| Doug Williamson | |
| Windsor Star |
Saturday, March 19, 2005
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Call it a money grab by doctors or a sign of the cultural times.
For new parents Michael and Susan Levesque, Windsor's fixation with circumcising its newborns is simply a matter of doing what their ancestors did.
"We just decided to go with it, based on tradition," said Michael, whose son Owen was born Feb. 1. "I was, 'So why not?' "
Just over 50 per cent of the boys born at Windsor Regional Hospital last year were circumcised, well above the national average of 13.9 per cent. The average in Ontario was 16 per cent.
Dr. Tony Hammer, a Windsor family doctor, said his colleagues may be performing the medically unnecessary procedure simply to make a buck. Hammer is critical of a procedure which is also not recommended by the Canadian Paediatric Society.
"There is a financial incentive for physicians, and I wonder if they are fully informing their patients of a lack of medical need," said Hammer.
Obstetricians and the hospital split a $200 fee for each procedure, which is not covered by OHIP.
The head of obstetrics at Windsor Regional couldn't be reached, but a hospital spokesman said all circumcisions are done at parents' request, and rejected Hammer's statement.
"That comment is appalling. In no way do we promote it," said David Musyj, vice-president of corporate services and medical affairs. "In no way do they do it for the money."
He also said the rate charged in Windsor is equal to and in some cases lower than those charged in other hospitals. Circumcision is the surgical removal of the foreskin of the penis.
Last year, there were 4,400 births at Windsor Regional and nearly 50 per cent were boys. Of those, 1,080 circumcisions were performed, representing 51 per cent, hospital officials said.
Jewish and Muslim rites dictate it is done on the eighth day after birth.
According to the Montreal-based Association for Genital Integrity, the Canadian average in 2003 was 13.9 per cent, and 16 per cent in Ontario. Leading the charge was Prince Edward Island at 29.5 per cent, the association said, citing figures from Statistics Canada.
Musyj said the hospital's share of the more than $200,000 charged for circumcisions last year was for supplies, attending nurses and other hospital costs.
Hammer said he regularly advises his pregnant patients not to have the procedure done, but acknowledged some do anyway.
He and Musyj agreed that Jews and Muslims, for example, require the procedure as a matter of religion, and others are doing it just because their parents did. Muslims represent one of Windsor's fastest growing ethnic populations.
In the case of the Levesques, "We didn't really look into the pros and cons," said Michael, although the couple feel that personal sanitation is improved with circumcised males.
"I just felt that guys are lazy, so I wouldn't have him go through that."
Kim and Stavros Kourtsidis of Windsor also decided to circumcise their son Joshua, who was born March 7, because his older brother had undergone the procedure.
"It's cleanliness," Kim said Friday.
But opponents argue there are more medical complications associated with circumcision, than not doing it.
"I don't think physicians are educating patients about the lack of medical need for it. In the majority of cases it is cosmetic," Hammer said.
Dr. Danielle Grenier, of the Canadian Paediatric Society, said the number of procedures is declining in Canada.
"There is no medical indication to have newborn boys circumcised," she said. "There are no advantages to doing it. And with any procedure, there's always a risk.
"It's a painful procedure," she added.
In most cases a local anesthetic is used, and there can also be reaction to medications. "You never know how much you are cutting or how much you are leaving," she added.
"Parent pressure, most of the time," is the reason it is still being done, she said.
The risks may be small but they are there, Hammer said. "They do exist. When they occur, one can argue they were avoidable.
"Any ethical physician refers to the recommendations of the Canadian Paediatric Society," he said.
Musyj said Windsor's "multicultural" population partly accounts for the high local rate, as well as local tradition.
"Windsor being the community it is, I think that has a lot to do with it," he said of the tradition of circumcising boys. Musyj said most parents know the sex of their child well before delivery, and usually have enough time to decide on the procedure. It is done before the baby goes home.
Grenier of the pediatric society said a lot of information is available on the subject.
"Heaven knows what has been published over a little piece of skin," she said.
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TO CUT OR NOT TO CUT
According to the Canadian Paediatric Society, of every 1,000 boys who are circumcised:
- 20 to 30 will have a surgical complication, such as too much bleeding or infection in the area.
- Two to three will have a more serious complication that needs more treatment. Examples include having too much skin removed or more serious bleeding.
- Two will be admitted to hospital for a urinary tract infection before they are one year old.
- 10 babies may need to have the circumcision done again because of a poor result.
- Of every 1,000 boys who are not circumcised, seven will be admitted to hospital for a urinary tract infection before they are one year old.
© The Windsor Star 2005
Not mentioned was the fact that three circumcised males will also develop urinary tract infections and about ten times as many females will develop urinary tract infections. Why would circumcision be necessary in order to prevent an isolated treatable condition even if it did occur?
There is no guarantee that circumcision will prevent UTI in males before they are one year old - nor will it prevent UTI in males over one year of age. Circumcised infants also developed urinary tract infections according to the study.
The prevention prediction is according to Thomas Wiswell studies which has very little credibility and which common knowledge does not support. (AAP stated study was retrospective in design.) (UTI in males could have resulted from the forceful retractions of the infant's foreskins which should never be done.) (All males with UTI had congenital defects.) This study was badly flawed and therefore had little credibility - and yet it is quoted to support the UTI fraud.
Males seldom develop urinary tract infections regardless of status - and if they do, it is no more serious in males than in females. So let's stop using this fraudulent excuse to promote circumcision. Webmaster's note.
Letters to the Editor
| Letter |
Thursday, March 24, 2005
Last year, a formal policy discouraging infant male circumcision was released by the governing body for doctors in B.C., the College of Physicians and Surgeons of British Columbia.
A strongly worded advisory against newborn circumcision has also been issued in Saskatchewan. Perhaps it's time the College of Physicians and Surgeons of Ontario followed suit.
Dennis Harrison
Vancouver, B.C.
© The Windsor Star 2005
| Letter |
Monday, March 28, 2005
In a March 19 front page story, Dr. Hammer and Dr. Grenier failed to mention one very good reason for circumcision. A couple of years ago, I read a Star story about a medical study done on the subject.
The study found that women whose male partners weren't circumcised have a much higher incident of vaginal and urinary tract infections than women with circumcised male partners. I could not locate this article, but I'm hoping that someone in the medical profession can find it and have it published again for those still unaware. Women already have the burden of bearing children, then becoming the principal homemaker while often working full time, and later going through menopause. Why give them more to struggle through?
The real questions should be, why are the circumcision percentages so low and why doesn't OHIP cover it?
Grant Pauli
Amherstburg
© The Windsor Star 2005
| Letter |
March 31, 2005
Re: Letter about woman risks infection with uncircumcised male. I have no objection to any young man of the age of majority having his foreskin removed if he perceives that this will prevent some disease that he feels he is at risk of developing, just as some healthy women have their breasts removed because they are worried that they might get breast cancer.
However, circumcising infants is dangerous because it makes unwarranted assumptions about the infants' behaviour 15 or 20 years in the future. After all, the circumcised infant may grow up to marry his high-school sweetheart and not be in any danger whatsoever of contracting or passing on any sexually transmitted disease. He may be homosexual, and have no chance of infecting a woman at all.
In any of these scenarios, the infant has been circumcised against his will and contrary to his human rights, and his full sexual sensitivity has been sacrificed for nothing. What if he would have preferred to have an intact penis? What if his lover prefers the advantages of a foreskin?
There is no doubt that circumcising a male infant for a supposed benefit to his future sexual partner is a violation of his basic human rights. What other surgery is done without the patient's consent for the supposed benefit of someone else? Would we perform surgery on an infant girl to benefit her future sex partner?
Lawrence Barichello
Toronto
© The Windsor Star 2005
| Letter |
Friday, April 01, 2005
Re: The March 19 article, Circumcisions Spark Debate, Local Rate Four Times National Average; MD Says Doctors May Be In It For The Money.
The headline and accompanying article in the March 25 issue are misleading, inaccurate, and not worthy of the reputable reporting we are accustomed to from Doug Williamson and The Star.
The article fails to mention any debate, but rather the opinion of a sole physician who does not do circumcisions, and is not a local or national authority on the subject. Furthermore, reference is made to statistics, without mentioning any sources. His opinions are his own, not supported in fact, and should not be the sole basis for smearing the integrity of his colleagues.
Obliged to see what sources were used in this article, I find that an obscure group known as the Association for Genital Integrity is the only source used. This group has no national or scientific standing, and does not appear to be involved in any academic institute, or published in any scientific journal.
Our own research into this subject reveals a different picture than that painted by the article in your paper.
A study from the Department of Epidemiology and Biostatistics from the University of Western Ontario, and published in the Canadian Family Physician journal, shows that the circumcision rate in southwestern Ontario is approximately 56 to 59 per cent.
An important finding in this study was that the prevalence of neonatal circumcision did not change after delisting. The circumcision rate at Windsor Regional Hospital is no higher than the provincial rate -- a fact that makes your article less than laudable.
Your article does not make reference to the multicultural mix in Windsor, the fourth most multicultural city in Canada, and how this could influence circumcision rates.
Your claim that "doctors may be in it for the money" is not accurate, unfair to the ethical and hard-working physicians in this city, and is simply gossip and not worthy of your paper, let alone the headline status you gave to it.
Joseph Shaban, MD
President
Essex County Medical Association
© The Windsor Star 2005
| Letter |
Saturday, April 02, 2005
Re: circumcision. There is nothing on the male or female body which needs to be cut off at birth. The prime reason for this barbaric operation is religious, and that is being questioned at this time. OHIP should not be paying for this and it should be done for purely medical reasons. Doctors are now being sued for this unneeded procedure.
Parents-to-be, get the facts before you decide on this. Don't let some doctor pressure you into a totally unneeded operation. And if by chance religion is your reason to have your son cut, remember God made Adam in his own image and Adam certainly wasn't circumcised.
BOB BATES
LaSalle
| Letter |
Tuesday, April 05, 2005
Re: Circumcisions Spark Debate, by Doug Williamson, March 19. The Windsor Star has performed a valuable service. Unnecessary painful, non-therapeutic surgery on tiny newborn babies is the epitome of bad medical practice.
The Canadian Charter of Rights and Freedoms provides that every Canadian has a fundamental human right to security of the person.
Circumcision excises large amounts of protective, sensitive tissue from the penis and is an obvious violation of that right.
George Hill
Bioethicist
Executive Secretary
Doctors Opposing Circumcision
Seattle, Wash.
| Letter |
Thursday, April 07, 2005
Re: Circumcision Article Has No Statistical Basis, letter, April 1. Dr. Joseph Shaban questions our statistics showing that the average provincial circumcision rate in Ontario is currently only 16 per cent, compared to 51 per cent at Windsor Regional. The statistics we have provided were compiled from the Ministry of Health and Long-Term Care databases and reflect the number of circumcisions completed in Ontario acute-care hospitals prior to initial discharge from hospital at the time of birth.
Furthermore, a study on patterns of health-care utilization carried out by the Institute for Clinical Evaluative Sciences (published by the Canadian Medical Association in 1996) found that Essex County consistently had the highest rate of infant male circumcision among Ontario's 33 district health councils.
In 1994-95, the circumcision rate in Essex County was 649.9 per thousand. This was more than twice the provincial average and three times the rate in Metropolitan Toronto, whose population, I suggest, is even more ethnically diverse than that of Windsor.
The reality is that newborn circumcision is not medically necessary. It is not recommended by the Canadian Pediatric Society. The Colleges of Physicians and Surgeons of Saskatchewan and British Columbia have expressed unease about the ethical and human rights aspects of infant male circumcision, and have also raised serious concerns about the ability of parents to consent to the procedure.
We have put forward our facts. Let Dr. Shaban present his evidence supporting the need for circumcising healthy infants.
Dr. Arif Bhimji, MD
Woodbridge
© The Windsor Star 2005
Dr Shaban wants to debate the merits of circumcision.
Our Challenge to Dr. Shaban
Dr. Shaban is highly critical of Doug Williamson's recent article "Circumcision spark debate" stating that it fails to mention any debate, but (is) rather the opinion of a sole physician who does not do circumcisions, and (who) is not a local or national authority on the subject. Dr. Shaban also takes issues with statistics quoted regarding the number of circumcisions done in the province of Ontario.
In light of these statements, I would assume that Dr. Shaban is an authority on the subject of male circumcision and would like to have a debate on the subject. If so, perhaps he would be willing to begin the debate by establishing the ethics and legality of performing surgery on non consenting individuals for which there is no medical indication. This is the first question which must be addressed if we are to condone or sanction male circumcision.
Dr. Shaban takes great issue that "doctors may be in it for the money" is not accurate, unfair to the ethical and hard-working physicians of this city. I have two observations to make: Ethical and hard-working doctors would hardly be engaged in the practice of male circumcision. As for the doctors who perform circumcisions, and since there are no valid medical reasons, if it is not for money, then what is their motive for performing them?
As for the ethics of male circumcison, or the legality of it under the Canadian Charter of Rights and Freedoms and the Criminal Code of Canada, perhaps Dr. Shaban and other advocates of circumcision would indicate:
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Where under any medical code of ethics or in the Criminal Code of Canada are doctors permitted to amputate normal, healthy and vital body parts of non consenting individuals for non-medical reasons, or permit parents to make such a request?
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Where under any medical code of ethics are doctors permitted to amputate body parts of children in order that they resemble their parents? Resemble their peers? To facilitate hygiene? For cultural or religious reasons? Tradition? Prevent treatable conditions? When has any one of these reasons ever been a mandate for surgery?
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Whose interests are doctors morally and ethically obliged to respect and protect, those of the patient, or those of the parent? What could be more important than the genital integrity of an individual?
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Why does no medical organization in the world, including the Canadian Paediatric Society, recommend routine male circumcision? Are all these organizations misguided and uninformed, or should we question the ethics of doctors who ignore guidelines regarding appropriate ethical medical practices?
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The Hippocratic Oath states that in any medical treatment, the physician has the primary obligation to "First Do No Harm". Since circumcision permanently destroys (50-80%) of important erogenous tissue which is also a vital protective covering of the penis , how can doctors performing circumcisions claim that they are working in accordance with the medical code of ethics or in the best interests of their patients?
The accuracy of the statistics of male circumcision for Windsor, or Ontario is irrelevant. The fact is (whatever the statistics) that there are large numbers of doctors performing surgery for which there is no medical justification. This reflects on the integrity of all doctors in Ontario, not just those responsible for circumcisions. Perhaps there is a reason why ethical doctors, as Dr. Tony Hammer, and others like him, question a practice for which there is no medical justification. Why should their reputations be tarnished?
Ethical doctors, medical ethicists, politicians, and all individuals who believe in human rights around the world are calling for an end to this dehumanizing practice. Doctors Opposing Circumcision, Nurses for the Rights of the Child, NOHARM-UK, the Canadian Children's Rights Council and many such organizations have exposed the circumcision hoax providing irrefutable arguments against it. The debate has long ended. The arguments in favour of circumcision has as much credibility as the flat earth theory.
We hardly need a new debate to rehash myths, old wives tales, fraudulent studies and claims which have been thoroughly researched and dealt with by many intelligent and reputable members of the medical profession, academics and people from every profession. Every aspect of circumcison has been thoroughly debated : medical, religious, cultural etc. and found wanting.
How much longer must newborn males be subjected to a painful and mutilating experience because of public ignorance and the refusal of doctors to acknowledge the truth? Finally, I would like to commend Doug Williamson and The Windsor Star for bringing this information to national attention. Regarding the legitimacy and the ethics of male circumcision, there can be no debate. We need to end this shameful practice.