Moreton S, Cox G, Sheldon M, Bailis SA, Klausner JD, Morris BJ. Comments by opponents on the British Medical Association’s guidance on non-therapeutic male circumcision of children seem one-sided and may undermine public health. World J Clin Pediatr 2023; 12(5): 244-262 [PMID: 38178933 DOI: 10.5409/wjcp.v12.i5.244]
Corresponding Author of This Article
Brian J Morris, DSc, PhD, Professor Emerita, School of Medical Sciences, University of Sydney, Building F13, Eastern Avenue, Sydney 2006, New South Wales, Australia. brian.morris@sydney.edu.au
Research Domain of This Article
Pediatrics
Article-Type of This Article
Frontier
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Pediatr. Dec 9, 2023; 12(5): 244-262 Published online Dec 9, 2023. doi: 10.5409/wjcp.v12.i5.244
Comments by opponents on the British Medical Association’s guidance on non-therapeutic male circumcision of children seem one-sided and may undermine public health
Stephen Moreton, Guy Cox, Mark Sheldon, Stefan A Bailis, Jeffrey D Klausner, Brian J Morris
Stephen Moreton, CircFacts, Warrington WA5 1HY, Cheshire, United Kingdom
Guy Cox, Australian Centre for Microscopy & Microanalysis and School of Aeronautical, Mechanical and Mechatronic Engineering, University of Sydney, Sydney 2006, New South Wales, Australia
Mark Sheldon, Medical Humanities and Bioethics Program, Feinberg School of Medicine, Northwestern University, Chicago, IL 60661, United States
Stefan A Bailis, Cornerstone Therapy & Recovery Center, St. Paul, MN 55101, United States
Jeffrey D Klausner, Department of Medicine, Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, United States
Brian J Morris, School of Medical Sciences, University of Sydney, Sydney 2006, New South Wales, Australia
Author contributions: Moreton S and Morris BJ conceived the study, Moreton S and Morris BJ prepared the initial draft of the manuscript, Moreton S, Cox G, Sheldon M, Bailis SA, Klausner JD and Morris BJ provided input to successive drafts. All authors have read and approve the final manuscript.
Conflict-of-interest statement: Stephen Moreton is an editor of, and contributor to http://www.circfacts.org, an online facility that provides evidence-based information on male circumcision. Brian J Morris is a member of the Circumcision Academy of Australia, a not-for-profit, government registered, medical society that provides evidence-based information on male circumcision to parents, practitioners and others, as well as contact details of doctors who perform the procedure. Research performed by Brian Morris is supported by U.S. National Institutes of Health Center of Biomedical Research Excellence grant 1P20GM125526-01A1 but was not used for the present publication. None of the authors receive income from their affiliations or work related to circumcision.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Brian J Morris, DSc, PhD, Professor Emerita, School of Medical Sciences, University of Sydney, Building F13, Eastern Avenue, Sydney 2006, New South Wales, Australia. brian.morris@sydney.edu.au
Received: June 30, 2023 Peer-review started: June 30, 2023 First decision: August 24, 2023 Revised: September 7, 2023 Accepted: September 25, 2023 Article in press: September 25, 2023 Published online: December 9, 2023 Processing time: 160 Days and 7.8 Hours
Abstract
The British Medical Association (BMA) guidance on non-therapeutic circumcision (NTMC) of male children is limited to ethical, legal and religious issues. Here we evaluate criticisms of the BMA’s guidance by Lempert et al. While their arguments promoting autonomy and consent might be superficially appealing, their claim of high procedural risks and negligible benefits seem one-sided and contrast with high quality evidence of low risk and lifelong benefits. Extensive literature reviews by the American Academy of Pediatrics and the United States Centers for Disease Control and Prevention in developing evidence-based policies, as well as risk-benefit analyses, have found that the medical benefits of infant NTMC greatly exceed the risks, and there is no reduction in sexual function and pleasure. The BMA’s failure to consider the medical benefits of early childhood NTMC may partly explain why this prophylactic intervention is discouraged in the United Kingdom. The consequence is higher prevalence of preventable infections, adverse medical conditions, suffering and net costs to the UK’s National Health Service for treatment of these. Many of the issues and contradictions in the BMA guidance identified by Lempert et al stem from the BMA’s guidance not being sufficiently evidence-based. Indeed, that document called for a review by others of the medical issues surrounding NTMC. While societal factors apply, ultimately, NTMC can only be justified rationally on scientific, evidence-based grounds. Parents are entitled to an accurate presentation of the medical evidence so that they can make an informed decision. Their decision either for or against NTMC should then be respected.
Core Tip: This article assesses arguments by circumcision opponents Lempert et al criticizing the British Medical Association (BMA)’s guidance on non-therapeutic male circumcision (NTMC) for failing to consider all of the issues. We find that the BMA’s focus on non-medical issues expose it to such claims by NTMC opponents. Indeed, the medical evidence, as used for evidence-based NTMC policies in the United States, does not support their claims. The lifetime benefits of early infant NTMC greatly exceed the risks, and the procedure has no adverse effect on sexual function or pleasure. The neonatal period is the optimal time for parent approved NTMC.
