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Entries in Circumcision (11)

Thursday
Sep132012

NYC Approves Ritual Circumcision Consent Form

David De Lossy/Digital Vision(WASHINGTON) -- After the deaths of two children who contracted the herpes virus through an ultra-orthodox practice of circumcision, the New York City Board of Health voted today to require parents to sign a written consent that warns them of the dangers.

In the most contentious part of the Jewish ritual, known as metzitzah b’peh, the practitioner, or mohel, places his mouth around the baby’s penis to suck the blood to “cleanse” the wound. The city wants parents to know the risks before circumcision.

Some estimate that 70 percent of the general population is infected with the Type 1 herpes I (HSV-1), which can be transmitted from the mouth to the child.  It is different from Type 2 or genital herpes (HSV-2), which is a sexually transmitted disease and can cause deadly infections when a newborn passes through an infected birth canal.

Neonatal herpes infections are nearly always fatal in infants.

The 5,000-year-old religious practice of circumcision, performed during a ceremony known as the bris, is seen primarily in ultra-Orthodox and some orthodox communities. New York has one of the largest such communities in the country.

In 2003 and 2004, three babies, including a set of twins, were infected with Type 1 herpes; the cases were linked to circumcision, and one boy died. Another died in 2010. In the last decade, 11 babies in the city have contracted the virus, and two have had brain damage, according to health officials.

Dr. Jay K. Varma, the New York City deputy commissioner for disease control, told the New York Times, “There is no safe way to perform oral suction on an open wound in a newborn.”

But some rabbis have said that they will oppose the law on religious grounds, insisting it has been performed “tens of thousands of times a year” worldwide. They say safeguarding the life of a child is one of the religion’s highest principles.

“This is the government forcing a rabbi practicing a religious ritual to tell his congregants it could hurt their child,” Rabbi David Niederman, executive director of the United Jewish Organization of Williamsburg, told ABC News. “If, God forbid, there was a danger, we would be the first to stop the practice.”

But Dr. William Schaffner, chair of preventive medicine at Vanderbilt University, told ABC News during the investigation of one of the deaths last spring, “It’s certainly not something any of us recommend in the modern infection-control era.”

“This is a ritual of historic Abraham that’s come down through the ages, and now it has met modern science,” he said. “It was never a good idea, and there is a better way to do this.”

The modern Jewish community uses a sterile aspiration device or pipette to clean the wound in a circumcision.

About two-thirds of boys born in New York City’s Hasidic communities are circumcised in the oral suction manner, according to Rabbi David Zwiebel, executive vice president of the Orthodox Jewish organization Agudath Israel of America.

The Department of Health argues parents should be informed of the risks before making a decision. Since 2004, it has received “multiple complaints from parents who were not aware that direct oral suction was going to be performed as part of their sons’ circumcisions,” according to a public notice.

The law requires mohels to explain the oral suction procedure and its risks, including the possible transmission of herpes simplex virus, and have parents sign a waiver.

Copyright 2012 ABC News Radio

Tuesday
Aug212012

Cutting Out Circumcision Could Cost Billions, Study Finds

David De Lossy/Digital Vision(BALTIMORE) -- Declines in infant male circumcision in the United States could add more than $4.4 billion in avoidable health care costs for sexually transmitted infections, experts warn in a new report.

In a paper in the Archives of Pediatrics & Adolescent Medicine, a team of health economists and disease experts at Johns Hopkins cite the declining rates of U.S. infant male circumcision -- from 79 percent in the 1970s to approximately 55 percent today -- as responsible for billions of dollars spent in the U.S. on preventable infections.

The decline in circumcision rates has already cost the nation an estimated $2 billion, the researchers say, and if rates decrease to the 10 percent levels seen in Europe, this could mean an additional $4.4 billion for the nation.

The cost of treating sexually transmitted infections in both males and females that could be prevented with circumcision accounts for most of this total.  Circumcision removes the foreskin at the end of the penis, which would otherwise potentially serve as a haven for bacteria and viruses that can cause diseases including HIV, herpes, genital warts, bacterial infections and urinary tract infections.  Research has also suggested that circumcision can cut risk of penile and prostate cancers in men, as well as cervical cancer risk in their female partners.

There are many possible reasons for the decline in circumcisions.  Many families may be averse to circumcision for personal reasons, objecting to a procedure that was imposed in the past because of religious beliefs.  Arleen Leibowitz and Katherine Desmond of UCLA’s department of public policy write in a comment following the paper that “low income families’ decisions to circumcise their newborn boys are quite responsive to whether or not Medicaid pays for the procedure.”

Dr. Aaron Tobian, the principal study investigator, agreed that Medicaid funding cuts are partially to blame.  Such cuts have already caused many states to stop paying for infant male circumcisions.  California, Mississippi, Nevada, North Dakota, Oregon and Washington stopped funding before 1999, and in the last decade, Arizona, Florida, Idaho, Louisiana, Maine, Missouri, Minnesota, Montana, North Carolina, and Utah all stopped Medicaid funding for circumcision.  The most recent states to ban funding were Colorado and South Carolina, in 2011.

“The financial and health consequences of these decisions are becoming worse over time, especially if more states continue on this ill-fated path,” said Tobian, who is an assistant professor of pathology at the Johns Hopkins Center for Global Health.  “State governments need to start recognizing the medical benefits as well as the cost savings from providing insurance coverage for infant male circumcision.”

Other experts agree that this finding should have policy implications.

“States’ efforts to reduce current costs by eliminating Medicaid coverage for male circumcision are penny wise and pound foolish,” write Leibowitz and Desmond.  “Investing today in a relatively low-cost procedure will avert greater future treatment costs for cancer, HIV, and other sexually transmitted infections.”

Copyright 2012 ABC News Radio

Monday
Mar122012

Circumcision May Cut Prostate Cancer Risk, Study Suggests

David De Lossy/Digital Vision/Thinkstock(SEATTLE) -- Circumcision may help reduce the risk of prostate cancer, according to a new study published in the journal Cancer.

A new analysis of 3,399 men found that those who were circumcised before their first sexual encounter saw a "significant" 15 percent decreased risk of developing prostate cancer compared with men who were uncircumcised or circumcised after the first time they had sex.

Prior research has found that men who are circumcised are at lower risk of infections like HPV and herpes.  Since infections have been linked to an increased risk of prostate cancer, researchers said the findings fit in with past research on the subject.

"This observation is consistent with accumulating evidence that infection [and] inflammation in the prostate may play a role in the development of this disease," said Janet Stanford, lead author of the study and co-head of the program in Prostate Cancer Research at the Fred Hutchinson Cancer Researcher Center in Seattle.

"Our study tested the hypothesis that men who are circumcised prior to becoming sexually active may be at reduced risk of prostate cancer," said Stanford.  "This follows upon the assumption that circumcision may reduce infection [and] inflammation in the prostate by reducing exposure to infectious agents that gain access to prostate tissue where they induce an inflammatory response."

Researchers said STDs cause chronic inflammation in the penis, and basic hygiene is extraordinarily important in preventing infection in men who have not been circumcised, said Dr. Durado Brooks, director of prostate and colorectoral cancers at the American Cancer Society.

"Foreskin can act as a breeding ground for infection, so it's important to wash under the foreskin after any kind of sexual activity," said Brooks.

Nevertheless, circumcision, where the foreskin of the penis is surgically removed, has been a topic of hot debate in recent years.  Lloyd Schofield, a San Francisco man who spearheaded a movement to ban circumcision in the Bay Area, began researching the procedure several years ago and found a local group of "intactivists," or people who believe that infant boys have the right to keep their foreskin intact.

"The foreskin is there for a reason," Schofield said last year.  "It's not a birth defect.  It serves an important function in a man's life, and nobody has a right to perform unnecessary surgery on another human being."

According to the Centers for Disease Control and Prevention, the rate of circumcision among baby boys in the United States seems to be declining.  The government agency found that the incidence of circumcision declined from 56 percent in 2006 to 32.5 percent in 2009.  But those numbers did not include procedures performed outside of hospitals, including Jewish rituals that are usually performed in the home, or circumcisions that were not reimbursed by insurance.

Copyright 2012 ABC News Radio

Monday
Mar122012

Baby Dies of Herpes in Ritual Circumcision by Orthodox Jews

iStockphoto/Thinkstock(NEW YORK) -- New York City is investigating the death last September of a baby who contracted herpes after a "ritual circumcision with oral suction" in an ultra-Orthodox Jewish ceremony known in Hebrew as metzitzah b'peh.

In a practice that takes place during a ceremony known as the bris, a circumcision practitioner, or mohel, removes the foreskin from a baby's penis, and with his mouth sucks the blood from the incision to cleanse the wound.

The district attorney's office in Kings County Brooklyn, which is investigating the death of the 2-week-old baby at Maimonides Hospital, would not disclose the name of the mohel or whether there would be prosecuted.

"We are looking into it, that's all I can say," a D.A. source told ABC News.

The 5,000-year-old religious practice is seen primarily in ultra-Orthodox and some orthodox communities, and has caused alarm among city health officials.  In 2003 and 2004, three babies, including a set of twins, were infected with Type 1 herpes.  The cases were linked to circumcision, and one boy died.

The mohel who performed the procedures, Yitzchok Fischer, was later banned from doing circumcisions, according to The New York Times.  It is not known if he was involved in this recent death.

"It's certainly not something any of us recommend in the modern infection-control era," said Dr. William Schaffner, chair of preventive medicine at Vanderbilt University.

"This is a ritual of historic Abraham that's come down through the ages, and now it has met modern science," he said.  "It was never a good idea, and there is a better way to do this."  (The modern Jewish community uses a sterile aspiration device to clean the wound in a circumcision.)

In the 2004 death and the most recent one, a mohel infected the penile wounds with Type 1 herpes I (HSV-1), which affects the mouth and throat.  It is different from Type 2 or genital herpes (HSV-2), which is a sexually transmitted disease and can cause deadly infections when a newborn passes through an infected birth canal.

Neonatal herpes is "almost always" a fatal infection, according to Schaffner.  "It's a bad virus.  [Infants] have no immunity and so it's a very serious illness.  Now we have another death -- an unnecessary, incredibly tragic death."

Copyright 2012 ABC News Radio

Tuesday
Oct042011

Male Circumcision Is Medically Beneficial, Experts Say

David De Lossy/Digital Vision(NEW YORK) -- Male circumcision continues to be debated in America.

This spring ABC News tracked the war waged on the procedure in San Francisco as anti-circumcision “inactivitsts” attempted to ban infant circumcision altogether. This summer Colorado became the 19th state to defund Medicaid coverage for infant circumcision, following in the footsteps of South Carolina, which made the cut in February.

With more states considering defunding as a way to cut health care costs, two Johns Hopkins epidemiologists decided it was time to speak up for circumcision. In an editorial published Tuesday in the Journal of the American Medical Association, Dr. Aaron Tobian and Dr. Ronald Gray argue for the medical benefits of circumcising boys in infanthood, citing several observational studies and recent clinical trials that show it reduces the transmission of sexually transmitted diseases such as HIV, HPV and herpes by about a third in both men and their female sexual partners.

“This is a simple surgery that’s been performed for over 6,000 years.  Clearly it’s safe to perform, and it has clear medical benefits,” says Tobian.

Just 20 years ago as many as 67 percent of all male infants born in U.S. hospitals were circumcised. Today, that number hovers around 32 percent, in part due to decreased funding for the poor and a rise in controversy over the ethics of the practice. Opponents claim circumcision is a form of genital mutilation without medical benefit.

“The foreskin is there for a reason,” Lloyd Schofield, who spearheaded the San Francisco anti-circumcision bill, told ABC News in May.  Shofield called circumcision an “unnecessary surgery” with no “sound medical evidence” behind it.

Recent studies suggests otherwise, Gray and Tobian argue.

Copyright 2011 ABC News Radio

Monday
Aug222011

Trial Begins in Amputated Penis Case

Comstock/Thinkstock(SHELBY COUNTY, Ky.) -- Phillip Seaton went to the hospital in October 2007 for a routine circumcision to treat inflammation but left the operating room without a penis.

Seaton sued his surgeon, Dr. John Patterson, for removing his penis without his permission, and the trial got under way Monday in Shelby County (Kentucky) Circuit Court. Seaton and his wife, Deborah, seek damages for "loss of service, love and affection."

Patterson said he found cancer while performing the routine circumcision, and Patterson's defense attorney, Clay Robinson, said the surgeon had no other options but to remove the penis immediately, according to court documents.

Judge Charles Hickman instructed both lawyers to refrain from commenting on the case because it is ongoing.

Despite the alleged seriousness of Seaton's penile cancer, experts contacted by ABC News said that the doctor needed consent from the patient before surgically removing his sex organ.

"I think the doctor made a big mistake, and will not win the case," said Dr. David Crawford, a professor of surgery at the University of Colorado Health Sciences Center.

Partial penectomy, or a partial removal of the penis, Mohs surgery, a precise surgery used to remove several types of skin cancer, laser and radiation therapies were all options when treating penile cancer, said Crawford.

Because the surgeon had said the cancer was so severe, Robinson told the courtroom that Patterson could treat it only by surgically removing the organ.

Nevertheless, "a surgical consent is needed to do this," said Dr. Glenn Bubley, associate professor of medicine at Harvard Medical School. "This is the standard of care. There would be no reason to breach standard of care in this case."

Seaton also sued Louisville's Jewish Hospital, where the surgery was performed. The hospital settled out of court for an undisclosed amount.

Copyright 2011 ABC News Radio

Thursday
Jul282011

Circumcision Ban May Get Snipped from San Francisco Ballot

Pixland/Thinkstock(SAN FRANCISCO) -- It looks as if the City by the Bay may not be voting on a controversial circumcision ban after all.

San Francisco Superior Court Judge Loretta Giorgi tentatively ruled Wednesday that the measure to criminalize circumcision must be withdrawn from the November ballot because it violated a California law which makes regulating medical procedures a state -- not a city -- matter.

Giorgi then ordered San Francisco's election director to remove the measure from city ballots.

The ban would have made it illegal to "circumcise, excise, cut or mutilate the whole or any part of the foreskin, testicles or penis of another person who has not attained the age of 18 years." Under that ban, any person who performed circumcisions would face a misdemeanor charge and have to pay a fine of up to $1,000 or serve a maximum of one year in prison.

San Francisco resident Lloyd Schofield spearheaded the movement with a group of local "intactivists," people who believe that infant boys have the right to keep their foreskin intact. Together they created an advocacy group called the Prohibition of Genital Cutting of Male Minors.

Copyright 2011 ABC News Radio

Thursday
May192011

Circumcision Ban to Appear on San Francisco Ballot

David De Lossy/Digital Vision(SAN FRANCISCO) -- Lloyd Schofield has come one step closer to achieving his mission to ban circumcision -- the surgical removal of the penile foreskin -- in the City by the Bay. San Francisco city officials said Wednesday that Schofield had collected enough signatures -- more than 12,000 -- to put the measure on the city ballot in November 2011.

Schofield began researching circumcision several years ago and found a local group of "intactivists," people who believe that infant boys have the right to keep their foreskin intact. Together they created an advocacy group called the Prohibition of Genital Cutting of Male Minors. The ban would make it illegal to "circumcise, excise, cut or mutilate the whole or any part of the foreskin, testicles, or penis of another person who has not attained the age of 18 years."

The group has not only collected thousands of signatures but a fair share of ire from religious groups and the medical community alike.

If San Francisco residents vote for the ban, doctors, mohels and any other person who performs circumcisions would face a misdemeanor charge and have to pay up to a $1,000 fine or serve a maximum of one year in jail.

Circumcision, performed on 8-day-old males, is an important ritual in the Jewish -- and Muslim -- faiths. Marc Stern, associate general counsel for legal advocacy at the American Jewish Committee, said the Jewish community is "clearly appalled" by the proposed ban.

According to the Centers for Disease Control and Prevention, the rate of circumcision among baby boys in the United States seems to be declining. The government agency found that the incidence of circumcision dropped from 56 percent in 2006 to 32.5 percent in 2009. But those numbers do not include procedures performed outside of hospitals, including Jewish rituals that are usually performed in the home, or circumcisions that were not reimbursed by insurance.

While male circumcision is usually performed for religious or cultural reasons, the American Academy of Pediatrics said there is some scientific evidence that points to potential medical benefits, but the data are insufficient for the organization to recommend routine circumcision in newborns.

Copyright 2011 ABC News Radio

Friday
May062011

Brooklyn Toddler Dies After Circumcision

Hemera Technologies/Thinkstock(NEW YORK) -- New York City's Office of the Chief Medical Examiner is investigating the death of two-year-old Jamaal Coleson, Jr. following a circumcision Tuesday at Manhattan's Beth Israel Medical Center.

"They gave him anesthesia, and after the circumcision he woke up he was fine," said Jabbar Coleson, Jamaal Jr.'s uncle, who lives in Jonesboro, Ga. "He asked to eat, he asked for something to drink, and then he started complaining about pain in his stomach."

Jabbar said his nephew was in the outpatient ward when doctors noticed something was wrong. But four hours passed before the toddler was rushed to the emergency room, he said. The case, which has been reported as an accidental death to the New York State Department of Health, highlights the extremely rare complications of the procedure performed widely throughout the United States.

"Circumcision is a surgical procedure and so with that there are certain risks, although the risks are quite small," said Dr. Ari Brown, a pediatrician in Austin, Texas, and author of Baby 411.

The most common complications are local infections and bleeding, but Brown says the risks are about one in 1,000 and one in 3,000 respectively. In infants, circumcision is done using local anesthesia -- a numbing cream or an injection into the skin. But the general anesthesia used for older children, like Jamaal Jr., can increase the risk of complications.

"The risk is still low, but it's higher than with local anesthesia," Brown said, adding that in extremely rare cases people can be allergic to an anesthetic.

Beth Israel Medical Center staff will conduct an internal review of the events the led to Jamaal Jr.'s death, the hospital said in a statement. A spokeswoman for the medical examiner's office said the cause of death would be released in two weeks, following standard tissue and toxicology tests.

Copyright 2011 ABC News Radio

Thursday
Apr282011

San Francisco May Vote on Banning Male Circumcision

David De Lossy/Digital Vision/Thinkstock(SAN FRANCISCO) -- Lloyd Schofield is a man on a mission to ban circumcision from his community.

"The foreskin is there for a reason," said Schofield, who is retired from a career in the hotel industry.  "It's not a birth defect.  It serves an important function in a man's life, and nobody has a right to perform unnecessary surgery on another human being."

And this November, San Francisco voters may have the opportunity to vote on whether they feel the practice -- often associated with religious protocol -- should be banned in the city and county of San Francisco.

He and his fellow organizers have created an initiative known as the "Prohibition of Genital Cutting of Male Minors.  The proposal would make it illegal to "circumcise, excise, cut, or mutilate the whole or any part of the foreskin, testicles, or penis of another person who has not attained the age of 18 years."

The group has collected more than 12,000 local signatures to put the proposal on the city ballot in November 2011.  They have also collected a fair share of ire from religious groups and medical experts alike.

Doctors, mohels and any other person who performs the procedure would face up to a $1,000 fine or a year of jail time.

Circumcision, where the foreskin of the penis is surgically removed, has been a hot topic for some time.  Schofield began researching the procedure several years ago and found a local group of "intactivists," or people who believe that infant boys have the right to keep their foreskin intact.

Circumcision is an important ritual in the Jewish faith, where it is performed on eight-day-old males.

Marc Stern, associate general counsel for legal advocacy with the American Jewish Committee, said the Jewish community is "clearly appalled" by the proposal.

"This is the most direct assault on Jewish religious practice in the United States," said Stern.  "It's unprecedented in American Jewish life."

Stern said that the Jewish community has held strategy meetings to diminish the proposal.

Copyright 2011 ABC News Radio







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