Critical Evaluation of Adler’s Challenge to the cdc’s Male Circumcision Recommendations

Abstract

We evaluate Peter Adler’s challenge to the Centers for Disease Control and Prevention (cdc) draft recommendations on male circumcision (this issue, see pp. 237–262). Thecdcadvocates elective male circumcision (mc) to improve public health in theusabased on strong scientific evidence. In marked contrast to thecdc, Adler’s criticisms depend on speculative claims and obfuscation of the scientific data. Adler’s central argument that circumcision in infancy should be delayed to allow a boy to make up his own mind as an adult fails to appreciate that circumcision later in life is a more complex operation, entails higher risk, is more likely to involve general anaesthesia and presents financial, psychological and organisational barriers. These limitations are avoided by circumcision early in infancy, when it is convenient, safe, quick, low risk, usually involves local anaesthesia and provides benefits immediately. Benefits of male circumcision include: protection against: urinary tract infections that are ten times higher in uncircumcised infants; inflammatory skin conditions; other foreskin problems; sexually transmitted infections and genital cancers in the male and his female sexual partners. Circumcision during infancy is also associated with faster healing and improved cosmetic outcomes. Circumcision does not impair sexual function or pleasure. Some authorities regard the failure to offer circumcision as unethical, just as it would be unethical to fail to encourage paediatric vaccination. Since the benefits vastly outweigh the risks, each intervention is in the best interests of the child. In conclusion, Adler’s criticisms of thecdc’s evidence-based male circumcision policy are flawed scientifically, ethically and legally, and should be dismissed as endangering public health and individual well-being.

CDC's Male Circumcision Recommendations Represent a Key Public Health Measure

“…Criticisms of the AAP and CDC policies by MC opponents have been consistently exposed as flawed (AAP policy 42 , 128 – 131 ; CDC policy 132 , 133 ). Convincing arguments have been made that it would be unethical to withhold information about the risks and benefits of MC from parents of boys 130 – 132 , 134 , 135 .…”

“…Convincing arguments have been made that it would be unethical to withhold information about the risks and benefits of MC from parents of boys 130 – 132 , 134 , 135 . as recommended by the AAP and CDC.…”

Critical evaluation of arguments opposing male circumcision: A systematic review

“…Legal, human rights and other arguments (presented below) have been invoked in opposing EIMC . Evaluation of those arguments have revealed flaws . Arguments criticizing the AAP's policy statement on ethical and legal grounds were followed by evaluations undermining the arguments used .…”

“…Arguments criticizing the AAP's policy statement on ethical and legal grounds were followed by evaluations undermining the arguments used . Articles critical of the CDC's draft recommendations in 2014 69,329,358 have also been shown to contain serious flaws . In its 2018 final statement, the CDC provided responses to public comments by MC opponents to the CDC's draft recommendations, repudiating most…”

“…The statement in the Hippocratic Oath, “ I will prevent disease whenever I can, for prevention is preferable to cure ” is pertinent. Recent evaluation of the legal and ethical issues was provided by professors of law, bioethics, urology, medicine, and medical sciences in the International Journal of Children's Rights and the Journal of Law, Medicine and Ethics . Rivin et al determined that given the strong evidence for diverse benefits and very low risk, in the light of current international conventions it would be unethical not to recommend EIMC …”