Male circumcision like vaccination? Um… no.

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 “Male circumcision is in principle equivalent to childhood vaccination”
~ Dr. Brian Morris, New York Times Blog

A new “review” of the medical issues surrounding circumcision, conducted by Dr. Brian Morris of the University of Sydney (who is rather circumspect given he is probably the world’s largest proponent of male circumcision, including having shared links to circumfetish sites from his own – take of that what you will) and colleagues[1], has suggested that male circumcision is, as you can read above, enough of a health benefit to be on par with childhood vaccination.  Yes, someone is seriously suggesting that the benefits conferred by male circumcision are equivalent in principal to those of trying to wipe out diseases that have killed and continue to kill hundreds of thousands of people around the world.

If there were really strong evidence of this, it might be worth looking into.  If it were such that the evidence was of diseases and disorders people had no other way of preventing, we should consider it.  But that’s just not the case.  According to this review, the benefits are primarily in the realm of urinary tract infections (UTIs), STIs including HIV/AIDS (which is often considered separately than other STIs), and penile cancer.  I want to do a more thorough review, but yet, it seems like I’d simply be repeating myself (see here and here) so let’s just take a quick look at how wrong these conclusions are.

We’ll start with the UTIs because it’s actually the only medical condition that may be reduced with circumcision.  However, it’s equivocal.  On the one hand, there is research suggesting that the reduction in UTIs is outweighed by the risk of complications from circumcision[2][3], but even those that concede there may be a slight reduction in risk point out that UTIs are healed by a common antibiotic whereas the complications from circumcision are not so easily fixed or reversible.  As written by a committee of doctors and health professionals worldwide in response to the American Academy of Pediatrics’ statement of neutrality on circumcision:

Only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss.

Now what of the STI and HIV/AIDS data?  Well, we need to simply look at actual data across countries to see that the issue is not about circumcision.  After all, the USA has an 80% circumcision rate and yet, according to the CDC[4], has higher rates of both STIs and HIV/AIDS than any other developed nation in the world.  In fact, the USA has double the rate of HIV/AIDS than the UK and six times the rate of Finland, both countries in which circumcision is the exception, not the rule.  But lest you think it has to do with not circumcising, the USA also has triple the rate of HIV/AIDS as Israel, a country for which circumcision rates are near 100%.  As I have written about elsewhere, the data linking a reduction in STIs and HIV/AIDS through circumcision was (a) done in Sub-Saharan Africa and studies that have attempted to replicate this in developed nations have failed to do so, and (b) were done on consenting adults.  As so eloquently put by Fatherhood for Geeks:

If you are ever presented with a multifaceted social problem and the first solution that springs to your mind is “We’d better cut off part of everyone’s penis,” you might want to consider another line of work.

This brings us to the issue of penile cancer for which the authors of this paper suggest a 20-fold increased risk for those who remain intact.  However, the numbers just don’t add up.  There is an increased risk of penile cancer for intact men who also suffer phimosis[5] (a medical condition which may actually necessitate circumcision), however even with that, 80% of children respond to a steroid cream and do not even require medically-indicated circumcision.  As Professor Kevin Pringle, the Professor of Paediatrics and Head of Obstetrics and Gynaecology at the University of Otago in Wellington, told the NZ Herald in response to Dr. Morris and colleagues’ review:

The incidence of penile cancer in Israel (almost 100 per cent of males circumcised) is about the same as that in Scandinavia (circumcision the exception), suggesting that it is cleanliness, rather than godliness that is important… Circumcision is an intervention with significant risks (ignored or minimised by the authors of this paper) to prevent problems that will not develop in the vast majority of males.

I suppose when you have a thing for circumcision yet you are fought by human rights activists, doctors, researchers, and parents worldwide, what else can you do but try to skew the data to fit your story?  If all else fails, turn to fear and watch the people come running.  Sadly, that’s all there is to this review: Fear without basis and I hope that people in the USA will take it for what it is and continue to educate themselves properly about male circumcision.

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[2] Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: A systematic review of randomized trials and observational studies. Archives of Disease in Childhood 2005; 90: 853-858.

[3] Frish M et al. Cultural bias in the AAP’s 2012 technical report and policy statement on male circumcision.  Pediatrics 2013; doi: 10.1542/peds.2012-2896.

[5] Tseng H-F, Morgenstern H, Mack T, Peters RK. Risk factors for penile cancer: Results of a population-based case-control study in Los Angeles County (United States). Cancer Causes and Control 2001; 12: 267-277.

 

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Comments

  1. Mark Lyndon says

    Professor Morris has been comparing male circumcision to vaccination for years. He isn’t a pediatrician or a urologist, and he’s not even a physician. He’s an Australian molecular biologist whose views on circumcision are refuted by his own national medical organization.

    The RACP says this:
    “After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.”
    (almost all the men responsible for this statement will be circumcised themselves, as the male circumcision rate in Australia in 1950 was about 90%. “Routine” circumcision is now *banned* in public hospitals in Australia in all states except one.)

    Here was one response to him:
    “The procedure is not to be equated with vaccination, either in its delivery or in its effectiveness.
    It should be noted that Professor Morris, quoted in your report, is not a member of the RACP and is not and has not been engaged as a reviewer for the College.
    Yours faithfully,
    David Forbes,
    Chair, Paediatrics & Child Health Policy & Advocacy Committee
    Royal Australasian College of Physicians.”

    PZ Myers’ response to the recent study:
    “But then, that’s Brian Morris all over the place. He actively tries to suppress work that doesn’t support his conclusions, he inflates any evidence that suggests circumcision might have a few benefits (there are some!), and dismisses any evidence to the contrary…or worse, twists it around to claim it supports the opposite of the author’s interpretations. All this in defiance of worldwide statements from pediatric organizations that say the evidence for health benefits from circumcision are weak, and that routine circumcision is not recommended.”

    Dr Russell Saunders in the Daily Beast: “Having reviewed Dr. Morris’s study, I find his statements about the benefits of circumcision as a routine procedure overblown, and the comparison with vaccination baseless.”

    Professor Kevin Pringle, the Professor of Paediatrics and Head of Obstetrics and Gynaecology at the University of Otago in Wellington, said the comparison with vaccination was inappropriate as most of the diseases for which infants are vaccinated are potentially lethal or produce significant handicap.

  2. says

    The supposed benefit for reduced rates of Urinary (not Uterine) Tract Infections is NOT seen where parents are informed about the proper care of the normal penis, that is, leave it alone. Only the OWNER should ever retract a foreskin.

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