News Archive

Wiswell-Svoboda Debate Transcript

From: J. Steven Svoboda
Date: 05 Feb 2003
Time: 17:45:38

Comments

Note: This is a more-or-less verbatim transcription of my debate with Thomas Wiswell on January 30. We appeared together on the 'Hot Talk' program on WDAY Radio in Fargo, North Dakota in connection with the ongoing Flatt v. Kantak case conducted by attorney Zenas Baer. I have been told the debate is archived somewhere in an hour-long WDAY segment obtainable for Real Media Player at http://media.i29.net:8080/ramgen/live/hottalk.rm. I have not yet been able to verify this myself.

My perception and evidently that of others was that with the quick format it was hard to break through to the truth. I felt like maybe Wiswell came off worse in his condescending tone (and his comment about 200 million circumcised American men). It was interesting that the moderator picked up on Wiswell's isolation and the US' isolation from the mainstream. Sorry for the delay in getting this out; finally I was induced to get it finished by my son Eli's first birthday today.

Steven

[Intro by moderator (M) Scott Hennen explaining about Flatt case and setting stage for debate. Brief introductions of Svoboda (JSS) and Wiswell (TW). Request by moderator that JSS and TW refrain from interrupting each other during discussion.]

M: Mr. Svoboda, I understand that this is receiving some national attention among your group and others that would like to see the practice of circumcision just eliminated. Is that correct?

JSS: Certainly in the case of non-religious circumcision, yes, we'd like to see the practice eliminated. Three leading American medical associations agree there's no medical benefit to it that justifies performing it. It's got known harm to the young boy who can't consent so yes, we'd like to see an end to it.

M: Dr. Wiswell, on this point of no medical benefit, do you disagree with that?

TW: Yes, the associations don't say that at all, and there are a number of medical benefits.

M: All right. What are the associations you are talking about, Mr. Svoboda?

JSS: The American Medical Association, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists. The American Cancer Society has said there's no benefit in terms of stopping cancer to circumcising. So these 'radical, fringe' medical organizations I've just named have gotten in line with the rest of the world and said circumcision must stop.

M: You're saying, Dr. Wiswell, that that's not in fact what they're saying?

TW: They didn't say that at all. Mr. Svoboda is misquoting them and their words. All of the above organizations have recognized known medical benefits of the procedure. What they have not come out and said is that every boy should definitely be circumcised at birth.

M: Let's go to the medical benefit question. In your view, Dr. Wiswell, what are the medical benefits to circumcision?

TW: There are a number of them and quite important ones. One is the prevention of bladder and kidney infections during early childhood. A second one is the prevention of cancer of the penis. That's usually an adult malignancy. Thirdly, the prevention of actually various sexually transmitted diseases, in particular, the most compelling evidence is the HIV/AIDS evidence over the last decade or so. Fourthly, the prevention of local infection, inflammation of the penis itself as well as local dermotologic problems of the penis. And finally, what received a lot of attention last April was a remarkable study which sort of supported various others in the past. Prevention of cancer of cervix in the partner of the uncircumcised gentleman.

M: Now, setting aside the debate on the medical benefit, Mr. Svoboda, I've seen some literature that calls this genital mutilation. Is that what you believe it is?

JSS: Well, terminology can get tricky. I mean, nobody's arguing about male circumcision being exactly the same as female circumcision. But it's a mutilation in the sense that it's removing a body part that there's no medical reason to remove and I can refute every one of Dr. Wiswell's suggestions. The last study he referred to by Castellsague has already been refuted in the same journal that published it. What Castellsague did was took a bunch of data from different countries that have very low or very high circumcision rates and combined the data together and did a bunch of fancy statistical footwork to try to show a correlation where there wasn't one or it was negative. As far as cancer of the penis goes, Dr. Sydney Gellis said more babies die from circumcision every year than old men die from penile cancer.

M: [cutting in] I think we're going to agree to disagree on the differences here only because of our lack of time. I'm going to go to another point. Judge Cynthia Rothe-Seeger, the local judge that has allowed this case to proceed to trial, which is I guess unusual and one of the reasons this case is being watched nationally, is saying the main harm the youngster in this case'who would be, what, five or six years old at this point?'seeks compensation for is diminished sexual sensation injury. Do you concur that that would be a proper claim in this case by the plaintiff, Mr. Svoboda?

JSS: I do concur with that and there have been recent medical studies that have documented that, showing that a large percentage of adult males that were circumcised as infants have had loss of functioning, have had various problems. And when they've compared males who were circumcised as adults they've shown that they have had loss of functioning as well. And also when you lose the foreskin, you lose the protective and immunological functions. Three important functions of the foreskin.

M: And what about that, Dr. Wiswell?

TW: Mr. Svoboda has said exactly opposite of what is quoted and what the studies, there's three major ones that have shown this that have come out in the last several years. Adult males who have been circumcised as adults have increased sexual function and those that are uncircumcised have more sexual dysfunction and so unfortunately what comes across, people come across and don't have access to medical journals or don't read them, they may not get the true perspective that Mr. Svoboda unfortunately is distorting.

M: So you don't see any downside at all as far as sexual sensation that the local judges raise to circumcision:

TW: No, in the medical literature and the trials that are out there actually show better sexual function in circumcised individuals. I sure invite the audience to look up those studies.

M: So it sounds like, Mr. Svoboda, what we're talking about here is a battle of science?

JSS: Well, not really, because every international and national medical association in the world that has spoken to the issue of should circumcision be done on infants routinely has said no, and Dr. Wiswell knows this. Beyond that, I'd like to ask Dr. Wiswell: Urinary tract infections, which was Dr. Wiswell's claim to fame on this issue a while back, occur three times as often in girls as in boys. Now, if we could take off part of the girls' genitalia and reduce urinary tract infections, Dr. Wiswell, would you favor that?

TW: Again, Mr. Svoboda, you are distorting the medical facts. The urinary tract infections during the first six months to one year of life are far more common in boys. After that, they are more common in girls. Unfortunately, during the first year of life, that's when these kinds of infections injure the kidney, scar the kidney, and are set up for high blood pressure and even the potential for dialysis replacement.

M: [trying to cut in] Let me ask you '

TW: I do not agree with your statements, Mr. Svoboda.

M: It seems as though many people in the international community agree with Mr. Svoboda. The United States seems to be rather unique in the large amount of circumcisions that occur as compared to, I guess Canada's at 17%, Britain at 5%. Elsewhere, Europe, South America, non-Muslim Asia, very rare. What do you make of that, Dr. Wiswell?

TW: I think over the years, really since the late 1800's, early 1900's, the United States has been at the forefront of medicine, medical science, research, etc., and it was recognized in the late 1800's and early 1900's that there were potential health benefits of this procedure and you know, this isn't anything new. The decrease in cancer of the penis, decrease in syphilis, etc., they were described as far back as the1890's and early 1900's. And so following hospitals, the increase in hospital-born babies, rather than home, that occurred in the first part of the century, the vast majority of males were being circumcised, and for potential health reasons, as well as it became in many respects a social tradition per se and parents didn't even care to hear about health reasons. Just circumcising just because their father was.

M: Mr. Svoboda, do you also claim that this leaves a scar, emotionally or otherwise, on the child that could last into the adult years?

JSS: Well, it's not really a claim. I mean, there have been studies that have also been published in medical journals that have documented that repeatedly. And as far as syphilis goes, it's interesting that Dr. Wiswell mentions the 1890's and the 1900's because we all know that antibiotics and other advances have helped eradicate some of these ancient, outdated diseases. Now, it might be interesting to know what Dr. Wiswell omits to mention, which is that circumcision started as a medicalized procedure 150 years ago to stop masturbation, which was then thought to cause basically every known disease and of course this was the days of bleeding patients to cure them. Now, we don't do these things any more but for some odd reason we've kept up with our circumcision. Although I'll note that circumcision rates are continually reducing and four states have recently discontinued Medicaid funding for circumcision.

M: What about the pain or ultimately any emotional scars as far as you're concerned, Dr. Wiswell? Is that a concern?

TW: Two things. There is no question that infant boys can and will have pain when they're being circumcised. That's why myself and most pediatricians use a kind of local anesthesia. That's why my organization, the American Academy of Pediatrics, recommends local analgesia, some kind of either cream or an injection of lidocaine, which is like novocaine for your teeth. For the emotional scarring, there is none. There are over 200 million circumcised men in this country, and we don't have an outcry that they're emotionally harmed by this procedure, and again, there are no reputable medical journals that back this up. There are some fringe editorials, testimonials of individuals and Mr. Svoboda's anti-circumcision groups that will say, 'I'm emotionally scarred because of this.'

M: Is the outcome of this lawsuit, will it have national ramifications, Mr. Svoboda?

JSS: It may, yes. Certainly it may for the other men in this country who may have been circumcised and who may feel a loss from that. And Dr. Wiswell, I'd like to know how you get 200 million circumcised men when the population of the US is around 300 million.

TW: I think you, as is unfortunately typical, you did not hear what I said. I said there are over 100 million circumcised men in this country.

M: Dr. Wiswell, do you see a national impact from the outcome of this trial in North Dakota?

TW: It all depends on what the outcome is. I think it's a crazy trial. A well-known lawyer that's similar to Mr. Svoboda that's outspoken opponent [sic] of circumcision, by coincidence, I don't know how, one of his partners is the mother of this child that's brought forth this suit. And she requested a circumcision and there's informed witnessed, informed consent counseling to it. And somehow his partner a couple years later decided to file a lawsuit. So I find a lot of things intriguing here. And I hope a lot of this does get into the national media.

M: Thank you both for the time. We'll continue to follow it and appreciate it. [He thanked both of us.]

Steven