March 19, 2005
Circumcisions spark debate
Local rate four times national average; MD says doctors may be in it for the money
Doug Williamson
Windsor Star
Call it a money grab by doctors or a sign of the cultural times.
For new parents Michael and Susan Levesque, Windsor’s fixation with circumcising its newborns is simply a matter of doing what their ancestors did.
“We just decided to go with it, based on tradition,” said Michael, whose son Owen was born Feb. 1. “I was, ‘So why not?’ ”
Just over 50 per cent of the boys born at Windsor Regional Hospital last year were circumcised, well above the national average of 13.9 per cent. The average in Ontario was 16 per cent.
Dr. Tony Hammer, a Windsor family doctor, said his colleagues may be performing the medically unnecessary procedure simply to make a buck. Hammer is critical of a procedure which is also not recommended by the Canadian Paediatric Society.
“There is a financial incentive for physicians, and I wonder if they are fully informing their patients of a lack of medical need,” said Hammer.
Obstetricians and the hospital split a $200 fee for each procedure, which is not covered by OHIP.
The head of obstetrics at Windsor Regional couldn’t be reached, but a hospital spokesman said all circumcisions are done at parents’ request, and rejected Hammer’s statement.
“That comment is appalling. In no way do we promote it,” said David Musyj, vice-president of corporate services and medical affairs. “In no way do they do it for the money.”
He also said the rate charged in Windsor is equal to and in some cases lower than those charged in other hospitals. Circumcision is the surgical removal of the foreskin of the penis.
Last year, there were 4,400 births at Windsor Regional and nearly 50 per cent were boys. Of those, 1,080 circumcisions were performed, representing 51 per cent, hospital officials said.
Jewish and Muslim rites dictate it is done on the eighth day after birth.
According to the Montreal-based Association for Genital Integrity, the Canadian average in 2003 was 13.9 per cent, and 16 per cent in Ontario. Leading the charge was Prince Edward Island at 29.5 per cent, the association said, citing figures from Statistics Canada.
Musyj said the hospital’s share of the more than $200,000 charged for circumcisions last year was for supplies, attending nurses and other hospital costs.
Hammer said he regularly advises his pregnant patients not to have the procedure done, but acknowledged some do anyway.
He and Musyj agreed that Jews and Muslims, for example, require the procedure as a matter of religion, and others are doing it just because their parents did. Muslims represent one of Windsor’s fastest growing ethnic populations.
In the case of the Levesques, “We didn’t really look into the pros and cons,” said Michael, although the couple feel that personal sanitation is improved with circumcised males.
“I just felt that guys are lazy, so I wouldn’t have him go through that.”
Kim and Stavros Kourtsidis of Windsor also decided to circumcise their son Joshua, who was born March 7, because his older brother had undergone the procedure.
“It’s cleanliness,” Kim said Friday.
But opponents argue there are more medical complications associated with circumcision, than not doing it.
“I don’t think physicians are educating patients about the lack of medical need for it. In the majority of cases it is cosmetic,” Hammer said.
Dr. Danielle Grenier, of the Canadian Paediatric Society, said the number of procedures is declining in Canada.
“There is no medical indication to have newborn boys circumcised,” she said. “There are no advantages to doing it. And with any procedure, there’s always a risk.
“It’s a painful procedure,” she added.
In most cases a local anesthetic is used, and there can also be reaction to medications. “You never know how much you are cutting or how much you are leaving,” she added.
“Parent pressure, most of the time,” is the reason it is still being done, she said.
The risks may be small but they are there, Hammer said. “They do exist. When they occur, one can argue they were avoidable.
“Any ethical physician refers to the recommendations of the Canadian Paediatric Society,” he said.
Musyj said Windsor’s “multicultural” population partly accounts for the high local rate, as well as local tradition.
“Windsor being the community it is, I think that has a lot to do with it,” he said of the tradition of circumcising boys. Musyj said most parents know the sex of their child well before delivery, and usually have enough time to decide on the procedure. It is done before the baby goes home.
Grenier of the pediatric society said a lot of information is available on the subject.
“Heaven knows what has been published over a little piece of skin,” she said.
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TO CUT OR NOT TO CUT
According to the Canadian Paediatric Society, of every 1,000 boys who are circumcised:
- 20 to 30 will have a surgical complication, such as too much bleeding or infection in the area.
- Two to three will have a more serious complication that needs more treatment. Examples include having too much skin removed or more serious bleeding.
- Two will be admitted to hospital for a urinary tract infection before they are one year old.
- 10 babies may need to have the circumcision done again because of a poor result.
- Of every 1,000 boys who are not circumcised, seven will be admitted to hospital for a urinary tract infection before they are one year old.
LETTERS
March 24, 2005
p. A7 [Final edition]
Ontario needs advisory against circumcision
They say in medicine that unnecessary surgery is bad surgery. If that’s true, then there’s a lot of bad surgery being done at Windsor Regional: infant male circumcision is medically unnecessary and unrecommended. To make matters worse, the surgery is performed on extremely vulnerable patients whose well-being is totally dependent on decisions made by others.
Last year, a formal policy discouraging infant male circumcision was released by the governing body for doctors in B.C., the College of Physicians and Surgeons of British Columbia. A strongly worded advisory against newborn circumcision has also been issued in Saskatchewan.
Perhaps it’s time the College of Physicians and Surgeons of Ontario followed suit.
Dennis Harrison
Vancouver, B.C.
March 28, 2005
p. A7 [Final edition]
Woman risks infection with uncircumcised male?
In a March 19 front page story, Dr. Hammer and Dr. Grenier failed to mention one very good reason for circumcision. A couple of years ago, I read a Star story about a medical study done on the subject.
The study found that women whose male partners weren’t circumcised have a much higher incident of vaginal and urinary tract infections than women with circumcised male partners. I could not locate this article, but I’m hoping that someone in the medical profession can find it and have it published again for those still unaware. Women already have the burden of bearing children, then becoming the principal homemaker while often working full time, and later going through menopause. Why give them more to struggle through?
The real questions should be, why are the circumcision percentages so low and why doesn’t OHIP cover it?
Grant Pauli
Amherstburg
March 31, 2005
p. A9 [Final edition]
Circumcision against infant’s human rights
Re: Letter about woman risks infection with uncircumcised male.
I have no objection to any young man of the age of majority having his foreskin removed if he perceives that this will prevent some disease that he feels he is at risk of developing, just as some healthy women have their breasts removed because they are worried that they might get breast cancer.
However, circumcising infants is dangerous because it makes unwarranted assumptions about the infant’s behaviour 15 or 20 years in the future. After all, the circumcised infant may grow up to marry his high-school sweetheart and not be in any danger whatsoever of contracting or passing on any sexually transmitted disease. He may be homosexual, and have no chance of infecting a woman at all.
In any of these scenarios, the infant has been circumcised against his will and contrary to his human rights, and his full sexual sensitivity has been sacrificed for nothing. What if he would have preferred to have an intact penis? What if his lover prefers the advantages of a foreskin?
There is no doubt that circumcising a male infant for a supposed benefit to his future sexual partner is a violation of his basic human rights. What other surgery is done without the patient’s consent for the supposed benefit of someone else? Would we perform surgery on an infant girl to benefit her future sex partner?
Lawrence Barichello
Toronto
April 1, 2005
p. A9 [Final edition]
Circumcision article has no statistical basis
Re: The March 19 article, Circumcisions Spark Debate, Local Rate Four Times National Average; MD Says Doctors May Be In It For The Money.
The headline and accompanying article in the March 25 issue are misleading, inaccurate, and not worthy of the reputable reporting we are accustomed to from Doug Williamson and The Star.
The article fails to mention any debate, but rather the opinion of a sole physician who does not do circumcisions, and is not a local or national authority on the subject. Furthermore, reference is made to statistics, without mentioning any sources. His opinions are his own, not supported in fact, and should not be the sole basis for smearing the integrity of his colleagues.
Obliged to see what sources were used in this article, I find that an obscure group known as the Association for Genital Integrity is the only source used. This group has no national or scientific standing, and does not appear to be involved in any academic institute, or published in any scientific journal.
Our own research into this subject reveals a different picture than that painted by the article in your paper.
A study from the Department of Epidemiology and Biostatistics from the University of Western Ontario, and published in the Canadian Family Physician journal, shows that the circumcision rate in southwestern Ontario is approximately 56 to 59 per cent.
An important finding in this study was that the prevalence of neonatal circumcision did not change after delisting. The circumcision rate at Windsor Regional Hospital is no higher than the provincial rate—a fact that makes your article less than laudable.
Your article does not make reference to the multicultural mix in Windsor, the fourth most multicultural city in Canada, and how this could influence circumcision rates.
Your claim that “doctors may be in it for the money” is not accurate, unfair to the ethical and hard-working physicians in this city, and is simply gossip and not worthy of your paper, let alone the headline status you gave to it.
Joseph Shaban, MD
President
Essex County Medical Association
April 2, 2005
p. A9 [Final edition]
Nothing on new baby needs to be cut off
Re: circumcision.
There is nothing on the male or female body which needs to be cut off at birth. The prime reason for this barbaric operation is religious, and that is being questioned at this time. OHIP should not be paying for this and it should be done for purely medical reasons. Doctors are now being sued for this unneeded procedure.
Parents-to-be, get the facts before you decide on this. Don’t let some doctor pressure you into a totally unneeded operation. And if by chance religion is your reason to have your son cut, remember God made Adam in his own image and Adam certainly wasn’t circumcised.
Bob Bates
LaSalle
April 5, 2005
p. A7 [Final Edition]
Circumcision a violation of baby’s human rights
Re: Circumcisions Spark Debate, by Doug Williamson, March 19.
The Windsor Star has performed a valuable service. Unnecessary painful, non-therapeutic surgery on tiny newborn babies is the epitome of bad medical practice.
The Canadian Charter of Rights and Freedoms provides that every Canadian has a fundamental human right to security of the person.
Circumcision excises large amounts of protective, sensitive tissue from the penis and is an obvious violation of that right.
George Hill
Bioethicist
Executive Secretary
Doctors Opposing Circumcision
Seattle, Wash., USA
April 6, 2005
p. A9 [Final edition]
Circumcision statistics paint a clear picture
Re: Circumcision Article Has No Statistical Basis, letter, April 1.
Dr. Joseph Shaban questions our statistics showing that the average provincial circumcision rate in Ontario is currently only 16 per cent, compared to 51 per cent at Windsor Regional. Our statistics were compiled from Ministry of Health and Long-Term Care databases and reflect the number of circumcisions completed in Ontario acute-care hospitals prior to initial discharge from hospital at the time of birth.
Furthermore, a study on patterns of health-care utilization carried out by the Institute for Clinical Evaluative Sciences (published by the Canadian Medical Association in 1996) found that Essex County consistently had the highest rate of infant male circumcision among Ontario’s 33 district health councils.
In 1994-95, the circumcision rate in Essex County was 649.9 per thousand. This was more than twice the provincial average and three times the rate in Metropolitan Toronto, whose population, I suggest, is even more ethnically diverse than that of Windsor.
The reality is that newborn circumcision is not medically necessary. It is not recommended by the Canadian Paediatric Society. The Colleges of Physicians and Surgeons of Saskatchewan and British Columbia have expressed unease about the ethical and human rights aspects of infant male circumcision, and have also raised serious concerns about the ability of parents to consent to the procedure.
We have put forward our facts. Let Dr. Shaban present his evidence supporting the need for circumcising healthy infants.
Arif Bhimji, MD, MBA
Spokesperson
Association for Genital Integrity
Woodbridge
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