Thursday, April 14, 2011

Letter to Editors at the Vancouver Sun

OK, so Neil Pollock, a Jewish mohel and child circumcisor by trade, notorious for plugging his business whenever, wherever he can, takes advantage of  yet another situation. In response to Sharon Kirkey's article "Circumcision best left to prepubescence," he, aided by well-known circumcision czar Edgar Schoen (he goes by "Ed" now, just so you know... ain't it cute?), plugs circumcision and his own business, YET AGAIN. You can read the article, which basically reads like an informercial, right here:

I took it upon myself to write a letter to the editors at the Vancouver Sun myself. Here it is:

To whom it may concern,

This is in response to Neil Pollock's shameless self promotion, and his support by Edgar (AKA "Ed") Schoen. Before anybody takes what Pollock and Schoen say seriously, there are some conflicts of interest that readers of the Vancouver Sun should know about.

First, Neil Pollock is a surgeon from Vancouver, Canada, whose sole livelihood comes from performing infant circumcision and vasectomy.[1] He charges $455.00 Canadian for circumcising children under 2 months of age,[2] and if his website is correct, he performs 2,500 annually, which means he grosses $1,137,500 Canadian on infant circumcision alone. Pollock is also a mohel by trade,[1][3] which suggests that aside from his livelihood, circumcision is of cultural and religious importance to him. Edgar Schoen also once made a living from circumcision, and has been a long-standing vocal advocate of circumcision for years. Pollock and Schoen are also both Jewish, where circumcision is a religious ritual central to their religious and cultural identities. Mentioning these men's religious affiliation is important, because belonging to a religious group where circumcision is a religious requirement is at odds with presenting anything disparaging about it; it predisposes people to presenting only that which puts circumcision in a positive light.[4]

Neil Pollock dispenses misleading, or outright untrue information. On his website, he sells his circumcision technique as "a new approach" that "has recently been developed."[5] Pollock's website uses language that suggests that he uses state-of-the-art techniques and equipment that no other surgeon possesses, by warning against others who try to "emulate" him.[6] Closer inspection reveals that Pollock isn't doing anything "new"; his website reveals that he uses the Mogen technique, which involves the Mogen clamp. The Mogen clamp was invented in 1954,[7] but it is actually one of many successors to the much older, traditional barzel device.[8]

Here are some things Neil Pollock may not tell parents about Mogen. On his website, and on this article, he insists that without experience, which he boasts for having, the methods and techniques he uses could be "potentially dangerous," however the Mogen clamp has been notorious for glans amputations, even among experienced conductors of circumcision.[9] Mogen went out of business after losing a 10.8 million dollar law suit, after a mohel severed the end of a baby's glans using one of their clamps. Mogen claimed that injury was impossible with its use. The injury behind a prior lawsuit in Fulton County Superior Court had already put Mogen on notice about the danger of the device. In a different case, at South Fulton Medical Center, another law suit was won in 2009. In that case, a child lost a third of his glans, and the plaintiffs were awarded 2.3 million dollars. [10]

Many of the "benefits" that Pollock tries to highlight are dubious, or are based on debunked information. For example, when he talks about the lining of the inside of the foreskin, and how the cells "trap the virus but are unable to destroy it," this was one of the original hypotheses that was used to run the circumcision trials in Africa. The specific name for these cells are the Langerhans cells, and deWitte actually found in his study that the Langerhans cells are not only impossible to eliminate, because they are found all over the body, but they actually secrete a substance called Langerin, which actually destroys the HIV virus.[11]

The langerhans hypothesis has been long forgotten, and researchers have tried to sell the lie that "Circumcision reduces the risk of HIV because it's harder for the virus to get through the keratinized glans." But other studies have found no difference between the keratinization of the inner and outer aspects of the adult male foreskin. Keratin layers alone are unlikely to explain why uncircumcised men are at higher risk for HIV infection. [12] Additionally, "No difference can be clearly visualized between the inner and outer foreskin."[13] As of yet, circumcision "researchers" have yet to explain the mechanism whereby circumcision prevents HIV transmission. The repeated studies are all based on disproven hypotheses, bringing their validity into question.

Pollock and Schoen say that STDs are more likely in uncircumcised men, but this does not reflect reality, where STD transmission rates are higher in North America, where the majority of the men are circumcised (approx. 80% according to Edgar Schoen), than they are in countries in Europe, where circumcision is rare. They also fail to mention studies that show circumcision makes no difference in HIV transmission [14] or that it actually has the opposite effect, increasing infection, especially to female partners [15]. They mention HPV transmission, but not that there are already vaccines for them. They say that penile cancer is "almost exclusive" to uncircumcised men, but they do not talk about the rate, which is something like 1 in 100,000 of men who smoke with poor hygiene practices.[16] Prostate cancer is more common in men; 1 in 6 North Americans will develop prostate cancer. [17] Using Pollock and Schoen's logic, removing prostates at birth is more urgent than male circumcision.

They briefly mention that "Sexual pleasure and power are not significantly affected by circumcision," but they will not mention that the foreskin is more sensitive than the most sensitive part of the circumcised penis. Sorrells shows that circumcision reduces sensitivity by a factor of 4. [18]

Regarding UTIs, it is common knowledge that whether boys are circumcised or not, girls are 10 times more likely to develop UTIs. UTIs are already quite rare in boys, and are as easily treatable with antibiotics in boys, as they are in girls. It makes no sense to amputate part of a child's genitals to prevent a disease that is already quite rare, and already easily treated. Neil Pollock and Edgar Schoen point out Tom Wiswell's work, but they will not mention that all of it has been thoroughly discredited.[19][20]

Neil Pollock talks about phimosis, but nothing is mentioned about the frequency of occurence of this condition, much less about how often circumcision is actually indicated, even when the condition develops. He talks about circumcision promoting hygiene, but surgery is not needed to promote hygiene. An uncircumcised male child needs no more care than an uncircumcised female child. It is true that men in old age are often unable to clean themselves, and somebody else must do it for them, but the same applies to women in old age.

The rest of the article is basically self promotion. Unless it is medically or clinically indicated, doctors have no business performing elective, non-medical surgery on healthy, non-consenting minors, much less pander to a parent's sense of entitlement.

Neil Pollock is a professional mohel and child circumcisor and in this article, he is merely promoting his trade. Schoen did his share of circumcisions as well, and he is a very vocal advocate for circumcision. According to a MEDLINE search, Edgar Schoen has been published 20 times in the medical literature on the subject of circumcision. In addition to reaping, or having reaped profit from the procedure they are promoting, Neil Pollock and Edgar Schoen are both Jewish. I feel this is important to mention, because circumcision is an important ritual and religious commandment. Although physicians may act with what they consider to be sound medical judgement, some physicians may be influenced also by nonmedical consideration. The cultural background of many Jewish circumcision advocates predisposes them to view circumcision in a positive light, to welcome evidence that the most particular and problematic religious custom of their people is medically beneficial, and to dismiss arguments to the contrary.[21] Please do not conflate my assessment of potential bias and conflicts of interest with anti-Semitism. These are conflicts of interest that put the objectivity of the information presented in question, and it is the responsibility of the Vancouver Sun to publish them so that the public can make a better assessment of the information presented by these men.

In closing, it needs to be mentioned that Edgar Schoen is a well-known circumcision evangelist that has been rejected wherever he goes.[22]

Yours truly,

Joseph Lewis

1."About Dr. Pollock". Retrieved 2011-04-08.
2. "Arranging a Circumcision". Retrieved 2011-04-08.
3. Owens, Anne Marie (2001-01-22). "Like father, like son". National Post, The. Retrieved 2011-04-08.
4. Siegfried et al. "Male circumcision for prevention of heterosexual acquisition of HIV in men." Cochrane Library 3 (2003)
5. "Parents' Guide to Circumcision". Retrieved 2011-04-08.
6. "Pollock Clinics Infant Circumcision". 2011-04-08. Retrieved 2011-04-08.
7. "Use of the Mogen clamp for neonatal circumcision". Retrieved 2011-04-08.
8. "Methods of circumcision". 2011-04-08. Retrieved 2011-04-08.
9. (April/May 2002). "Pain During Mogen or PlastiBell Circumcision". Journal of Perinatology 22 (3): 214-218. Retrieved 2011-04-08.
10. Tagami, Ty (2010-07-19). "Atlanta lawyer wins $11 million lawsuit for family in botched circumcision". The Atlanta Journal-Constitution. Retrieved 2011-04-08.
11. deWitte et al. "Langerin is a natural barrier to HIV-1 transmission by Langerhans cells". Nature Medicine Retrieved 2011-4-14
12. Dinh et al. "HIV-1 Interactions and Infection in Adult Male Foreskin Explant Cultures". Retreived 2011-4-14
13. Dinh et al. "Keratinization of the adult male foreskin and implications for male circumcision." Retreived 2011-4-14
14. Westercamp, M; Bailey RC, Bukusi EA, Montandon M, Kwena Z, et al. (2010). "Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs". PLoS ONE 5 (12). Template:Hide in print.
15. Wawer MJ, Makumbi F, Kigozi G, et al. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. Lancet 2009;374:229 ?37.
16. Wallerstein E (February 1985). "Circumcision. The uniquely American medical enigma". Urol. Clin. North Am. 12 (1): 123?32. PMID 3883617
17. ACS "What are the key statistics about prostate cancer?" Retreived 2011-4-14
18. Sorrels et. al "Fine-touch pressure thresholds in the adult penis" Retreived 2011-4-14
19. AAP Task Force on Circumcision. Circumcision Policy Statement. Pediatrics 1999;103(3):686-693.
20. Van Howe RS. Effect of confounding in the association between circumcision status and urinary tract infection. J Infect 2005;51(1):59-68.
21. Glick, Leonard (2005). ""This Little Operation", Jewish American Physicians and Twentieth-Century Circumcisoin Advocacy". Marked in Your Flesh. New York, New York: Oxford University Press. pp. 183-184. ISBN 0-19-517674-X.
22 .G Hill, J V Geisheker (2006) "Edgar Schoen does not represent the North American view of male circumcision". Retrieved 2011-04-08.

I was in a hurry, otherwise I would have also included the following:

Pollock promises a "virtually painless" circumcision,[1] but this claim assumes the methods he boasts in using are actually effective. On his website, it says that the pain control methods used are Tylenol, sugar,[2][3] a topical cream, and a local anaesthetic injection called a dorsal penile ring block. The topical anaesthetic only serves to numb the area to lessen the pain of the injection, but studies have shown that a dorsal penile ring block is not always effective in stopping the pain of circumcision.[4][5] During the circumcision, the child is given sugar pacifiers to "reduce his pain perceptions", but in at least one study, data shows that giving sugar to a child doesn't help to reduce the perception of pain in the child.[6] Post-operative pain and the pain the child must endure during recovery is hardly, if ever, addressed.

Pollock advertizes that it takes him "only 30 seconds" to perform circumcision, but this doesn't take into account the fact that the child must first have topical anaesthetic applied, and then be given the dorsal penile ring block for which there is a 10 minute waiting period for the injection to take effect. In the FAQ page, it is admitted that "although the circumcision takes under 30 seconds, we require you to be in our office for one hour and fifteen minutes in total so that we can carefully review with you all post procedure care and answer any of your questions."

In closing, Neil Pollock is just doing what any other merchant does to promote his business. It must be emphasized that Neil Pollock was first and foremost a mohel, and that he, Edgar Schoen and other circumcision advocates were circumcising children long before the current HIV hype. Pollock is not interested in facts, he is interested in promoting his own trade and absolving his own religious practices. Pollock will never admit the truths about circumcision because it would be devastating to his livelihood, devastating to his faith, and devastating to his own personal identity. The fact that he is a Jewish mohel, and that his livelihood depends on the circumcision of children bring this man's objectivity into question.

"It's hard to get a man to understand something when his livelihood depends on his not understanding..."
~Upton Sinclair

1. "Pollock Clinics Infant Circumcision". 2011-04-08. Retrieved 2011-04-08.
2. "Parents' Guide to Circumcision". Retrieved 2011-04-08.
3. "Before the Circumcision". 2011-04-08. Retrieved 2011-04-08.
4. Taeusch, H William; Alma M Martinez, J Colin Partridge, Susan Sniderman, Jennifer Armstrong-Wells, Elena Fuentes-Afflick (April/May 2002). "Pain During Mogen or PlastiBell Circumcision". Journal of Perinatology 22 (3): 214-218. Retrieved 2011-04-08.
5. Williamson, Paul S.; Nolan Donovan Evans (August 1986). "Neonatal Cortisol Response to Circumcision with Anesthesia". Clinical Pediatrics 25 (8): 412-416. Retrieved 2011-04-08.
6. Slater, Rebeccah; Laura Cornelissen, Lorenzo Fabrizi, Debbie Patten, Jan Yoxen, Alan Worley, Stewart Boyd, Judith Meek, Prof Maria Fitzgerald (2010-10-09). "Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial". Lancet, The 376 (9748): 1225-1232. Retrieved 2011-04-08.

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