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Old 27th August 2012, 08:58 AM   #1
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AAP And Circumcision

Quote:
"Revising its policy on circumcision for the first time in 13 years, the American Academy of Pediatrics (AAP) now says that the preventative health benefits of infant circumcision clearly outweigh the risks. The AAP is also emphasizing that the procedure should be covered by third party payers, including Medicaid, so more families have access to it. However, the organization stopped short of recommending circumcision routinely for all infant boys, saying it’s still up to parents to weigh the health, cultural, and religious implications to make the best decision for their child.

Circumcision is the surgical removal of the foreskin, a small flap of skin that covers the tip of the penis, generally performed in the days after birth. Many Jews and Muslims circumcise their sons because of their religious beliefs. Other parents choose to snip for hygiene reasons, believing it’s easier to keep a circumcised penis clean, or cosmetic ones, wanting junior to “look like dad.”

Plus: “Why I Circumcised My Sons”"
Read more: http://www.parenting.com/article/ben...6pLid%3D197424
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Old 27th August 2012, 10:04 AM   #2
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The question isn't so much "do the benefits outweigh the risk" as it is "are the benefits so great that surgery is necessary". Since a few billion men around the world are doing just fine, I'd have to say no.
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Old 27th August 2012, 10:09 AM   #3
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If you're uncut in a society where circumcision is the norm, you aren't going to get as many BJs. Life is harsh and sacrifices must be made.
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Old 27th August 2012, 10:23 AM   #4
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Originally Posted by TragicMonkey View Post
If you're uncut in a society where circumcision is the norm, you aren't going to get as many BJs. Life is harsh and sacrifices must be made.
Ah, but that is where game comes in. You are not "uncut" you are "exotic".

(Hey, the reverse worked for me in Europe.)
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Old 27th August 2012, 04:19 PM   #5
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Originally Posted by tragicmonkey View Post
if you're uncut in a society where circumcision is the norm, you aren't going to get as many bjs. Life is harsh and sacrifices must be made.
i demand to see the study of circumcision and bj frequency
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Old 27th August 2012, 05:10 PM   #6
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Originally Posted by Wuglife View Post
i demand to see the study of circumcision and bj frequency
Demand all you like.
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Old 28th August 2012, 05:44 AM   #7
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Originally Posted by Wuglife View Post
i demand to see participate in the study of circumcision and bj frequency
Fixed that for you
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Old 28th August 2012, 06:12 AM   #8
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Originally Posted by TragicMonkey View Post
If you're uncut in a society where circumcision is the norm, you aren't going to get as many BJs. Life is harsh and sacrifices must be made.
Thanks the FSM I am in one of those country where being circumcised is seen as "strange" as it is not the norm. Heck even the US is 50/50 about now.
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Old 28th August 2012, 06:22 AM   #9
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There's another thread on this here btw: http://www.internationalskeptics.com...d.php?t=242706

I checked out the techier version of the paper. It raises some interesting points but an awful lot of the studies included in this metastudy are the ones conducted in Africa and I am pretty skeptical that the social context of those papers can be lifted up and carried over to extrapolate circumcision's potential effects on HIV numbers in the US.

The paper also claims it found no significant effect on sexual function but to reach that conclusion (if I'm reading the paper right) they looked at only one study (and that was one of the African ones too).

They've left the potential for goof-ups out of their consideration due to rarity:

Quote:
The majority of severe or even catastrophic injuries are so infrequent as to be reported as case reports (and were therefore excluded from this literature review).
I think this bit is the most relevant for most of the discussions we've had here:

Quote:
Stratification of Risks

Based on the data reviewed, it is difficult, if not impossible, to adequately assess the total impact of complications, because the data are scant and inconsistent regarding the severity of complications. For example, studies that report bleeding as a complication do not uniformly report how frequently the bleeding was controlled with local measures versus requiring a transfusion or surgical intervention. Similarly, infection is rarely further divided into local tissue infection versus bacteremia or sepsis. Financial costs of care, emotional tolls, or the need for future corrective surgery (with the attendant anesthetic risks, family stress, and expense) are unknown.

Some reports have attempted to compare potential benefits of circumcision with reported complication rates. One study with good evidence attempted to estimate complication rates compared with benefits from male circumcision. Based on an estimate that 100 circumcisions must be performed to prevent 1 UTI, and 909 circumcisions must be performed to prevent 1 case of penile cancer, the study yields an estimate of 1 complication for every 5 UTIs prevented and 2 complications for every 1 case of penile cancer prevented.

Assuming an overall minor adverse event rate for newborn circumcision of 0.2%, and a severe adverse event rate of 0.005%, another study with fair evidence estimated that over 322,000 newborn male circumcisions are required to prevent 1 case of penile cancer per year. Similar modeling for HIV, herpes, and HPV in the United States is not available.
It's nice to finally see some numbers that give me a chance to go to the original papers and see what they're basing these numbers on. Really, the list of papers they've included in the metastudy is my favorite thing about it. Their criteria for choosing which papers to look at seem pretty good to me so the whole list would probably be interesting reading.

I also found this interesting because I'd never seen it before and it seems to confirm a worry I had about the overall effect of the way circumcision is being promoted in Africa:

Quote:
One Ugandan RCT study with good evidence found that, at 24 months, the risk of HIV infection among women whose male partners were circumcised was 21.7% compared with 13.4% for female partners of uncircumcised men.
That looks to me like the result of promiscuous men treating circumcision like an 'invisible condom.' I haven't looked at the original paper though so, a grain of salt, etc.

Last edited by Lithrael; 28th August 2012 at 06:25 AM.
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Old 28th August 2012, 08:43 AM   #10
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Whether or not cutting a kid's head off saves him catching brain cancer does not justify decapitation on religious grounds.
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Old 28th August 2012, 08:55 AM   #11
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Quote:
Commentary on American Academy of Pediatrics 2012 Circumcision Policy Statement.
By the staff of Doctors Opposing Circumcision
http://www.doctorsopposingcircumcisi...Commentary.pdf
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Old 28th August 2012, 10:11 PM   #12
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Originally Posted by TragicMonkey View Post
If you're uncut in a society where circumcision is the norm, you aren't going to get as many BJs. Life is harsh and sacrifices must be made.
Speak for yourself. My experience was different. There's something to be said for standing out from the crowd. I will say that I was told several times that they were surprised it didn't smell, that they'd heard it would smell. I guess people forget that body parts can be washed.

(Writing in the past tense. I was circumcised in my late twenties, after an injury resulted in tearing and scarring.)
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Old 29th August 2012, 03:01 AM   #13
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That's surprising! If you declare complications as rare and all but exclude them from the review, the conclusion is that the benefits outweigh the risks. Amazing!
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Last edited by Megalodon; 29th August 2012 at 03:03 AM.
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Old 29th August 2012, 04:43 AM   #14
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Originally Posted by Lithrael View Post
There's another thread on this here btw: http://www.internationalskeptics.com...d.php?t=242706

I checked out the techier version of the paper. It raises some interesting points but an awful lot of the studies included in this metastudy are the ones conducted in Africa and I am pretty skeptical that the social context of those papers can be lifted up and carried over to extrapolate circumcision's potential effects on HIV numbers in the US.
Is there any good reason why all these studies have been done in Africa and not in the US? It's not like there is a scarcity of circumcised, as well as non-circumcised people in the US.
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Old 29th August 2012, 04:53 AM   #15
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Originally Posted by ddt View Post
Is there any good reason why all these studies have been done in Africa and not in the US? It's not like there is a scarcity of circumcised, as well as non-circumcised people in the US.
Folks in the US are a bit more prudish about their manly bits, maybe?
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Old 29th August 2012, 05:00 AM   #16
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Originally Posted by ddt View Post
Is there any good reason why all these studies have been done in Africa and not in the US? It's not like there is a scarcity of circumcised, as well as non-circumcised people in the US.
A few US studies have been done (they were linked to in prior threads; they're relatively few) however they don't support the "benefits" of circumcision and tend to be ignored by proponents.
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Old 29th August 2012, 05:02 AM   #17
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Originally Posted by ddt View Post
Is there any good reason why all these studies have been done in Africa and not in the US? It's not like there is a scarcity of circumcised, as well as non-circumcised people in the US.
Perhaps it is due to the rate of AIDS infections in Africa.

http://www.avert.org/worldstats.htm#
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Old 29th August 2012, 05:16 AM   #18
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Originally Posted by catsmate1 View Post
A few US studies have been done (they were linked to in prior threads; they're relatively few) however they don't support the "benefits" of circumcision and tend to be ignored by proponents.
Thanks. I followed those threads but got a bit lost in the multitude of studies. I don't recollect studies being done in the US on STD's though.

Originally Posted by Skwinty View Post
Perhaps it is due to the rate of AIDS infections in Africa.

http://www.avert.org/worldstats.htm#
I'm aware of that, but with 0.6% prevalence in North America you'd still get meaningful numbers if there really was such a difference. Of course, the demographics of HIV patients in Africa and in the US is vastly different. But these studies also claim benefits in other STD's. Are they more prevalent in Africa too?
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Old 29th August 2012, 05:18 AM   #19
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Good. It's about time. Circumcision is not needed in an industrialized nation where one can easily take care of hygiene needs.
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Old 29th August 2012, 05:26 AM   #20
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Originally Posted by ddt View Post
Are they more prevalent in Africa too?

"The WHO estimates that 340 million new cases of syphilis, gonorrhea, chlamydia and trichomoniasis occurred throughout the world in 1999 in men and women aged 15-49 years. The largest number of new infections occurred in the region of South & Southeast Asia, followed by sub-Saharan Africa and Latin America & the Caribbean. The highest rate of new cases per 1,000 population occurred in sub-Saharan Africa."


http://www.avert.org/std-statistics.htm
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Old 29th August 2012, 05:27 AM   #21
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Originally Posted by TragicMonkey View Post
If you're uncut in a society where circumcision is the norm, you aren't going to get as many BJs. Life is harsh and sacrifices must be made.

I believe it was Jake Johannsen who said that if you've gotten to that point, you've pretty much sealed the deal.


Originally Posted by Redtail View Post
The question isn't so much "do the benefits outweigh the risk" as it is "are the benefits so great that surgery is necessary". Since a few billion men around the world are doing just fine, I'd have to say no.

The "surgery" took under thirty seconds for each of my children. And the men who were circumcised as infants seem to be doing just fine as well.


Originally Posted by Soapy Sam View Post
Whether or not cutting a kid's head off saves him catching brain cancer does not justify decapitation on religious grounds.

Is anyone arguing that children should be routinely decapitated for religious reasons?
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Old 29th August 2012, 05:33 AM   #22
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Originally Posted by ddt View Post
Thanks. I followed those threads but got a bit lost in the multitude of studies. I don't recollect studies being done in the US on STD's though.


I'm aware of that, but with 0.6% prevalence in North America you'd still get meaningful numbers if there really was such a difference. Of course, the demographics of HIV patients in Africa and in the US is vastly different. But these studies also claim benefits in other STD's. Are they more prevalent in Africa too?
Keep in mind that this is the whole population of the US, they were focused only on heterosexual men. The rate of infection in that population is far lower. The population studied in Africa was a high-risk population, the few studies performed in the US were on high-risk populations. I think the only reasonable conclusion you could draw from them is that there may be a case for offering circumcision to men in high-risk populations.
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Old 29th August 2012, 06:46 AM   #23
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Originally Posted by jdp View Post
Keep in mind that this is the whole population of the US, they were focused only on heterosexual men. The rate of infection in that population is far lower. The population studied in Africa was a high-risk population, the few studies performed in the US were on high-risk populations. I think the only reasonable conclusion you could draw from them is that there may be a case for offering circumcision to men in high-risk populations.
Yes, and in Africa the incidence of HIV is higher among hetero men than among gay men, while in the US the reverse is true. So that's one reason why those African studies don't carry over. And secondly, if you're going to argue that it's beneficial for high-risk populations, than you should indicate circumcision only for those high-risk groups. Good luck with identifying the sexual orientation of an infant.
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Old 29th August 2012, 06:47 AM   #24
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Originally Posted by Skwinty View Post
"The WHO estimates that 340 million new cases of syphilis, gonorrhea, chlamydia and trichomoniasis occurred throughout the world in 1999 in men and women aged 15-49 years. The largest number of new infections occurred in the region of South & Southeast Asia, followed by sub-Saharan Africa and Latin America & the Caribbean. The highest rate of new cases per 1,000 population occurred in sub-Saharan Africa."


http://www.avert.org/std-statistics.htm
Thanks for indulging my laziness to browse the site you had already linked to.
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Old 29th August 2012, 06:54 AM   #25
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Originally Posted by ddt View Post
Good luck with identifying the sexual orientation of an infant.
How much does the infant like boobies?
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Old 29th August 2012, 06:55 AM   #26
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Originally Posted by Skwinty View Post
"The WHO estimates that 340 million new cases of syphilis, gonorrhea, chlamydia and trichomoniasis occurred throughout the world in 1999 in men and women aged 15-49 years. The largest number of new infections occurred in the region of South & Southeast Asia, followed by sub-Saharan Africa and Latin America & the Caribbean. The highest rate of new cases per 1,000 population occurred in sub-Saharan Africa."


http://www.avert.org/std-statistics.htm
Oh yeah? Guess those "scientists" haven't been to Brooklyn lately.
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Old 29th August 2012, 07:02 AM   #27
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Originally Posted by Alt+F4 View Post
Oh yeah? Guess those "scientists" haven't been to Brooklyn lately.
More than half the population of Brooklyn NY are either Asian, African, Latin American or Caribbean.

So that fits with the WHO figures.

http://www.epodunk.com/cgi-bin/popInfo.php?locIndex=286
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Old 29th August 2012, 07:15 AM   #28
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Originally Posted by ddt View Post
Yes, and in Africa the incidence of HIV is higher among hetero men than among gay men, while in the US the reverse is true. So that's one reason why those African studies don't carry over. And secondly, if you're going to argue that it's beneficial for high-risk populations, than you should indicate circumcision only for those high-risk groups. Good luck with identifying the sexual orientation of an infant.
It isn't even the identification of sexual orientation that is at issue, even if you could know that an individual child would be heterosexual, there is more to assessing future HIV risk. The lifetime risk of most men in the US population is going to be very low so the change in that lifetime risk by circumcision is going to be relatively low. There are more appropriate risk-factors to focus on and correct such as the disparity between white men and black men.
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Old 29th August 2012, 08:11 AM   #29
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Originally Posted by jdp View Post
There are more appropriate risk-factors to focus on and correct such as the disparity between white men and black men.
This would go down like a lead zeppelin in Africa.
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Old 29th August 2012, 08:39 AM   #30
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Originally Posted by Skwinty View Post
This would go down like a lead zeppelin in Africa.
I was speaking in the US context of course.
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Old 29th August 2012, 08:47 AM   #31
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Originally Posted by catsmate1 View Post
A few US studies have been done (they were linked to in prior threads; they're relatively few) however they don't support the "benefits" of circumcision and tend to be ignored by proponents.
Except for the ones that do support the "benefits", with or without quotes, of circumcision.

In particular, the Kaiser Permanente study of urinary tract infections among infant males, in which it was shown that those infections were significantly less common among circumcised infants.
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Old 29th August 2012, 08:55 AM   #32
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Originally Posted by Meadmaker View Post
Except for the ones that do support the "benefits", with or without quotes, of circumcision.

In particular, the Kaiser Permanente study of urinary tract infections among infant males, in which it was shown that those infections were significantly less common among circumcised infants.
http://www.circumstitions.com/Utis.html

By "significantly less common" you mean:
Quote:
it probably requires somewhere between 300 and 417 circumcisions to prevent a single UTI and
it requires between 1,200 and 3,548 circumcisions to prevent a recurrent UTI.
Also
Quote:
The UTI incidence among young girls in the study was 1.48%, while the highest credible UTI incidence among intact young boys was 0.83% -- i.e., the rate anong girls was at least 78% higher than the rate among intact boys -- hardly a comparison upon which to base advocating prophylactic surgery on boys.
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Old 29th August 2012, 09:22 AM   #33
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Originally Posted by ehcks View Post
http://www.circumstitions.com/Utis.html

By "significantly less common" you mean:


Also
You can spin the numbers a bunch of ways. You can say that it would take 300 circumcisions to prevent a UTI, or you can say UTIs are 20 times more likely among uncircumcised male infants. Both are correct. Which spin do you prefer? No matter how it's spun, the data is what it is.

And of course, by "correct" what I mean is that I can cherry pick the numbers from studies to suit my needs. The figure of 20 comes from a single study. More recent studies show lower multipliers, around 10. The figure of hundreds of circumcisions to prevent one UTI doesn't sound right, either. I think it's one UTI that required hospitalization, but I'll check the links I looked up earlier to see if that's right.

ETA: When participating in that other thread, I felt that the best summary paper on the subject was from the RACP. (Royal Australian College of Physicians? Not sure. It was an Aussie doctor group.) They gave a figure of 111 circumcisions to prevent one infection. In general, their study was without hyperbole and was well documented. Its primary conclusion was that there was insufficient benefit to perform routine circumcision, but that there were health benefits to the procedure, and that doctors should describe benefits and risks to prospective parents so that the parents could make an informed decision.

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Old 29th August 2012, 10:06 AM   #34
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Originally Posted by Loss Leader View Post


The "surgery" took under thirty seconds for each of my children. And the men who were circumcised as infants seem to be doing just fine as well.
As a male who was circumcised as a toddler who is doing just fine I agree. I was just pointing out that the benefits from being circumcised aren't so great that surgery is necessary.

Does it upset you that circumcision is surgery?
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Old 29th August 2012, 10:42 AM   #35
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Originally Posted by Redtail View Post
Does it upset you that circumcision is surgery?
I suspect that Loss Leader put surgery in quotation marks because, in his case, it most likely wasn't any medical personnel that put the blade to his kids, but a rabbi.
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Old 29th August 2012, 12:06 PM   #36
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Originally Posted by Ryokan View Post
I suspect that Loss Leader put surgery in quotation marks because, in his case, it most likely wasn't any medical personnel that put the blade to his kids, but a rabbi.
Mohels aren't necessarily rabbis, and it's not uncommon for professional mohels to also be physicians.
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Old 29th August 2012, 03:03 PM   #37
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Originally Posted by Redtail View Post
Does it upset you that circumcision is surgery?
Originally Posted by Ryokan View Post
I suspect that Loss Leader put surgery in quotation marks because, in his case, it most likely wasn't any medical personnel that put the blade to his kids, but a rabbi.
Originally Posted by Cleon View Post
Mohels aren't necessarily rabbis, and it's not uncommon for professional mohels to also be physicians.

Yes, it's hard to think of something as a surgery when it took place in my parents' living room.

Neither of the two mohels we used were doctors. Having read how circumcisions are performed in hospitals, I much prefer the way the mohels did it.
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Old 29th August 2012, 03:46 PM   #38
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Originally Posted by Loss Leader View Post
Yes, it's hard to think of something as a surgery when it took place in my parents' living room.

Neither of the two mohels we used were doctors. Having read how circumcisions are performed in hospitals, I much prefer the way the mohels did it.
So its not surgery because its hard for you to think of it as surgery? Ok...
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Old 29th August 2012, 05:15 PM   #39
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Originally Posted by Redtail View Post
So its not surgery because its hard for you to think of it as surgery? Ok...

I'm sorry, but what is your definition of surgery? And what would the taxonomic classification of circumcision as surgery have to do with whether it's a good idea? I'll agree that circumcision is surgery, if it will make you feel better. I still chose it for my children and would do so again.

If you'd like, I'll agree that all raccoons are "savage, wild beasts." I still think they're adorable.
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Old 29th August 2012, 10:24 PM   #40
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AAP is just using junkscience to support greed.

This takes a little history:

Sexual genital mutilation is a cure looking for a disease. It started as a way of preventing masturbation, which religions mutilating and doctors profiting from sexually mutilating genitals claimed cause blindness, incontinence, insanity, hairy palms, et cetera. When people stopped believe that ********, it changed to cancers and venereal diseases. This canard started in the 1980s:

As AIDS entered the news in the 1980s, the sexual genital mutilators looked around the world for cherries to pick. The trouble for them was that the numbers did not back them up:

Sexually mutilated America has a higher rate of AIDS than Europe. In Asia, one cannot find a correlation either way. In Africa, they could not find any correlation —— ¡except in East Africa!:

In East Africa, they noticed the sexually mutilated Muslims had a lower AIDS-Rate than than intact Animists. This is apples to oranges.

Then came the junk-studies.

0 Gather a few thousand intact HIV-Negative men.
1 Sexually mutilate half of them, thus making them incapable of sexual activity for several months.
2 After a few months, test the groups for HIV.
3 Journal-Shop until someone publishes the results.

The HIV-Rate of the sexually mutilated men at 6 months was 40% of the intact men, but look at # 1:

“ 1 Sexually mutilate half of them, thus making them incapable of sexual activity for several months.”

They could not have sex for months. I could do a study showing that eating an apple-a-day reduces the odds of catching HIV:

0 Collect a few thousand young sexually active HIV-Negative young adults.
1 Lock half of them in a dungeon, 1-to-a-cell, and feed those a healthy diet with 1-apple-a-day in it for a few months.
2 Test both groups for HIV.
3 Journal-Shop until some journal publishes it.

Even if we give them everything, sexually mutilating genitals is not ever effective and cost-ineffective:

They claim, using junk-science, that sexually mutilating genitals reduces the rate of HIV-infection to 40%. Condoms reduce the rate of HIV-infection 95%. Condoms are 8 times more effective at reducing the spread of HIV than sexually mutilating genitals USING THEIR OWN NUMBERS.

A condom costs approximately ~.10 U$D. Sexually mutilating men and boys costs approximately ~100.00 U$D. USING THEIR OWN NUMBERS, condoms are tens of times more cost effective.

The Europeans do not suffer from health-problems from being intact. The claims of the AAP do not hold water. ¿Where are the health-problems and extra costs for the Europeans?

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