A commentary written by a very long list of authors in response to the AAP’s position on circumcision. (Frisch M, Aigrain Y, Barauskas V, et al: Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision. Pediatrics 2013). They accuse the task force of the AAP of having a cultural bias, and as a result of having produced a flawed statement. One of their points is that much of the evidence retained is of limited relevance for the practice of routine infant circumcision.
The response of the task force (Circumcision task force: Cultural Bias and Circumcision: The AAP Task Force on Circumcision Responds. Pediatrics 2013, 131(4):801-804.) is to say ‘we’re not culturally biased, its you that are culturally biased’. And we were right.
I think they are all culturally biased, I don’t think its possible not to have biases. We need to recognize them and try to take them into account. I do think that Frisch et al have a point, the prevention of HIV acquisition and AIDS in randomized trials of adults who agreed to be randomized to be circumcised has no relevance at all for routine neonatal circumcision. We have no idea if the same effect would occur with neonatal circumcision, and, of course, the baby doesn’t have a chance to consent. Similarly the data on penile cancer are all observational studies which were all done before HPV vaccination, which is likely to be much more effective and doesn’t require surgery. I don’t think that many adults would consider having a circumcision to reduce the risk of penile cancer (number needed to treat about 200,000), so to use that argument to support routine neonatal circumcision makes little sense.
Why discussions on infantile circumcision do not deal with pain prevention? Current data show that no available analgesic method (EMLA, penile nerve block, sucrose) reduce to nil pain during circumcision: they reduce but not delete pain; therefore, can we routinarely make a manoeuvre that produces pain without the patient’s consent? cb
You are absolutely right, Carlo, it is a very important issue, if there were no pain, and no other risks, then it would be less of an issue.