Sunday, August 28, 2011

CALIFORNIA: Circumcision Medically Beneficial - BY LAW

"A law was made a distant moon ago here,
July and August cannot be too hot;
And there's a legal limit to the snow here,
in Camelot"

In the 1960's musical "Camelot," King Arthur professes by royal decree that Camelot has a perfect climate all the year long. Can you imagine such a place where claims are facts by law? Well, California has just come one step closer to become something like the imagined Camelot.

At the beginning of this year, a measure to ban non-medical circumcision in healthy, non-consenting minors was successfully put on the November San Francisco ballot. This agitated advocates of circumcision, particularly religious interest groups and physicians who are ostensibly looking out for "public health" and "parental rights," prompting them to launch campaigns of their own to strike the ban off the ballot before it was voted on in November.

Not missing the opportunity, Assemblyman Mike Gatto gutted and amended Assembly Bill 768, which was supposed to be a carbon emissions regulation law, and re-wrote it into one that says "[m]ale circumcision has a wide array of health and affiliative benefits," and that "[n]o local statute, ordinance, or regulation, or administrative action implementing a local statute, ordinance, or regulation shall prohibit or restrict the practice of male circumcision, or the exercise of parental authority with respect to the same."

This measure went before the Senate Judiciary Committee last Tuesday, which voted unanimously (5-0) in favor of passing it. The measure is now at the full state senate, where it will be considered in the following week. It is being  presented as an "urgency bill necessary for the immediate preservation of the public peace, health, or safety," where, if signed into law, would take effect immediately.

Legalism, Sophistry, and the Derailment of the Democratic Process
There are some major problems that have happened recently in the democratic process in California, beginning with the fact that the San Francisco ballot initiative was stricken off the November ballot using a dubious statute in California that was created to prohibit local governments from regulating the "medical arts profession." The statute was established namely to allow veterinarians to declaw cats, but the wording of "medical arts profession" allows circumcision advocates to apply the statute to the forced circumcision of healthy, non-consenting human children.

The measure in and of itself is dubious, because it allows "healing arts professionals" to profit from a procedure that is considered to be "professionally recognized," namely that "everybody's doing it." Enough veterinarians are reaping profit from declawing cats, therefore it is "professionally recognized medical practice," therefore it cannot be regulated, and this goes for any other "professionally recognized medical practice" that many vets perform on animals, such as the debarking of dogs (some owners want their dogs to be quiet because they live in apartment buildings), possibly ear cropping and tail docking.

Now, I'm an animal lover, and I think it's bad enough that there is a law that allows vets basically to profit from doing whatever they want to animals unmitigated, requested by or solicited to pet owners, as long as it's "acceptable practice." That this statute can be directly translated to the practice of human medicine is simply horrifying. Just imagine if this statute was in place before 1996, before the ban of all female genital cutting was instituted. Yes, female genital cutting was "professionally recognized medical practice" before this ban, and it was performed on American girls, and paid for by American insurance companies in the past. If enough doctors got together they could have said that female circumcision was "professionally recognized medical practice."

It seems this law basically allows doctors to get away with quackery, if they can get enough people to call it "professionally recognized medical practice." It's bad enough for cats and dogs; I feel sorry for human children.

Let's just say for the sake of argument that the definition of "professionally recognized medical practice" was more concrete. Usually, as far as I was aware, "medical practice" refers the performance of procedures or the administration of drugs that are essential for curing or preventing disease. Medically, surgery should only be performed when it is necessary for the physical health of the person on whom it is performed because of a clear, compelling, and immediate medical need where other, less-destructive alternative treatment has failed.

The first part of the statute used to block the San Francisco circumcision measure actually sounds rather reasonable:

No city or county shall prohibit a person or group of
persons, authorized by one of the agencies in the Department of
Consumer Affairs by a license, certificate, or other such means to
engage in a particular business, from engaging in that business,
occupation, or profession or any portion thereof.
Who wants to keep a doctor from doing his job, right? I fully agree! If a doctor has a disease to cure, a life to save, then why should any city or county prohibit him/her from practicing medicine?

The problem is the foregone assumption that the circumcision of healthy infants (or the declawing of cats for that matter) is indeed essential to practice medicine. The danger is in having self-interested quacks and charlatans labeling a procedure "professionally recognized medical practice."

Another major problem with how this measure was handled was how opponents of the San Francisco measure consistently misrepresented it as a complete ban on all circumcision. Were this the case, then the ban would have actually been a hindrance to medical professionals. The wording of the circumcision bill was perfectly clear; it would not be a complete ban, but a restriction of non-therapeutic circumcision to adults 18 and above, with exception to those cases where a circumcision procedure is actually medically necessary. The ban would have been consistent with the statute raised against it, which states:

This subdivision shall not be construed to prevent a city,
county, or city and county from adopting or enforcing any local
ordinance governing zoning, business licensing, or reasonable health
and safety requirements for establishments or businesses of a healing
arts professional licensed under Division 2
The ban, had it passed, would have been akin to safety requirement. It would have not limited professionals from doing their jobs, rather, it would have held doctors to their own standards, and ensured that they were performing medically legit operations.

How this ban was struck off the ballot, and the statute used against it are rather dubious. The ban seeks to ensure that human rights are respected, and that doctors act legitimately. The wording in the statute seems to allow greedy, self-interested  tradesmen to reap profit from quackery and charlatanism at the expense of animal and human rights. It is a dubious statute that ought to be challenged.

The Problem with AB 768 
The problem with the legislation Gatto has proposed begins with its opening declaration:
125850. (a) The Legislature finds and declares as follows:
(1) Male circumcision has a wide array of health and affiliative benefits.
The Legislature, if approved by the senate, etches into law claims that no medical organization in the world has dared to make. This, the claim that male infant circumcision is a surgery with health benefits, enough to endorse the practice, is not at all consistent with the view of male circumcision given in the statements of medical authorities in and outside of the United States.

The AMA, AAP, AAFP, and even the CDC all reject the idea of routine circumcision for medical reasons. The American Medical Association's most recent major document on medical circumcision, the "Report 10 of the Council on Scientific Affairs" was created by their "Council on Science and Public Health" in 1999. It states that "The British Medical Association has a longstanding recommendation that circumcision should be performed only for medical reasons", by which they mean only rare cases that require drastic treatment. Furthermore, it states that "Recent policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns".

Regarding STDs in general, the AAFP's "Position Paper on Neonatal Circumcision" states that "the association between having a sexually transmitted disease (STD) - excluding human immunodeficiency virus (HIV) and being circumcised are inconclusive", and regarding HIV, "most of the studies...have been conducted in developing countries, particularly those in Africa. Because of the challenges with maintaining good hygiene and access to condoms, these results are probably not generalizable to the U.S. population".
"The official viewpoint of KNMG (The Royal Dutch Medical Association) and other related medical/scientific organizations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications – bleeding, infection, urethral stricture and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence. KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications."
"...benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised."
The Canadian Paediatric Society "does not support recommending circumcision as a routine procedure for newborns."

"...the level of protection offered by circumcision and complication rate of circumcision do not warrant a recommendation of universal circumcision for newborn and infant males in an Australian and New Zealand context."

~The Royal Australasian College of Physicians (RACP)
The trend of opinion on routine male circumcision is so overwhelmingly negative in industrialized nations that it would be quite surprising were male circumcision to be recommended in the United States. No respected U.S. based medical board recommends circumcision for U.S. infants, not even in the name of HIV prevention. They must all point to the risks, and they must all state that there is no convincing evidence that the benefits outweigh these risks. To do otherwise would be to take an unfounded position against the best medical authorities of the West, within and outside of the United States. And yet, despite this clarity, self-serving politicians like Gatto have managed to get a 5-0 vote from California judges. How is this possible?

Other Forces at Work
Politicians like Gatto might have you believe they're acting purely out of interest of public health, but deeper investigation into the matter reveals it's a bit more complicated than that. Among the loudest voices of opposition were Jewish and Muslim religious groups, backed by the Jewish interest group, the Anti-Defamation League. It is rather peculiar that while these groups allege that circumcision is their "religious freedom" and their "parental right," they saw it necessary to turn to arguments of "medical benefit" and a dubious legal loophole, namely the aforementioned measure that allows vets to declaw cats. Even curiouser is the fact that nobody seems to care that some of the loudest purporters of the so-called "medical benefits," also happen to be Jewish mohels.

Methinks that even religious groups are realizing that arguments of "religious freedom" and "parental right" have lost their validity, as these are the same arguments that would vindicate female genital cutting, and so they saw it necessary to get behind the "medical benefits" argument. Last year, the AAP tried endorsing a "ritual nick," but it didn't take long for human rights groups to muster a world outcry that forced the AAP to retract their endorsement. The message was clear; under no circumstance could a medical professional come near a girl's genitals with a knife, not even for a "ritual nick."

The claim that government should not meddle in religion sounds like an honest and true proclamation of freedom, solidarity and independence, however in reality, government already steps in to regulate what one can do in the so-called name of religious freedom, for adults as well as children. Polygamy is illegal, for example. Adult men cannot marry underage girls, much less engage in sexual relationships with them. According to Oregon law, and to the laws of other states, parents cannot deny their children needed medical treatment, not even in the name of "religion." Parents cannot force their children to hold snakes or drink poison. They cannot also slash their children's heads on the holy day of Ashura. And, parents cannot have genital cutting of any kind performed on their daughters, not even a "ritual nick."

Advocates of male infant circumcision encourage the belief that circumcision is a public health issue, often presenting male circumcision as a controversial and ongoing debate, with health benefits and cultural justifications posed against minor risks and the possibility of trauma to the infant. Gatto, in particular, is creating this controversy, one can only assume, fueled in great part by the need to look busy, establish political brownie points and gain votes.

Gatto’s former employer, Representative Brad Sherman, who has also introduced a similar bill in the U.S. House of Representatives, may be the real person pulling the strings; initial statewide redistricting plans show Sherman’s district being consolidated with Representative Howard Berman’s district, which means an impending fight over one congressional seat. Both Sherman and Berman are Jewish, as is an important chunk of the proposed constituency. Sherman might have taken the same action regardless of the circumstances, but saving traditional circumcision certainly can’t hurt his popularity at this critical time.

The generation of this controversy is supported by the fact that, despite the infant circumcision rate being low, particularly in California, infant circumcision is still as of yet, a social norm; it's not very hard to gain favor from those who feel entitled to having their children circumcised. And it's not very hard to gain favor from medical professionals who profit from performing said circumcisions.

Despite the clarity in the statements of the aforementioned medical organizations, some physicians defend circumcision as a "medically beneficial procedure" that "the government shouldn't be interfering with" yet.

Quoth Charles Wibbelsman, MD, president of Chapter 1 for Northern California District 9 of the American Academy of Pediatrics: "You cannot have a referendum on the practice of medicine... We all have been taught to practice medicine in the most ethical and forthright way, and so much of what we do comes from experience. [The ban] would be taking the practice of medicine out of the profession and into the hands of a layperson." He seems to be forgetting that "putting the practice in the hands of a layperson" is precisely what happens when parents are asked whether or not they want their children circumcised. "Circumcision has proven health benefits," he added, "including a decrease in urinary tract infections among infants and a lowered risk for HIV later in life," briefly forgetting the AAP's stance that: "...[the] benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised."

Even physicians whose profession should have absolutely nothing to do with pediatrics, much less the circumcision of male children, seem to have something to say.

Quoth obstetrician-gynecologist Ruth Haskins, MD, chair of the California Medical Association Council on Legislation: "It's very clear a ban would disrupt the doctor-patient relationship," seemingly forgetting who the "patient" is. One must seriously ask, what are ob/gyns doing reaping profit from the circumcision of healthy, non-consenting MALE children?

And then, just to be funny, Wibblesman of the AAP chapter says "[the r]egulation of circumcision also could lead to more ballot initiatives or proposed rules on other procedures, such as abortion and tubal ligation." Nevermind the fact that abortion and tubal ligation is out of this man's professional jurisdiction, the age of the subjects always seems to be lost in the "controversy." I'd like to know when was the last time abortion or tubal ligation was performed on newborns.

The CMA, which supports Assembly Bill 768, suffers from amnesia, or they really have turned to outright lying. In a letter they wrote to the Senate Judiciary Committee requesting its approval they said:

"From political to religious, there are many differing views on the practice of male circumcision. However, in the medical world, the CMA has long endorsed the concept of newborn circumcision as an effective public health measure."

Not only would they be going against positions from respected American medical boards, this claim is simply not true; there was a resolution to endorse circumcision back in 1989, but this lapsed years ago.

In a recent report on their news website,  Alicia Gallegos asserts AMA policy:

"American Medical Association policy strongly opposes interference by the government or other third parties that "causes a physician to compromise his or her medical judgment as to what information or treatment is in the best interest of the patient."

Again, provided there is actually a patient with a legitimate medical problem to treat. Nobody is trying to interfere with physicians' ability to treat others, just ensure the rights of others, particularly healthy, non-consenting minors, are respected.

"The AMA also advocates that the decision for neonatal circumcision be determined by parents in circumstances in which the procedure is not essential to the child's current well-being. "To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision," AMA policy states."

Although the AMA is perfectly clear in their "Report 10 of the Council on Scientific Affairs" that "[r]ecent policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns". According to the AAP "...benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised." One should wonder, if there isn't enough evidence of "medical benefit" to recommend infant circumcision, how is it enough to be giving parents the "opportunity" to discuss it?

It is fascinating to see American medical authorities trying to give parents authority that generally would be in doctors hands - to assess whether surgery is indicated is surely a medical matter, not one for laypeople to decide; that's the doctor's job!

It is interesting AAP Chapter President Wibblesman expresses concern that a measure to limit circumcision to adults 18 and over, and/or actual underage patients with a genuine medical necessity for surgery would be "taking the practice of medicine out of the profession and into the hands of a layperson." Quite the contrary; it would ensure the practice of medicine is limited to professionals, and prevent said professionals from pawning off their responsibilities on naive parents.

Not only does the impending California law assert claims about the health benefits of circumcision that the AAP and AMA, not to mention medical associations in the rest of the world, have consistently refused to make; the law basically protects the act of pawing professional responsibilities on lay parents. Medical professionals, with their years of medical training and "experience" (not to mention their knowledge of positions of medical associations within their country and around the world), are suddenly too stupid to know whether or not a surgical procedure is medically necessary, and must seek the counsel of parents who have never even picked up a textbook on human anatomy. Doctors are pushing their responsibilities on parents, and this new law basically protects this professional abuse; the law would allow doctors to legally get away with charlatanism. Presumably, this is the "doctor-patient relationship" the AMA seeks to "protect?"

The Bottom Line
The foreskin is not a birth defect. Neither is it a congenital deformity or genital anomaly akin to a 6th finger or a cleft. Neither is it a medical condition like a ruptured appendix or diseased gall bladder. Neither is it a dead part of the body, like the umbilical cord, hair, or fingernails. The foreskin is normal, natural, healthy tissue with which all boys are born.

Unless there is a medical or clinical indication, the circumcision of healthy, non-consenting individuals is a deliberate wound; it is the destruction of normal, healthy tissue, the permanent disfigurement of normal, healthy organs, and by very definition, infant genital mutilation, and a violation of the most basic of human rights.

Doctors have absolutely no business performing surgery on healthy, non-consenting individuals, much less giving their parents any kind of "choice."

State of Affairs
Clearly, it was not enough for circumcision advocates that the San Francisco circumcision ban was struck off the ballot using a preexisting statute. Perhaps acknowledging that the statute is too dubious, as is the claim that the circumcision of healthy, non-consenting minors is a valid "medical procedure", circumcision advocates have decided to take it a step further. Perhaps acknowledging that "religious freedom" and "parental choice" are weak arguments that have lost their validity, religious interest groups have taken it upon themselves to legally buttress the argument of "medical benefits," in hopes of salvaging an important religious ritual that has come ever under scrutiny.

A measure that essentially asserts claims that medical organizations around the world have consistently refused to make, and which briefly grants parents the title of MD is on its way to becoming law. The Senate Judiciary Committee voted 5-0 in favor of the bill, and it is currently going to the full state Senate where it will be considered as early as this week.

If the full state Senate approves the bill, then circumcision will be "medically beneficial" in healthy, non-consenting infants, BY LAW, medical organizations around the world be damned, and parents of male children will continue being bestowed the privilege of being a medical professional for a few brief moments. After years of training and experience, doctors are still confused, you see, and they need to ask the help of naive parents to guide them.

"The winter is forbidden till December
And exits March the second on the dot
By order summer lingers through September
In Camelot"
The winter is forbidden till December And exits March the second on the dot By order summer lingers through September In Camelot Camelot, Camelot I know it sounds a bit bizarre But in Camelot, Camelot That's how conditions are


The winter is forbidden till December And exits March the second on the dot By order summer lingers through September In Camelot Camelot, Camelot I know it sounds a bit bizarre But in Camelot, Camelot That's how conditions are

The winter is forbidden till December And exits March the second on the dot By order summer lingers through September In Camelot Camelot, Camelot I know it sounds a bit bizarre But in Camelot, Camelot That's how conditions are

I know it sounds a bit bizarre.
But in California, that's how conditions are.

EDIT: One of my readers felt it was important that people knew that Gatto has taken money from the ADL, which could help explain why he helped author this law; the ADL wishes to help protect the Jewish custom of infant circumcision, and they expect Gatto etc. to deliver. One can only wonder how many law makers endorsing this are on the ADL payroll... The ADL's contribution to Gatto can be investigated here.


  1. Wonderful analysis of Bills AB_768 and HR_2400. These bills are so unbelievably amateurish -- they spit in the face of the U.S. Constitution. But will lawmakers even notice?

    Gatto and Sherman seem hell bent on institutionalizing child genital cutting. Gatto of course takes money from the ADL, and Sherman takes money from numerous hospital organizations.

    You better believe we're going to give them an earful before they ram through these garbage, unconstitutional bills advocating for the sexual cutting of defenseless children.

  2. Excellent look at the recent chain of events in San Francisco. Interesting analogies between circumcision of baby boys and declawing cats.

    Those interested in seeing the sleazy politicians in action can visit:

  3. This is so well written. I agree with every word. Too bad critical thinking like yours is so rare. The politicians of CA have proven themselves to be like all politicians--self serving and without any moral compass. The doctors who added their voices to this farce and miscarriage of the democratic process are more disappointing. Who cares if we are mutilating the sexual
    organs of non consenting males as long as it's profitable.