, this can result in a complication known as "paraphimosis," where the narrow foreskin strangles the penis trapped behind an enlarged glans, thereby necessitating surgical intervention.

It must be noted here that these problems rarely present themselves in countries where circumcision is rare or not practiced. There is simply no epidemic of foreskin problems in countries where male children aren't circumcised. These problems tend to suspiciously present themselves in countries where circumcision is common, and diagnosed by doctors who happen to specialize in child circumcision. Children may have been circumcised to correct "problems" that either never existed, or whom were given their problems by ignorant doctors to begin with.

It is harmful and misleading to tell parents that a child's foreskin must be forcibly retracted. In children whose foreskins are still adhered to the glans, or where the foreskin has not dilated to allow the glans, this can be a harrowing experience. Forcibly retracting a child's foreskin "to clean under it" is the equivalent of cleaning out a girl's vagina with a pipe cleaner. Surely, a doctor who would instruct parents to clean out their child's vagina would be dismissed as a lunatic. Medical associations advise not to forcibly retract the foreskin of an infant, as this interferes with normal penile development, and may result in scarring or injury.(21)(22).

Camille et al (2002), in their guidance for parents, state that "[t]he foreskin should never be forcibly retracted, as this can cause pain and bleeding and may result in scarring and trouble with natural retraction."(23)

Simpson & Barraclough (1998) state that "[n]o attempt should be made to retract a foreskin in a child unless significant separation of the subpreputial adhesions has occurred. Failure to observe this basic rule may result in tearing with subsequent fibrosis and consequent [iatrogenically induced] phimosis. ..."(24)

The American Academy of Pediatrics cautions parents not to retract their son's foreskin, but suggest that once he reaches puberty, he should retract and gently wash with soap and water.(25) The Royal Australasian College of Physician as well as the Canadian Paediatric Society emphasize that the infant foreskin should be left alone and requires no special care.(26)

Summary
The facts, which are well-documented in medical literature, speak for themselves.

A foreskin that is adhered to the glans and/or will not retract is a normal stage of development in all healthy male children in infancy. The belief that a foreskin that is "tight" and will not retract is a problem in male infants implies that all human male children are born with some kind of birth defect, congenital deformity or genetic anomaly akin to a 6th finger or a cleft.

In the great majority of males, the foreskin separates from the glans and becomes retractable as they approach puberty, without the aid of medical or surgical intervention.

A foreskin that will not retract in older males is rare, and may or may not be a pathological problem. In order to determine the cause of a non-retractile foreskin, a knowledgeable doctor who understands anatomically correct male genitals, the normal stages of development of healthy males, and true pathological problems of male genitalia, must run the correct analyses in order to detect the presence or absence of pathological lesions; then, and only then, can the doctor determine whether the problem can be remedied with conventional medicine or by means of surgical correction.

Even when a genuine case of phimosis that necessitates surgical intervention presents itself, circumcision, or the full excision of the foreskin is not always called for; there are surgical interventions which will correct phimosis while preserving the foreskin and its functions.

Intervention to hasten the retraction of the foreskin in otherwise healthy, prepubescent males may actually cause iatrogenically induced problems. The forced retraction of the foreskin may itself cause non-retractability. Forcibly dilating the foreskin causes scar tissue to form, which may result in a fibrotic ring at the end of the foreskin. Breaking the natural adhesions which occur between the glans and the foreskin during normal stages of development may cause new adhesions to form between the glans and the foreskin, becoming fused as the raw wounds of the broken adhesions heal together. Forcibly pulling back naturally narrow foreskin over the glans in otherwise healthy children may result in paraphimosis, where the narrow foreskin catches behind the glans, preventing the foreskin from returning to its neutral position covering the glans, ironically necessitating the need for surgical intervention.

Efforts need to be made to bring English-language curriculum on the foreskin, the natural stages of development and genital pathology up to date. Doctors need to educate themselves and stop dispensing erroneous and dangerous advice to parents. They need to learn to differentiate between the normal stages of development in human males, and actual pathological phimosis.

Conclusion
So what's with the father's son-peeing-on-leg story?

And what does this have anything to do with "phimosis?"

Where is peeing on one's leg listed as a symptom for phimosis and not merely a case of childhood incontinence?

Is Chase's father genuinely concerned for the well-being of his son? Are Chase's father's intentions truly in his son's best interest? Or only his own?

How was the conclusion that this boy was suffering any kind of medical condition determined?

How did the doctors determine that he was suffering a genuine case of phimosis, and was not merely exhibiting the stages of normal development?

Can we assume good faith and say that the diagnosis of "phimosis" given by the doctors on the father's side was born out of genuine ignorance?

Or did they deliberately raise false testimony on the father's behalf?

I surmise that the father hoped that by producing some sort of medical "problem," he would secure permission from the judge to allow for a "medically indicated" circumcision. That, or he was intending to secure funds from Florida Medicaid, which states specifically that funds are to be used for medically indicated treatment or surgery.

Doctors who diagnose "phimosis" in a perfectly healthy child are either uneducated when it comes to the foreskin and natural stages of development, or may in fact be committing medical fraud, deliberately inventing a misdiagnosis in order to justify surgery in a healthy, non-consenting minor, and/or collecting medicaid funds intended for actually medically necessary surgery.

Intactivists will be watching what happens very closely, and we will work for this case to be thoroughly investigated. Reaping profit from performing non-medical surgery on healthy, non-consenting individuals constitutes medical fraud. In children, it constitutes child abuse. This is to be compounded with the fact that the consent forms for this elective, non-medical surgery were signed by a mother under duress. Whoever decides to circumcise this boy will have heavy litigation on his hands.

References:
1. Gairdner D. The fate of the foreskin: a study of circumcision. Br Med J 1949;2:1433-7.

2. Spence J. On Circumcision. Lancet 1964;2:902.

3. Deibert GA. The separation of the prepuce in the human penis. Anat Rec 1933;57:387-399.

4. Øster J. Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys. Arch Dis Child 1968;43:200-3.

5. Catzel P. The normal foreskin in the young child. (letter) S Afr Mediense Tysskrif [South Afr Med J] 1982 (13 November 1982) 62:751.

6. Wright J.E. (February 1994). "Further to 'the further fate of the foreskin'". The Medical Journal of Australia 160 (3): 134–5. PMID 8295581. http://www.cirp.org/library/normal/wright2/

7. Øster J. Further fate of the foreskin: Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys. Arch Dis Child (published by the British Medical Association), April 1968. p. 200-202.

8. Kayaba H, Tamura H, Kitajima S, et al. Analysis of shape and retractability of the prepuce in 603 Japanese boys. Journal of Urology, 1996 Nov, V156 N5:1813-1815.

9. Warren JP: NORM UK and the Medical Case against Circumcision. In: Sexual Mutilations: A Human Tragedy; Proceedings of the 4th Intl Symposium on Sexual Mutilations , Denniston GC and Milos MF, Eds. New York, Plenum, 1997) (ISBN 0-306-45589-7)

10. Celsus. De medicina, vol 3. Harvard University Press, Cambridge, p 422

11. Celsus. De medicina, 6.18.2. In: Spencer WG (ed and trans) (1938) Celsus. De medicina, vol 2. Harvard University Press, Cambridge, p 269

12. Hodges FM. Phimosis in antiquity. World J Urol 1999;17(3):133-6.

13. Thorvaldsen MA, Meyhoff H.. Patologisk eller fysiologisk fimose?. Ugeskr Læger. 2005;167(16):1852-62.

14. Marques TC, Sampaio FJ, Favorito LA (2005). "Treatment of phimosis with topical steroids and foreskin anatomy". Int Braz J Urol 31 (4): 370–4; discussion 374. doi:10.1590/S1677-55382005000400012. PMID 16137407. http://www.brazjurol.com.br/july_august_2005/Marques_ing_370_374.htm.

15. Denniston; Hill (October 2010). "Gairdner was wrong". Can Fam Physician 56 (10): 986–987. PMID 20944034. PMC 2954072. http://www.cfp.ca/content/56/10/986.2.long. Retrieved 2014-04-05.

16. Huntley JS, Bourne MC, Munro FD, Wilson-Storey D (September 2003). "Troubles with the foreskin: one hundred consecutive referrals to paediatric surgeons". J R Soc Med 96 (9): 449–451. doi:10.1258/jrsm.96.9.449. PMID 12949201. PMC 539600. http://www.jrsm.org/cgi/pmidlookup?view=long&pmid=12949201.

17. McGregor TB, Pike JG, Leonard MP (April 2005). "Phimosis—a diagnostic dilemma?". Can J Urol 12 (2): 2598–602. PMID 15877942.

18. Metcalfe PD, Elyas R. Foreskin management. Survey of Canadian pediatric urologists. Can Fam Physician 2010;56:e290-5.

19. Spilsbury K, Semmens JB, Wisniewski ZS, Holman CD (February 2003). "Circumcision for phimosis and other medical indications in Western Australian boys". Med. J. Aust. 178 (4): 155–8. PMID 12580740. http://www.mja.com.au/public/issues/178_04_170203/spi10278_fm.html.

20. Osborn LM, Metcalf TJ, Mariani EM. Hygienic care in uncircumcised infants. Pediatrics 1981;67:365-7.

21. "Care of the Uncircumcised Penis". Guide for parents. American Academy of Pediatrics. September 2007. http://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Care-for-an-Uncircumcised-Penis.aspx.

22. "Caring for an uncircumcised penis". Information for parents. Canadian Paediatric Society. July 2012. http://www.caringforkids.cps.ca/handouts/circumcision.

23. Camille CJ, Kuo RL, Wiener JS. Caring for the uncircumcised penis: What parents (and you) need to know. Contemp Pediatr 2002;11:61.

24. Simpson ET, Barraclough P. The management of the paediatric foreskin. Aust Fam Physician 1998;27(5):381-3.

25. American Academy of Pediatrics: Care of the uncircumcised penis, 2007

26. Royal Australasian College of Physicians. (2010) Circumcision of Infant Males.

Tuesday, June 9, 2015

FLORIDA BULLETIN: Circumcision Scheduled for 4-yo - Anonymous User Discloses Details

The mother of the boy in question as she is forced

to sign consent papers for her son's circumcision.

Previously on the Florida Circumcision Saga, a mother was forced to sign the consent form for the circumcision of her healthy, non-consenting son, by Florida courts, in order to appease his father's wishes.

It appears that the father has become successful in finding a doctor that will perform the elective surgery, and a circumcision has been scheduled. The child is scheduled to be circumcised on Thursday, June 11 at Joe DiMaggio Children's Hospital by one Gary Birken, MD.

The following was sent to the group dedicating itself to help the child:

"To the page administrators,
This is a throwaway account. I cannot give you any further information about me. This is NOT my real name. But I work at JDCH and due to my position and job I have gotten to see a lot of what has been going on surrounding Chase's situation. I want to share what I know because I am so strongly against anyone so much as touching Chase with a ten foot pole. This is what I know - rumor or otherwise - and whether you share it with your followers or not is up to you.

-Chase's father has not actually met with Dr Birken. From what I understand from his scheduling nurses, they are being ushered in without needing to establish a new patient relationship. Thursday will be their first meeting.

-Dr Birken will cut Chase no matter what Chase says or does in office. I have worked with Dr Birken in his office before and he is a very no nonsense doctor who will do whatever he has to in order to get done what he feels should be done. He has pressured patients and parents into unnecessary or excessive procedures in the past and I have no doubt he will have Chase forcibly restrained and put under anesthesia without regard to Chase's medical history. Birken is NOT one of the more well loved doctors in our hospital system and that he has agreed to do this does not surprise me. You WILL NOT stop this by trying to reach out to Birken's office - but you WILL make a big difference through the hospital itself. If you can convince them that their general image will be tarnished or that they may face lawsuits they may bar Birken from taking Chase as a patient.

-Hospital administration is threatening staff that chooses to participate in any sort of walk out, protest, or refusal to come in/work with the patient. Nobody in Birken's office is allowed to call off sick on Thursday. They have said that they will place anyone who participates in any acknowledgement of Chase's procedure on leave or will outright fire them for insubordination and violation of HIPPA (because by refusing to come in, protesting, or refusing to work with Birken or Chase they are acknowledging that he is a patient who will be in that day - it is a VERY fine line but the hospital believes they are within their rights).

-There is talk of secretly rescheduling the procedure to TOMORROW (Wednesday, June 10) or even to Friday. A very good friend of mine is a float nurse that was in Birken's office yesterday and she said that one of the administrators is even considering having Birken be called to "emergency surgery" later today so that Chase can be circumcised, but I do not think this will happen.

-Regardless of when the procedure occurs the hospital will likely hire additional security detail and may also ask the police to be present all day on Thursday. This may mean additional risk for protesters, so those who do choose to protest should bring cameras and be prepared to be as open and obvious about being peaceful as possible.

-Currently the hospital is directing all questions about the case to the director of corporate communications, Kerting Baldwin - and that's only because if it's going to one person then all phone calls and emails can be systematically ignored if they are not "important". I have been told that comments on the Facebook page will likely start being deleted soon (within 24 hours) and that they may shut down commenting entirely.

-Despite discussing taking precautions, hospital administration does NOT think that there will be much to worry about on Thursday. They are PREPARING for the worst but I have personally heard one of the upper level admins say that they would be shocked if there were "more than one or two of those crazy, smelly hippie moms with misspelled signs whose kids are homeschooled and unvaccinated". That comment will probably stick with me forever. It was wrong on so many levels."

It appears as if this country will actually allow a miscarriage of justice, and allow a doctor to get away with performing elective, non-medical surgery on a healthy non-consenting child.

The good that will have come from this fight is that it has garnered global attention about this, and the forced circumcision of healthy, non-consenting minors has become an issue that people can no longer ignore.

One thing is for sure; even if the father is successful in having his healthy, non-consenting son forcibly circumcised by a medical professional, it won't be the last we will have heard from this.

One Dr. John Trainer MD has publicly posted this on Joe DiMaggio Children's Hospital's Facebook Page where the boy is scheduled to be forcibly circumcised: