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Monday, August 24, 2009

Tipping point

The government is considering recommending routine circumcision for newborn baby boys, as a way of lowering their risk of contracting some sexually transmitted diseases, especially HIV. This is sure to stir up some serious controversy, and maybe even an analog to the recent "death panel" hysteria.

A lot of states don't cover the procedure under Medicaid; as best we can tell, the Oregon Health Plan doesn't. (See page 16 of this document.) It's another example of the class divide between the have-not's and the have's.

Comments (41)

As the father to two young kids (both under 3), I can say that the anti-circumcision freaks are second only to the breast-feeding nazis on the please-don't-make-me-get-into-a-conversation-with-these-nuts list. The anti-vaccine crazies are pretty bad as well.

Except circumcision is an outdated and barbaric practice that is no longer routine. It may reduce HIV rates, but so does not sleeping around and using safe sex practices.

More info at:

Is this a situation where tipping 15% may be too much?

So you're saying the haves have not?

Dave J:

As a father, your comment rings so true. The breast-feeding nazis almost sent my wife (unable to breast feed) over the edge, then came the anti-circumcision crew, then the anti-vaccine crazies. Ah, yes...but Keep Portland Wierd.

In going through my late Mother's papers, I ran across the surgeon's bill for my circumcision - $5 (it was 1954). How expensive can it be now? There's been hardly any medical inflation...

Your use of the paranoia laden expression "tipping point" leads the reader to believe that provision of this common medical procedure in health care progams is tantamount to exceeding some empirical angle of repose resulting in a virtual landslide of socialism, government hedgemony over our lives and the institutionalization of Eugenics resulting in establishment of the Master Race.

There is no "tipping point". If you don't want your kid circumsized don't do it.

My boys made a bigger fuss having their first hair cuts.

Mutilating a baby for religious and not medical reasons is oh so.....American. Leave their willies alone.

My dear 95-year-old neighbor, one of Portland's premier surgeons (and agnostic and uncaring as hell) would be glad to inform anyone of the hygiene problems (at the very least) faced by elderly "uncut" men. The benefits of circumcision are many. "Mutilating a baby for religious and not medical reasons" does not reflect the contemporary rationale for circumcision. "If you don't want your kid circumsized don't do it" sums it up perfectly.

Hey Jack!
Any idea what a good Portland moyle, charges for his services?

If you don't want your kid circumcised, don't have it.

Your use of the paranoia laden expression "tipping point"

Was your sense of humor removed for religious reasons, or medical reasons?

Ah, yes...but Keep Portland Wierd.

These debates are not peculiar to Portland.

Incidentally, when we had our son this past January, the guy who did the circumcision was "Dr. House," which was kind of awesome, although I was a bit nervous that he'd come back from the procedure with some rare, never-seen-before freakish medical issue. Thankfully, that did not happen.

Your use of the paranoia laden expression "tipping point"... Actually Jack, all else has been removed except for my sense of humor! Yours however is infinitely more subtle and laden with irony than mine. I am more likely to react to the sophomoric end of the scale. Thanks for giving us all such a tumescent title to tee off on!

Ya gotta nip this in the bud, Andy -- nip it!

Well, that cuts close to home.

"In going through my late Mother's papers, I ran across the surgeon's bill for my circumcision - $5 (it was 1954). How expensive can it be now? There's been hardly any medical inflation..."

I don't have the exact figure, but at a local pediatrics clinic with which I am familiar, the price is about $400 cash up front. (Oregon medicaid does not cover it and this private clinic will not bill private insurance for it.)


What would be the contemporary rationale for it?

The percentage of American parents who choose to keep their boys' genitals intact is growing and varies according to the region of the US in which they live:

Northeast 32% intact
Midwest 18% intact
South 35% intact
West 62% intact

source: National Center for Health Statistics, US Department of Health and Human Services, 1997

Curious to see the geographic disparities here.

If God had wanted us to be uncircumcised, we'd all be born with foreskins. --J.D. Ahmanson

Lifer sez "My dear 95-year-old neighbor, one of Portland's premier surgeons [...]"

Fellow that age, it's unsurprising that he holds that opinion. Fifty years before or after, he probably would not have. If you read up on the modern medical-scientific view, you'll find that - aside from the HIV benefit being mentioned above - the studies say there's no particular benefit to the procedure.

Basically, circumcision for non-religious reasons amounted to a fad. It's been over for a while.

If you read up on the modern medical-scientific view, you'll find that - aside from the HIV benefit being mentioned above - the studies say there's no particular benefit to the procedure.

Hey, wait, you can't just say "aside from the HIV benefit mentioned above" like it's nothing! That's a huge benefit. That's like saying "aside from protecting you when your car crashes, there's really no need to wear a seat belt."

Tastes and explanations of things thought vestigial change; for example:

We never catch up with what's been done to us by people who thought they knew what was best for us.

Perhaps a personal injury attorney is already on the case.

Circumcision is a "class divider"? What's
next: genuflection? Now, that's an issue for government.

Hey, wait, you can't just say "aside from the HIV benefit mentioned above" like it's nothing! That's a huge benefit.

Well, sure. But this is a very specific benefit, recently discovered. (And thus unknown to the old codger referenced above.) My point is that for the last couple decades until this result came along, there was thought to be no medical benefit at all for routine circumcision*; the hygiene argument had been debunked by Science.

The HIV result might swing the trend back towards circs, though... just in time for millions of kids to grow up with an HIV vaccine but no foreskins. :-)

[*: Of course, there are always those special cases where it's highly beneficial. But that's rare, not routine.]

I researched and debated circumcision with my wife before our first child. I remember some study about increased penile cancer and several hygiene-related conditions that show up more often in the uncircumcised. They seemed fairly low risk though, so I wanted to be open minded on the topic (after all it wasn't my penis).

I was on the fence, but my wife thought circumcision was a better choice for non-medical reasons (awkward conversations at school, my son wondering why his thingy looks different from like mine, female preference?, etc.,).

We opted to do it eventually. Problem was that we didn't have a simple painless experience. The incision cut a blood vessel. The doc said some bleeding is normal, but to keep watch on it. It kept bleeding into the bandages long after we got home though. Since newborns don't have a lot of blood to lose, we eventually called same doctor to ask if this amount was "normal". The doc suspected we were overreacting (new parents) but drove back to the clinic anyway. Upon seeing the level of bleeding she confirmed our worries and quickly sutured him (without an anesthetic). He'd lost enough blood that she wanted to watch him for a while, it was midnight by the time we left for home. She said that she'd only had one other case like that in 10 years.

What happened to us was a freak event I suppose. I'm still not sure what we'd decide if we end up pregnant with another boy.

Thank goodness a government plan will make up our minds for us in the future.

Alan DeWitless:

"Well, sure. But this is a very specific benefit, recently discovered. (And thus unknown to the old codger referenced above.)"

I would be honored to exchange phone numbers and addresses with you through Jack Bogdanski for the opportunity for you to meet my neighbor, the "old codger," you refer to above. If you think he is not up to speed on his practice (although obviously retired), I would be more than happy to help contribute to your education though your meeting with him.

Pardon me, "... through your meeting with him."

As I understand it, when a mohel performs a circumcision, it is more like a little snip. I believe the baby is held by one of the participants in the ceremony, which is full of love and caring.

You don't want to know how it's done in a hospital, but I'll tell you anyway. It is very clinical, the baby is stretched out on a board and secured to it. The doctor has a metal instrument that fits over the little penis to keep it still. He then cuts the foreskin away.

I'm so sorry I allowed my son to be circumcised, even though we didn't have the horrible experience related by PanchoPDX. I'm very for the parents and their little son that they were subtly pressured into doing something they probably felt in their hearts was not right.

Isn't there an iphone app for that, yet?

I'm curious to know: Are any of you that aren't circumcised fighting in favor of circumcision? How about those who are fighting in favor for not circumcising?

Mohels (Moyles) do not charge, they just take tips.

Mutilating a baby for religious and not medical reasons is oh so.....American. Leave their willies alone.

mp97303, For Jews circumcision is a sign of the covenant between God and Israel. Jewish boys, are marked on their generative" organ as having joined the covenant with God, a covenant that links generation to generation.

For my people, this is certainly not mutiliation. It is a covenant. Please do us all a favor and leave your biased views/uber-Portland perspective at the door. I won't tell you what to do...don't tell me that a significant aspect of my faith is "mutilation".

Oh, now lifer, don't be mad. I didn't mean anything bad by "codger". I like codgers. I'm just saying what he knows is a maybe a bit obsolete. No shame in that.

Anyway, it so happens that through my work I got to know about a dozen currently practicing pediatricians. About eighty percent of them refer to circumcision as "ritual genital mutilation".* (As in, "Well, I have to go ritually mutilate a boy's genitals. I'll talk to you more when I'm done!") Only about thirty percent will actually perform the procedure at all. Several have young male children, and through water-cooler conversation I happen to know that the circumcision rate in that group is zero.

From this, it is possible to draw some reasonably reliable conclusions about current pediatric opinions, no? †

If you think some retired guy you know is going to dazzle me with his opinion enough to override that personal knowledge, well, I think that's great. The world needs more dreamers! But I think I'll pass on the meeting anyway, unless you're buying dinner, drinks, and diesel.

[*: Though obviously they don't do so in front of the parents!]
[†: Since dueling anecdotes should never impress anyone, perhaps it would be better for readers to check what the American Academy of Pediatrics had to say last go-around.]

The one question that hasn't come up yet in this discussion: consent.

A newborn boy is unable to provide consent for this elective surgical procedure. Absent an immediate threat to the boy's health, shouldn't medical professionals delay the procedure until such time as he is able to consent?

It may be true that a lack of circumcision may increase the risk of contracting HIV from a sexual partner - but shouldn't that decision be made by the patient around the time he becomes sexually active?

There's simply no rationale for parents to make this choice for the newborn.

Interesting that the one subject that cannot be blamed on Adams gets the biggest response in ages.
For me it's just a sad hangover from primitive times that stuck around for reasons of fashion. The fact that we have recently discovered some possible benefits does not excuse it. Chopping other parts off baby boys would lead to societal benefits (lower crime rates) and female circumcision would certainly help lower STD levels but we don't do that.
Leave them intact, teach them to clean themselves and they can use the money they save on Jergens to buy you a nice thank you gift.

Things are getting a little snippy. Time to cut off this thread.

Speaking of health care ripoffs:

Reason says "Forget death panels, let's have circumcision panels."


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