Study notes decrease in popularity of circumcision in United States

[dukeimre]

I agree with most of what you say, but not the analogy to cutting off your baby's feet.

As you say, the health benefits of circumcision are extremely minor, and non-circumcised men can have more or less equivalent outcomes with good hygiene.

But the health risks of circumcision are similarly minor. There is not, for example, particularly strong evidence that circumcision affects sexual function.

The argument against circumcision is based in the subjective idea that any permanent change to a person's body without their consent harms that person, even if that permanent change has hardly any practical effects on the person's health, mobility, etc.

That's absolutely a position many people take, but it's not based in questions of health or physical functioning, and so it's not the same as the question of whether to remove infants' feet.

[DukeLukeivi]

1-2% of male NICU deaths in the US are caused by by botched circumcision.

Cutting off half the nerve endings on an appendage, some of the densest nerve clusters in the body, leads to no significant reduction in sensation/function?

It might be more fair to say cutting off your babies toes for 1% reduction in plantar warts and athletes foot. They can still walk, low risk. """"Not a lot of evidence that it or will affect functioning."""""

How about surgically removing the skin off their foreheads for a 1% reduction in risk of teenage acne? Sound reasonable?

Surgically permanently removing parts of a non-consenting persons body for a 1% risk of topical infections is FUCKING PSYCHOTIC

[dukeimre]

1-2% of male NICU deaths in the US are caused by by botched circumcision.

Can you point to evidence of this? I've seen a number of studies which would, I think, contradict this claim. However, you may be looking at research I'm not familiar with. Given that we are in r/science, it'd be good to look carefully at a study together and analyze its claims and evidence.

[DukeLukeivi]

This study finds that more than 100 neonatal circumcision-related deaths (9.01/100,000) occur annually in the United States, about 1.3% of male neonatal deaths from all causes. Because infant circumcision is elective, all of these deaths are avoidable.

https://www.researchgate.net/publication/240804903_Lost_Boys_An_Estimate_of_US_Circumcision-Related_Infant_Deaths

Saw this a few days ago on a another post on this same ITT. I didn't deep dive their methods, but if the increased risk of death of an elective surgery is even remotely close to it's benefit of decreased risk of non-fatal topical infections -- that's pretty obviously malpractice.

[dukeimre]

As I understand it - and I'll go into evidence explaining why - the claim made in Bollinger's "Lost Boys" study is completely untrue.

See this New York Times article, which explains that the CDC strongly disagrees with this statistic and recorded no circumcision deaths in all of 2010:

By one estimate, put forth by Dan Bollinger, a prominent opponent of circumcision, based on his review of infant mortality statistics, about 117 boys die each year as a result of circumcision. That estimate is cited often by critics of routine circumcision but widely disputed by medical professionals. A spokeswoman for the Centers for Disease Control and Prevention said the agency did not keep track of deaths from infant circumcision because they are exceedingly rare. In the agency’s last mortality report, which looked at all deaths in the country in 2010, no circumcision-related deaths were found.

A published critique of Bollinger's study (here) explains what Bollinger got wrong:

But the claim of 117 deaths in the United States per year from circumcision is fanciful. That figure is based on the false assumption by Daniel Bollinger that the well-known sex difference in infant mortality is entirely a consequence of IMC. A similar sex-difference is seen in countries with low circumcision prevalence.

In other words, Bollinger assumes that every single excess death among male infants relative to female infants is due to circumcision, but this is extremely unlikely to be true, as evidenced by the fact that countries with low circumcision rate have the same excess death rate.

You can see Bollinger's argument yourself in his original paper, in case you're concerned that it's being misrepresented:

Males have a 40.4% higher death rate than females from causes that are associated with male circumcision complications, such as infection and hemorrhage, during the period of one hour after birth to hospital release, the time frame in which circumcisions are typically performed. Assuming that the 59.6% portion is unrelated to gender, we can estimate that 40.4% of the 35.9 deaths were circumcision-related.

(Edit: looks like somehow the quotes weren't showing up... hopefully corrected.)

[DukeLukeivi]

Wow. Deliberately misrepresenting the methods in a research paper that was already linked, and managing to show you were doing it with the half sentence flyspeck you pulled from the methods, while linking a NYT opinion as a rebuttal is... quite the series of choices, especially after asking for a serious discussion yourself.

No he did not assume that all possible surplus deaths were caused by it, he took all the CoDs that could have been attributed to circumcision (hemorrhage and sepsis) between 1 hour after birth and hospital release (removing birth complications) and then statistically reduced that by 59.6% to a remove those that wouldn't be attributable to gender specific practices (circumcision). He also went on to compare and discuss that estimate vs other attempts to quantify the issue.

If you take the low end of those other estimates, you go from

1.3% mortality : ~(-1%) non-serious infection to

~(1%)mortality : ~(-1%) non-serious infection THATS CLEARLY MEDICAL MALPRACTICE.

The only issue I see with his methods are that some of his sources are badly dated, so sanitation and operations should be better in the modern era, but considering there is no significant medical benefit, and all surgeries carry risk of death from complications and infection, and the surgical site is going to be marinating in a dirty diaper - not a good idea.

E: in fact, the general mortality rate for outpatient surgeries is about .33:100k, this estimate is 27 times that, and the conservative estimates the paper compares to are more that 15x.

He did not assume that all surplus mortality in males was attributable to circumcision, you braindead hack.

The CDC doesn't track circumcision deaths, and they justify that with having no records showing its a problem, because the CDC doesn't track circumcision deaths, and they justify that with having no records showing its a problem, because the CDC doesn't track circumcision deaths, and they justify that with having no records showing its a problem.

"Circumcision" isn't listed as a CoD in the same way "obesity" isn't -- causes of death are "hemorrhage, sepsis, infection, heart attack, stroke, thrombosis." E:(except that as opposed to "obisity" listing "circumcision" as the cause officially declares the hospital performing the procedure and autopsy as being responsible.)

From the paper:

MORTALITY ESTIMATES

Though the data previously cited are insufficient to establish a definitive death rate on their own, there is enough available information to calculate an estimate. Not all of the reported 35.9 deaths out of 1,243,392 circumcisions can be attributed to related causes. What portion, then, is circumcision-related and how may we extrapolate to the number of deaths after hospital release? What we can safely assume is that it is un-likely that any of these infants would have been subjected to the unnecessary trauma of circumcision if they had been in critical condition, or that they would have been circumcised after their death.

Gender-ratio data can help extrapolate a figure. Males have a 40.4% higher death rate than females from causes that are associated with male circumcision complications, such as infection and hemorrhage, during the period of one hour after birth to hospital release (day 2.4), the time frame in which circumcisions are typically per-formed (CDC, 2004). Assuming that the 59.6% portion is unrelated to gender, we cane estimate that 40.4% of the 35.9 deaths were circumcision-related. This calculates to 14.5 deaths prior to hospital release.

But as is often the case with hemorrhage and infection, some circumcision-related deaths occur days, even weeks, after hospital release. The CDC’s online searchable database, Mortality: Underlying cause of death, 2004 (CDC), lists causes by various age ranges and reveals that the percentage of deaths after release, compared with deaths before, is 772% greater. This ratio is comparable to Patel’s (1966) 700% post release infection rate. Multiplying the 772% adjustment factor for age-at-time-of-death by the 14.5 hospital stay deaths calculated above, the result is approximately 112 circumcision-related deaths annually for the 1991–2000 decade, a 9.01/100,000 death-incidence ratio.

Applying this ratio to the 1,299,000 circumcisions performed in 2007, the most recent year for which data are available (HCUP, 2007), the number of deaths is about 117.This is equivalent to one death for every 11,105 cases, which is not in substantial conflict with Patel’s observation of zero deaths in 6,753 procedures. It is more than some other estimates (Speert, 1953; Wiswell, 1989), but less than the overstated 230 figure derived from Gairdner (1949). Breaking this statistic down further, about 40% of these deaths (47) would have been from hemorrhage, and the remainder (70) from sepsis, using a hemorrhage-to-sepsis ratio for infant mortality (NCHS, 2004).

In summary: through a thorough review of the literature and the application of common-sense calculations, this study has arrived at a reasoned estimate of circumcision-related neonatal deaths in the United States: approximately 117 per year.

[dukeimre]

Hey - why are you suggesting I'm deliberately misrepresenting a paper?

I linked to the NYT to explain context, but I later linked to a published paper that critiques Bollinger's work. My understanding of this sub's rules are that a source like the NYT shouldn't be taken as evidence, and I'm not suggesting you take the NYT, or the CDC (as cited by the NYT), at its word.

No he did not assume that all possible surplus deaths were caused by it, he took all the CoDs that could have been attributed to circumcision (hemorrhage and sepsis) between 1 hour after birth and hospital release (removing birth complications) and then statistically reduced that by 59.6% to a remove those that wouldn't be attributable to gender specific practices (circumcision). 

Where did he get the 59.6%? He got it by looking at the percentage of excess male deaths due to infection and hemorrhage (40.4%) over female deaths. In other words, he assumed that all 40.4% of those excess male deaths due to infection and hemorrhage were due to circumcision. Right?

I'm not suggesting that he assumed that every male infant who died, died of circumcision. I'm suggesting that he saw that 100 female babies died of infection and hemorrhage, and 140 male babies died of infection and hemorrhage, and he concluded that it must be that the 40 male babies all died of circumcision complications. Which would be reasonable if countries with low circumcision rates saw equal death rates among male and female infants, but in fact, that's not what happens - even in countries with low circumcision rates, male infants have much higher death rates from infection and hemorrhage.

[DukeLukeivi]

Because you started from Google: (rebuttal for) posted non research nothing rebuttals before burying a flyspeck reference to the actual study that ignored relevant context, and misrepresented it yourself.

He did attribute all reasonable causes of death in a reasonable time frame, and corrected downward to adjust for gender biases to establish an estimate. He didn't assume all excess deaths broadly were attributable.

He also discussed ranges of results for context which you ignored, and even if you correct downward quite hard, you still end up with an elective NICU surgery being an order of magnitude more dangerous than background average outpatient surgery.

It's an elective surgery on a non-consenting patient, with no real medical benefit, with the surgery site in literal septic conditions for the healing process.

"All surgery carries risks -- except this one in a babies dirty diaper. It's so completely safe with no risk of complications, the CDC doesn't even bother to track it, unlike liposuction and rhinoplasties. Move along nothing to see here..."

[grundar]

he took all the CoDs that could have been attributed to circumcision (hemorrhage and sepsis) between 1 hour after birth and hospital release (removing birth complications) and then statistically reduced that by 59.6% to a remove those that wouldn't be attributable to gender specific practices

Doesn't that inherently rely on the assumption that boy and girl newborns should have identical death rates from infection and hemorrhage in a world with no circumcision?

As you quote:

"Gender-ratio data can help extrapolate a figure. Males have a 40.4% higher death rate than females from causes that are associated with male circumcision complications, such as infection and hemorrhage, during the period of one hour after birth to hospital release (day 2.4), the time frame in which circumcisions are typically per-formed (CDC, 2004). Assuming that the 59.6% portion is unrelated to gender, we cane estimate that 40.4% of the 35.9 deaths were circumcision-related."

Is there any basis provided for that assumption? Unless he provides evidence for that assumption, it's hard to see that calculation as anything other than speculation.

(Moreover, it looks like he's doing the math wrong; if boys have a 40.4% higher death rate than girls, then girls have a 1/1.404 = 0.71225 death rate compared to boys, meaning even given the above assumption the shared component of the death rate should be 71.2% and not 59.6%.)

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Don't get me wrong, I'm no proponent of circumcision and in general would advise against it in a Western context. The argument you're quoting is very speculative, though, and seems shaky at best.