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To Circumcise or Not?

Rating

2 Star

To Circumcise or Not?

Our Review Summary

This story reports on two recent reviews evaluating the risks and benefits for male circumcision, which may factor into how the American Academy of Pediatrics revises its current neutral stance on infant circumcision.  As this piece points out, each review comes to different conclusions regarding the benefits and risks associated with male circumcision; however, a clearer discussion on how the outcome of studies involving adult circumcision performed on men in Africa may not necessarily translate well to infant circumcision in the U.S., would have been useful.   

 

Why This Matters

Male circumcision is an important and emotionally charged debate in health care.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

This story did not discuss the cost of circumcision or its coverage by insurance companies. Currently, some state Medicaid programs do not cover its cost.

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

Not Satisfactory
The piece does not provide any data illustrating how circumcision may or may not impact the rates of STD, including HIV/AIDS. This seems like a glaring omission given that these are the benefits of the procedure. Instead, the story ends with one expert’s quote – "we have a lot of evidence for some benefit" – but without the details.

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

Not Satisfactory
The story points out that the risks of adverse events from circumcision vary between the two reviews, with one review reporting a complication rate of less than 1%, while the other suggests it is as high as 10%. However, the piece failed to indicate that the lower rate pertains to neonates and the higher rate includes neonates and men who were circumcised as adults. As the Annals of Family Medicine review mentions, adult circumcision may be associated with a higher risk of complications. That’s a pretty important distinction to make for readers.
 
As mentioned above, the story did not provide any data regarding the psychological harms, which one researcher suggests are linked to circumcision. 

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

Not Satisfactory

There were some quotes about the evidence not being “robust” or that it is lacking in some areas. But the ending quote – often the one that may have the greatest impression on readers – said "we have a lot of evidence for some benefit." But the story didn’t provide much discussion of what the evidence was. At the very least, the story could have mentioned the drawbacks and merits of review articles.

Does the story commit disease-mongering?

Satisfactory

While studies have found that circumcised men in Africa have a lower risk of contracting HIV compared to uncircumcised men, this piece points out that these results may not translate to the U.S., as AIDS is much less prevalent here. Furthermore, in Africa, HIV is primarily spread by heterosexual sex, whereas, in the U.S., men who have sex with men make up the majority of newly diagnosed cases, a point that could have been made here. 

In addition, one of the researchers indicates that circumcision may lead to “significant anger, or feeling incomplete, hurt, frustrated, abnormal or violated.” No evidence was provided in the story to suggest how many men feel this way or whether these feelings occur in adult circumcision cases only.

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

Satisfactory
This story included remarks from a pediatrician, who is also on the American Academy of Pediatrics task force, as well as an assistant professor working in the field of AIDS and STD.

Does the story compare the new approach with existing alternatives?

Not Satisfactory
This story does not discuss other ways to reduce the risk of contracting or transmitting STDs, such as condom use and other safe sex practices.  Just one brief line could have easily addressed this.

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

Not Applicable
The option to circumcise a newborn male in the U.S. is not in question. 

Does the story establish the true novelty of the approach?

Not Applicable
Infant circumcision is widely performed in the U.S. and is not a novel procedure. However, since the review articles included studies on adult circumcision, it would have been interesting to know how many U.S. males undergo this procedure. 

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

Satisfactory
This story does not appear to rely on a news release. 

Total Score: 3 of 8 Satisfactory

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