OPINION: Circumcision study was ‘poor science’

By Dr Howard Cohen, who is a Mohel for the London and South East UK Jewish community and an officer of Liberal Judaism

An article published last Friday online by Frisch and Simonsen, claiming ritual circumcision doubles the risk of autism spectrum disorder, certainly caught our attention and that of the national press. 

As a GP and a mohel (a ritual circumciser) for more than 20 years, a father of an autistic son and the step father of another it was a bit too close to home. My initial response was a feeling of dread that our choice to circumcise our new born sons in accordance with our tradition could have harmed them in any way – that our sons’ lifelong disabling condition could have been the result a single ill-advised event.

Coping with a diagnosis of autism brings with it the recurring cycle of parental self-doubt and guilt triggered by others’ opinion or poorly conducted research. From the discredited theories of Bruno Bettleheim that autism arose from emotionally frigid parenting to the unfounded concern over the MMR vaccine, autism history has been littered with erroneous theories of causation, laden with censure and blame. These left parents bewildered, saddened and with little hope or even a preventative strategy to at least avoid parenting more disabled children in the future.

In addition, the paper triggered an understandably defensive response. Outsiders questioning circumcision is guaranteed to unite even our fragmented Jewish community in a robust rebuttal and in this case rightly so. It is hard not to respond to this paper simply as an attack on Jews and Muslims and our practices.

This is poor science.

The wrong type of study was done to explore whether a causative link exists. Observational studies can suggest associations but cannot explain the mechanisms of diseases. The authors seemingly failed to grasp both what autism is or what happens at a circumcision.

The complexity of the autistic brain with it challenges and on occasion wonders, so clearly arises from the combination of numerous factors, most of which are currently poorly understood. The single trigger theories, whilst superficially attractive are merely illusions which fade on close inspection. 

The paper views all circumcisions as the same, whether on day eight or year eight, with or without suitable anaesthetic or analgesia. It plays into the prejudicial stereotype that the circumcision is a hugely traumatising event for the baby, accompanied by unimaginable pain and suffering. This is so clearly not the case, no parent would let the mohel through the door if it were, let alone invite them back which successive sons and grandsons.

As a Mohel, over the last 23 years I have circumcised new born boys, usually within the first twenty eight days of birth, always with a suitable local anaesthetic. As a Liberal Jew, I have learnt to question all our traditions, including Brit Milah.

Quite separate to this article, there is no need medically or religiously, to hurt a baby and I would be at the head of a campaign to stop the practice if we showed it caused harm. This article does not and could not make that case.

It does however raise a question, which is the role of observational research; it is for us to answer in a clear calm and reasoned way. That is the challenge for us all in the Abrahamic Tradition who are called upon to circumcise our sons.