Royal Australasian College of Physicians disowns Brian Morris

The following letter was sent to the Sydney Morning Herald by Professor David Forbes, Chair of the Paediatrics & Child Health Policy & Advocacy Committee, Royal Australasian College of Physicians. He is commenting on a disgraceful article about the RACP's recently released circumcision policy - an article that is not really a news item at all, but an editorial defending routine circumcision of innocent babies, criticising the RACP for rejecting the practice, and giving sympathetic coverage to the maverick views of the notorious circumcision fanatic, Professor Brian Morris. 

The article is quite in keeping with the SMH's decrepit pro-circumcision policy and expresses its complete failure to keep up with developments in science, medicine, medical ethics, human rights and law. Wake up, granny!

The letter was posted at 6minutes - Interesting stuff for doctors today.

Please find copied below a letter sent to the SMH today in response to this article from the RACP.

Dear Editor, 

Your Friday 11 article "Doctors circumspect on circumcision" warrants clarification on a number of issues.

The key point of the recently released RACP statement on circumcision is that the RACP believes that at the present time there is not evidence to support routine circumcision of newborn and infant males.

Your article sends a dangerous public health message that circumcision prevents HIV transmission. It is vital that everyone engage in safe sexual practices such as condom use, whether circumcised or not.

Recent reports of circumcision offering some protection against HIV infection in Africa relate to circumcision of adult males, not of infants. Further the stated benefits of protection against urinary tract infection are marginal, and do not justify mass circumcision. Our changing understanding of the relationship between urinary tract infection and chronic renal disease further weakens the case for routine circumcision.

There is evidence that circumcision does result in memory of painful experiences, and is not quite as simple and low risk as your report states.

The Colleges' recent statement is not anti-circumcision, but clearly states that parents should be informed of risks and benefits, and then supported in their decision. When circumcision is undertaken it should be with appropriate anaesthesia, and by a skilled operator who can minimise the risks of side effects.

The option of delaying the decision to circumcise is one way of dealing with the ethical and potential legal issues of undertaking an elective procedure on a minor.  The procedure is not to be equated with vaccination, either in its delivery or in its effectiveness.

It should be noted that Professor Morris, quoted in your report, is not a member of the RACP and is not and has not been engaged as a reviewer for the College.

Yours faithfully, 

David Forbes,

Chair, Paediatrics & Child Health Policy & Advocacy Committee

Royal Australasian College of Physicians. 

11 September 2009

6minutes - Interesting stuff for doctors today

RACP's new circumcision policy available here

The wit and wisdom of Brian Morris

Professor Morris has been waging a one-man war against the foreskin since the mid-1990s, using his professorial position at Sydney University to give the impression that he speaks with the voice of medical authority. ("As a full professor at Australia's largest medical school I must insist ... etc etc etc".) On at least one earlier occasion in the past the university has felt obliged to caution Professor Morris for claiming to speak on behalf of the university, when he was only uttering his personal opinion. (Though the university has not gone so far as to require Morris to move his eccentric website from the Physiology Department's server.)

Among Morris's charming eccentricities are the following gems:

• Louis XVI of France was forced to get circumcised in order to become capable of having sex with his wife.
• The former Pope died of a urinary tract infection caused by his foreskin.
• Boys should be circumcised to prevent their foreskins getting caught in the zipper of their jeans.
• Uncircumcised men need three showers a day to keep the stench of their foreskin down.
• Uncircumcised men always make a mess on the bathroom floor when taking a leak.
• Circumcision must be performed in infancy because if the choice was left up to the individual to make when he grew up he would make the wrong decision.

It is quite disgraceful that the SMH fawns on this maverick and cites his minority opinions against the considered judgement of Australian medical authorities.

Sydney Morning Herald's twisted logic in attacking/defending circumcision

Editorial: Arguments as old as the practice

MORE than a billion men are circumcised and billions more have undergone the ritual over the centuries. The practice is both ancient and commonplace. Yet now we are supposed to accept the argument, promoted in some ethical circles, that circumcision is both dangerous and an infringement on the rights of the child.

Any surgical procedure, however minor, is dangerous if performed crudely. The world is full of risks, with children the most vulnerable. What matters is proportionality. A report from the Tasmanian Law Reform Institute, released this week, suggests that, in the absence of specific laws relating to the practice of circumcision, it may be an abuse of the rights of the child. The report goes so far as to countenance that circumcision itself may, by its very nature, be an act of cruelty, law or no law.

The matter has been given an airing after the Tasmanian Children's Commissioner, Paul Mason, sought guidance from the institute for the handling of cases where, for example, a dispute arises over whether a child should be circumcised. This is a nettlesome legal issue because cultural practice is divided and the law is largely silent.

The cultural direction in Australia is moving away from circumcision. Western medical organisations no longer recommend routine neonatal circumcision. What used to be commonplace, involving more than 90 per cent of male infants born in Australia in the 1950s, has become a minority position. Only about one in seven newborn boys are circumcised. The majority of circumcisions involve religious customs, largely the rites of Muslims and Jews.

The arguments for and against male circumcision are as old as the practice itself. In Australia, the procedure has a negligible rate of serious physical injury. Proponents argue the practice leads to lower rates of infection from sexually transmitted diseases, and has no adverse impact on sexual function. Opposition has largely come in the form of ethical arguments over the rights of the child being compromised by a procedure performed for no reason other than cultural practice, with the possibility of later psychological injury. The argument that circumcision involves psychological risks is finding growing support in medical studies.

Common sense suggests that in a dispute between or within families over whether to circumcise, prudence favours leaving the child untouched. Common sense also suggests that where both parents want their child circumcised there are no compelling medical, legal or ethical grounds for not doing so.

Sydney Morning Herald, 4 June 2009

Comment

The Sydney Morning Herald's editorial is quite in accord with its longstanding practice of giving prominent publicity to every half-baked slander against the foreskin that posthephobic toilers in America's bloated medical research industry cook up, and ignoring the vast body evidence to the effect that circumcision of minors is a harmful, cruel and unnecessary procedure that violates the rights of the child and is already technically illegal under existing laws of assault, mayhem and molestation - as the Queensland Law Reform Commission found in 1993.

So long as ignorant editorial writers use their unaccountable power to champion bad habits it is unlikely that there will be any laws to restrict the practice of male genital mutilation, let alone the degree of protection from female genital mutilation afforded to women. The key facts that refute the editorial's concluding pontification are its earlier admissions that circumcision has always been a controversial and contested operation, and on a world scale a minority practice. These facts alone dictate that the only person entitled to make an irreversible decision about the shape of his penis is its owner.

At least the SMH had the decency to publish Paul Mason's letter, pointing out the crazed illogic in the editorial's position. The way some  circumcision promoters attempt to argue, you would think it was a large chunk of their brain that had been surgically removed in infancy.

The paper by Tasmanian Law Reform Institute is here.

Stopping circumcision a matter of human rights

Your editorial ("Arguments as old as the practice", June 4) misrepresents my input into the Tasmanian Law Reform Institute's issues paper on the validity of parental consent to unnecessary circumcision, and reveals a glaring non sequitur.

You conclude that "there are no compelling medical, legal or ethical reasons for not" operating on a boy without his informed consent -- but only after observing that "the law is silent"; that circumcision "may be an act of cruelty"; that medical organisations no longer recommend routine circumcision; that "the possibility of ... psychological risks is finding growing support in medical studies"; and that "prudence favours leaving the child untouched".

I did not refer the issue to the institute in connection with cases where a dispute arises whether to circumcise: the law is pretty clear that it will not proceed in those cases. I referred it in the context that babies are human beings and all human beings have the right to bodily integrity assured by the Universal Declaration of Human Rights (1948). I referred it in the context that the first principle of the Hippocratic Oath is "Do no harm" and that the irreversible, invasive and painful removal of any neurologically complex external organ of a powerless patient at the request of a third party is an ethical travesty.

Your editorial seeks to seduce readers into denying babies and children their legal and human rights, while taxpayers are footing the bill through Medicare - circumcision is the only item that requires no medical indication for payment. One reason for its declining popularity in the West since the 1970s may be the influence of women, who see their babies as perfect and not for cutting: from this perspective unnecessary circumcision is a feminist issue.

Paul Mason Commissioner for Children, Hobart

Letter: Sydney Morning Herald, 6 June 2009

Australian children healthier than ever: Boys with foreskins are happier

The health of Australia's children continues to improve, according to the latest report on child health from the Australian Institute of Health and Welfare.

During the period 1986-2006 there was a dramatic decline in infant and child deaths (which fell by half), improved survival in cases of cancer, and a reduction in the incidence of asthma.

These are significant findings, given that the period 1986 to 2006 witnessed a huge decline in the incidence of circumcision, from about 40 per cent of boys in the early 1980s to about 10 per cent in 2006. It is thus good empirical proof that "lack of circumcision" does not increase child health problems.

Even more significantly, it is a decisive refutation of "scientific" predictions by Terry Russell, Brian Morris and other diehard promoters of routine circumcision  that the fall in the circumcision rate would lead to an explosion of genito-urinary problems in boys and an ever-increasing death toll from urinary tract and bladder infections. No such problems are identified in this report, which does not even mention any health problems affecting the genito-urinary area.

On the contrary, the halving of the death rate among infants and children suggests that leaving the foreskin in place has significantly improved child health outcomes and contributed to the decline in infant and child mortality. It is, after all, quite illogical to claim that a boy with great wound in his penis is somehow healthier than a boy who has not been injured there. As the British child health expert N.R.C. Roberton points out, "it is fundamentally illogical that mutilating someone might be beneficial." *

Problems identified by the AIHW report include an increasing incidence or diabetes and obesity, more, tooth decay, too much television, not enough vegetables, and persistent poor health among indigenous Australians.

It is hard to see how even a fanatic like Brian Morris could blame "lack of circumcision" for children not eating their vegetables.

The Australian Institute of Health and Welfare is the Australian Government's premier health research foundation.

The full report and press release can be downloaded from the AIHW website.

Reference

N.R.C. Roberton, "Care of the Normal Term Newborn Baby," in Textbook of Neonatology, eds. Janet M. Rennie, N.R.C. Roberton, 3rd edn. (Edinburgh: Churchill Livingston, 1999), 378-379.

Circumcision criticised in Human Rights Consultation: Submission argues that boys need protection even more than girls

The Commonwealth Government is holding a National Human Rights Consultation, providing the individuals with an opportunity for you to express their views on human rights. The Consultation is run by an independent Committee, supported by a Secretariat within the Attorney-General's Department.

The Consultation is a chance to hear people's ideas about human rights and talk about ways to protect and promote human rights in the future. The questions in which it is most interested are

• Which human rights and responsibilities should be protected and promoted?
• Are human rights sufficiently protected and promoted?
• How could Australia better protect and promote human rights?

The Committee has called for public submissions that address these questions and any other human rights about which people are concerned. For further details see the website.

A substantial submission from Dr Robert Darby has raised the question of circumcision and asked why boys are given no protection from unwanted alterations to their genitals when similar operations on girls or women are a serious criminal offence in most states.

The submission argues that human rights include the right to bodily integrity and to protection from unwanted surgical interventions:

In this submission it is argued that there is a glaring gap in the Australian human rights framework, namely, that boys are not given any protection against unwanted and unnecessary surgical interventions such as circumcision. It is suggested that boys are entitled to as much protection from circumcision (male genital mutilation) as girls from female genital mutilation (female circumcision). Since it is unlikely that any such protection will be provided by legislative measures, alternative means such as public education and the removal of financial incentives are proposed.

Read the full submission here.

Submission text also available on this site.

Circumcision of male children "a hidden human rights violation"

In the April 2007 issue of the Australian Journal of Human Rights, Ranipal Narulla argues that circumcision of male minors should be recognised as a violation of human rights.

Synopsis

Male circumcision is an accepted practice within Australian society, despite the fact that female circumcision is widely reviled in the Western developed world. This article will consider why society and the law treat circumcision of males and female differently. Analysis will focus upon the circumcision of male children in Australia, with reference to the United Kingdom and the United States of America. The similar social history of the practice within these jurisdictions is instructive when critically analysing the Australian context. The discussion will encompass the circumcision of all male children, as the issues of lack of consent and the imposition of a parent's religious and cultural norms upon the child are consistent for all minors, with specific focus on neonatal children where such extreme youth creates additional vulnerability. The absence of domestic law in Australia dealing with the circumcision of male children invites analysis of the protection afforded under international human rights instruments to which Australia is legally bound. This article deconstructs the medical myths that surround the circumcision of male children, and in so doing makes a strong argument for the need to recognise circumcision of male minors as a human rights violation.

Ranipal Narulla, "Circumscribing circumcision: Traversing the moral and legal ground around a hidden human rights violation", Australian Journal of Human Rights, Vol. 12, April 2007, pp. 89-118

The Australian Journal of Human Rights is published by the Australian Human Rights Centre at the University of New South Wales

On-line issues available from AustLii

Tasmanian Children's Commissioner wants circumcision banned

Tasmania's Children's Commissioner, Paul Mason, wants the State Government to ban the non-medical circumcision of young boys.

Female genital mutilation is illegal in Tasmania.

Mr Mason said it's unfair that boys aren't given the same protection. "We're discriminating against the little baby boys themselves, because they're not safe whereas the little girls are," he said.

He said circumcision is an abuse of human rights and should be outlawed until the person is old enough to decide for themselves. "It's a permanent procedure. They get no choice. It's painful -- even under anaesthetic."

Mr Mason has prepared a report on the issue for the Council of Obstetric and Paediatric Mortality and Morbidity. The Council will forward a recommendation to the State Government.

ABC News, 13 August, 2007

Circumcision specialist censured and fined for improper conduct

Dr Terry Russell, the ageing Queensland GP who has made a career and a fortune out of amputating the foreskins from baby boys, also seems keen to cut boys' tongues. In 2004 he was fined and censured by the Commonwealth Professional Services Review of Medicare services for falsely diagnosing "tongue tie" when the boys were brought to be circumcised, and cutting their tongue as well as their penis.

The frenulum that tethers the tongue to the floor of the mouth is very similar to the frenulum that tethers the foreskin to the rest of the penis. Perhaps Dr Russell feels that any body part resembling the foreskin should be removed "just to be on the safe side". There was a time, back in the nineteenth century, when many doctors believed that surgery to correct so called "tongue tie" should be as routine as cutting off the foreskin.

The Review reported that Dr Russell had been reprimanded, counselled and ordered to repay the $4,488.88 he had claimed from Medicare.

The Committee noted that there was no clinical indication for cutting the tongue and thus that there was no basis for performing the procedure, nor for claiming the cost of the service under Medicare. Had the Committee looked into the cases of the boys brought in to be circumcised, it would have found that there was no clinical indication for circumcision either, and thus that there was no basis for that procedure to be charged to Medicare. Apparently, the government believes that it is OK to alter the appearance and function of the (highly visible) penis without the consent of the owner, but not to interfere with anybody's (usually concealed) tongue.

The Medicare guidelines state clearly that Medicare does not cover "medical services which are not clinically necessary" or "surgery solely for cosmetic reasons". Why, then, does it continue to waste taxpayers' money on clinically unnecessary circumcision procedures?


The full text of the report on Dr Russell follows.

Director
Dr John Holmes

The Hon. Tony Abbott MHR
Minister for Health and Ageing
Parliament House
Canberra ACT 2600

Dear Minister

In accordance with subsection 63(1) of the Public Service Act 1999 and section 106ZQ of the Health Insurance Act 1973, I provide you with the 2003-2004 Annual Report of Professional Services Review for your presentation to Parliament.

This report has been prepared in accordance with the Requirements for Annual Reports approved on behalf of the parliament by the joint Committee of Public Accounts and Audit under section 63 of the Public Service Act 1999.

Yours sincerely

John Holmes
5 October 2004


Dr Charles Terence Russell,
General Practitioner, Qld

Dr Russell practiced at Macgregor and Browns Plains in Queensland during the referral period of 1 January 1999 to 31 December 1999 inclusive.

In relation to the rendering of MBS item 30278 (repair of tongue-tie) Dr Russell's conduct was found by the committee to be unacceptable to the general body of general practitioners. In the majority of services examined, the patients had seen Dr Russell for circumcision procedures. He subsequently performed repairs to tongue-ties. Given this pattern, the committee was concerned that while parents consulted with Dr Russell for circumcisions, he opportunistically diagnosed tongue-tie. The committee found there were no clinical indications for the services.

The services were examined in accordance with an approved sampling methodology which resulted in a finding that 90 per cent of MBS item 30278 services rendered by Dr Russell during the referral period were inappropriate. The committee detailed its reasons in a final report to the Determining Authority. Dr Russell did not make a submission on the draft determination. The Authority issued a final determination directing that Dr Russell be reprimanded, counselled and repay $4 488.88. The determination came into effect on 13 February 2004.

Text available on-line here.

If the link does not work, search for Russell +tongue tie +Medicare on Google.

Age op-ed writer calls circumcision male genital mutilation

It's child abuse and it's time it was cut out

Catherine Deveny

The Age (Melbourne), October 24, 2007

People give plenty of reasons for circumcising their male children, writes Catherine Deveny. But most of them don't amount to anything.

NO ONE seems to be able to explain to me why the circumcision of baby boys is not considered child abuse. Why in 2007 is it still acceptable for parents to have their babies' foreskins ripped off? How can it be legal, let alone ethical, for any human being to choose for another human being's body to be irreversibly mutilated? No medical reason, no rational thought and in many cases no aesthetic. Just because.

I suggest that we should ban the use of the term "circumcision" and force people to use the term "genital mutilation". Because that's what it is. It's not "a personal choice", because that person is not making a choice. It's human rights abuse.

The We Circumcised For Religious Reasons camp justify genital mutilation citing religion. They embrace the parts of religious texts that suit them and dismiss the ones that don't. And when I say "they", not all of them do. Many believers I know have all applied a little rational thought to the equation and just decided not to inflict unnecessary pain on their child or expose them to avoidable risk. They've decided to file that bit of the Holy Book under the other things that just don't fit; like selling your daughter into slavery or killing your neighbour if they work on the Sabbath.

What kind of God would disapprove of you, stop loving you, or not give you eternal life if you don't mutilate your child's genitals? That doesn't sound like a nice kind of God. And what caring community would shun you, judge you or ostracise you for not inflicting genital mutilation on your child?

Then we have the We Circumcised Our Boys So They Look The Same As Their Father camp. Sure, it's not fair for me to pick on people less fortunate in the brains department than the rest of us, but when they are subjecting innocent children to genital mutilation I'm going in swinging. I'm not going to bother asking the hard question "why do you need them to look like their father?", because you cannot reason with something that has not come from reason but from mindlessness.

I ask the So They Look The Same As Their Father camp, why stop there? If you want them to look the same as their father, dye their hair, have them undergo cosmetic surgery and if the father has any tattoos or facial hair, sort that out too.

Related to this camp is the We Circumcised Our Boys Because A Circumcised Penis Looks Nicer camp. We are talking the shallow end of the intelligence pool here. How would they feel if they had had their nipples, nose or ears cut off by their parents when they were a child because their parents thought "it looked nicer"? I must say that I do applaud these two camps on their frankness and honesty despite it revealing their stunning stupidity. After all, they could do what others do and make the decision for no rational reason and then rationalise it by joining the We Circumcised Our Boys For Health And Hygiene Despite Looking Closely At The Research camp.

I have read the various studies suggesting that circumcision may reduce the spread of HIV and cervical cancer. I have also read the studies disproving the circumcision-reduces-infection myth. Here in Australia, all of these risks can be effectively and safely managed with condoms and cleanliness. That's right, a bit of frangers and face washers, rubbers and rubbing. Why would you expose a child to an unnecessary medical procedure and all the risks that come with it when you could teach them how to clean themselves and use a condom? Because you can, I suppose. By the same logic, removing all your children's teeth would prevent them getting fillings.

Unless, of course, there is a sound medical reason to circumcise. And when I say sound, I mean sound as in last resort. I don't mean that you walk into a GP with a seven-year-old with a constricted foreskin that is not retracting and walk out with a referral to a surgeon to have your child's genitals mutilated, as a family I know could have.

One of their sons had that very problem. They were offered a referral to a surgeon to have him circumcised. They didn't like the sound of that. Luckily they didn't have private health insurance, because that meant that they were given a referral to the Royal Children's Hospital, where they saw a general pediatric surgeon, or as their son referred to her, a Dick Doctor.

Yes, she said, he could be circumcised, but she was having great success using an ointment available over the counter from the chemist. Three days later, the boy had a retracting foreskin. And two years later, he still does. The wonders of a health service on a budget as opposed to a private business. So if he wants to get himself circumcised as an adult, that's his choice. And he'll have that choice. Because when you circumcise someone, you can't uncircumcise them.

Professor fails history:

No evidence that Louis XVI was circumcised

In the latest rewrite of his familiar list of "compelling" reasons as to why boys must not be allowed to keep their foreskins [1], Professor Brian Morris makes the extraordinary claim that Louis XVI, King of France 1754-93, was prevented from consummating his marriage to Marie Antoinette by his "tight foreskin", and was obliged to submit to circumcision so that he could perform his marital duties. This assertion is presented as one of the numerous reasons why circumcision is "a biomedical imperative" for the 21st century.

The first point to make is that there is no evidence at all that Louis XVI was circumcised. Professor Morris seems to be awkwardly aware of the absence of evidence, for the only citation he provides for his claim is a reference to his own website. The story is one of the many anecdotes recorded as "compelling reasons" for circumcision by the notoriously unreliable circumcision evangelist Peter Charles Remondino, who wrote in the 1890s that the King "was afflicted by a congenital phimosis which prevented the flow of semen from properly discharging itself". But even a fanatic such as Remondino was forced to concede that that there was no truth in the circumcision rumours, for even if it had been suggested, Louis refused to submit to the operation. Instead, according to Dr Remondino, he worked on dilating his foreskin manually, with such success that he soon fathered three children. [2]

There has been much speculation as to why Louis and Marie took eight years to produce an heir. Explanations offered have included their strict religious educations, their traumatic childhoods, the extreme youth of the two spouses, and the condition of the King's foreskin. A reliable review of the case is provided by the Greek urologist G. Androutsos, who concludes that there is no evidence that Louis was circumcised, but suggests that he was probably late in reaching puberty and also that he might have had an associated persistent phimosis or a short frenulum (frenulum breve) that made intercourse difficult. If so, it is possible that the problem was corrected by a very mild surgical intervention, involving no more than nicking the strands of tissue that tethered the foreskin, and not by amputating anything from the royal person. [3] This would have been similar to the operation for phimosis later recommended by the French sexual health authority Philippe Ricord, and practised in England by William Acton. [4] There is no firm evidence that Louis ever had any kind of surgery on his penis, but if he did have an operation, this is the most likely contender.

Professor Morris's airy assertion that Louis was circumcised at the insistence of Marie-Antoinette's brother, Joseph II of Austria, is plainly false.

References

1. Brian Morris, "Why circumcision is a biomedical imperative for the 21st century", BioEssays, November 2007

2. Peter Charles Remondino, History of Circumcision from the Earliest Times to the Present: Moral and Physical Reasons for its Performance, Philadelphia and London, F.A. Davis, 1891, pp. 201-2

3. Androutsos G., Le phimosis de Louis XVI (1754-1793) aurait-il ete a l'origine de ses difficultes sexuelles et de sa fecundite retardee?. Prog Urol. 2002; 12(1):132-7.

An English translation of this article is available on this site.

1. William Acton,A Practical Treatise on the Diseases of the Urinary and Generative Organs (in Both Sexes), 2nd edition, London, Churchill, 1851, pp. 77-78