The Centers for Disease Control and Prevention (“cdc”) is poised to recommend that physicians counsel the parents of every newborn boy and heterosexually active adolescent and man in the United States – approximately 36 million boys and men – that the benefits of circumcision outweigh the risks, that parents should take non-medical factors into account in making the “circumcision decision”, and that Medicaid should pay for it.
The draft cdc recommendations are not medically correct, ethically sound, legally permissible or procedurally valid. Accordingly, they should not be implemented and would be legally invalid if they are. They provide erroneous and misleading advice to physicians that exposes them to the threat of lawsuits by men and parents. The cdc must revise its draft guidelines to comport with the correct and prevailing view in the Western world that circumcision is on balance deleterious to health; that men have the right to make the “circumcision decision” for themselves; that physicians are not permitted to circumcise healthy boys; and that it is unlawful to use Medicaid to pay for unnecessary surgery.
cdc Background Materials. Background Methods and Synthesis of Scientific Information Used to Inform the “Recommendations for Providers Counseling Male Patients and Parents Regarding Male Circumcision and the Prevention of hiv infection stis and other Health Outcomes”: http://www.regulations.gov/#!documentDetail;D=cdc-2014-0012-0002.
FrischM.et alCultural Bias “Cultural bias in the aap’s technical report and policy statement on male circumcision”Pediatrics131 (2013): 796–800 (Criteria for Preventive Medicine).
Draft cdc Recommendations. Draft cdc Recommendations for Providers Counseling Male Patients and Parents Regarding Male Circumcision and the Prevention of hiv Infection stis and Other Health Outcomes: http://www.regulations.gov/#!docketDetail;D=cdc-2014-0012.
KupferschmidC. et alEuropean cdc CritiqueCommentary on the cdc “Recommendations for providers counseling male patients and parents regarding male circumcision and the prevention of hiv infection stis and other health outcome (2015): http://www.regulations.gov/#!documentDetail;D=cdc-2014-0012-2455.
Peer Review Plan. Peer Review Plan For Draft cdc Recommendations and The Background Methods and Synthesis of Scientific Information Used to Inform the Recommendations for Providers Counseling Male Patients And Parents regarding Male Circumcision in the Prevention of hiv Infection stis and Other Health Outcomes:http://www.cdc.gov/hiv/pdf/policies/mcrecs_PeerReviewPlan.pdf.
Public Comments on Proposed cdc Circumcision Guidelines: http://cdc.intactivist.net/.
Van HoweR. S.Van Howe Peer Review “A cdc-requested, Evidence-based Critique of the Centers for Disease Control and Prevention 2014 Draft on Male Circumcision: How Ideology and Selective Science Lead to Superficial, Culturally-biased Recommendations by the cdc” (2015).
1999 ama Circumcision Report. Council on Scientific Affairs. Report 10: Neonatal circumcision. Chicago: American Medical Association1999.
1999 Hammond Poll. The National Organization to Halt the Abuse and Routine Mutilation of Males (noharmm) sent a survey to individuals who had previously contacted organisations opposed to circumcision. T. Hammond “Preliminary Poll of Men Circumcised in Infancy or Childhood” bju International83 Supp. 185–92 (1999): http://www.noharmm.org/bju.htm.
Taddio et al. (Taddio Vaccination) “Effect of neonatal circumcision on pain response during subsequent routine vaccination” The Lancet 1997; 349(9052):599–603 (“Circumcised infants showed a stronger pain response to subsequent routine vaccination than uncircumcised infants”).
Burden of Proof. See generally: http://www.trans-lex.org/966000.
cdc Mission Role and Pledge: http://www.cdc.gov/about/organization/mission.htm.
AffidavitDiekema Plaintiff’s Reply Memorandum of Law Superior Court of Washington in and for Jefferson County (Diekema Affidavit) (18 January 2006) (available from the author).
Diekema et al. Clinical Ethics in Pediatrics A Case-Based Textbook (2011) (Diekema Clinical Ethics).
EarpB. (Earp Critique of the cdc) “Do the Benefits of Male Circumcision Outweigh the Risks? A Critique of the Proposed cdc Guidelines” Front in Pediatr 2015; 3: 18 (2015). doi: 10.3389/fped.2015.00018: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4364150/.
hhs Guidelines for cdc. hhs Information Quality Web Site Guidelines for Ensuring the Quality of Information Disseminated to the Public D. Centers for Disease Control and Prevention: http://www.aspe.hhs.gov/infoquality/guidelines/cdcinfo2.shtml.
MerkelR.PutzkeJ. (Merkel Criminal Assault) J. Med. Ethics, “After Cologne: male circumcision and the law. Parental right, religious liberty or criminal assault?” British Medical Journal (4 June 2013).
New Hampshire Criminal Statute. New Hampshire rsa 167:61-a (‘1. It is a felony crime when a Medicaid provider—with intent to defraud—2. Submits a false claim for payment; submits a claim for a good or service that was not medically necessary according to professionally recognized standards.’).
omb Final Information Quality Bulletin for Peer Review (omb Quality Bulletin): http://www.whitehouse.gov/sites/default/files/omb/memoranda/fy2005/m05-03.pdf.
MassachusettsPrince v. 321 U.S. 158 (1944).
Royal Dutch Medical Association Non-therapeutic circumcision of male minors (2010): http://knmg.artsennet.nl/Publicaties/knmgpublicatie/Nontherapeutic-circumcision-of-male-minors-2010.htm.
Schweiker v. Hogan 457 us 569 at 573 (1982) citing 42 usc 42 usc § 1396a(a)(10)(C).
Svoboda et al. (Svoboda Fatal Flaws) “Out of step: fatal flaws in the latest aap policy report on neonatal circumcision” J. Med Ethics (2013) (a critique of the similar 2012 aap circumcision policy statement).