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 Declining circumcision rates in the United States could wind up costing billions later, researchers warn.
August 21st, 2012
10:15 AM ET
Decline in circumcisions could cost billionsAs the number of American parents increasingly leave their baby boys uncircumcised, HIV and other sexually transmitted disease rates are likely to climb, according to researchers from Johns Hopkins University, and the costs associated with those diseases could reach into the billions. "The medical benefits of male circumcision are quite clear," said Dr. Aaron Tobian, an assistant professor of pathology at Johns Hopkins and lead author of the study published Monday in the Archives of Pediatric and Adolescent Medicine. "But while the medical evidence has been increasingly more positive, male circumcision rates in the U.S. have been decreasing." Specifically, he says, circumcision rates had been fairly stable in the 1970s, at about 79%. By 1999, he says less than 63% of boys had the procedure, and by 2010, the rate had dropped to 55%.
What's more, state-run and private insurance companies in at least 18 states have dropped coverage for male circumcision - a procedure that can cost between $250 and $300 without insurance coverage, causing even more parents to pass on the procedure for male infants. Jews, Muslims slam German circumcision ruling as assault on religion "If circumcision rates decrease to 10% - the levels seen in Europe where insurance coverage is limited - the direct medical costs associated with that drop could exceed $4 billion," said Tobian. That added cost, he says, is largely from an increase in HIV infections and human papillomavirus (HPV)-related cancers he believes would result from the drop in circumcisions. Should teens make circumcision decision? "Three randomized trials have demonstrated that male circumcision decreases HIV, male herpes, and HPVÂ - the virus that causes cervical and penile cancer," Tobian said. "As male circumcision rates increase, you decrease HIV acquisition among men. Later down the road, because fewer men are infected, you'd have less transmission." As a result of this study, Tobian says he's calling on the American Academy of Pediatrics, other advocacy groups and insurance companies to pave the way for more circumcisions. "We should eliminate all of the current barriers that are in the way of individuals receiving this procedure," he said. "Once we do that, families can discuss the risks and the benefits of having the procedure with their physicians, and then can make an informed decision." Circumcising our son: How do we decide? The debate over circumcision has been ongoing for years. Critics of the procedure maintain it is not medically necessary, carries the risk of complications and pain and that foreskins are a part of the natural body that help protect the penis. The American Academy of Pediatrics is expected to release an updated position paper supporting the health benefits of male circumcision by the end of this month. California governor signs law preventing male circumcision ban
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This article fails to cite just how having foreskin increases the risk of obtaining or spreading an STD. Simply because a certain number of individuals in a trial, who had foreskin, contracted or spread a disease, does not provide any scientific foundation for the conclusion that foreskin contributes to disease.
Thank you! My thoughts exactly. Quoting this assistant professor without providing any reasoning behind his statement is fear mongering.
You are correct. The article does not give a mechanism, and we do not know if foreskin is correlated or causative. That is why further stude is needed to determine why it is observed that certain venereal disease is less predominant in cut males than in uncut males. But of course, science usually begins with an observation and the question of "what is going on here?"
you are correct. just because a bunch of smokers in a trial were far more likely to develop lung cancer than their non-smoking counterparts does not mean cigarettes increases the chance of lung cancer. this is not how science works. science works by me making up my mind about something, designing and performing an experiment, and then regardless of the outcome claim that my initial viewpoint was correct.
It because they don't use a condom, the "foreskin" traps the viruses...
do you really expect them to publish the entire study in the article? if the article was how wine reduced the probability of heart disease, would you really expect them to explain beyond "anti-oxidants are good for the heart"?
This study is indeed very flawed.
An easier thing to teach children is how to CLEAN themselves. Washing before and after sex reduces transmission of a LOT of STDs. Its the same thinking that goes behind washing your hands...before surgery...before dinner. We teach our children to brush their teeth.. We dont cut off their cheeks to prevent food from being trapped and spoiling.
WASH. Say NO to genital mutilation!!
The results of three randomized control trials is a good amount of evidence. The randomized control trial study design is the gold standard of epidemiologic studies for demonstrating a potential causal relationship.
This is a cost analysis study...it is beyond the scope of this study to identify a mechanism or causation. It has been built on many other previous studies.
I would rather teach my son about safe sex practices than remove part of his body without consent. This is a ridiculous assumption by the author. Most of the "studies" were proven to be incorrect.
"Proven" to be incorrect where? In what journal?
Does that logic of asking your child's permission first apply to vaccination, dental procedures and feeding vegetables against his 'will' as well?
court: "I would rather teach my son about safe sex practices than remove part of his body without consent."
Oh dear. Guess you won't be able to feed him, teach him, or, in fact, do anything for him until he's able to "consent", right?
Much less, your misguided and absurd belief that if you just "teach" safe sex that your son will engage in safe sex has been shown to fail time and again. Why? Because teenagers and adults do as they please without regard to the potential or probable consequences of their actions.
"Most of the "studies" were proven to be incorrect."
Citation please.
And don't pull out a partisan website.
Yeah, and all those parents who teach abstinence to their children don't become grandparents at an early age. Look at Sarah Pailin - she's the shining example of parental education.
Why vaccinate your children, by the way? Just teach them not to catch any communicable diseases. They don't need vaccinations to be healthy.
Don't you just *love* all these Philosophy students who bandy about their (possibly) recently-acquired (logic) terminology?
In other news, we used to rip off the nails of our children at birth, but the increasing practice of leaving them alone will make the expense of curing ingrown nails skyrocket.
Agreed. Off with their toenails!
don't worry folks...your baby boys will grow up and punch giant holes and ink various parts of their body all the same.
Your fear is pointless.
Routine tonsillectomies are still being performed, and folks are STILL routinely having their newborn daughters ears poked with holes. Where's the outrage over THAT? Oh right, I forgot, it doesn't have a Christian connection to it, only a pagan one. So, of course it gets a pass.
That's all well and good— when they choose to do something to their bodies (as adults), they can go for it. We, as parents, have no right no lop off a portion of them for any reason— whether it's preventative of disease or due to some ridiculous "tradition".
What you're suggesting is completely away from the topic at hand.
let: "We, as parents, have no right no lop off a portion of them for any reason— whether it's preventative of disease or due to some ridiculous "tradition"."
You as a parent have every right in the world to do something that benefits your child. Your belief that you have no right to prevent diseases in your children is nauseating.
This is crazy, rather than teach people to cut pieces of body off, how about they teach people proper hygiene?
What a world we live in..it's all topsy turvy...
You're referring to "Common Sense" of course. Yeah, that went out the window about 100 years ago.
yes, because teaching people what they SHOULD do is so easy. i assume you floss as often as your dentist recommends?
Lindsay... you're right, so your parents should have taken your teeth out at birth becuase you can't be trusted to floss. I get ti now.......
The foreskin has a function. Cutting it off is not the answer.
I'm so glad that the rates are falling. My oldest is cut, a surgery...and has adhesions. He's going to have to have MORE surgery to correct it. I didn't have my second son cut and guess what: he doesn't need any surgery. Ta-da! Saved money for myself and my insurance company.
We'll be teaching both boys about hygene. If my yongest wants to get cut when he is older, that is fine by me, at least he'll be consenting to cosmetic surgery.
the problem is that when they are young, the proceedure isnt a big deal (its a rare occurance to have any problems). When they are older, its extremely painful and takes a while to recover.
Yes, being that a penile dorsal nerve block is nearly impossible, it is a big deal.
I LIKE UR THOUGHTS.... IN AFRICA THOSE cut have sex more freely b cause they can't git hiv.. they r told.. & don't use protection very often either...
B, what makes you think it isn't a big deal for a newborn to have half the skin of his penis and over 50% of the nerves in his penis removed? Because he passes out during the procedure and the nurse says "he slept right through it?" Problems abound and are VERY common and results in many preventable deaths each year.
46, Uncut and never had a single disease or health issue with my member. I think some doctors make presumptions about hygiene and sexual behavior that don't bear fruit. If it were assured that I would be immune to the diseases sited I would go under the knife in a heartbeat however.
40 and cut. Never had any issues. I think the general layperson makes assumptions that anecdotal evidence equates to scientific study. (as much as soft science can do at any rate).
Mike v; Never had any issues – yet. Wait for ED in your late 40's due to keratinization. Had it since 30, which is why I restored. Much better these days! =)
Again... Anicdotal. 🙂
With of course the proper spelling of anecdotal.
I forgot to disclose however that rubbers (as they were called back when) were my friend. I guess the cases used in these "anecdotes" reference the more carefree and careless among us...If people don't care to protect themselves from the preventable there is no amount of cutting genitals that is going to prevent infection. i.e., Tobacco!
George Burns smoked cigars for almost 70 years and never got cancer. Is this proof that tobacco does not cause cancer?
KE: My husband is uncirc'd and started having ED issues in college. In his 20's! He's otherwise in perfect health. Your one anecdote does not make for scientific proof any more than mine does, I guess!
Johns Hopkins University + CNN = FEAR MONGERING
Ignorance + lack of critical thinking skills = fear
There is something very odd about this story; we could also save billions and reduce the incidence of breast cancer by removing young womens' breasts at puberty - but we don't...
Perhaps because they have a function... to feed infants. There is a difference.
MomInWI, since when do foreskins not have a function or purpose?! The foreskin is there to protect the glans.
To protect the glans from what exactly, Sarah? Breasts to produce milk to feed a child versus a mucous membrane that protects...? A nerve cluster that heightens sensation during sex? To prevent the head of the penis from drying out and being itched by cheap underwear? The foreskin-breast comparison is inaccurate.
You didn't just say that, did you??
The foreskin has a purpose... to protect the glans. Removing the foreskin removes that protection. The skin of the glans then thickens as a result of friction from the environment... reducing sensitivity while building up those calluses. Fast forward to age 40-50 and you have erectile dysfunction. This is NOT a harmless surgery. It is a pointless, harmful surgery.
You should solicit an opposing point of view, from sources such as intact america. There are other issues such as the rights of infants that are not considered. This article is one sided.
This subject has a magnetic attraction to the ninnys among us ! ! !
How about the suggestion to remain a virgin until you marry another virgin and wallah, no hiv, herpes, or any other undesirable side effects of "safe sex". Its not a popular suggestion though, but worth the effort.
Anon.. You are actually comparing mutilating genitals with piercing ears... that is simply ridiculous! Having said that.. please don't touch bodies of helpless infants... don't care how many holes or cuts they want on their bodies when they grow up but the choice should be theirs! This article is sheer nonsense..
Shameful article. There is no medical basis for mutilating a baby boys penis.
Know what else tends to prevent HIV, HPV, and herpes? Condoms.
boguslycannedfromthegitgo
Cutting off part of someone's body against their will is a civil rights violation.
forcing a child to eat green vegetables against their will must also be civil rights violation. do you fully understand the concept of guardianship? the parents are there to make decisions in the best interest of their child. do you believe in getting children vaccinated? the needle is painful and completely unnecessary and the baby does not consent. i would guess thousands or millions of children did not want to get the polio vaccination because the shot hurt. should we have waited until they were 18 and could decide for themselves if they would like protection from disease?
Don't you just *love* all these Philosophy students who bandy about their (possibly) recently-acquired (logic) terminology? Get over yourselves. The male member is beautiful. I believe deciding to cut or leave it as nature rendered it is a personal choice of the body to which it belongs, but it's only MY opinion. To make the analogy (there you go, students, one for you) that a parent who trusts in the creative force (God, Nature, Whatever) and their mature offspring to decide what is best for a perfectly good penis, which doesn't belong to anyone else, with someone who would then likely not feed a child a proper diet, guard their safety or innoculate them against preventable diseases is inane. Doctors and scientists are not infallible, in fact they once believed that the world was flat, the sun revolved around the Earth, that persons needed to be bled to be healed, didn't wash their hands or surgical instruments against invisible 'germs', and thought it was OK to let pregnant women take amphetamines during pregnancy so as to retain their 'girlish figures'. Doctors and scientists are often wrong and often revise their recommendations. Cut or don't cut – you're the parents, only you can make the decision for the baby; but are you *really* doing it for the medical reasons? Or does an uncut genital look 'gross' to you? Is it just strange? Are you doing it for religious reasons? Or are you just going along like so many others during the last century in the U.S. because it's what your used to? Maybe you really, truly, believe that little bit of your baby is dangerous medically; but be honest about your reasoning and own it. You may have to defend your decision to an 18 year old someday, and it's conceivable that the medical community may have a different take on the matter in that future time. Less important though, how about parents on both sides of the issue *butt-out* of each others' decisions? It's one thing to express an opinion of *your own*, fully another to indulge in infantile name-calling and insults to those who do not conform to your ideology. Oh, and my son still has what he had when he arrived on this planet, since I only owned his raising, not his body.
It is a waste of the medical literature to encourage a surgical procedure when a baby boy has just entered the world to prevent issues that can be better prevented by making good decisions later in life. The foreskin did not cause any of these viruses to occur or be contracted. This physician should be ashamed of himself for taking data and utilizing it to emphasize a point that isn't even substantiated in the research that was performed. It is a cruel welcome to the world to strap a baby boy down and alter his genitalia.
Removing a woman's breasts would also prevent breast cancer the treatment of which costs even more than treating STDs considering how common it is. So, should this be also medically recommended?? We know that this is the most effective breast cancer prevention method .... and the list can continue for other "non-essential" organs.
Read it somewhere that the sex center in the brain is right next to the intelligence center, so when a baby is cut when severals days old, the intelligence center gets more blood and the child becomes more intelligent. Hmm, Is that why the jews are mostly scientists. How much of a loss will that be, if the nation produces less intelligent species.
Jews are mostly scientists? Where do you get this information from? I think you're wrong. Stereotypical propaganda is what it seems to me. If I wanted to make a racist comment like you, I could easily say most doctors this generation are predominantly Hindu Indians, right "Manmohan"?
Reeally.....Reeeeeeeeeaally? Please someone educate me. Since when leaving the skin on the head become a desease. My own skin can cause to have me a HIV on my own, reeeeeally.
More pro "mutilation" likely by a certain group that whines about being treated bad in history, mainly WW2 and wanting to keep all their "Bronze Age Taboos"...
Check out google. there's a "Scourge upon the wicked" named Herp Peez... get it? And one of their "Mohels" has it and he sucks the BLOOD from BABIES after he's cut them and gives it to them, one after another after another. You see, he won't use a glass tube, he has to suck blood with his lips, despite the cold sores dripping on an open wound that he just made on the .... of a little boy.
Aaron Tobin? Sounds Jewish to me. Think he has a bias?
Why stop at that? Amputate the damn winnie and you'll have a huge decrease in STD transmission.
Sheesh, what's wrong with this "doctor"?
moran
What a crock. That means there's an STD epidemic in Europe, according to this fear mongering journalism.
Leave the foreskin alone, unless the male decides to get it off when he is of consenting age.
Uncirc. pen..ise.s are gross and disgusting. They look like horse do.ngs. Cut that nasty stuff off or stay away from me.
I agree!
Sounds like Sally has a whole lot of time invested in peeping at horse dongs. I'll wager that you turn the lights off whilst making the beast with two backs dressed as an 18th century missionary.
Sally you have a choice in partners. If you are so shallow as to love a man's heart and soul but reject him because nature (and God) created him and all males with a foreskin, that is a testament to you as a woman and human being. Perhaps your partner will one day be some abusive, uncaring jerk with a cut member.
Leaving newborn girls' breasts intact makes breast cancer rates skyrocket.
The health benefits to removing all female's breasts at birth is undeniable.
This seems to be a bit of a flawed viewpoint. While it may or may not increase or decrease the chances of spreading/contracting STD/STI's I don't think it is a valuable argument to say "remove body part A for slight benefit" I could chop of my children's arms so they don't get tennis elbow but I don't think any sane person would agree with me. Even *AFTER* you remove the item you *think* is causing the issue, they don't receive a promise of being STD/STI free anyways. Why mutilate someone over a chance of prevention?
The $300 fee is bad enough but on top of that you have to leave a tip...
Very witty... Love it!!
This is so upsetting. Foreskin does not cause disease!! Bad choices, improper hygiene, and reckless behavior does.
So, since we are so often reminded that proper hand washing helps prevent disease....and cover our mouth when we cough....or cover our nose when we sneeze...but we don't. People get viruses and infections all the time. Costs a lot of money. Should we hack of all those body parts as well?
It was interesting when I read Deuteronomy and the laws of Moses. Much of them were health based and are still valid today. I love it when science and the bible come together. Eventually religion will also be able to see the creation and evolution in the writings but that might take a while as most of the powerful have too much to lose in acknowledging that.
I SEE THEIR POINT, BUT THIS WOULD NOT BE AN ISSUE IF EVERYONE JUST PRACTICED SAFE SEX!
You don't just catch a disease from having a foreskin. You catch STDs from having sex with multiple partners who have had sex with multiple partners, etc. Leave the foreskin alone and let the person grow up and decide for themselves if they wish to have it or not. Supposedly, there are a lot more nerve endings in the foreskin which makes sex even more enjoyable.
erin: "You catch STDs from having sex with multiple partners who have had sex with multiple partners, etc. Leave the foreskin alone and let the person grow up and decide for themselves if they wish to have it or not."
Err, sorry, but that's entirely the point. Most people will decide to have sex with multiple people, continue to contract diseases, and then spread those diseases to others.
If circ-umcision helps prevents that spread, how can you be against it?
Hmm...I read recently there's been a huge jump in brain cancers in the last 10 years. Maybe we should use the same philosophy and procedures of this article, and turn everyone into a Republican.
I realize that logic is lost on you, but I'm going to explain this to your feeble mind anyway. Brain cancer is not contagious. You cannot catch it from another person.
Sexually-transmitted diseases MUST be caught from another person.
An argument that lacks even the most fundamental levels of logic is an argument that can never be won. I don't expect you to understand this, as those of below-average IQ don't have the skills to comprehend simple things like logic, but I'm on a mission to point out the fallacies of logic wherever possible.
Breed7 – obviously, Breed7, you have no brain at all, as you missed the whole point of my comment, dah.
Don't you just *love* all these Philosophy students who bandy about their (possible) recently-acquired (logic) terminology? Get over yourselves. The male member is beautiful. I believe deciding to cut or leave it as nature rendered it is a personal choice of the body to which it belongs, but it's only MY opinion. To make the analogy (there you go, students, one for you) that a parent who trusts in the creative force (God, Nature, Whatever) and their mature offspring to decide what is best for a perfectly good penis, which doesn't belong to anyone else, with someone who would then likely not feed a child a proper diet, gaurd their safety or innoculate them against preventable diseases is inane. Doctors and scientists are not infallible, in fact they once believed that the world was flat, the sun revolved around the Earth, that persons needed to be bled to be healed, didn't wash their hands or surgical instruments against invisible 'germs', and thought it was OK to let pregnant women take amphetamines during pregnancy so as to retain their 'girlish figures'. Doctors and scientists are often wrong and often revise their recommendations. Cut or don't cut – you're the parents, only you can make the decision for the baby; but are you *really* doing it for the medical reasons? Or does an uncut genital look 'gross' to you? Is it just strange? Are you doing it for religious reasons? Or are you just going along like so many others during the last century in the U.S. because it's what your used to? Maybe you really, truly, believe that little bit of your baby is dangerous medically; but be honest about your reasoning and own it. You may have to defend your decision to an 18 year old someday, and it's conceivable that the medical community may have a different take on the matter in that future time. Less important though, how about parents on both sides of the issue *butt-out* of each others' decisions? It's one thing to express an opinion of *your own*, fully another to indulge in infantile name-calling and insults to those who do not conform to your ideology. Oh, and my son still has what he had when he arrived on this planet, since I only owned his raising, not his body.
My husband and I decided we would much rather teach our son not to be promiscuous than to remove a part of his body without his consent. Informed by correct information, he can make the decision later if he chooses. His foreskin will not cause him to contract a disease! I couldn't live with the thought of causing my newborn baby stress and pain by removing a body part which doesn't harm him and may be beneficial sexually. Bad decisions are harmful, not foreskins.
es: "His foreskin will not cause him to contract a disease!"
Sorry, but the science seems to be against you on this.
"I couldn't live with the thought of causing my newborn baby stress and pain"
Guess you can't take him to the doctor for shots, give him baths, leave him alone, ignore him while he's crying, etc., eh?
"Bad decisions are harmful, not foreskins."
And if the harm from those bad decisions - which many people make, regardless of what they're taught - are mitigated by circ-umcision, why would you not have a circ-umcision as a preventive measure?
Funny how all these supposed benefits of infant genital mutilation can be obtained more effectively, more easily, and less painfully... and more consentually with condoms. Yes, it can increase the chances of spreading STIs.. if you are having unprotected sex in the first place!
i had no idea one of the benefits of condoms was improved penile hygiene. so informative you are.
squoose: "Funny how all these supposed benefits of infant genital mutilation"
Ooh, loaded language, an ad hominem and a strawman all in one short sentence.
You must be a non-partisan intellectual.
The nastiest one I ever saw was uncut. I'm so glad my husband is cut. If I had a baby, I would ensure that he had anesthesia before having the procedure done. As an adult, it would be more terribly painful because the nerves are more well-developed and don't heal as fast. That is why we neuter or spay puppies while they are less than 6 months old.
A baby cannot have anesthesia until they are at least 6 months old. They give the baby sugar water and potentially some numbing cream that has been linked to cancer, but most of the time, it is just sugar water.
A baby can have local anesthesia. Not general anesthesia.
Lindsey is a self-righteous moron who has never taken a science class in his/her life
Thank you for your well thought-out and articulated counterpoint
The human body is beautiful as is. Baby boys are born the way they're supposed to be. The foreskin should be left as is unless the man wants to change it as he gets older. The key is to keep it clean-which everyone should do anyway!
Maybe happening less because of awareness but because most health insurance does not cover it. Never has. Back in the day, when my kids were born, I had a great policy ....Zero deductibles etc..except for that Damned $100 foreskin charge. Amazing?
YOU DO NOT WANT TO AVOID THE LONG TERM HEALTH RISKS FOR YOUR CHILD?
Condoms protect those with foreskins just as well as those without. I do not see how a foreskin spreads disease if a condom is used.
NEWSFLASH: Condoms are not always used when they should be.
Personnal hygeine my freinds. Never got snipped, but keep the whole 23 cm clean as a whistle. And whilst we are at it, $4 Billion?? Is that straight cost or does that include "tips"?
There's excellent data on the benefits of the procedure, however the procedure also decreases sensitivity, meaning that greater force/stimulation is required. There has been no serious attempt to scientifically study what effect, if any, that has on relationship health or mental well-being, and it is unscientific for health-care professionals to state that the procedure is entirely beneficial while one of the main effects has not remotely been analyzed.
No offence CNN (& readers), but here is a much more comprehensive report on this issue from the BBC – Perhaps some of you would like to take another stab at it (sorry).
http://www.bbc.co.uk/news/magazine-19072761
It will cost billions in lost profit for the medical establishment. This unnecessary surgery has been a real money tree.
Its a two billion dollar a year industry, for very little work from doctors. That's what this is all about. It's unneeded and dangerous as over 500 babies die a year to infection and blood loss from botched surgery.
Speaking as someone missing their foreskin I can state I don't miss my foreskin. Logic dictates that a moist environment is a great place for bacteria and viruses to call home. As far as sensitivity my little friend is sensitive enough sans the foreskin. Not to mention evolution has presented these wonderful things called clothes which protects my skin from all manner of environmental irritants. If done early not much pain is experienced. Thankfully my parents didn't believe I should dictate how they raised me.
Okay, you don't mind the loss of sensitivity. That's anecdotal evidence. There has been no large-scale scientific study into the effects of that loss of sensitivity on mental health and relationship health. Until there has been a valid scientific study, any discussion concerning the benefits of the practice is ludicrously uninformed. We're simply missing a huge piece of the picture.
So sick of these studies, they do nothing but scare people into mutilating their kids, or themselves. If you want to prevent STDs, you should be practicing safe sex rather than getting cut, and then having unprotected sex with anything that moves. This article almost goes out of its way to say that getting cut is more important than wearing a condom. what will they say next, that legitimate rape can shut down the body's reproductive system?
barbaric practice.