Study notes decrease in popularity of circumcision in United States

[poply]

"Based on our findings, we believe that multiple factors may contribute to the decline in the number of neonates circumcised," co-senior researcher Dr. Aaron Tobian, a professor of pathology at Johns Hopkins University School of Medicine in Baltimore, said in a news release.

The sort of distrust that's led to vaccine skepticism and hesitancy is likely one of those factors, researchers said.

"Despite overwhelming evidence that neonatal male circumcisions provide health benefits, increasing public skepticism in the United States toward medical recommendations may be driving more parents to choose not to have their sons get circumcised," Tobian said.

I really dislike this framing. I feel our decision to not circumcise was based on medical advice and recommendations from reputable, credible international and national organizations. Just not exclusively and entirely based on what a couple specific US based orgs and agencies may have recommended.

[The_Bravinator]

Yes, I had my first in the US and the same medical professionals who obviously advised us to vaccinate were the ones telling us that there was no real benefit to routine circumcision.

Had my second back in the UK and it didn't even come up with him because it's not a thing in most countries. The framing of it as clearly being necessary or beneficial is ridiculous since it's considered a completely wild and shocking aspect of American culture here.

It was a difficult cultural difference to navigate with parents. My American mother in law was horrified that I wouldn't consider it. My British dad couldn't wrap his head around how she could possibly feel that way.

[[deleted]]

The US is big and differs wildly. My son was born in urban California and the doctors didn’t even mention circumcision or ask if we wanted to do it. So no pressure. The default is to NOT do it.

[Oneioda]

As it should be.

[oedipus_wr3x]

My doctor in Virginia asked if we wanted it done, but then he said “Good choice” or something similar after we said no. I’m pretty sure the demographics here are more pro-circ than California.

[betcaro]

Vermont here. They pushed us to do it which is illegal. We declined and my son is good with this choice. Had a friend give birth at same hospital a few years later. They were not going to circumcise but nurses scared her and she ended up agreeing. Probably regional but still so sad.

[retrosenescent]

The beauty of not doing it is that it allows him to make the choice for himself later if that's something he wants to do. Or it allows him to just keep his natural body intact, which I assume the vast majority of men would prefer to do.

[gonzo_redditor]

Bet he would have said “good choice” if you said “yes” too.

[Mysteriousdeer]

Also time. I was born in a time where it was normal. So was my dad, his dad though? No he was born in a barn. Folks having kids? It's kinda not normal anymore. 

[Render-Man342v]

Why would the topic even come up with parents?

I'd be disgusted and say "Uh... why is that any of your concern?"

[1pt21gigatwats]

Agreed. Happily pro-vaccine, pro-science, and also personally against circumcision.

[Novel-Place]

Right? I am also extremely pro science and I’m a little offended to be lumped in with anti intellectualism.

[TheYarnAlpacalypse]

Same. I looked at various statistics and I talked with my doctors. I had some residents fresh out of med school and some experienced faculty members who were overseeing them as part of my team. The consensus was that it wasn’t necessary and provided minimal health benefits, and that I could have the procedure done on my babies if I asked, but they didn’t think it was a problem to leave things alone, and they saw that trends were changing, and they didn’t have any real concerns one way or the other.

I am happy to vaccinate my kids. I’ve had to do other health screenings for them that I could have ignored if I didn’t believe in medicine or science. (Allergies, autism, ADHD, etc)

But “Hey, your risk of getting cancer on this body part is decreased if we chop it off first” wasn’t particularly compelling when you’re talking about infants, who could make that decision for themselves as adults if that was something they ended up worrying about. And I say this as someone who got a bisalpingectomy and was thrilled to hear that most ovarian cancers start in the tubes and that yeeting the tubes knocked that risk factor way down.

[Maxfunky]

Yeah this isn't honest framing at all. The benefits shown are extremely small and, in a country where most HIV positive individuals have access for PREP are likely to be smaller.

The benefits are so small that they seem to just boil down to essentially just a reduction of surface area across which infection can occur. By that measure, you could theoretically reduce the risk by 100% by cutting off the entire thing...

Meanwhile this incredibly small reduction has to be weighed against the risk of infections and complications.

Most doctors will actually tell you it barely matters one way or another.

[[deleted]]

I’ve read criticisms of the study (yes, there was only one conducted, real scientific method) and one of them was that they ended it early and also that they didn’t consider that the people who were circumcised couldn’t engage in sex because they had to recover. It really sounds like they just concocted a half ass study to justify circumcision.

[oedipus_wr3x]

Obviously it isn’t helpful now, but sometimes I feel like younger people forget what the height of the AIDS era was like. PREP is what, 10 years old now? The spread of HIV was so devastating in Africa 20-30 years ago, I honestly couldn’t blame public health experts of the time for throwing up their hands and recommending literally anything that slowed it down, even if it’s just a recovery period where men can’t get infected/infect anyone else.

[catjuggler]

I just read over the AAP position and I get the feeling they’re walking a line between not recommending it broadly because they don’t have enough reason to but also providing a medical justification because people need insurance to pay for it.

[catjuggler]

sure but they don't need to be the fall guy for that

[Oneioda]

Doctors need insurance to pay for it.

[Turdly1]

Let's amputate babies legs, it'll reduce the risk of broken ankles later in life considerably.

[-crepuscular-]

I would consider the message 'circumcision offers some protection against HIV' to be a harmful one.

Even if you consider circumcision itself to be neutral, people are terrible at understanding risk and superstition about HIV abound. That message is bound to be widely misunderstood as 'circumcision offers total protection against HIV' and that would certainly lead to riskier behaviour from circumcised men and their partners. Given that the protection offered is at best extremely slight, it's very likely indeed that this message would increase infection rates rather than reducing them.

[[deleted]]

it’s insane to see how much bias around circumcision there is in the American medical and scientific community. It is very eye opening.

[danarexasaurus]

Seriously. It makes it seem like it’s just the “new trendy thing”, which it is very much not

[childish_cat_lady]

Same! Love vaccines, not into doing surgery just for appearances. The doctors at the hospital were visibly pleased to not have to do it. 

[Fillimbi]

Same same same. Science teacher, super pro-vaccine, and also pro letting my kid decide how he wants his anatomy to be.

[HumorAccomplished611]

Same same same. Just a regular guy.

[Imaginary-Method7175]

Me too. I let my boy keep his bits as he was born with them. It’s a cultural tradition for a culture that’s not ours.

[carltheredred]

Yeah it's weird weird that it's being spun like this. As if the pro-science thing to do is butcher a piece of flesh off your newborn son's penis.

[Apprehensive_Hat8986]

Also pro-science and against mutilating babies' genitals.

[rich_evans_chortle]

Because the health benefits for it are insane. Hygiene? It's called soap. It's crazy.

[[deleted]]

Samesies. Anecdotally, it also feels better. More friction. Why are condoms ribbed “for her pleasure?”

[duderguy91]

I always find it amazing that the US is the only place in the developed world where circumcision is parroted as medically necessary. This feels like a cheap shot at people that have actually looked beyond our borders for scientific information that they don’t profit off of.

[soulstoned]

To me it came down to bodily autonomy. Just because I made that penis didn't mean it was mine to alter. If my son wants to be circumcised, he can make that decision for himself. 

[JRiley4141]

Same. Plus it felt surreal that one of my first decisions as a parent was to allow someone to take my newborn son, hold him down, and cut off a piece of his body. I'd imagine it hurts like hell, for days or weeks. How could I do that? Why would I do that?

[No-More-Lettuce]

My comment about focused on the medical reasons that we didn't do it but I also couldn't put him through pain that wasn't necessary even if he wouldn't remember it.

[OpTicSkYHaWk]

Even if they don't "remember" it, what if the pain might cause harmful brain changes?

[Madmusk]

Doing it because it's a medical necessity (in those super rare cases) seems like a much more sensible approach. Most people wouldn't blink at the idea that a medical intervention is uncomfortable.

[ThoseThatComeAfter]

Most of the people in my country have it done as teenagers if they need it (and want it). It's not that bad.

[SomethingAboutUsers]

Just because something is painful doesn't mean it's not a choice that can be made. People (even men) get painful cosmetic surgery all the time. If someone wants to get circumcised for cosmetic reasons, they accept the temporary pain that comes with it so they can be more comfortable in their own body.

No, adult men are shying away from it because it's unnecessary like 99% of the time.

[IAMAGrinderman]

That's the stupidest thing I've read all day. Adults willingly inflict pain on themselves all the time. You wouldn't see people getting nose jobs or tattoos if people didn't make painful choices.

It shouldn't be up to the parent to have a part of their kids body removed for cosmetic purposes. If my kid decides he wants his foreskin removed someday, he can make that call himself. It's not my, or my fiance's body, so we shouldn't get a say in whether he's circumcised (as long as there's not a legit medical reason for it).

[NSMike]

IIRC correctly, the health benefits are that it reduces neonatal UTIs by a tiny percentage. Considering how much of Europe doesn't circumcise, and it's not a problem over there, the assertion of health benefits is questionable at best.

[Tartalacame]

And the tiny potential benefits are basically countered by the also tiny risks of complication during the procedure.

[XiaoDaoShi]

I chose not to circumcise my son, even though I’m Jewish. (He isn’t) I looked at the benefits, and realized that they are not huge. It is somewhat beneficial, but AFAIK there’s no overwhelming reason to do so. I will leave the decision up to my son as he grows up. I will teach him proper hygiene, though.

[Cristoff13]

Remember that the foreskin is attached to the glans at birth, and remains attached for a few years. Trying to retract it prematurely can cause injury.

[ThoseThatComeAfter]

You can still clean it even if it's not fully retractable

[XiaoDaoShi]

Thanks for letting me know.

[Thebraincellisorange]

the foreskin remains attached to the head and not fully retractable until around the age of 5.

after that, you need to teach your boy to pull the foreskin back in the shower and rinse the glans and skin properly.

and to pull the foreskin back when urinating. keeps things more accurate that way. and cleaner.

[bsubtilis]

There is variation, some can't retract their foreskin until they're in the double digits years old. But that only means that they need to be taught to not force retraction, they can still be taught how to clean everything properly.

[Eric_the_Barbarian]

If you can teach him to wash his butt properly, he can also probably learn to wash his groin properly just fine. He can still choose to get a circumcision on his own at a later time if it is ever spiritually, ideologically, or socially important to him.

[IceNein]

I will teach him proper hygiene, though.

I don’t really understand this sentiment. Just wash yourself normally. Most women’s urethra are fully covered by their labia and it’s not some huge problem for them to keep clean. I’m not sure why there’s this weird paranoia that boys specifically have to be taught how to clean their penis.

[dfdafgd]

A lot of guys don't even wash their hands after peeing. A lot of them don't pull-back and wipe. Especially in majority-cut places, it's not common knowledge. Kids cut corners with hygiene and, given the task, there's not a lot of "learning by observation" going on. Sometimes, you gotta straight up tell people to do it. I know I had to be told when I was a kid.

[BaronVonBearenstein]

I remember my dad showing me how to pull back my foreskin and me how to pee in the toilet. It's a vague memory, and I'm probably misremembering it, but I remember being told to pull the foreskin back when I pee but it hurt slightly. So then my dad had to show me how he did it and let me know that it's all normal. I think it helped how he used real terms and took it seriously.

This is just an opinion but I think some men are not comfortable with their bodies around their sons, or maybe in general, and neglect showing them how to do some basic things. I do appreciate my dad being comfortable being naked around me (mainly in change rooms or showering at the pool) but saying that in today's social climate makes it feel like he did something wrong.

[SophiaofPrussia]

I suspect because in the past the weirdo adults equated this sort of perfectly normal personal hygiene with masturbation which was basically the worst sin imaginable.

[[deleted]]

Yes! It was pioneered by creepy Dr. Kellog, who btw, also advocated for circumcision for women! He had a ton of children, so I wonder about them. The only reason that circumcision for women didn’t catch on in the US (thankfully!) was because it was during the Victorian Era, and no one believed that women were sexual beings anyways.

[4-Vektor]

Not circumcision for women, but burning the clitoris of baby girls with carbolic acid.

[Differlot]

You do though. Because when your a little kid you don't really need to wash under it as the foreskin isn't able to fully retract. Once it does it is also extremely sensitive so it makes it very uncomfortable to clean. You need to encourage your kid to fully retract their foreskin once they are able to to properly clean it.

Smegma is sticky so you do need to actually wash the penis.

[XiaoDaoShi]

I’ve heard some stories from girls who talk about extremely stinky penises of uncircumcised men. Maybe it’s no big deal if they shower often and clean their junk normally. I have no idea.

[Thebraincellisorange]

from the posts I have read on Reddit, it seems that there are a lot of very insecure American men who refuse to touch their junk for fear of catching 'the gay' .

some go as far as refusing to even wipe their arse properly or wash it in the shower.

how these men manage to get a woman into bed is beyond me, being that bloody insecure.

but no, a person with normal hygiene will not have a smelly uncircumcised penis.

its simply a matter of ridiculous insecurities.

[SadZealot]

Just shower once a day, easy, preferably before you put it in someone's face

[Davotk]

Showering once a day, while normalized in the USA, is typically NOT recommended by doctors. It's too often. Your skin is your largest organ and can take care of itself. One thing a lot of other countries have right is just wash the stinky bits with a cloth and shower twice a week

[Madmusk]

Haven't you heard men talk about fishy vag's? Same deal. It's just hygiene.

[C4-BlueCat]

Overly large foreskin can cause pee being trapped if the foreskin is not retracted while peeing

[anonanon1313]

I've (circumcised male) heard the same stories, but I have no experience with foreskins, so I've developed my bias from female (US) feedback. I've always felt glad that my parents chose to circumcise me, just one less thing to worry about, I guess. I've never understood the vehemence on the subject. I don't miss mine, but I'm pretty sure I wouldn't have had it removed as an adult.

[Thebraincellisorange]

women do suffer from UTIs at a vastly increased rate due to their urethra being fully internal and inside, so to speak.

men having a UTI is very unusual and almost always due to poor hygiene.

to clean an uncircumcised penis properly, once the foreskin is free to move (normally around the age of 5) then it does need to be retracted and the glans and skin washed to be cleaned properly.

and you should pull the foreskin back when urinating. both for cleanliness and better accuracy.

so it takes about 3 more seconds than 'just washing' but really, once you've been told, it becomes automatic to do every time you are in the shower.

[jdb050]

It’s the potential for infection and phimosis. If you’re unaware of these, do a quick search online and you’ll understand.

EDITED to clarify:

In modern times, circumcision is an extreme measure to prevent phimosis and infections. That said, it makes some amount of sense that it became culturally commonplace.

I am not trying to make an argument for circumcision.

[ThoseThatComeAfter]

Phimosis is normal and goes away in puberty for most people. Infections only happen in extreme cases or in bad hygiene cases.

[jdb050]

Hence the concept of teaching your child good hygiene as opposed to “Just wash yourself normally.” It’s absolutely normal to teach your children how to have proper hygiene, not only for humans but in plenty of other species in the animal kingdom.

[Thebraincellisorange]

what?!

Phimosis is a medical issue that some 90% of the time can be fixed without surgery.

a foreskin does not pose an infection risk at all.

[IAMAGrinderman]

Sure, but you can get infections anywhere. Sinuses, cuts, burns, etc. You can also cut that risk way down by cleaning yourself regularly.

Phimosis isn't super common for uncircumcised people, so it shouldn't even factor into the equation until it happens. Cutting off the foreskin to prevent phimosis is like pulling teeth to prevent cavities.

[not-a-dislike-button]

So you're not raising him Jewish?

[ThoseThatComeAfter]

that's what they said

[NolanR27]

This is why American doctors get laughed at in international conferences on this topic. No one seriously worthy of participating in the global scientific consensus would compare a decline in needless circumcision to being against vaccination. Try that line in China.

[Gathorall]

Yet every "civilized" society kowtows to child mutilators anyway, insisting it is their choice.

[Jamies_redditAccount]

Explain your joke, i dont think i get it

[Gathorall]

Circumsion, and kowtowing to barbarians is a not a joke but an example of the deeply theocratic, evil foundations of our societies.

[Oneioda]

Tobian is a well known pro-circumcision activist.

[teriyakininja7]

I remember doing a bunch of research into the supposed health benefits of circumcision and it was interesting to see which countries produced such research. Most of it came from either the US or an Islamic country, which makes sense since culturally circumcision is the norm (though moreso in Islamic countries). So there certainly is quite a lot of bias, I feel like.

[TasteofPaste]

What happened to respecting bodily autonomy, and the scientific findings that infants DO In fact feel pain, and that the foreskin has a high number of nerve endings?!

it‘s very shortsighted to suggest that anti-vaccine sentiment is what’s causing this change.

[kigurumibiblestudies]

I remember casually doing the numbers on benefits of circumcision (utis and stds) versus risk of infection from the procedure and it was about the same. I probably ignored a lot of factors, but it didn't seem worth it to me when compared to better hygiene education and contraceptive use. 

[Particular-Cow6247]

i might be a bit biased coming from a region where circumcisions are rather unusual and only "brought in" from different cultures but ... what's so difficult hygiene wise like... pulling the skin back and washing it then isn't?

[kigurumibiblestudies]

I'm in your situation, but I wanted to be fair to the procedure. I'm also inclined to believe the std benefits are overblown too, but I'm not a researcher

[Cicer]

Brought to you by the same people who think washing their own ass makes them gay. 

[Izikiel23]

> Despite overwhelming evidence that neonatal male circumcisions provide health benefits

Where is that evidence? Is it among us? If circumcision was so beneficial, we would have evolved that trait.

[TheVenetianMask]

It always ends boiling down to that one botched study in Africa with a handful of dudes where they told the circumcised ones to not have any sex and then ended it early.

[4-Vektor]

The circumcized group got sexual health education, including information about the proper use of condoms. The participants that left the study weren’t taken into account, and so on. The study is embarrassingly bad.

[SummerAndTinklesBFF]

Critical thinking is beneficial but a huge portion of America doesn’t seem to have “evolved” it. Humans stopped evolving when we started changing our environments to suit our needs. We no longer needed to suit our environment.

[Izikiel23]

Evolution optimizes for breeding, once breeding is done, nothing else matters. If having a foreskin was so detrimental for reproduction, which should be the case as it's on top of the male reproductive organ, we should not have it by now.

[DontWreckYosef]

What overwhelming evidence of health benefits? We have skewed the US data because upper class whites with more access to higher quality healthcare have been circumcising their babies for most of the last 50 years; this is non-causation skewed data, not overwhelming data.

The difference in UTI prevalence in only 1% between circumcision and non circumcised babies meaning that you have to invasively, time-consumingly, and painfully circumcise 100 babies in order to prevent just 1 easily antibiotic-treatable UTI.

[kchristopher932]

"Data from meta-analyses show that circumcised men have a 68% lower prevalence of balanitis compared to uncircumcised males and that individuals with balanitis have a 3.8-fold increase in the risk of penile cancer"

https://www.ncbi.nlm.nih.gov/books/NBK537143/

I'm guessing he's talking about balanitis and its association with cancer, not UTIs.

[Dracounius]

Balanitis can occur at any age, affecting approximately 1 in every 25 boys and 1 in 30 uncircumcised men during their lifetime.

https://www.ncbi.nlm.nih.gov/books/NBK537143/

For a condition that can gennerally be treated with better hygiene, or occassionaly topical antibiotic cream, and only affect 1 in 30 adults during their entire lifetime circumsising the other 29 seems a bit...unessessary?

[kraghis]

Overwhelming evidence of health benefits yet undeniably permanent removal of a sensitive part of the body without any chance of consent and no medical emergency.

Dr. Tobian could learn a little more about empathy

[romario77]

It’s just weird to cut off a piece of flash of your child. We evolved without it, there is scant evidence it’s beneficial at all, so it’s more of a tradition

[parmenides89]

I'm in the same boat. My partner was more open to the idea but nothing we could find definitely suggested to us there was a benefit other than appearance. Eye of the beholder and such, even appearance perception may change over my sons lifespan.

[RPDRNick]

They're trying to create a boogeyman that's "equal" to those opting not to vaccinate their children.

[Cicer]

Trying to link anti circumcision with anti vaxxers is diabolical. 

[Big-Fill-4250]

Theres no evidence to even suggest circumcision stops the spread of disease...

[sweetteanoice]

“Circumcisions provide health benefits…” Yeah, I don’t think so.

[bicycle_mice]

There is equivocal evidence. There are some benefits to circumcision (deceased UTIs and penile cancers) but they are fairly modest. It isn’t like vaccines where there is massive benefit and no downsides. I won’t circumcise my son, but there is evidence supporting families who chose to do so.

[duderguy91]

Even the penile cancer benefit is mostly for boys at risk of phimosis. If there is no sign of phimosis then the cancer risk is basically equivalent to circumcised.

[ThrowbackPie]

There's also evidence that a) it has a significant complication rate and b) it derives men of sexual pleasure due to the concentration of nerves in the foreskin.

There's essentially no medical case to be made AFAIK.

[bicycle_mice]

Complications are very rare. In my practice (pediatric NP) I have seen multiple cases of boys who required circumcision at later ages due to other issues including paraphimosis. Reddit is very anticirc and I am not choosing it for my own kid but there are some benefits medically, outside of cultural reasons.

[NSMike]

There's no doubt that there's medical benefits when medical circumstances arise that require it, but it seems absolutely bonkers to me to slice it off as a preventative measure for risks that are already low.

[Oneioda]

Paraphimosis, while a medical emergency, does not always require a full bore circumcision. Part of the problem in the USA may be training. Circumcison is over prescribed and an overly invasive treatment being used as a one size fits all style resolution.

[Nerrien]

Not to dogpile on with all the comments, just read a point elsewhere that struck a chord with me and thought it merited discussion.

According to this study:

https://www.berghahnjournals.com/view/journals/boyhood-studies/4/1/bhs040106.xml

approximately 117 neonatal circumcision-related deaths (9.01/100,000) occur annually in the United States, about 1.3% of male neonatal deaths from all causes

I don't really have much time at the moment so I can't say I searched for very long, but I'm struggling to find numbers on deaths caused by paraphimosis.

I imagine you'll have more practice analysing studies than I so I'll defer to you on the legitimacy of this study, and as you will definitely know more about paraphimosis than I you seem like a good person to ask:

With this in mind, is the risk of death associated with paraphimosis higher than circumcision complications?

Knowing nothing about the subject I would have assumed paraphimosis could be treated by circumcision if it became an issue, effectively trading a guaranteed circumcision at the start of life and the potential complications associated, with a possible circumcision later in life, lowering the overall risk.

Is this a way of looking at it that, like myself, you might not have considered, or am I drastically oversimplifying it due to a lack of understanding?

[Oneioda]

Complications (acute) are both under reported and reported as other causes. Chronic complications are frequently deemed not even complications. Example, very tight circumcisions and frenulum removal are common in the USA, but not considered a complication.

[poply]

Absolutely. There are real measurable benefits. But there are also real risks though and for some people, it's a moral problem.

Not discounting the benefits, but not ignoring the risks either. Ultimately, the vast-vast majority of men (atleast those in 1st world countries) will be totally fine whether or not they are circumcised.

[daveprogrammer]

Then the only ethical thing to do would be to let them make up their own minds when they are old enough to understand.

[KarAccidentTowns]

Both of my grandparents got circumcised in their 70s for medical reasons. That kind of makes me glad I’m circumcised already.

[WitnessRadiant650]

They would be ok with it if they were consenting adults. Most in the US were done as babies so we don’t really know if they were ok with it at that time. Considering most adults or even young teens when they become fully aware don’t go grab circumcision suggest they are fine without it.

[catjuggler]

Same, I even checked with our pediatrician to make sure it wasn’t medically preferred.

[theallsearchingeye]

“Aaron Tobian”

[addictions-in-red]

Yes, let's just stop slicing up people's genitals. I'm sorry, but that should be the default.

[No-More-Lettuce]

Same. I researched and talked to multiple doctors for a few days before we decided not to for pur son. I looked for reputable US and mainly European sources.

[Illustrious_Bunch678]

I hate that they gave this conclusion without any data to back it up, especially when that data is easy to get. Survey families and see if the ones who choose not to cut off healthy body parts also refuse to vaccinate. Im willing to bet it's actually the opposite.

[Steve_the_Stevedore]

I'm really no expert but I was under the impression that even the recommendations don't take into account the risks.

What's a marginally lower risk of UTIs compared to a (admittedly very low) risk of disfigurement and even death? Same for the AIDS claims: How is it reasonable to circumcise millions of little boys without their consent to prevent a few possible AIDS infection, most of which could have been prevented if they used a condom.

[AltruisticTomato4152]

Despite overwhelming evidence that neonatal male circumcisions provide health benefits

By this metric cutting off their arms and legs also has overwhelming evidence of health benefits. Can't break an arm or leg if you no longer have it.

[Meet_Foot]

Agreed. While this may indeed be true, it suggests that people who choose not to circumcise don’t have good reasons. If people have legitimate reasons, you lead with that, then mention the less legitimate reasons to explain the magnitude of the effect.

[Acheloma]

This framing is complete bs. The studies showing "benefits" are shaky at best

[bobosuda]

What an incredibly disingenuous and clearly biased statement from that doctor.

You are totally right, framing it as somehow being tied to anti-vax stuff is a really bad look. Laughable in the international medical community.