The court of public opinion speaks against the circumcision of 4 and 1/2 year old in Florida

While the Joe DiMaggio Children's Hospital keeps tight silence over the reported scheduled circumcision, activists and public from all over the world rush to the facebook page of the hospital to express their distaste for what a German commenter called a "middle-age procedure".

Posts to the hospital, reviews, comments on the reviews, comments on the posts of the facebook page of the hospital. Allegedly the hospital started deleting comments yesterday (Tuesday) but gave up given the high numbers.

New Times Broward-Palm Beach, Palm Beach Post and ABC 25 WPBF were among the first news outlets to pick up the information, along with several bloggers and discussion forums.

What can you do? (1) Post on the hospital's Facebook page, demanding that they refuse to circumcise a healthy child whose mother is vehemently opposed to the surgery, and telling them that if they do, there will be both public relations and legal consequences; (2) call the hospital 954-265-5933, and (similarly) tell the risk-management department that there will be both legal and reputational consequences if they circumcise the Hironimus (Nebus) boy; (3) call the physician's office (954) 265-0072 and warn him that the mother of the child is vehemently opposed to the circumcision, and that to conduct medically unnecessary surgery under these circumstances is both unethical and legally risky. SPREAD THE WORD, PLEASE!!

The hospital wrote one post trying to "appease" the commenters. It had been shared 236 times and had over 1800 comments:



While posts to the page can be easily deleted, that didn't stop people from posting to the page anyway.



Thousands of reviews clearly indicated the rejection:





New Times Broward-Palm Beach: In Hironimus Case, Circumcision Scheduled for 4-Year-old; Protest Planned at Hospital,

Palm Beach Post: Protests planned at hospital where Boynton boy may be circumcised

ABC 25 WPBF: Circumcision scheduled for 4-year-old boy

Anonymous information about Nebus vs Hironimus, Joe DiMaggio Children's Hospital, Dr. Gary A. Birken MD

The Chase's Guardians page received this anonymous message:

"To the page administrators,

This is a throwaway account. I cannot give you any further information about me. This is NOT my real name. But I work at JDCH and due to my position and job I have gotten to see a lot of what has been going on surrounding Chase's situation. I want to share what I know because I am so strongly against anyone so much as touching Chase with a ten foot pole. This is what I know - rumor or otherwise - and whether you share it with your followers or not is up to you.

-Chase's father has not actually met with Dr Birken. From what I understand from his scheduling nurses, they are being ushered in without needing to establish a new patient relationship. Thursday will be their first meeting.

-Dr Birken will cut Chase no matter what Chase says or does in office. I have worked with Dr Birken in his office before and he is a very no nonsense doctor who will do whatever he has to in order to get done what he feels should be done. He has pressured patients and parents into unnecessary or excessive procedures in the past and I have no doubt he will have Chase forcibly restrained and put under anesthesia without regard to Chase's medical history. Birken is NOT one of the more well loved doctors in our hospital system and that he has agreed to do this does not surprise me. You WILL NOT stop this by trying to reach out to Birken's office - but you WILL make a big difference through the hospital itself. If you can convince them that their general image will be tarnished or that they may face lawsuits they may bar Birken from taking Chase as a patient.

-Hospital administration is threatening staff that chooses to participate in any sort of walk out, protest, or refusal to come in/work with the patient. Nobody in Birken's office is allowed to call off sick on Thursday. They have said that they will place anyone who participates in any acknowledgement of Chase's procedure on leave or will outright fire them for insubordination and violation of HIPPA (because by refusing to come in, protesting, or refusing to work with Birken or Chase they are acknowledging that he is a patient who will be in that day - it is a VERY fine line but the hospital believes they are within their rights).

-There is talk of secretly rescheduling the procedure to TOMORROW (Wednesday, June 10) or even to Friday. It's said that one of the administrators is even considering having Birken be called to "emergency surgery" later today so that Chase can be circumcised, but I do not think this will happen.

-Regardless of when the procedure occurs the hospital will likely hire additional security detail and may also ask the police to be present all day on Thursday. This may mean additional risk for protesters, so those who do choose to protest should bring cameras and be prepared to be as open and obvious about being peaceful as possible.

-Currently the hospital is directing all questions about the case to the director of corporate communications, Kerting Baldwin - and that's only because if it's going to one person then all phone calls and emails can be systematically ignored if they are not "important". I have been told that comments on the Facebook page will likely start being deleted soon (within 24 hours) and that they may shut down commenting entirely.

-Despite discussing taking precautions, hospital administration does NOT think that there will be much to worry about on Thursday. They are PREPARING for the worst but I have personally heard one of the upper level admins say that they would be shocked if there were "more than one or two of those crazy, smelly hippie moms with misspelled signs whose kids are homeschooled and unvaccinated". That comment will probably stick with me forever. It was wrong on so many levels."

Nebus vs Hironimus - circumcision is scheduled

According to Intact America and intactivist Brother K, there is a report "that Dr. Gary A. Birken, MD, 1150 N 35th Ave, Hollywood, FL phone: (954) 265-0072, has diagnosed Chase with a foreskin problem and that the circumcision is scheduled for June 11 at a Florida hospital."

Dr. Gary Birken also writes fiction, with his name, and as Mason Lucas MD. As Mason Lucas MD he published "Error in Diagnosis". Using his name he published "Error in Judgement"

Dr. Gary Birken will commit a terrible error in judgment if he proceeds to circumcise Chase based on a fraudulent diagnosis.

Physicians examining C.R.N.H. or performing surgery on him should be warned that they are being observed by thousands of activists, several intactivist organizations, the national and international media and the international community, and any fraudulent referral or procedure over “phimosis” will no doubt lead to reports of misconduct and ethics complaints.

Phony phimosis - medical fraud

Physicians examining C.R.N.H. should be warned that they are being observed by thousands of activists, several intactivist organizations, the national and international media and the international community, and any fraudulent referral over "phimosis" will no doubt lead to reports of misconduct and ethics complaints.

In 2013, Dr. Saleem Islam published a study called: "Allocation of Healthcare Dollars: Analysis of Nonneonatal Circumcisions in Florida", indicating that the cost of circumcisions in the state of Florida had "skyrocketed" since Medicaid stopped covering neonatal circumcisions.

Islam explained: (continue reading)

Mary Jane Minkin, MD, FACOG, stigmatizes men and pathologizes a normal body part

In an interview in 2Dun's Spread, Dr. Mary Jane Minkin, MD, FACOG, clinical professor of obstetrics and gynecology at Yale School of Medicine and staff member at Obstetrics Gynecology & Menopause Physicians, violates the ethical principle of justice by stigmatizing 70% of the males in the world, those who are not circumcised, and by pathologizing a normal body part, the foreskin, in what only can be interpreted as blatant cultural prejudice.

This starts with the media circus around the CDC proposed guidelines, of which we spoke on our previous post. The Background document by the CDC also warned (page 40):

"Furthermore, recommendations to increase rates of male circumcision in the U.S. to reduce male acquisition of heterosexually acquired HIV infection may result in stigmatization of uncircumcised men or groups of men who are not routinely circumcised should they choose to not undergo circumcision." ~ CDC

And Dr. Minkin gives us a clear example of what that meant. Asked by 2Dun whether "doing the deed with an uncircumcised man puts you at a higher risk for contracting an STI?", Dr. Minkin replies: "To be exact, yes, if uncircumcised men are more likely to get infected with [an STD], then they'd be more likely to transmit".

 

Dr. Minkin tells us two lies in this statement, first, that the mere presence of foreskin makes a man more likely to get infected, and second that the mere presence of foreskin makes a man more likely to transmit an infection.

 But some readers will say, "the science is sound". What the readers are forgetting, what the AAP and the CDC often would like people to forget, is that adult individuals can make lifestyle choices. Humans have a capability to make rational decisions, we are not bound by uncontrollable instincts, we can make decisions about whether to have sex or not, whether to engage in safe sex or not, whether to have multiple sex partners or follow a more monogamous lifestyle, and all those decisions are not reflected in the presence or absence of a normal part of the body.

A high risk male has a larger chance of contracting STIs than a low risk individual, regardless of their circumcision status. The risk attitude has far more priority on the chance of contracting sexually transmitted diseases than submission to circumcision.

If the presence of foreskin immediately implied a higher prevalence of HIV and STIs, how can we explain that most countries in Latin America and Europe, where circumcision is uncommon, have a lower prevalence of HIV than U.S., where circumcision rates are prevalent?

Dr. Minkin's second implication, that uncircumcised males would be more likely to transmit an STI, is again fallacious and stigmatizing. Infected males will transmit infection no matter what, as the virus pollutes the sperm. The presence or absence of foreskin does not alter the composition and presence or absence of virus in sperm.

Dr. Minkin then re-states her lie: "The data is certainly suggestive that circumcised males are at less risk of acquiring—and then transmitting—certain STDs" and then says the only fully true statement:"but not to the point of saying it's okay to not use a condom."

"All sexually active adolescent and adult males should continue to use other proven HIV and STI risk-reduction strategies such as reducing the number of partners, and correct and consistent use of male latex condoms, and HIV preexposure or postexposure prophylaxis among others. " - Recommendation #2 in the proposed CDC guidelines

It is sad and corrupt when doctors and university professors, particularly in such a prestigious university, abuse their positions to pass cultural prejudice and false beliefs as science, stigmatizing in the process the vast majority of males in the world and demonizing a normal part of the body. It is simply shameful.

We recommend that Dr. Minkin takes the time to read the full Background document and review those good old ethical principles.

P.D., would it be a surprise that Dr. Minkin is originally from New Jersey, an area with high prevalence of circumcision? And why is a doctor who is "interested in all aspects of women’s health, she has a special interest in menopause" speaking about men's health? Does she teach her students based on her beliefs on circumcision - or in real science?

Dr. Minkin, you had a chance to educate the public on the importance of safe sex and risk management, but you wasted it to promote a social surgery. We are so disappointed.

CDC, circumcision and misleading headlines

Also posted on CircWatch
 
For anyone following the issue of genital cutting of minors in the United States, yesterday brought a plethora of new and misleading headlines:

• The Verge: Benefits of circumcision outweigh the risks, US CDC says
• PR: CDC Considers Counseling Males Of All Ages On Circumcision
• webmed: CDC Endorses Circumcision for Health Reasons – WebMD
• Salon: CDC: Circumcision is a very good idea - Salon.com
• The Raw Story: CDC to parents: Consider circumcising your sons, because...
• UPI: CDC recommends circumcision procedure, says benefits
• NYTimes (blog): Circumcision Guidelines Target Teenagers - NYTimes.com

But are these guidelines really such endorsement?

Or is it that the media is hungry to present benefits and call for a universal endorsement, something that really hasn't happened?

It is our opinion that these headlines are nothing but a feeble attempt to manipulate the public opinion, under the assumption that everybody is too lazy to go to the source materials.

Anyone wishing to produce objective reporting on the CDC guidelines should start by fully reading and understanding the 8 pages draft document and the 60 pages technical report. It is unlikely that any of the reporters lending their names to the apparently carefully scripted articles, read any of the documents.

But we did, so let's share our interpretation.

The CDC guidelines refer to counseling. Counseling does not mean immediate and universal endorsement. Counseling means aiding a person through a decision-making process, and that is what the guidelines attempt to do, to counsel patients or parents through a decision-making process.
In this decision making process, the CDC considered 3 main categories of individuals based on the age range: neonates and children, adolescents, and adults.

The CDC also considered the sexual orientation and lifestyle choices as factors to be weighted during this decision making process. And for those willing to go deep enough (as deep as page 36 of the technical report), the CDC also gave consideration to the fact that parents deciding for a newborn raise concerns about autonomy, including the argument that "a man with a foreskin can elect to be circumcised but if circumcised as a newborn, cannot easily reverse the decision". The PHEC (Public Health Ethics Committee) subcommittee is, however, of the opinion that "both a decision to circumcise and a decision to not circumcise are legitimate decisions". This is one opinion that genital integrity promoters and people for the rights of the child would oppose though.

For those saying that the CDC is fully recommending circumcision, they probably need to read in detail where the technical report indicates that "There are advantages and disadvantages to performing male circumcision at various stages of life" and one of the listed disadvantages of neonatal circumcision is that "the newborn has no ability to participate in the decision".

The guidelines recognize that in the case of adolescents, both the adolescent and his parents should be involved in the decision-making process.

Let's make one thing clear. One of the main reasons for the CDC's discussion of circumcision has to do with the African trials on circumcision and HIV, considered to be evidence that circumcision could help reduce the risk of heterosexual transmission of HIV from infected females to males. The role of the CDC is not to discuss each one of those studies and their validity, strengths and flaws, but to make their recommendations based on currently accepted medical practices and standards. So of course an important premise of these guidelines is the so-mentioned potential benefit of reducing the risk of heterosexual transmission of HIV from infected females to males. As such, it is not within our current scope to discuss the African trials, something that has been already done by others in detail, but to discuss how the CDC interpreted those trials in reference to the U.S. conditions.

When discussing adult circumcision, the CDC recognizes both the documented benefits and limitations of circumcision as part of the prevention of HIV, that is:

• that circumcision does not replace the need for condoms and safe sex,
• that circumcision does not reduce the risk of male to female transmission
• that circumcision does not reduce the risk or male to male transmission,
• that circumcision does not reduce the risk of transmission through anal or oral sex, or for intravenous drug users.

In other words, that circumcision would only curb the transmission of HIV from females to males during vaginal penetration.


So, with those premises, the guidelines recommend a discussion of the person's HIV risk behavior, HIV status, sexual preferences and gender of the sexual partner, in order to provide proper guidance depending on individual circumstances.

"The PHEC subcommittee concluded that the disadvantages associated with delaying male circumcision would be ethically compensated to some extent by the respect for the integrity and autonomy of the individual."

And what are those "disadvantages"? A slightly increased risk of UTIs during the first year of life (risk of UTIs is low and they are generally easily treatable) and the possibility of the adolescent having a sexual debut prior to counseling and assessment of risks, which could potentially expose the adolescent to the risk of heterosexually transmitted HIV from infected female partners.
The CDC then states that:

"The prevalence of HIV infection in the United States is not as high as in sub-Saharan Africa, and most men do not acquire HIV through penile-vaginal sex. Targeting recommendations for adult male circumcision to men at elevated risk for heterosexually acquired HIV infection would be more cost effective than offering routine adult male circumcision. Men may be targeted according to sexual practices or an elevated prevalence of HIV within a geographic region or race/ethnicity group. "

Also, regarding sexually active individuals:

"All sexually active adolescent and adult males should continue to use other proven HIV and STI risk-reduction strategies such as reducing the number of partners, and correct and consistent use of male latex condoms, and HIV preexposure or postexposure prophylaxis among others."

So, are these guidelines an immediate and universal recommendation for circumcision? No, as much as biased media and individuals would like it to be, it is not.


The CDC gave slight consideration to sexual effects of circumcision. Again, we need to consider that they are reviewing existing medical standards, practices and publications (and it is noteworthy that proper discussion of the male foreskin is so absent from American health books that even pictorial representations of the foreskin are missing most of the times except in the context of its removal through circumcision). So, the guidelines devote the full length of a single paragraph to the discussion of sexual effects from circumcision:

"The foreskin is a highly innervated structure and some authors have expressed concern that its removal may compromise sexual sensation or function. However, in one survey of 123 men following medical circumcision in the United States, men reported no change in sexual activity and improved sexual satisfaction, despite decreased erectile function and penile sensation. Furthermore, a small survey conducted among 15 men before and after circumcision found no statistically significant difference in sexual function or sexual satisfaction. Other studies conducted among men after adult circumcision have found that relatively few men report that there is a decline in sexual functioning after circumcision; most report either improvement or no change."

This paragraph acknowledges the histological studies of John Taylor and Sorrells' study on fine touch pressure thresholds, but not the European surveys of Bronselaer in Belgium and Frisch in Denmark (both of which showed sexual difficulties among circumcised males), preferring instead to refer to Krieger's Kenyan study (which does not show the same difficulties). This begs the question of why African studies are more relevant to the sexual function and satisfaction of American citizens than European studies, but we will leave such discussion for the readers to make their own conclusions.
Finally, missing from the guidelines is any discussion of the role and functioning of the foreskin, something that could be accomplished by simple observational studies of the sexual behavior of uncircumcised males. But one could argue that the role of the CDC is to counsel on control and prevention of diseases, and not on sexuality.

I can't avoid, however, citing this quote from the late Dr. Paul Fleiss, from his 2002 book:

"Accurate information about the foreskin itself is almost always missing from discussions about circumcision. How can parents make a rational decision about circumcision when they are told nothing about the part that will be cut off?" Fleiss. What your doctor may not tell you about circumcision.

Our conclusion is that the CDC draft is far from being the universal recommendation for circumcision that biased media, organizations and individuals may wish for, it is actually more balanced on its ethical aspects than the AAP's Policy Statement, however it is not unbiased as it still gives more relevance to African studies than European, in spite of the American circumstances being more comparable to those of Europe than to Sub Saharan Africa. The media however latches to key phrases like "benefits from circumcision" ignoring the harms and collateral effects and autonomy concerns, thus distorting the message and manipulating the public opinion.

A mom speaks out about #SavingChase

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