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Law.com – Atlanta Lawyer Takes on Botched Circumcision Claims Nationwide

Posted: July 29th, 2010 | Author: | Filed under: Briefs | Tags: , , , , | 3 Comments »

"I didn't set out to be a circumcision lawyer; it just sort of happened," said David J. Llewellyn of his legal practice suing doctors, hospitals, and medical supply makers around the United States. Llewellyn recently won a $10.7 million default judgment "against Mogen Circumcision Instruments, claiming one of its devices severed the head of the boy's penis during a bris, a Jewish ceremony for a male infant," Katheryn Hayes Tucker reports.

"The circumcision of infants is the American sickness, and unfortunately, we're spreading it around the world because of a small group that's pushing it," Llewellyn said. He recalls his early days fighting the practice, being routinely confronted with jokes and questions like "what does it matter?" The American Academy of Pediatrics (AAP) remains neutral on the matter, claiming "most of the complications that do occur are minor," and advising parents to "determine what is in the best interest of the child." But how, I wonder, are parents to know?

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3 Comments on “Law.com – Atlanta Lawyer Takes on Botched Circumcision Claims Nationwide”

  1. 1 Wendy Blackheart said at 9:12 pm on July 29th, 2010:

    I lvoe that the AAP claims ‘most of the complications…are minor.’ I swear, they really need to take a fucking stand on this issue and actually do some education. I can’t believe how many people I meet who honestly think uncut cocks are actually, physically dirty. I’ve had a fair few un-cut partners, and they were no more or less funky than any other guy their age. 4 hours of dancing in tight leather will do that to anyone.

    When I was a little girl, I spent quite a bit of time listening, not talking, and making myself seem like I wasn’t in a room so I could hear what was going on. The son of my mother’s best friend (and my best friend’s little brother) was about 3-5 years old and in *agony*. Crying, all sorts of pain and he was so upset and confused.

    Turns out his circumcision wasn’t done well, and had healed awfully, creating skin bridges so short, that when he had erections, it was massively painful. Sure, he may or may not remember it now, and sure, its just one case, but still, a kid in screaming agony over something that could have *totally* been prevented doesn’t really seem like a minor thing to me. Nor does mutilation a child’s genitals.

  2. 2 Clarisse Thorn said at 12:55 am on July 30th, 2010:

    Oh great, another privileged Western activist claiming that we’re “exporting circumcision to the world” out of … what? Culture? Sorry dude, we’re actually exporting circumcision to the world because both the Centers for Disease Control and the World Health Organization have done several studies that clearly demonstrate it to have at least a 60% reduction rate on the transmission of HIV. And if this Western dude actually lived and worked with HIV in Africa, like I do, then he’d know that African men are lining up to have the procedure done. Are there complicated questions about consent involved in circumcising boys? Sure. But thousands of health workers are promoting circumcision for a reason, and if he lived in a place where over a quarter of the population had HIV, he’d have a very different perspective.

    Sorry, this issue just gets me really angry. I’m tired of people acting like I’m blindly playing into screwed up sex & gender issues when I promote circumcision. It works, people. Acknowledge that. Then we can have a conversation about consent.

  3. 3 Wendy Blackheart said at 6:16 am on August 2nd, 2010:

    Of course, they didn’t take into consideration the area where they were applying this research – See this article from the International Journal of STD and AIDs, January 1999, which collects and asses the data from a variety of research on circumcision and AIDs.

    Particularly note:

    Three studies have linked the foreskin to HIV infection by looking at maps, instead of men. These studies found an association between the practice of male circumcision at a societal level and regional HIV seroprevalence in Africa. In locations where male circumcision is practiced, HIV seroprevalence was found to be considerably lower than in areas where it is not practiced2-4. Other cultural factors, such as age at first coitus, chastity and monogamy, that could otherwise explain the differences were not considered by the authors. The authors employed data collected in the 1950s concerning circumcision practices. They assumed that circumcision practices had not changed since that time and that, within a given area, circumcision was universal or completely absent. Circumcision was not a panacea in preventing the spread of HIV as several areas where circumcision was practiced also demonstrated high levels of HIV seroprevalence.

    In all of these studies, the presence of other STDs and other risk factors were not taken into account. In addition, the indices of HIV prevalence were very crude, as were the data on which the circumcision rates were based.

    Applying the same methodology used in these studies to first world countries produces the opposite result. If the World Health Organization data from 1995 for AIDS prevalence5 are plotted against estimated circumcision rates (Table 1) and the data points are weighted for population, a positive correlation (Figures 1 and 2) is found between circumcision and AIDS prevalence (slope=14.95, 95% CI=13.19-16.71, R2=0.69) in first world countries6.

    As with the previous map studies, this analysis ignores a number of important risk factors including cultural sexual practices. The results illustrate the inaccuracy and lack of power associated with this type of investigation.

    And here are whole chunks of the discussion:

    The quantification of a potential benefit, if any, that could be expected from male circumcision as protection from HIV transmission is highly problematic. Inconsistent study results coupled with the results of the meta-analysis emphasize this. While meta-analysis is an inexact tool66, it may help place the impact of small studies in perspective. Interestingly, the combined data from the high-risk populations yielded a lower odds ratio than any of the studies of that type. The lack of parity of circumcision status in the individual studies and the wide variation in HIV prevalence can help to explain this finding. By combining the data, the number of circumcised subjects is closer in number to those not circumcised than in any of the individual studies. Whether this makes the comparison more valid is debatable.

    Another weakness of the meta-analysis is the inability to correct for confounding factors, the most important of which is the presence of genital ulcers. It is also difficult to incorporate studies of varying design. Recent studies, in which the raw numbers suggest circumcised men to be at greater risk for HIV infection have found that circumcised men have more sexual partners17,26. When corrected for number of partners, the foreskin was found to increase the likelihood of HIV infection. Based on the recent findings that circumcision significantly alters sexual activity in adult males53, it may be inadvisable to look at these factors separately. It is likely that circumcision may be responsible for the increased number of partners and therefore the increased risk.

    The recommendation to routinely circumcise boys in Africa is unfounded and even dangerous. In some parts of Africa, circumcision is a leading cause of tetanus (59.4% of cases)67. The use of dirty instruments and mass ritual events, including group circumcision, may increase the number of young boys developing HIV infections68 The risk of spreading tuberculosis through circumcision in developing countries is also a valid concern69. Severe complications and death are not uncommon following ritual circumcision70,.

    If one assumes that circumcision does not prevent some cases of HIV infection, what impact would universal circumcision have? Using the data provided by Seed et al.43, the relative risk of developing HIV infection is 1.37 times greater in the male with a foreskin, and 27% of HIV cases might be attributed to this factor. With an AIDS prevalence in the United States of 16 per 100,0005 and an attributable risk of 27%, it would take 23,148 circumcisions to prevent one case of AIDS. In Australia and the UK, it would take 82,304 and 154,320 circumcisions respectively to prevent one case of AIDS. One could expect 46, 165, and 308 life-threatening complications in the US, Australia, and UK respectively, for each case of AIDS prevented72. In a developing country, the risks of tetanus, tuberculosis, infection, exsanguination, amputation, and death from circumcision would outweigh the benefit of preventing a small number of HIV infections.

    Based on the studies published in the scientific literature, it is incorrect to assert that circumcision prevents HIV infection. Even if studies showing circumcision to be beneficial are accurate, the risk from circumcision outweighs any small benefit it may have. To depend on circumcision to protect against HIV infection in lieu of condoms, which have been shown to be efficacious76,77, is dangerous. Promoting circumcision as protection against HIV could also promote, intended or not, the inference, that a circumcised penis is adequate protection from contracting HIV, resulting in an increase in HIV infections. The circumcision experiment in the United States, which has failed to prevent the spread of this pandemic, should serve as a lesson to other countries.

    American men are reluctant to use condoms. Studies indicate a considerably higher acceptance and usage rate for condoms in Europe and Japan, where circumcision is almost never practised. Some have suggested that American men are resisting a layer of latex that would further decrease sensation from a glans already desensitized from the keritinization following circumcision. Moreover, condoms are more likely to fall off the circumcised penis78. This low acceptance of condoms may be responsible for the high rate of STD and teenage pregnancy rates in the United States–the only industrialized country that has failed to control bacterial STDs during the AIDS era79.

    Wise allocation of our resources demands that we divert our attention away from treating unproven risk factors and focus on proven prophylactic interventions.

    And for good measure, a collection of studies and article citations discussing the many, many negative side effects of circumcision. (The studies are not linked to. though are cited for those who want to look them up.) http://www.circumcision.org/studies.htm

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