Efforts to Defund Or Ban Infant Male Circumcision Are Unfounded and Potentially Harmful

Johns Hopkins infectious disease experts say the medical benefits for male circumcision are clear and that efforts in an increasing number of states (currently 18) to not provide Medicaid insurance coverage for male circumcision, as well as an attempted ballot initiative in San Francisco earlier this year to ban male circumcision in newborns and young boys, are unwarranted. Moreover, they say these actions ignore the last decade of medical evidence that the procedure can substantially protect men and their female partners from certain sexually transmitted infections.

The Johns Hopkins experts argue that implementing policy or financial barriers to safe circumcision could potentially disadvantage people most in need of publicly financed services to improve their health. These groups include minorities and the poor, among whom sexually transmitted infection rates are often the highest.

Critics of infant or childhood circumcision claim, among other things, that the procedure should not be considered until males can give legal informed consent at age 18.

In an editorial to be published in the Journal of the American Medical Association online Oct. 5, Johns Hopkins health epidemiologist and pathologist Aaron Tobian, M.D., Ph.D., and health epidemiologist Ronald Gray, M.D., highlight the most recent medical research showing the considerable life-long health benefits of circumcision performed during infancy and the potential disadvantages associated with waiting until adulthood before undergoing the procedure. The experts point out that there are medical benefits during childhood, as many young men are already sexually active before age 18, and at greater risk of infection from sexually transmitted infections. Circumcision at older ages is also associated with more complications and cost than having the minimal surgery in infancy.

“Our goal is to encourage all parents to make fully informed decisions on whether to circumcise their infant boys based on medical evidence and not conjecture or misinformation put out by anti-circumcision advocates,” says Tobian, an assistant professor at the Johns Hopkins University School of Medicine.

Among the research cited by Tobian and Gray, a professor at the University’s Bloomberg School of Public Health, are multiple studies conducted within the last five years showing that in heterosexuals, circumcision reduced HIV infection risk by 60 percent, genital herpes by 30 percent and cancer-causing human papillomavirus (HPV) by 35 percent in men. Females benefit from a 40 percent or greater reduced risk of bacterial vaginosis or parasitic trichomonas spread during sex, as well as HPV infection, which causes cervical cancer.

In addition, the experts say the data clearly show that having the procedure in infancy reduces the risk of urinary tract infections, as well as inflammation in the opening or head region of the penis. Risk of infection from surgically removing the foreskin, considered a minimal and simple surgery, is already low overall but even lower during infancy, at between 0.2 percent and 0.6 percent. In adults, infection and complication rates are higher, between 1.5 percent and 3.8 percent.

In contrast to what circumcision’s opponents claim, Tobian and Gray say that research shows no reduction in sexual satisfaction or male performance. Indeed, they add, circumcised men in the trials, the gold standard of medical evidence, reported no difference or even increased penile sensitivity during intercourse and enhanced orgasms compared to uncircumcised men. The majority of female partners also reported either no change or increased sexual satisfaction, largely because of improved hygiene.

The Johns Hopkins experts argue that delaying circumcision until adulthood, when young men can legally decide for themselves, not only carries added risk of infection, but also challenges the long-held rights and responsibilities of many parents to make decisions about the long-term health of their children, including vaccinating them against hepatitis B, measles, polio, whooping cough and influenza. The proposed ban or delays also counter the religious rights for parents who observe Jewish and Muslim faiths, in which infant male circumcision is a prescribed religious obligation.

In the editorial, Tobian and Gray conclude that if a vaccine comparable in disease-prevention benefits to male circumcision was available, with the same disease-preventing benefits, “the medical community would rally behind the immunization, and it would be promoted as a game-changing public health intervention.” They say that banning male circumcision would be “ethically questionable.”

Tobian and Gray say Medicaid and other insurers should cover male circumcision costs if parents opt for the procedure, and that leading medical groups, such as the American Academy of Pediatrics and the U.S. Centers for Disease Control, need to recognize the health benefits of male circumcision and do more to educate parents and physicians about them.

More than 500 U.S. and international observational studies and 13 studies from randomized trials, Tobian says, have been published in the most influential medical journals, including the New England Journal of Medicine and the Lancet, in the past decade – reaffirming the benefits of male circumcision in preventing sexually transmitted infections.

However, the Academy’s policy on male circumcision, last issued in 1999 and re-affirmed in 2005, is ambiguous with respect to medical benefits. The CDC's policy also takes no firm position on the medical benefits of male circumcision, but that policy is expected to be updated shortly.

“In light of the latest medical evidence, the medical community and government officials at all levels would do well to revisit their policies on male circumcision, so as best to counsel parents on the potential health benefits to their children well into adulthood,” says Gray.

Jewish and other community groups successfully challenged the San Francisco ballot initiative in court, and in July, the male circumcision ban was taken off the city’s November ballot because of a legal technicality. The most recent states to stop Medicaid funding for infant circumcision are Colorado in June, and South Carolina, in February 2011. States that already had funding bans in place include Louisiana, Idaho and Minnesota, all since 2005; Maine, since 2004; Montana, Utah and Florida, since 2003; and Missouri, Arizona and North Carolina, since 2002. California, North Dakota, Oregon, Mississippi, Nevada and Washington – all had stopped funding before 1999.

Study shows looking for job on Internet reduces unemployment time

Better job boards, technology benefit job seekers

A new study shows that using the Internet to look for a job reduces the time spent unemployed by an average of 25 percent.

The discovery directly contradicts a 2004 study showing that using the Internet actually prolonged unemployment.

"In 2004 the researchers came up with two scenarios for their findings – the Internet was not an effective tool or that people who looked on-line for jobs were not as qualified," said Hani Mansour, Ph.D., assistant professor of economics at the University of Colorado Denver who conducted the new study with Peter Kuhn, economics professor at the University of California at Santa Barbara.

The sweep and depth of the Internet has also changed dramatically since the late 1990s, Mansour said. The share of young unemployed workers using the web to look for employment increased from 25 percent in1998/ 2000 to 74 percent in 2008/2009.

Utilizing the Internet has a large impact on the duration of unemployment especially when used to contact friends and family. A decade ago, Mansour said, people who didn't have personal contacts used the Internet for their job search to little effect. Now, those using personal contacts on-line have dramatically increased their chances of finding employment.

Job sites themselves are better designed and far more specific and user friendly than in the past.

"This hypothesis is certainly consistent with our findings that the Internet is highly effective when used to look at ads, to send out resumes and to fill applications," the study said. "Simply because the Internet now connects each work to many more firms (and vice versa) in several new and low-cost ways it may be a more powerful tool in the job search process than it was a decade ago."

Mansour and Kuhn's study drew on data collected from surveys of young job seekers, asked a series of questions about the methods they used to find employment.

"What we don't find is that online job search increases wages compared to the worker's last job," Mansour said.

The findings, says Mansour, help solve the puzzling results of the 2004 study showing the Internet increased the time spent unemployed.

"We speculate that significant improvements in technology over this period, ranging from better on-line job sites to network externalities associated with greater overall Internet penetration itself, might explain this change over time," the study said.

Americans Still Want 2 or More Children but 1 Million Births Postponed/Foregone Since Recession Began

Even though the U.S. total fertility rate (TFR) fell more than 10 percent to below two births per woman on average from 2007 to 2010, ordinary Americans still believe that two or more children is ideal, according to a new report released today.

In the study, "The Sustainable Demographic Dividend: What Do Marriage & Fertility Have To Do With the Economy?", Dr. Sam Sturgeon, director of research for Demographic Intelligence, finds that the ideal family size for Americans of childbearing age (18-46) rose to 2.66 in 2010, even as the U.S. total fertility rate fell to 1.91 children per woman in 2010. In 2007, the total fertility rate was 2.13.

According to Sturgeon’s analysis for Demographic Intelligence (DI), approximately 1.08 million babies will have been postponed or foregone from 2008 to 2011. Parents considering a second, third, or fourth child have been particularly likely to avoid having a child since the recession began in December of 2007. “Childbearing is partly an economic decision and clearly many couples feel like they cannot afford an additional child,” said Sturgeon.

Nevertheless, the report indicates that Americans’ ideal family size has risen from 2.39 in the late 1990s to 2.66 in 2010. “Even though couples and women are having fewer children today because of the fallout associated with the recession, most Americans of childbearing age think that having two or more children is ideal,” said Sturgeon.

Indeed, the growing gap between Americans’ fertility ideals and behaviors suggests that companies in the juvenile products industry may have cause for optimism. Demographic Intelligence, which provides fertility forecasts to companies working in the juvenile products industry and related sectors, is predicting increases in total U.S. births in both 2011 and 2012 as women try to recoup the fertility they postponed from 2008 to 2010. U.S. births fell from 4.37 million in 2007 to 4.01 million in 2010. “U.S. births bottomed out in 2010 and now seem headed up,” said Sturgeon.

Major findings of the report include:

Among developed countries, over the next two decades, the United States will be one of the only countries to maintain fertility levels close to the replacement level of 2.1, and only if the U.S. economy does not stagnate or fall back into recession. For most of the last 40 years, about 25 percent of the change in the U.S. fertility rate from one year to the next can be attributed to changes in the economy, and the report includes new projections for U.S. birth rates under three separate economic scenarios: a quick economic recovery, a slow economic recovery, and no economic recovery. One reason U.S. fertility remains comparatively high is that Americans continue to value relatively large families, at least by the standards of the developed world.

Seven sectors of the U.S. economy are tied to "marriage and the baby carriage." Based on 2008 consumer spending data, in each of these seven sectors – child care, groceries, health care, home maintenance, household products and services, life/personal insurance and juvenile products – married parents spent at least 23 percent more per capita than childless singles. Translated into household terms, married parents spent at least 2.46 times more than did households headed by childless singles.

"The Sustainable Demographic Dividend" was released today by the Social Trends Institute and the National Marriage Project at the University of Virginia.

Re-Defining Food, Marriage, and Cars

Here are some concurrent but unrelated images people put on facebook this week....

This is What Democracy Looks Like

Thousands of protesters, nearly no press coverage.

Critical Finance Deadline - Donate NOW!

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Chris Murphy for Senate
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Elizabeth Warren

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Common Cause CT & Amy Goodman (YaY!)

Common Cause Connecticut Annual Celebration Brunch and Silent Auction:

Special Guest: Amy Goodman

"Goodman is an award-winning investigative journalist and syndicated columnist, author and the host of Democracy Now! airing on more than 950 public television/radio stations worldwide. Goodman is the first journalist to receive the Right Livelihood Award, widely known as the 'Alternative Nobel Prize.'"
 
Common Cause Connecticut will also be honoring Miles Rapoport, "President of DEMOS, former Connecticut Secretary of the State, State Representative and longtime champion of good government in Connecticut and around the country."

As well as the Connecticut Center for a New Economy, "a non-profit organization dedicated to improving the economic and social well-being of working families in Connecticut's urban centers."

Saturday, October 1st
10:30 am

Tango Creative Banquets

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Glastonbury CT

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