Thursday, March 26, 2009

Winning Back the Penis--One Piece at a Time

The first time I ever saw a man who was status post penectomy I decided that circumcision was the right thing to do.

He was a young man, in his thirties, and when I explored his medical history it contained reports of chronic low-grade infection involving the internal foreskin (he was then uncircumcised); multiple sexual partners, and phimosis (a condition where the foreskin is too tight).

This anecdotal experience lead me to the "stacks" (the magazine and journal library where we went for information before GOOGLE) where I reviewed the literature on penile cancer and circumcision. Although penile cancer was rare, it was significantly and seriously more common in uncircumcised men, who also had more frequent infections and complications than uncircumcised males. That was my take and I was OK with it.

Today we have news about circumcision. Namely, it seems that the procedure is extremely effective in reducing STD's. In fact:

"Over two years, the men who were circumcised had a 28 percent reduced risk of infection with the herpes virus and a 35 percent reduction in HPV infection."

Of course, HPV virus is an etiologic factor in cervical cancer, so these data have serious implications not only for the health of men, but for women also. Yet rates of circumcision have been falling dramatically all over the world in the past two decades, especially in the United States.

Why so?

Don't Touch That Penis!
Around the same time that I decided circumcision was a good thing, people had begun talking about the downsides of circumcision and a movement took hold which has since exploded, propelled by activists, disease-specific lobbyists and not a few doctors, who even formed an activist group of their own, "Doctors Opposing Circumcision (DOC)." Many of these groups cited the American Academy of Pediatrics (AAP) 1999 position statement which was selectively cited as saying that "the procedure is not essential to the child's current well-being"

If you read the entire position statement, however, the AAP admits quite a few risks associated with the uncircumcised state, including:

"the risk of developing penile cancer in an uncircumcised man compared with a circumcised man is increased more than three fold"

In the end the AAP conclude in their position statement that parents should evaluate the data and make an informed decision.

Along Came Mary
People who need work frequently look for injustices to remedy then they try to find publicity. This usually requires trumping up an issue with fiddled data, acquiring a celebrity, gaining publicity and eventually twisting the arm of a legislator to create a law to support the position, create a new class of "victims" and criminalize the opposition. Unfortunately, this happens in "health care" all the time.

Eventually, these groups rise in power and prestige and their pet legislators funnel pork back to the activist cause, creating a little industry funded by eternal government grants...and all this creates a nice little living, or avocational supplementation, for the activists and their socially and politically aligned warrior friends.

So they came to a new cause, circumcision. And they came like hungry birds: Activists, rights groups and newly formed coalitions like MAC (mothers against circumcision). A mini-movement overwhelmed the scientific data concerning circumcision, which rose in the socio-political ranks until it reached full-blown status as "child abuse" as detailed in this Fox report.

Soon enough, the government in multiple states was disallowing Medicaid reimbursement for circumcision (no matter what the parents decided was best for their male child) and the MAP (movement against the Penis) continued to pick up steam so that feminists were analogizing it to female mutilation and began trying to push circumcision to the level of a criminal act, which is the Holy Grail of activists.

If health activists cannot criminalize you they will demonize you. Public reprobation is another tactic of these oh-so-righteous activists. Soon enough people were ashamed to admit they circumcised their child, as recounted in a serious but humorous article on this topic in Salon which tracks the guilt and public shame heaped upon two Jewish parents who were torn between circumcision and the public disgust it seemed to incur:

"On one family visit, they'd been teasing me, saying that Elijah would probably end up being a Republican engineer, whatever that was. I said that I'd love him no matter what he became."

Individuals get slammed, but they are only pawns of bad doctors...and, of course, the American health care system, as demonstrated nicely by the words of Tim Hammond, a leading opponent of circumcision and founder of NOHARMM, the U.S. National Organization to Halt the Abuse and Routine Mutilation of Males:

Tim Hammond, believes that circumcision in the U.S. is perpetuated by arrogance and the radical American health environment.

Radical, Dude
No one can deny that grass roots movements often inform the public and help individuals make decisions regarding their own health. This can be powerful and good as demonstrated by the public awareness surrounding drunk driving and smoking. However, it is my contention that this process has been usurped by radicals, publicity seekers and those who need to make a living off of federal grants and monies.

Too often the tactics of bullying and public recrimination are used to blackmail legislators and voters, and the end result is wasted funds, wasted research, wasted health.

If we are going to reform health care (whatever that is), I think it is unwise not to look at this phenomenon and address it...unless you want these people deciding the fate of your penis.

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