Health News Review

A reasonable report on a new policy statement by the American Academy of Pediatrics.

Our Review Summary

This story adequately addressed most of our criteria; exceptions were actual costs and better discussion of potential harms.


Why This Matters

Circumcision has been on the decline in the country although the American Academy of Pediatrics’ examination of the evidence suggests that long-term health benefits from this procedure may outweigh risks associated with circumcision, a stance they have not taken in the past.


Criteria

Not Satisfactory

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Cost was mentioned as a barrier for some people but no actual cost estimates were given in the story.  AP’s story gave a CDC estimate of nationwide costs ranging from $200-600.

Satisfactory

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

Only relative risk reduction figures were given for UTI and HIV risk reduction.

The AAP website notes: “A slightly lower risk of urinary tract infections (UTIs). A circumcised infant boy has about a 1 in 1,000 chance of developing a UTI in the first year of life; an uncircumcised infant boy has about a 1 in 100 chance of developing a UTI in the first year of life.”  This would have given readers a bit more of an idea of what the numbers are.

Nonetheless, the NPR story did a better job on this by giving some numbers than did the competing AP story, so we’ll give it a pass.

Not Satisfactory

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The only specific harm mentioned in the story was critics’ comparison to genital mutilation.

But the story didn’t cite what the AAP wrote in its statement:

“Complications are infrequent; most are minor, and severe complications are rare.”

Or what appears on the AAP website:

Problems after a circumcision are very rare. However, call your pediatrician right away if

  • Your baby does not urinate normally within 6 to 8 hours after the circumcision.
  • Bleeding doesn’t stop.
  • The redness around the tip of the penis gets worse after 3 to 5 days.
  • Yellow discharge lasts longer than a week. It is normal to have a little yellow discharge or coating around the head of the penis in the first week.

 

Satisfactory

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story attempted to discuss some of the limitations of the evidence by citing the HIV health benefit was mainly based on evidence from Africa. But the story was short on the specifics of the research methods other than noting, the task force, “….analyzed more than a thousand studies.”  Nonetheless, we’ll give it the benefit of the doubt on this criterion.

Satisfactory

Does the story commit disease-mongering?

Satisfactory

The story did not commit disease mongering.

Satisfactory

Does the story use independent sources and identify conflicts of interest?

Satisfactory

Both advocates for circumcision and opponents were quoted within the story.

Satisfactory

Does the story compare the new approach with existing alternatives?

Satisfactory

The alternative is no circumcision and was presented in the article.

Satisfactory

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The availability is clear in the story, as is the decline in use…and the fact that many state Medicaid programs have stopped covering it.

Satisfactory

Does the story establish the true novelty of the approach?

Satisfactory

The story makes it clear that the AAP has previously issued recommendations on the topic of circumcision and points out that this latest recommendation is a bit contrary to that previously issued.

Satisfactory

Does the story appear to rely solely or largely on a news release?

Satisfactory

The article does not rely solely on a press release and attempted to obtain quotes from individuals not involved in the policy recommendations.

Total Score: 8 of 10 Satisfactory


Comments

Ron Low posted on September 2, 2012 at 4:25 pm

The story did not mention that in their report the AAP admits they excluded deaths, amputations, and botched jobs so severe they required surgical revision. Hundreds of US doctors specialize on doing such revisions.

Reply

Ash Paul posted on September 4, 2012 at 9:33 am

You might be interested to read this posting from Brian Earp, from the University of Oxford, writing in the Practical Ethics Blog:

The AAP report on circumcision: Bad science + bad ethics = bad medicine

Web-link:
http://blog.practicalethics.ox.ac.uk/2012/08/the-aap-report-on-circumcision-bad-science-bad-ethics-bad-medicine/

Reply

Judith Lienhard posted on September 5, 2012 at 11:56 pm

no mention is made of how circumcision impacts breastfeeding. circumcision is an elective, cosmetic procedure done to a patient who cannot consent!

Reply

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