There may have been a time when one could make a case for circumcision on grounds of medical benefits, but that time has passed. Today we know that although there may be some evidence of medical benefits from infant circumcision, none of those are sufficient enough to recommend the procedure. The new debate over infant circumcision is whether or not it is ethical.
The following is a short listing of medical studies done in the 90's weighing the cost against the benefits of circumcision and their analysis method and conclusions reprinted from the 2nd edition of Jim Bigelow's The Joy of Uncircumcising.
1990 Robert S. Thompson, M.D., "Is Routine
Circumcision Indicated in a Newborn?: An
Opposing View"
This study utilized an analysis methodology designed
to differentiate and evaluate the risk factors
of intervention as opposed to treatment of a disease
already present.
Conclusion: The complication rate for circumcision
(even the lowest estimate) overbalances the "...price
of a potential benefit to 9 [individuals] in 1000..."
1991 Theodore G. Ganiats, M.D., et al., "Routine
Neonatal Circumcision: A Cost-Utility Analysis".
This study "...analyzed the various costs and benefits
of routine neonatal circumcision to 1) discover which
elements in the circumcision controversy are significant
and 2) estimate the cost-utility of the procedure using
the current data."
Conclusion: "For routine neonatal circumcision
..advantages and disadvantages cancel each other.
Cost and health factors should be removed from the
decision, and personal factors (e.g. cultural or
religious) should be considered for primary importance..."
1991 Frank H. Lawler, M.D., et al., "Circumcision: A
Decision Analysis of Its Medical Value".
This study utilized "...a cost effectiveness analysis
of the consequences of the treatment choices (circumcision
vs no circumcision) using a decision tree model.
Conclusion: "We conclude that there is no medical indication
for or against circumcision...The decision regarding
circumcision may be most reasonably made on nonmedical
factors such as parent preference or religious convictions."
1992 John B. Chessare M.D., MPH, "Circumcision: Is the
Risk of Urinary Tract Infection the Pivotal Issue?"
This study focused on the UTI issue and utilized a
decision analysis model.
Conclusion: "For the set of values assigned to the outcomes,
the choice of no circumcision yielded the highest expected
utility...The choice of circumcision, excluding those for
religious belief or cultural reasons, must be made by well-
informed parents and should not be dictated by the risks of
urinary tract infection alone."
1992 Dante Amato and Jaun Garduno-Espinosa, "Circumcision
in the Neonate Male and the Risk of Urinary Tract Infection
During the First Year of Life: A Cross Analysis".
This study focused on the UTI issue and utilized a
cross-analysis method "...which combines the results of
different medical studies, with the purpose of trying
to obtain better conclusions about diagnosis, therapeutic
efficacy or risk factors.
Conclusion: "Recommendation of routine circumcision to all
newborns is not justified with these data."
Although they may differ on how strongly opposed to circumcision they are, no major medical association in the world recommends circumcision on the grounds that the potential benefits do not strongyl outweigh the risks. The following quotes are taken from medical organisations in Australia, Britain, Canada and the United States. Only medical organisations in English speaking countries have statements on circumcision because it isn't even practiced for medical reasons in the rest of the world.
Australasian Association of Paediatric Surgeons; Guidelines for Circumcision;
"The Australasian Association of Paediatric Surgeons does not support the routine circumcision of male neonates, infants or
children in Australia. It is considered to be inappropriate and unnecessary as a routine to remove the prepuce, based on the
current evidence available."
"We do not support the removal of a normal part of the body, unless there are definite indications to justify the complications
and risks which may arise. In particular, we are opposed to male children being subjected to a procedure, which had they
been old enough to consider the advantages and disadvantages, may well have opted to reject the operation and retain their
prepuce."
"Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anaesthesia to remove a
normal functional and protective prepuce. At birth, the prepuce has not separated from the underlying glans and must be
forcibly torn apart to deliver the glans, prior to removal of the prepuce distal to the coronal groove."
British Medical Association; Circumcision of Male Infants;
"Where conditions can effectively be treated conservatively, it is accepted good practice to do so. Even limited procedures
should only be carried out where there is good reason, and then only after adequate conservative treatment. The BMA
opposes unnecessarily invasive procedures being used where alternative, less invasive techniques, are equally efficient and
available."
"Doctors have a duty to keep up to date with developments in medical practice. Therefore, to circumcise for therapeutic
reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical
and inappropriate."
"It is rarely necessary to circumcise an infant for medical reasons."
Canadian Paediatric Society; Neonatal Circumcision Revisited;
"Recommendation: Circumcision of newborns should not be routinely performed."
"The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending
circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982
should be changed."
Note – In 1982 the CPS took a stand against routine infant circumcision because "there are no valid medical indications for
circumcision in the neonatal period."
American Academy of Pediatrics; Circumcision Policy Statement (RE9850);
"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are
not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits
and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best
interest of the child."
Finally, if this still needs to be put into perspective, this chart lists the most common claimed benefits of circumcision against the number of male circumcisions performed each year and the incidence of these the conditions.
Circumcision is no longer a medical issue. It's now an issue of human rights.
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