Tuesday, August 27, 2013

GUEST BLOGGER: WHO Retrocedes 150 Years

In my last post, I wrote about the WHO and its codifying of a completely bogus diagnosis. I just read another blog post which goes into greater detail regarding the history of the diagnosis "adherent prepuce," and the normal development of anatomically correct male organs, which has already been well-documented in medical history. I thought it warranted a re-post on my blog, so I asked permission from the original blogger, dreamer, if he would allow me to do so and he complied. I feel it will be a good lesson in history and male anatomy for my readers.

The balanopreputial synechiae conspiration - or when medicine reverses 150 years thanks to a committee 

By dreamer - August 27, 2013
Or can the World Health Organization can be hijacked by special interest groups?

The description of the circumcision procedure often includes a step, described as follows in the circumcision advocacy site circinfo:

"The adhesions between glans and foreskin are divided with a hemastat (artery forceps). "

Yet Douglas Gairdner in his 1949 "The Fate of the Foreskin" article, indicated that "It will be seen that preputial "adhesions" is an inapposite term to apply to the incompletely separated prepuce, suggesting as it does that the prepuce and glans were formerly separate structures."

In Intactivist circles, these adhesions are often referred to as "balanopreputial synechiae", "balanopreputial lamina", "balanopreputial membrane".

"Balanopreputial" means specifically something that is related to the glans ("balano") and the foreskin ("prepuce").

Synechiae is defined as an adhesion between two parts of the body.

Lamina refers to a structure, particularly a flat structure (2D)

In Anatomy, a membrane may refer to a thin film that is primarily a separating structure.

Wikipedia used to have an article on the balanopreputial membrane. This article was marked for deletion in 2007. The argument for deletion is that these words basically are an expression used by "lobbying" groups (in other words, "anticircumcision" or intactivist groups) to refer to "the epithelial layer fusing the foreskin to the glans". There is no equivalent article describing the "epithelial layer fusing the foreskin to the glans".

While this term is difficult to find, I've found references to the process of "balanopreputial separation" as an external sign of puberty in rats! More details here.

A book on Pediatric Drug Development includes the term "balanopreputial separation" again in reference to rats.

What about people?
It is known and reference in literature even as old as 1933, that "the prepuce in the human penis is adherent to the glans at birth, a layer of stratified squamous epithelium being interposed, and shortly after birth these parts become separated so that the prepuce may be retracted.", and the presence of this epithelium is referenced in this article as being described as far back as 1860.

In 2012 a group of Brazilian researchers studied the development of the foreskin in the fetal period and found "the presence of preputial lamella and a large amount of mesenchymal tissue between the foreskin and glans"

The glandulopreputial lamella is defined as "a layer of embryonic epithelial tissue that gives rise to the prepuce."

A lamella is a thin plate-like structure.

The development of the balanopreputial cavity in one humped camels has also been studied, finding references to the same lamella.

A 2010 paper describes the Development of the Glandopreputial Lamella and Sulcus in Female Fetuses, including the presence of a "stratified squamous epithelium" - the same epithelium mentioned in 1933 and in 1860.

So, this epithelium as a normal part and stage of the development of the foreskin has been known for at least 150 years. Whether we call it epithelium, or membrane, or synechiae, or lamina, we are referring to the same thing. A normal structure that connects the glans and the foreskin during their development.

The same 1933 paper describes that "The separation of the prepuce in the human penis is essentially a process of keratization of the intervening epithelium. It begins anteriorly and posteriorly at about the same time and proceeds toward the center. When confined on all sides the separation manifests itself as an epithelial pearl formation. On the surface, as is possible in the anterior region, it appears as a desquamation."

What's more important is that the paper then indicates that "Separation is not completed at birth, but is accomplished sometime during infancy or early childhood."

The exact age of retraction has been a subject of debate. This old paper indicated that " Unless the prepuce has been retracted, slight adhesions may persist in the posterior regions of the glandar lamella at 5 and 6 months. Separation is sufficient at the 10-day stage to allow mechanical retraction without danger of a tear, apparently an important factor in completing the division."

 Based on more recent observations, the Royal Children's Hospital in Melbourne posted in 2013 that "The normal foreskin is attached to the glans and is non-retractile in most newborns. Over time the foreskin separates and becomes retractile. The proportion of boys with retractile foreskins is: 40% at 1 year, 90% at 4 years and 99% at 15 years."

By what means are the foreskin and the glans attached? By the presence of a synechiae, or a membrane, or a lamina, or an epithelium.

So basically, it doesn't matter if we call it a synechiae or a membrane or a lamine or an epithelium. There is a normal structure that appears during the normal development of the fetus (male or female), which later starts to dissolve and separate, and the final product, usually years after birth, is the presence of a separate glans and prepuce, either the glans penis and the foreskin on the male, or the clitoris and the clitoral hood on the female.

So there is no need to play thug of war over the use of one word or another. This structure exists, has been described, has been sufficiently observed and it's normal. There is no denying this.

Which is why it can only generate shock that the new 2013 ICD-10 codes of the World Health Organization, scheduled to go into effect in October 2014, include a code (N47.0) for "adherent prepuce, newborn" as part of the disorders of the male genitals.

With this new code, every human male will be born with a medical condition N47.0 - not because it's a medical condition, but because it has been codified as such. A normal stage of the human development has been pathologized by the World Health Organization.

And who can guess what procedure cures this condition?

If this doesn't sound like a conspiracy to circumcise the world, then I don't know what is it. I can only conclude that the World Health Organization has been hijacked by a special interest group.

Original post can be read here.

Related Links:
WHO: Codifying Medical Fraud

Sunday, August 25, 2013

WHO: Codifying Medical Fraud

How do you justify the forced genital mutilation of minors?

  1. Invent pathological conditions that make it indispensable.
  2. Link anatomically correct male organs to the proliferation of disease.

It used to be that forced genital mutilation, particularly the forced genital mutilation of males at any age, was sanctioned under the immunity of "religious freedom." Additionally, parental privilege and cultural relativism could be invoked in order to justify the forcible amputation of a male child's foreskin.

Given other practices that fall under this category, however, the alibis of "religious freedom, "parental choice" and "cultural immunity," have lost validity.

Perhaps the best example of this is none other than female circumcision; a federal law makes the forced cutting of girls of any kind, and at any age, a punishable offense, and there are no exemptions for "religious" female genital cutting, or cultures where female genital cutting is practiced.

For this reason, advocates of circumcision, particularly male circumcision, have sought to, not only justify the forced circumcision of healthy, non-consenting minors, but to make the practice indispensable.

For over a century, circumcision "researchers" can be seen trying to link circumcision with the prevention of feared diseases; there is no shortage of "studies" that say that circumcision prevents this or that, all written by "researchers" who promote its universal adaption. They can also be seen trying to pathologize the presence of anatomically correct male genitalia, and the many stages of its development, setting arbitrary ages by which the foreskin should be "retractable for cleaning."

While there will never be enough "research" to justify the forced circumcision of girls, it seems circumcision advocates have made the covert contract with themselves, that the forced circumcision of boys will one day be justified, even made compulsory, if only they could come up with the right amount of "studies" that say circumcision prevents disease. We see them trying very hard today, promoting "mass circumcision" in Africa, in the so-called name of AIDS prevention.

Despite their hard work and efforts, however, not a single respected medical organization has found the latest HIV/circumcision propaganda to be convincing enough to recommend the circumcision of minors. In their latest statement, the AAP tries to sell the one-line "benefits outweigh the risks" slogan, but still concluding that the same "benefits" are "insufficient to recommend the practice."

Not quite having achieved the recommendation they wanted, it appears circumcision advocates are returning to the older tactic of trying to pathologize anatomically correct genitals.

WHO Codifies False Conditions Into Existence
The World Health Organization (WHO) has just released their new 2013 ICD-10 codes, which are scheduled to go into effect in October 2014. ICD, which stands for "International Classification of Diseases", is the global system for reporting morbidity and mortality statistics, for billing, and for health care automated decision support.

The new codes for conditions of the foreskin include a prominent (first on the list) billable code, for a condition whoever wrote these codes want to call "adherent prepuce in the newborn." If these codes go into effect, it means that doctors and hospitals will be able to claim "adherent prepuce" as a valid medical diagnosis in neonates (valid in the sense that a billable code exists in the WHO ICD system, not that it is an actual medical condition necessitating surgical correction), and be able to legally charge to "correct" it, thereby possibly justifying routine infant circumcision.

The new proposed codes under classification N47, "Disorders of the Prepuce," can be seen here. (To view, click on the hyperlink for "9 codes" in the second bullet point to read the full list of nine, beginning with N47.0 - Adherent Prepuce, Newborn.)

Without medical or clinical indication, doctors have no business performing surgery on healthy, non-consenting newborns, let alone asking parents to make any kind of "decision." However, if these codes, which the US Centers for Medicaid and Medicare use, go into effect, doctors will have a code available to justify routine infant circumcision, starting next year unless the new code is rescinded. A whole new ICD-11 code system is slated to be introduced for 2015.

Who Did It?
Research documents the normal development of anatomically correct male organs,(1-5) and there is no such thing as a pathological condition known as "adherent prepuce in the newborn"; all boys are born with the prepuce fused to the glans at birth, and if we are to believe the WHO, then all boys are born with a pathological condition which doctors can charge for "correcting." In essence, the WHO's board of physicians has declared the newborn foreskin, which is normally fused to the glans at birth, to be a disorder.

"How many legs does a dog have if you call the tail a leg? Four. Calling a tail a leg doesn't make it a leg." - Abraham Lincoln

The fact that the WHO's board of physicians have decided to call a normal stage of development in the male infant penis a medical disorder, and have even made an ICD code for it does not make it a medical disorder. The foreskin is not a congenital birth defect. 

What I want to know is, who was responsible for writing these codes?

I suspect it was Americans who are in cahoots with fellows at the American Academy of Pediatrics; judging from their last statement, the AAP would like nothing more than to force the 18 state Medicaid programs who dropped coverage for male infant circumcision to start covering it again.

It is despicable to know that interested individuals at the WHO can use their ICD system to codify anatomically correct organs as pathological disorders, in order to warrant medical reimbursement for their "correction."

Who wrote these codes?

Who is responsible for this deplorable travesty? 

Why would a Geneva-based international organization do such a thing as pathologize all males at birth? I would expect that coming from a country where circumcision is rare, that the people of Switzerland would have a better understanding of anatomically correct male genitalia.

The WHO needs to be called on this immedeiately.
  1. Kayaba H, Tamura H, Kitajima S, et al. Analysis of shape and retractability of the prepuce in 603 Japanese boys. J Urol 1996;156(5):1813-5.
  2. Imamura E. Phimosis of infants and young children in Japan. Acta Paediatr Jpn 1997;39(4):403-5.
  3. Ishikawa E, Kawakita M. [Preputial development in Japanese boys]. Hinyokika Kiyo 2004;50(5):305-8.
  4. Øster J. Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys. Arch Dis Child 1968;43:200-3.
  5. Thorvaldsen MA, Meyhoff H. Patologisk eller fysiologisk fimose? Ugeskr Læger 2005;167(17):1858-62.
Related Posts:
Politically Correct Research: When Science, Morals and Political Agendas Collide

AAP: Around the Bush and Closer to Nowhere