Non-Therapeutic Circumcision: The Problem of Advocacy-Based Medicine
On March 31, 2014, the Journal of Medical Ethics (JME) published an e-letter by Robert Van Howe, M.D. and Steven Svoboda, entitled, "Non-therapeutic circumcision: The problem of advcocacy-based medicine," to close an exchange in the JME with notorious circumcision advocate Brian Morris and colleagues. (A final e-letter from Morris and colleagues was also concurrently published by the JME.) The exchange started with an article Van Howe and Svoboda publshed in 2013 in the JME's special issue on circumcision. The article, titled, "Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision," critically analyzed the American Academy of Pediatrics' (AAP's) 2012 position statement and technical report regarding neonatal circumcision. Late in 2013, Morris replied to the Svoboda-Van Howe JME article with his own paper, which was answered by an e-letter by Svoboda and Van Howe dated January 20, 2014 and titled, "Circumcision: A bioethical challenge."
The publication in the JME of the Svoboda-Van Howe paper was accompanied by the somewhat remarkable concurrent publication of a response by the AAP that attempted to suggest bias on behalf of Svoboda and Van Howe without being able to point to a single specific error anywhere in our article. The Svoboda-Van Howe JME article also influenced an October 2013 debate at the Medical University of South Carolina between the AAP's Michael Brady, M.D. and Svoboda, in which Brady effectively conceded defeat, finding himself unable to rebut a single one of our numerous arguments and citations.
The full exchange of e-letters including the latest ones is available at jme.bmj.com/content/early/2013/08/16/medethics-2013-101614.abstract/reply#medethics_el_16775. The original paper by Svoboda and Van Howe can be found at http://arclaw.org/sites/default/files/svoboda-van-howe-aap-jme-2013.pdf. Morris' paper, entitled "Veracity and rhetoric in paediatric medicine: a critique of Svoboda and Van Howe's response to the AAP policy on infant male circumcision," is available at http://arclaw.org/sites/default/files/j-med-ethics-2013-morris-medethics-2013-101614.pdf.
As many people know, and as our e-letters (particularly the January one) note in detail, Morris has violated numerous principles of academic integrity in his tireless, quixotic quest to promote the useless, harmful, and antiquated practice of male circumcision.
Attorneys for the Rights of the Child
Here is the text of our e-letter.
Non-therapeutic circumcision: The problem of advocacy-based medicine
by J. Steven Svoboda and Robert S. Van Howe
Non-therapeutic circumcision is a contentious issue on which most readers will drift toward the position that reflects their backgrounds or affirms their cultural affinities. Unfortunately, the efforts of various self-appointed "experts" have done little to clarify the issues, and some are notorious for cherry-picking a vast and inconclusive medical literature in order to advance their prior agenda.
We invite readers to take the time to read the 29 self-citations that Brian Morris provided in the latest e-letter, check out the veracity of the claims contained therein, read the studies attacked by the letters to editor and the responses to these, perform their own literature searches, and reach their own independent, fully-informed judgments. Such a review will show that Morris is simply out of line with most other authorities.
For example, Morris and a colleague have recently disclaimed the Hippocratic Oath, thereby rejecting a venerable medical principle. Even the American Academyof Pediatrics is unwilling[4, 5] to support Morris’ assertions that circumcision is a “biomedical imperative” that “should be made compulsory”. Finally, apart from a legally questionable German law protecting religious circumcision, Europe has begun to see circumcision as a violation of an infant’s human rights[10-11], medical ethics, and even criminal law.[13-14]
1 Morris BJ, Tobian AAR, Hankins CA, et al. Veracity and rhetoric in paediatric medicine: a critique of Svoboda and Van Howe’s response to the AAP policy on infant male circumcision. J Med Ethics 2013; epub ahead of print.
2. Morris BJ, Tobian AAR. Reply to ‘Circumcision is a Religious/Cultural Procedure, Not a Medical Procedure.’ JAMA Pediatrics 2014;168(3):294.
3 Miles S. The Hippocratic Oath and the Ethics of Medicine. New York: Oxford University Press; 2005.
4 American Academy of Pediatrics Task Force on Circumcision. Technical report: male circumcision. Pediatrics;2012:130:e757-e785.
5 American Academy of Pediatrics Task Force on Circumcision. Circumcision policy statement. Pediatrics;2012:130:585-586.
6 Morris BJ. Why circumcision is a biomedical imperative for the 21(st) century. Bioessays 2007;29:1147-58.
7 The kindest cut? Sunday Night program. Seven Television Network. May 24, 2009. YouTube. Available on: http://www.youtube.com/v/7yDvL4hNny4. Accessed March 23, 2014.
8 Merkel R and Putzke H. After Cologne: Male circumcision and the law. Journal of Medical Ethics 2013;39: 444–449.
9 German Civil Code (Bürgerliches Gesetzbuch)§ 1631d.
10 Council of Europe. Resolution: Children’s right to physical integrity. Available on: http://www.assembly.coe.int/nw/xml/XRef/Xref-DocDetails-EN.asp?FileID=20174&lang=EN. Accessed March 23, 2014.
11 KNMG (Royal Dutch Medical Association). Non-therapeutic Circumcision of Male Minors (Utrecht, Netherlands: KNMP, 2010).
12 Suomen Lääkäriliitto. Poikien ympärileikkaus. Available on: http://www.laakariliitto.fi/uutiset/kannanotot/ymparileikkaus.html. Accessed March 23, 2014.
13 Landgericht Köln; 7 May 2012; Urteil Ns 169/11.
14 OLG Hamm; 30 August 2013; Az. 3 UF 133/13.