OPINION: Circumcision study was ‘poor science’

How could circumcision not be harmful? If you were forcefully restrained and were subjected to having a part of your genitals cut off, that would be harmful. Because infants are more sensitive to pain and trauma, it is also harmful to them. Let’s remember the Golden Rule.

Studies show that circumcision causes significant pain and trauma, behavioral and neurological changes in infants, potential parental stress from persistent crying (colic) of infants, disrupted bonding between parent and child, and risk of surgical complications. Other consequences of circumcision include loss of a natural, healthy, functioning body part, reduced sexual pleasure, potential psychological problems, and unknown negative effects that have not been studied.

Some circumcised men resent that they are circumcised. Sexual anxieties,
reduced emotional expression, low self-esteem, avoidance of intimacy, and
depression are also reported. Some doctors refuse to perform circumcisions because of ethical reasons. Relying on presumed authorities (e.g., American Academy of Pediatrics or doctors who echo AAP views) is not sufficient because of their personal, religious, financial, and political conflicts of interest.

The problem is that those who circumcise generally refuse to seriously consider the harm because it would be emotionally disruptive and reflect on themselves (if male) and their decision to circumcise and harm a son. They do not have an open mind on the subject. Fortunately, a growing number of Jews choose not to circumcise and they find rabbis who support their choice. See http://www.jewishcircumcision.org .

Frisch is a well-known Danish anti-circumcision activist. His previous research attempting to find adverse effects of male circumcision has been discredited. His new publication in a low-ranked journal should ring alarm bells, given the history of other false links to autism. Dr John Wakefield was struck off the medical registry when his paper linking childhood vaccination to ASD was subsequently shown to be fraudulent.

In the new study, Frisch and Simonsen performed a “data dredging” exercise of the public medical records of 342,877 boys in Denmark looking for any adverse medical condition they could associate with circumcision. Although they found a slight excess of ASD in circumcised boys, the numbers were trivial. In the largest population group in Denmark in which boys receive a circumcision – Muslims – the excess was only 10 boys! … and the statistical significance was marginal. The association applied only to ASD diagnoses in infancy. In non-Muslim boys there were only 6 with autism. One should question the statistics used, given that the enormous number of ASD cases in the control group.

Frisch speculates, without evidence, that the reason for the associations found had to be “pain” caused by circumcision, even though local anesthesia is recommended and surveys show only a tiny proportion of boys experience pain (probably indicating that the anesthetic was inadequately applied).

Frisch & Simonsen ignore data from a study in 2013 that showed an association of ASD with the upswing in paracetamol use after 1995 [Bauer et al. Environ Health 2013;12:41]. That study used infant circumcision as a proxy for paracetemol use (the mid-1990s being the time that analgesia post-circumcision became a recommendation). The Bauer study pointed out that in infancy (only) the metabolism of paracetamol in the body results in generation of toxic degradation products that can cause neuronal damage in the still-developing brain, so potentially contributing to ASD in a small proportion of susceptible infants. But the authors of that study emphasized that the association was juts that, and did not imply a causal link.

Frisch & Simonsen also ignore data showing anesthetic use in children under 3 years of age (which is not advisable for a trivial procedure such as circumcision, but is nevertheless used by some medical practitioners for convenience) also has the potential to increase risk of neuronal damage, based on the detection of cognitive defects at age 10 in such children [Ing et al. Pediatrics 2012;130:e476-85]. But again, that study emphasized that other factors could be explaining the association. Importantly, newer anesthetics are less likely to cause such problems, so that problem may be historic only.

If Frisch & Simonsen were actually concerned about pain in childhood being a cause of ASD then they would have studied well-known causes of pain. It is well-known that urinary tract infections (UTIs) cause excruciating pain. Since UTIs are common and the rate of UTIs is 10 times higher in uncircumcised infant males, in the unlikely event that their hypothesis were correct then they would have seen an association of LACK of circumcision with ASD!!! But they didn’t look (or at least one suspects, given the general obfuscation that appears in their article, if they did find any association that pointed to yet another adverse effect of lack of circumcision then one might expect that they would be reluctant to reveal it, as it would undermine their anti-circumcision agenda. Even then, any association could be from paracetamol use for pain relief.

They cite a study by other circumcision opponents, Bollinger and Van Howe, claiming “circumcision trauma” causes alexithymia, but fail to cite the devastating critique of that study that was published in the same journal.

Finally, the mere increase in contact with the medical system by parents seeking a circumcision for their boy will elevate the chance of DIAGNOSIS of ANY medical condition that the doctor might perceive to be present, but which the parents were unaware of. That would obviously include ASD.

Thus, for many reasons, the conclusions by Frisch & Simonsen are highly speculative, biased (just as the rhetoric, selective citation and bias contained in their article), have alternative explanations unrelated to so-called “circumcision pain”, and are by an author (Frisch) who has a history of discredited research, and whose attack on the American Academy of Pediatrics affirmative infant male circumcision policy backfired when the AAP Task Force responded to point out the bias against circumcision was evident in Europe, but not in the USA.

Therefore these new findings by Frisch should be viewed with extreme scepticism.