Letter to AAP 1988-1989
Re: The re-evaluation of the American Academy of Pediatrics’ position on routine infant circumcision in light of Thomas Wiswell, M.D.’s study on “Decreased Incidence of Urinary Tract Infections in Circumcised Male Infants.”
(Originally written and mailed in May of 1988. Re-typed into computer in 1991.)
This letter is being addressed to each of the officers and executive board members of the American Academy of Pediatrics. I hope that it is acceptable that I address you as an equal as I write this. My background is that of a college graduate (University of California, Santa Barbara, B.A. 1969), former elementary school teacher, former childbirth educator, and mother of five young children, including four boys. My oldest three sons were circumcised as infants, while my youngest son, now age 2 ½, has been left intact (and has experienced absolutely no problems with his foreskin.) I am also the author of a book entitled Circumcision: The Painful Dilemma, © 1985, Bergin & Garvey, S. Hadley, MA.
Following the birth and circumcision of my third son in 1977, I began to deeply question the then extremely common but poorly understood operation. I spent 7 ½ years intensively researching the subject and writing my book. Therefore, while not a doctor, I do consider myself an authority on the subject of circumcision.
When my first three sons were born in the ’70’s I had a typical, uninformed middle class bias towards circumcision. When I began my research for my book, I was mainly concerned about infant pain, while still believing that the circumcised state was, somehow, better. However, the findings through my research, along with continuous contacts with hundreds of people with unhappy stories to tell (some of which are related in my book) soon turned me strongly against the operation, and filled me with deep remorse that I had naively agreed to circumcision for my own three sons. Therefore, I did not initially set out to write my book with a preconceived anti-circumcision bias. Instead, as the book took shape, it yielded up a strong case against the operation, and I have unwittingly found myself on a soapbox convincing countless other parents to leave their sons intact.
The American Academy of Pediatrics’ Ad Hoc Task Forces’ pronouncement in 1971 and 1975 that “There is no absolute medical indication for routine circumcision of the newborn …” has been a powerful drawing card in the case against routine infant circumcision. I have seen that statement quoted repeatedly, both in neutral and in strongly anti-circumcision articles.
Obviously I do have a vested interested in the subject, particularly as to the outcome of the AAP’s investigation of the Wiswell study. Wiswell’s observations had not yet been published when my book first came out in 1985. Yet I would like to believe that the overwhelming argument that I have presented against the operation is still valid and convincing and that 7 ½ years worth of research on my part is not negated by just one study. I would like to believe that I have, indeed, made the correct choice for my own youngest son whose foreskin is still intact. I would like to believe for the many, untold thousands of little boys who have been left intact as a result of my writing (directly or indirectly) – that I have indeed directed their parents towards the correct choice. And I would like to believe in my own heartfelt conviction that “nature is right”, i.e. that the human body is designed correctly the way it normally comes into the world and does not need to have any part of it cut off to promote health, insure cleanliness, or “look better.”
However, I too can share a concern over urinary tract infections as I have personally suffered from a multitude of troublesome uti’s. I know that such a matter is not one to be taken lightly. While I have been deeply concerned over the pain inflicted upon a helpless infant if subjected to circumcision, I am sure that the agony of a severe urinary tract infection would rival the pain of circumcision. While I am normally a surgery shy person, while in the throes of uti, had some operation promised me a relief and/or prevention of future flare-ups, I probably would have readily agreed. There are a small groups of doctors in this country, and probably many in middle eastern countries who do recommend female circumcision for health reasons. However, since female circumcision is not a popular operation in this country, no such option was ever offered to me. I have had to deal with my own uti problems by other, non-surgical means.
I am deeply concerned about both infant circumcision and uti’s. I have thoroughly read Wiswell’s study in Pediatrics, as well as many of the subsequent letters from other physicians and Wiswell’s replies. I have garnered a number of ideas on the subject which I wish to share with you in the hopes that you will give each your most careful consideration. Please forgive me if some of these suggestions may already be issues into which you have delved deeply. My concerns are as follows:
1.) I note that the parents of the intact male babies in Wiswell’s study had been “counseled to gently retract the foreskin to allow the easily exposed portion of the glans to be cleaned.” I wonder if this type of intervention may be the iatrogenic factor which causes the bacteria to be introduced into the urinary meatus.
My extensive studies into the correct care of the intact male infant have repeatedly reinforced the advisability of leaving the infant foreskin alone, at least during the first several months of life, or until the child’s foreskin has become fully retractable of its own accord. Misunderstanding of the correct nature of the infant foreskin resulting in forcible and/or repeated retraction has often, sadly led to such catastrophes as balanitis, posthitis, acquired phimosis, and paraphimosis, not to mention pain and trauma to the infant.
I note that three different follow up letters in Pediatrics, by Drs. Malleson, Altschul, and Cunningham all suggest that intervention in the form of retracting and cleaning the infant foreskin may be the causal or contributory factor to uti infections. Wiswell appears to be aware of the dangers of forcible retraction of the foreskin, and in each of his replies insists that since what he and his staff advises is merely a gentle retraction of the foreskin, only as far as it will easily go, he doubts that this action contributes in any way to uti.
However, (as an experienced diaper changer) I wish to pose another hypothesis: It is well known that the bacteria in urinary tract infections usually originates in the normal flora in human feces. The obvious source of this would be the baby’s stool in his soiled diaper. The parent or caretaker commonly gets some of the baby’s stool on his/her hands during the course of diaper changing and cleaning of the baby. Even following normal hand washing, traces of fecal bacteria may still remain on the adult’s hands. If the parents have been advised to retract the infant’s foreskin for cleaning, (however gently) chances are they may do this while cleaning up the baby after a changing a soiled diaper. By touching the baby’s glans at this time, or by washing it with the same washcloth used to clean off feces, the parent or caretaker may be inadvertently introducing trace amount of fecal bacteria into the urinary meatus. The parent or caretaker of a circumcised child is usually given no particular instruction as to the care of the child’s penis, and would not normally be giving any special attention to touching or cleaning the baby’s glans or meatus at this or any other time.
In my own, widely distributed information sheet on the correct care of the intact child’ penis, I have always advised parents to either leave the baby’s foreskin entirely alone (which appears to be the normal practice in other countries where virtually all males are left intact) or to very gently retract it no further than it will easily go while bathing the baby or changing his diapers. However, in the light of Wiswell’s finding, and my own strong suspicion of how the contaminating bacteria may be introduced, I am seriously considering rewriting my information sheet to reflect an even more conservative stand about leaving the infant foreskin entirely alone during the diaper wearing period. Although I occasionally retracted my own infant sons’ foreskin during bath time (always very gently) I see absolutely no reason for doing so. I never, honestly, could see anything there to clean.
(Editor’s note – This information in the article “Caring for your Intact Boy” has since been revised.)
It appears to be well established that leaving the infant’s foreskin entirely alone (i.e. never retracting it, only washing the outside of it during the bath, just as all other parts of the body are washed) is a completely safe practice (based upon observances of entire populations of males in most parts of the world where infant circumcision is not practiced.) Therefore, why risk even a slight possibility of introducing an infecting pathogen via contaminated fingers or washcloth, through even the gentlest retraction of the foreskin?
I would also pose that urinary tract infections are less common among older intact boys than among infants, not because the foreskin is more likely to be retractile at a later age, but simply because the older child is no longer wearing diapers, and therefore is less likely to be in contact with his own feces, from whence most urinary tract pathogens originate. And I would also hypothesize that under ordinary, non-interventive circumstances, in which the normally tight infant foreskin is left entirely alone, it would be more likely to prevent such infecting pathogens from entering the urinary tract.
2.) My second concern is how the risk of uti in the intact infant (whether preventable by my previously posed “hands off” hypothesis or not) balances against the many well known, medically documented complications of circumcision.
I have enclosed a xeroxed copy of the chapter on “Complications of Circumcision” from my book Circumcision: The Painful Dilemma for each of the AAP members who will receive this letter. I am certain that you are aware of most, if not all of these complications already. I realize that some of the complications listed therein are extremely rare. However, many of the more recognized complications such as hemorrhage, infection of the circumcision wound, and various types of disfigurations of the penis are statistically significant, and are generally much more qualitatively devastating and life threatening than urinary tract infections (which are normally readily treatable with antibiotics.) I would wonder what the rates of circumcision complications were among the circumcised infants in Wiswell’s studies.
I wish to particularly draw your attention to the first two complications which I have covered in my chapter on the subject: those two conditions being meatal ulceration and meatal stricture and the resultant urinary and renal difficulties brought about by continued erosion and constriction of the unprotected infant glans during the diaper wearing period. This problem has particularly concerned me because two of my own sons had difficulty with meatal ulceration, one of them to a particularly severe extent. Today I have been particularly thankful for the knowledge that has led me to leave my youngest son intact – not only because of his having been spared a traumatic experience during his newborn days, nor out of a personal desire to see my own years of knowledge and research manifested in my choice for my own child, but simply because I know that his more sensitive glans is protected from abrasion, ammonia irritation, and diaper contact, by the protection that his foreskin provides (much as the way eyelids protect the more delicate, sensitive eyes.) While pro-circumcision oriented thinking has led the public to believe that the intact penis is “terribly fraught with difficulties” and that the circumcised penis “needs no particular care”, in my own experience I have found the opposite to be true. I have been very much thankful not to be hassling with the troublesome problems with meatal ulceration that my other sons manifested. I have honestly found my youngest son’s intact state so ridiculously simple that I am amazed that people still continue to make such an incredible case over the subject, or for that matter, that I wrote a 454 paged book on the subject.
Unfortunately we still have a circumcision biased society. I have heard circumcision defined as a “solution in search of a problem.” The repeated media coverage over the past few years of the non-necessity of infant circumcision, with emphasis on infant pain and trauma and lack of personal choice were bound to invite a backlash. Therefore, it seems to me that the Wiswell report has received an unusual and disproportionate amount of media coverage. This is not to say that Wiswell’s study should be disregarded. But it appears to me that other, equally significant medical data describing the many complications or otherwise indicating distinct disadvantages of infant circumcision have been largely ignored or glossed over by a large proportion of both the media and the medical profession. I recall a family relative, a general practitioner, being quite skeptical and unsupportive of my extensive research and work in opposition to infant circumcision because in his opinion/experience “non-circumcised boys have so many problems.” Yet I recall at an earlier date, his observing my second son’s extensive difficulties with meatal ulceration and simply shrugging it off as “that’s just a common problem that baby boys have.” Therefore, does the American, circumcision oriented mindset choose to perceive and emphasize problems where it wants to see them while ignoring other types of problems where it does not want to believe that they exist?
3.) My third area of concern is that of the very small overall percentages of uti among both intact and circumcise infants and what bearing this has on the advisability of any proposed universal newborn circumcision in terms of cost/effort/effectiveness. Depending on whose figures one considers, at least several hundred, more likely overall, several thousands of intact infant boys have perfectly healthy foreskin and do not develop uti for every one that does. I note that in Wiswell’s 1985 study, 24 out of 583 intact infants developed uti, with the other 559 presumably having no problems. In his 1986 study only 8 out of 44 intact infants had uti, with the other 36 presumably having no problems. (Wiswell’s figures being 4.12% and 1.8% respectively for the rates of uti among intact infants in each group.) However, I note in Altschul’s letter in Pediatrics (Vol. 80, No. 5, Nov. 1987, p. 763) that over a period of 6 years (1979-1986) out of approximately 25,000 total infants cared for at Northwest Region Kaiser Foundation Hospitals, only 19 infants in all developed uti’s. Of these only two were normal intact boys. Altschul notes that the newborn circumcision rate declined from 83% to 76% during that period. Estimating that roughly half of the total infants in the study were boys, this would leave an approximate figure of 12,500 male infants. Noting that between 17% and 24% of those baby boys were left intact over the years, and choosing a mean percentage of 21% left intact in all, would leave a figure of roughly 2,623 intact male infants. If only two of those infants developed uti’s, then roughly 2,621 of those intact infants presumably had normal foreskins with no urinary tract difficulties. (Altschul gives a figure of roughly 0.12% for the rate of uti among intact boys in his investigation.)
Therefore, I and many others question the overall advisability of needlessly destroying hundreds, if not thousands of presumably normal and health infant foreskins to purportedly “prevent” a small percentage of uti’s, in light of 1.) uti infections being easily treatable through antibiotics, 2.) uti probably being virtually totally preventable via a non-invasive approach to the care of the infant foreskin, 3.) the risk of the many well documented complications of the circumcision operation itself, 4.) the purpose, function, and advantages to having a foreskin, 5.) the risk of pain and trauma inflicted upon an infant if circumcised, and 6.) the matter of individual, personal rights as regards to keeping or losing a part of ones body, of which an infant is not afforded if circumcised. (These three final concerns I will address in the remainder of this letter.)
4.) The function of the foreskin. We usually consider all normally occurring body parts in terms of their function and usefulness, despite any attendant problems that they might impose. i.e. Toes balance out and complete the foot. However, most of us do not need toes for tree climbing (as the probably served our primitive ancestors), and people could probably walk and function perfectly well with digitless feet. Toes require considerable extra effort to keep one’s foot clean. Probably a myriad of physical ailments such as corns, bunions, and athletes’ foot could be prevented were people spared the nuisance of toes. A simple operation to amputate the toes of all newborn babies could spare each individual a lifetime of potential health problems. Nonetheless, I am certain that virtually all parents and medical practitioners alike would reject such a procedure as ludicrous and repugnant. Similarly, outer ears complete the structure of the face and enhance ones hearing ability. But outer ears also collect earwax and dirt and can become infected or cancerous. Nonetheless, routine newborn preventative amputation of outer ears would never be accepted as a valid and worthwhile hygienic measure. (I understand that even tonsils and appendixes, once thought of as only disposable, have now been discovered to have a function within the entire body system.)
I realize that the above analogies using ears and toes sound quite silly, but I have used them simply to make a point. Can we ever learn to think of the foreskin in the same light? My research has repeatedly revealed that the foreskin is a useful, protective body part. As I have already emphasized in my discussion of meatal ulceration, the foreskin covers and protects the more sensitive glans of the penis from ammonia irritation in diapers. In the older child and adult it protects the glans from abrasion, from outer clothing, and undoubtedly it protected our more primitive ancestors from brambles and sunburn. The absence of the foreskin through circumcision makes what nature intended to be an inner organ (the glans) into an outside organ. Therefore, the glans of the intact male is much more sensitive. Many people claim that the intact male has a much better experience of sexual sensation. Furthermore, the foreskin is a sensitive piece of tissue, listed among the body’s many erogenous zones. Therefore, some sexual sensations are lost if this skin is gone. Some men claim that the foreskin affords for greater ease in sexual penetration and for greater variations in sexual foreplay and masturbation.
Unfortunately, I have found that those of us who strongly support the choice of leaving ones son intact come up against a huge mental “roadblock” when we attempt to present this facet of information about the foreskin. Most American males have been circumcised, and most American doctors are male. Most American women are abysmally ignorant about the entire subject. Perhaps I am in a unique position, having thoroughly researched the topic, and being female, not having to consider the state of my own genitals in this matter, I have been able to explore this facet of the issue straightforwardly and factually.
Under separate cover I am sending one copy of my book Circumcision: The Painful Dilemma as a complimentary gift to the American Academy of Pediatrics. I am sorry that I can only afford to send you one copy. But it is my sincere hope that each of you will use it as a reference as you carefully research and consider this issue. I implore you to please, at least take to heart the many individual reports from the people whose experiences have been shared in my book and seriously consider this facet of the issue in terms of what one is actually doing to a little boy by taking away his foreskin.
What I consider to be the most important facet of the entire issue is that of individual, personal rights. A baby or small child does not have a choice about whether or not he will keep his foreskin or lose it through circumcision. If someone grows up intact and decides that he would rather be circumcised, he can always have it done very easily. But if someone grows up circumcised and wishes that he had his foreskin, he cannot grow another one.
While this was an aspect that, as a woman, had never even occurred to me when I first set out to explore this topic, I have found a large number of men, many of whom have become strong supporters of the growing concern against routine infant circumcision, who were circumcised as infants or young children, and who do have strong feelings of missing something due to their lack of foreskins. While I certainly have no nationwide cross-section sampling of overall male attitudes about circumcision, and would venture to guess that probably most men are content with themselves the way they are, simply the fact that some men do have valid feelings of loss and resentment over not having foreskins strongly challenges the ethics of altering another persons’ (i.e. a baby’s or young child’s) body without his permission.
Jeffrey R. Wood (past president of the now inactive INTACT Educational Foundation in Wilbraham, MA.) defined our nation’s approach to infant circumcision as one of “parental/medical authoritarianism.” Therefore, the choice is one of dictating to the child: “You cannot have that part of your body!” versus respecting the child for himself and allowing him to keep (or at least decide the fate of) all normally occurring body structures.
I have saved the facet of infant pain and trauma for last. My initial concern over infant circumcision was borne out of an overwhelming feeling of cruel violation of the precious innocence of my own newborn sons and my own maternal protective instincts. My book and much of my earlier writings emphasized this aspect extensively. However, I fear that I and many others have often overemphasized the “infant pain and trauma” issue to the point that others have only partly heard us. Today increasing numbers of doctors are using local anesthetics while performing infant circumcision. Although use of a local probably does alleviate at least some of the infant’s pain, I have repeatedly pointed out that just forcibly strapping an infant down and working on him is in itself stressful for a baby, injections directly into the penis are not without pain, and the circumcision wound will be sore and raw for several days, especially when the baby urinates.
It appears that a lot of people think that they have “solved the problem” of the whole circumcision “dilemma” by using a local anesthetic. For some use of a local for infant circumcision has created an excuse to sweep all of the other issues under the rug.
I greatly appreciate your time and consideration in carefully reading and thinking about each of the issues I have covered in this letter, as well as the information covered in my chapter on complications, and in the enclosed information sheet on the care of the intact child. Also, I thank you for using my book Circumcision: The Painful Dilemma as one of your references and for giving each facet of its message your most careful consideration.
Incidentally, I am well aware that all too frequently egos and unfortunate “politics” seriously hampers people’s ability to communicate and cooperate in endeavors such as this. Therefore, while I have thoroughly researched the subject of circumcision for many years, I also know full well that in some circles my works may not be taken seriously simply because I lack an M.D. degree. Therefore, if any of you wish to adopt any of my suggestions as “your own” and attach your own name and title to it instead of mine, please go ahead and do so if this will give it a better chance of acceptance within the medical community. I have long outgrown any need for ego gratification and “limelight” in this.
I will very much appreciate being kept posted on your complete findings and conclusions re Wiswell’s study, particularly the extent to which my own suggestions herein are taken into consideration.
Thank you again for this opportunity to communicate. If I can be of any further assistance to you in any way, such as providing you with any additional information, please let me know.
President of Peaceful Beginnings
Author of Circumcision: The Painful Dilemma
© 1985, Bergin & Garvey, South Hadley, MA.
Copies of this letter were initially sent to the following individuals:
American Academy of Pediatrics Board Members:
Richard M. Narkewicz, M.D., S. Burlington, VT.
Donald W. Schiff, M.D., Littleton, CO.
William C. Montgomery, M.D., Detroit, MI.
James E. Strain, M.D., (c/o AAP) Elk Grove Village, IL.
David Annunziato, M.D., (c/o AAP) Elk Grove Village, IL.
George Comerci, M.D., (c/o AAP) Elk Grove Village, IL.
Robert Grayson, M.D., Surfside, FL. *
Birt Harvey, M.D., (c/o AAP) Elk Grove Village, IL.
Kenneth O. Johnson, M.D., Milwaukee, WI.
Maurice E. Keenan, M.D., West Newton, MA.
Betty A. Lowe, M.D., Little Rock, AR.
Arthus Maron, M.D., West Orange, NJ.
Leonard P. Rome, M.D., Shaker Heights, OH.
Edgar J. Schoen, M.D., Oakland, CA. **
* Dr. Grayson requested removal from Peaceful Beginnings’ mailing list after receiving this letter.
** Dr. Schoen was the chairman of the AAP 1989 task force on circumcision. He is strongly pro-circumcision.
Peaceful Beginnings Board Members: (as of 1989)
Penny Bradbury Armstrong, CNM, Gordonville, PA. *
Richard J. Eliason, M.D., Salt Lake City, UT.
Robert W. Enzenauer, M.D., Denver, CO. **
Paul Fleiss, M.D., Los Angeles, CA.
Juan R. Fraga, M.D., Alexandria, VA.
John C. Glaspey, M.D., Racine, WI.
Belinda Lassen, R.N., Des Moines, IA. ***
Delwyn L. Lassen, M.D., Des Moines, IA. ***
Edward J. Linkner, M.D., Ann Arbor, MI.
John T. McCarthy, M.D., Honolulu, HI. ****
Marilyn Milos, R.N., San Anselmo, CA. *****
John Money, Ph.D., Baltimore, MD.
Carl Otten, M.D., Indianapolis, IN.
Nancy Otten, R.N., Indianapolis, IN.
Janice Presser, R.N., Palmyra, NJ.
John C. Redenius, M.D., Waterloo, IA.
Thomas E. Reichelderfer, M.D., Annapolis, MD.
Thomas J. Ritter, M.D., Orwigsburg, PA.
Peter S. Rosi, M.D., Des Plaines, IL.
Gregory Skipper, M.D., Newberg, OR. ***
T.D. Swafford, M.D., Seattle, WA.
Martha A.T. Walke, M.D., Abilene, TX.
* Ms. Armstrong now resides in Island Falls, ME.
** Dr. Eliason is a close colleague of Wiswell. He remains supportive of Peaceful Beginnings and the concern against infant circumcision.
*** Dr. Lassen, Belinda Lassen, & Dr. Skipper are now no longer serving on Peaceful Beginnings’ board.
**** Dr. McCarthy has been “lost” after a letter was returned “unforwardable.”
***** Ms. Milos is the president of NOCIRC in San Anselmo, CA.
****** Dr. Ritter has since authored the book Say No To Circumcision. He passed away during the 1990’s.
******* Dr. Swafford passed away during the 1990’s.
Gail Brewer, San Francisco, CA. (author of many books on birth, infancy and prenatal nutrition, former Peaceful Beginnings board member.)
Anne Briggs, Charlottesville, VA. (author of Circumcision: What Every Parent Should Know, © 1985, Birth & Parenting Publications, Earlysville, VA.)
Suzanne Arms, Palo Alto, CA., (author of Immaculate Deception, © 1975, Houghton Mifflin, Boston, MA. and several other books on birth-related issues.)
Edward Wallerstein, New York, NY.* (author of Circumcision: An American Health Fallacy, © 1980, Springer Publications, NY.)
Kurt Bomke, Oakland, CA.
John Erickson, Biloxi, MS.*****
George Soule, Washington, D.C. **
Warren Smith, Lakehurst, NJ.
James Peron, Richboro, PA. ***
John G. Schwede, St. Petersburg, FL.
John Forakis, Modesto, CA.
D.C. McKnight, D.C. *** Dr. McKnight passed away during the 1990’s
Chris Davenport, New Canaan, CT.
Julia Attwood, Portland, OR. ****
Jeffrey R. Wood, Wilbraham, MA. (Founder of INTACT Educational Foundation which disbanded in 1986.)
Thomas E. Wiswell, M.D., Derwood, MD. (Author of numerous studies associating infant circumcision with lower rates of urinary tract infections.)
* Mr. Wallerstein became incapacitated from a stroke in 1988 and died in 1991.
** Mr. Soule passed away in 1990.
*** Mr. Peron & Dr. McKnight are now Peaceful Beginnings Board members.
**** Julia Attwood now goes by Julia Bertschinger.
***** Mr. Erickson passed away in 2001.
Individuals who had letters published in Pediatrics in response to Wiswell’s findings:
Stan J. Watson, M.D., Palm Springs, CA. *
Nicholas Cunningham, M.D., Dir. P.H., New York, NY.
Peter Malleson, M.D., B.S., MRCP, Vancouver, B.C., Canada.
Martin S. Altschul, M.D., Salem, OR.
*A recent letter to Dr. Watson’s Palm Springs address was returned “unforwardable.”
Update: In 1989 the AAP re-issued a non-committal statement that infant circumcision “… may have benefits as well as some definite disadvantages and risks.” (This statement underwent unfortunate media distortion which led the reader to believe that the AAP had “reversed its position” and was more pro-circumcision than they truly are.)
In 1999, the AAP task force on circumcision (comprised of a completely different group of doctors) re-convened, and issued a similarly non-committal statement: “… these data (in support of circumcision) are not sufficient to recommend routine neonatal circumcision. …the procedure is not essential to the child’s current well-being.” They conclude by urging parental decision and recommend procedural analgesia. (PEDIATRICS, vol. 103, #3, p. 686-693, March 1, 1999.)
In 2012 the American Academy of Pediatrics issued a statement that is somewhat more biased towards promoting infant circumcision. Every other medical organization in the rest of the world * has come out against routine circumcision (or has at least verified its non-necessity.) With their most recent statement the American Academy of Pediatrics has entirely ignored the matters of personal body ownership (since no baby can consent to circumcision), infant trauma, and the protective and sensual function of the foreskin. They have also trivialized the multitude of devastating injuries and deaths resulting from circumcision complications. (If a toy or other product were to cause as many injuries or deaths as has circumcision it would be quickly taken off the market.) The AAP has been sent numerous medical documentations of these and other matters, which they have apparently ignored. We suspect that medical arrogance because a grass roots movement opposing circumcision has been successfully influencing the public has skewed their stand (even though this movement includes countless doctors and other medical professionals). We also believe that financial incentives have held sway since there is much money to be made from circumcising babies. Parents or insurance companies pay for the operation. Infant foreskin tissue is then sold to pharmaceutical and cosmetic companies for use in various skin care products.