1/17/06

Circumcision made normal
As discussed by polemicists.

In the new issue (January 19th) of the New England Journal of Medicine, David L. Gollaher of the California Healthcare Institute reviews two histories of circumcision: Leonard B. Glick's Marked In Your Flesh: Circumcision From Ancient Judea to Modern America, and Robert Darby's A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain. (Glick's book was reviewed some time ago in the Forward by Jay Michaelson.)

The NEJM review isn't available on-line yet, but here are some quotes:
Although circumcision has a long and interesting past, its historiography has suffered from a lack of objectivity. Most books and articles on the subject have an agenda, either to advocate the practice as an effective, preventive health measure or, more commonly, to attack it as genital mutilation that violates the rights of children. The books by Leonard Glick and Robert Darby are firmly in the anticircumcision camp. These authors aim to use historical analysis to strip circumcision of its medical and cultural legitimacy by exposing the myths, erroneous beliefs, and bad science that have been used to promote it.

Glick, an anthropologist with a medical degree, describes himself as "a scholarly activist" who belongs to "several organizations dedicated to ending all forms of genital injury to male and female children throughout the world." His tone is that of one who has seen the light, as he puts it, "that male infant circumcision is medically unnecessary, harmful to normal sexuality, and ethically unjustifiable." Marked in Your Flesh is less a historical narrative than a polemic. . . .

[. . .] Although [Glick] states that modern scholarship has overturned received wisdom about the authorship and provenance of the Torah, he treats the account in Genesis of Abraham as a historical record. This treatment is not trivial. Many Jews, Christians, and Muslims believe that God appeared to Abraham and told him to cut his foreskin, and that the failure of Abraham's descendants to do so thousands of years hence violates a sacred covenant. Such a belief is a matter of religious faith, however, not of documented history.

[. . .] On this topic [how circumcision came to be a widely accepted procedure in American hospitals], Glick presents few new sources or fresh insights. [. . .]

Perhaps one third of Marked in Your Flesh is devoted to reviewing the medical debate about neonatal circumcision. Professional journals have published thousands of papers about whether circumcision leads to a lower incidence of urinary tract infection, cancer, and sexually transmitted diseases. A balanced reading of the record suggests that circumcision carries both benefit and harm. It prevents rare penile cancer, but occasionally it seriously injures a baby. The American Academy of Pediatrics Task Force on Circumcision reviewed the medical literature and reported in 1999 that "existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.

The task force saw the ambiguity in the data on the health benefits of circumcision. This ambiguity only increases when one learns, for example, that in July 2005 French and South African AIDS researchers halted a large, randomized, controlled trial of adult male circumcision to reduce the incidence of AIDS after early results showed that men who had undergone the procedure had a dramatically reduced risk of contracting HIV through intercourse with infected women. Much more research is necessary, which may not bear out this result. But while reading Glick's book, one senses that the idea of benefiting from circumcision is inconceivable to him. This unwillingness to suspend the belief that circumcision is an unalloyed evil weakens Marked in Your Flesh and limits its explanatory power.

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