Evidence that male circumcision has health benefits is growing, even as the quick but often-controversial surgery becomes less common in the United States, say medical experts making new efforts to publicize the benefits.
In a study out Monday, researchers say falling infant circumcision rates could end up costing billions of U.S. health care dollars when men and their female partners develop AIDS and other sexually transmitted infections and cancers that could have been prevented. Separately, the American Academy of Pediatrics is about to issue a new policy statement that says infant circumcision has "significant" health benefits, replacing a statement that takes a more neutral stance. "We have a tremendous amount of information coming out about the benefits of male circumcision," says Aaron Tobian, a researcher at the Johns Hopkins University School of Medicine who is among the authors of the cost study. But rates among U.S. infants have dropped since the 1970s and are likely to keep dropping if more insurers follow 18 state Medicaid programs that have stopped covering the procedure, says the report from Tobian and his colleagues, published in the Archives of Pediatrics & Adolescent Medicine. The researchers say that if U.S. rates dropped to 10% — the level seen in European countries where insurers don't cover circumcision — the results would include: Circumcision by the numbers
• Rates peaked at nearly 80% in the 1970s and 1980s. • About 56% of newborns were circumcised in 2008, down from 64% in in 1995. • Infant circumcision rates in Europe average 10% and are as low as 1.6% in Denmark.
Source: Johns Hopkins Hospital •211% more urinary tract infections in baby boys. •12% more HIV cases in men. •29% more human papillomavirus (HPV) cases in men. •18% more high-risk HPV infections in women. The fallout also would include more cases of cervical and penile cancer linked to HPV, but the highest costs would be associated with HIV, the virus that causes AIDS, the researchers say. Each skipped male circumcision would end up costing $313 in direct medical bills, and the total cost over a decade could exceed $4 billion, they say. The estimates are based largely on a recent study in Uganda in which men underwent circumcision — a surgery that removes the foreskin on the penis — or remained uncircumcised and then were followed, along with their female partners. Three such "gold-standard" randomized trials in Africa now back up observational studies around the world, including in the United States, Tobian says. The same evidence is behind the new statement by the pediatrics group, says Michael Brady, an expert in infectious disease at Nationwide Children's Hospital in Columbus, Ohio. He is on the committee writing the new statement and says the revision is likely to be published online in September. "We are going to say there is now reasonable evidence of benefit. And there are certainly some risks," including bleeding, infection and pain, which the group will make clear should be well controlled, Brady says. "We are going to try to make sure people are educated on the risks and benefits and say that the decision should be based on what the family feels is the best interest of the child." Insurers should cover the surgeries, he says. Religious and cultural differences must also be respected, he adds. But some activist groups oppose infant circumcision, even for children from families who practice it as a religious rite, because they say it is an unneeded surgery that violates babies' rights. "We believe in protecting all babies," says Georganne Chapin, executive director of one such group, Intact America. Chapin questions the studies finding health benefits and cites other studies that do not, but she says parents should let boys grow up and make their own choices. "We don't let parents chop off other healthy body parts." The World Health Organization says that while circumcision is safe for adults, they heal more slowly and have more complications than babies do. For more information about reprints & permissions, visit our FAQ's. To report corrections and clarifications, contact Standards Editor Brent Jones. For publication consideration in the newspaper, send comments to letters@usatoday.com. Include name, phone number, city and state for verification. To view our corrections, go to corrections.usatoday.com.
My DH who is English wanted the boys circumcised. After listening to my office manager talk about his circumcision at 25 and not because he was converting, I'm glad I did.
Wait until you see the issue with anesthesia in children. Holy hell..
what related to circumcision or because they have medicaid we don't give them anesthesia?
I relate it to circ as we have been weighing it for lt as our agency didn't get it done beer he came home with us. He would have to under at this age. On the news, they are linking anesthesia with cognitive development issues. Sorry, it was just my link.
what related to circumcision or because they have medicaid we don't give them anesthesia?
I relate it to circ as we have been weighing it for lt as our agency didn't get it done beer he came home with us. He would have to under at this age. On the news, they are linking anesthesia with cognitive development issues. Sorry, it was just my link.
DH was really reluctant to put DS under for tubes because of the anasthesia and his brother is an anasthesiologist
Post by SusanBAnthony on Aug 20, 2012 18:49:30 GMT -5
As a rabid anti-circ hippie, I don't care. I want DS to use a condom regardless, and I am not willing to cut off part of his sexual organs without his consent for the low, low odds that he forgets to use a condom with an HIV+ partner, and happens to be in the minuscule group of people who wouldn't have been infected if they had been circed. I am happy to fund a circ for him if he looks at the research and decides for himself once he can give informed consent.
I think the "is Paul Ryan a social con masquerading as a fiscal con" is a slightly less contentious issue.
Seeeeriously. All I will say is that I am not at all surprised, and expect that going forward we will see more studies backing up the AAP's soon-to-be-changing position. That said, I am still all for parents making the decision to not circ. There are clear medical risks and benefits to both circumcising and not circumcising. Parents can be thoughtful, informed, educated and acting in the best interest of their child - and still come to EITHER decision.
FWIW, I do not believe that the findings on circ/HIV will be borne out as potentially causal for many years to come. The trend away from circumcising is relatively new, so it will not be until the kids grow up that we might see a more meaningful trend, whereas circ rates in Europe have always been low.
Im on the 'either decision is the right one' bandwagon. There are risks and benefits to both. but i also think uganda is probably not the best country to compare with.
Tef, what's the deal with anesthesia? Link me up. I finally consented to my youngest going under for blocked tear ducts last January after 18 months of goopy eyes and infections. Hope it didn't shave off some IQ points.
Im on the 'either decision is the right one' bandwagon. There are risks and benefits to both. but i also think uganda is probably not the best country to compare with.
Im on the 'either decision is the right one' bandwagon. There are risks and benefits to both. but i also think uganda is probably not the best country to compare with.
I'm curious as to why you say this.
Culturally, geographically, socio-economic status, everything is quite different in Uganda. I would have thought they would compare with a European or North American country, kwim?
A few others in this thread also thought it was strange that Uganda was used for comparison.
Culturally, geographically, socio-economic status, everything is quite different in Uganda. I would have thought they would compare with a European or North American country, kwim?
A few others in this thread also thought it was strange that Uganda was used for comparison.
ETA - I'm high on cough medicine and Im not sure im reading the study right. Im coming back tomorrow am
Uganda also has one of the most research universities in Africa, complete with an incredible repository of patient data. Some of the most important discoveries in cancer research came out of Uganda; Makere University is very well regarded. It's not to say that Uganda is no different than the US, but by no means is it some sort of backwater. Like I tell people who want to know why we are investing in cancer research there, you go where the disease burden is highest.
I'm in the camp that if you teach proper sex ed and encourage condom use, not circ-ing is not an issue.
It's a backup for future unsafe sex practices, but not a necessary thing in protecting people from STDs.
If you want to circ, fine, there's research to support that, but the minute moms start judging people who don't circ for not loving their boys enough to save them from The AIDS, I'm going to get ragey.
It's great that circ'ing seems to be lowering HIV rates in Uganda - but that doesn't explain why Europe's very low rate of circ'ing hasn't caused an increase in HIV. And heck, maybe we are more like Uganda than Europe, but that seems a little odd and would need some explaining as well.
Of course, I'd also like an explanation for why uncirc'd American boys have such high rates of UTIs while European boys don't. I'm sure it has nothing to do with outdated medical professionals telling parents to yank back the foreskin, or yanking it back themselves to take a urine sample. There are a lot more factors at play than just circ itself.
If there was early, but not wide spread, research suggesting a potential medical benefit to clipping off a piece of the clitoris, would you have it done to yourself? Would you have it done to your daughter?
So let me get this straight. Women who don't want men legislating their rights are letting their uncirced boys spread diseases to our daughters (and some sons) like unvaxed kids spread their shit. Sounds legit.
/Weak argument with nugget of impenetrable, truthy nougat inside.
So let me get this straight. Women who don't want men legislating their rights are letting their uncirced boys spread diseases to our daughters (and some sons) like unvaxed kids spread their shit. Sounds legit.
/Weak argument with nugget of impenetrable, truthy nougat inside.
::drops mic Obama style::
But dyl, it's GENITAL MUTILATION. These poor boys could have decreased sexual sensation one day because we didn't leave them intact. We MUST PROTECT THE PENII!!! It's totally different from vaccination. And we all know teenagers are responsible enough to just wear a condom instead.
(I'm kidding. I totally mutilate my boys' genitals.)
Post by karinothing on Aug 21, 2012 7:43:28 GMT -5
I am having trouble with the idea that leaving the boys intact could really end up costing the US government billions when the UK stopped paying for the procedure when they went to public health (to save money). I mean don't you think if the UK was spending billions of dollars in money for peopel with STDs due to a lack of circ that they would start paying for the procedure?
MM mom's posted another article comparing the US and Dutch recommendations which I thought was interesting. www.bbc.co.uk/news/magazine-19072761