New England Journal of Medicine

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The New England Journal of Medicine (NEJM) has shifted from a balanced approach, to a one-sided, pro-circumcision stance. They have a tendency to present the purported benefits of circumcision, while failing to print any letters critical of these claims, and failing to confront the ethical problems and medical complications associated with circumcision.

Shift from neutrality to a pro-circumcision stance

In 1997, the NEJM printed a strongly pro-circumcision editorial by Dr. Thomas Wiswell,[1] but did not print the alternative opinion in favor of normal anatomy (see Abstracts & Analysis). When misinformation in Wiswell's editorial was brought to the attention of the editor, there was no attempt to correct Wiswell's exaggerated benefit claims. In contrast, the NEJM had printed a Sounding Board discussion of circumcision examining the purported advantages and disadvantages of circumcision earlier in 1990.[2][3]

In a previous article in the NEJM, Royce et al. insinuated that the prepuce may be a risk factor for HIV infections.[4] This factually inaccurate article was referenced in a letter to the editor as proof that circumcision protects an individual from HIV infections.[5] The NEJM failed to mention, however, that Laumann pointed out the fallacy of this logic. "The lack of rigorous, systematic controls for co-factors relevant to the particularities of the African context, the prophylactic status of the presence or absence of the foreskin remains an open question."[6]

Research the NEJM has overlooked

Circumcision is losing popularity in the United States and has been discredited by the Canadian Pediatric Society[7]and the Australasian Pediatric Surgeons[8] in 1996 position papers. Taylor described the unique innervation of the preputial mucosa in 1996, and its loss to circumcision.[9] Taddio et al. showed that circumcision with and without local anesthesia (EMLA) resulted in negative behavioral changes in a child's response to pain.[10] Laumann has shown that circumcision causes sexual behavior changes and an apparent increased risk of many venereal diseases in adult men. [11] Price has questioned whether parents can ethically change their child's genitalia.[12]

The research on EMLA and circumcision presented by Taddio et al. was proclaimed as a major advance.[13] When the limitations of this form of local anesthesia was brought to the attention of the editors, they failed to print the criticism (see Abstracts & Analysis). They failed to point out that this form of local anesthesia (EMLA) did not prevent the long term negative behavioral response to pain previously reported in the Lancet. [14] The lack of effects of EMLA on long term negative behavioral changes caused by circumcision was printed in British medical journals.[15][16]

References

  1. Wiswell TE. Circumcision circumspection. N Engl J Med 1997; 336:1244-5.
  2. Schoen EJ. The status of circumcision of newborns. N Engl J Med 1990; 322:1308-12.
  3. Poland RL. The question of routine neonatal circumcision. N Engl J Med. 1990; 322:1312-5.
  4. Royce RA, Sena A, Cates W Jr, Cohen MS. Sexual transmission of HIV. N Engl J M ed 1997; 336:1072-1078.
  5. JAMA 1997; 278(3):201
  6. Laumann EO. JAMA 1997; 278(3):203
  7. Fetus and Newborn Committee, Canadian Paediatric Society. Neonatal circumcision revisited. Can Med Assoc J 1996; 154:769-80.
  8. Australasian Association of Paediatric Surgeons. Guidelines for circumcision. April 1996.
  9. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996; 77:291-95.
  10. Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997; 349:599-603.
  11. Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practices, and sexual practice. JAMA 1997; 277:1052-7.
  12. Price (Bull. Medical Ethics).
  13. Taddio A, Stevens B, Craig K, Rastogi P, Ben-David S, Shennan A, Mulligan P, Koren G. Efficacy and safety of lidocaine-prilocaine cream for pain during circumcision. N Engl J Med 1997; 336:1197-1201.
  14. Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997; 349:599-603.
  15. Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997; 349:599-603.
  16. Taddio A, Goldbach M, Ipp M, Stevens B, Koren G Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet 1995; 345:291-2.
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