Analysis of Intact America propaganda

I recently became aware of this. An obviously well-funded group called "Intact America" have placed what appears to be a full-page advertisement in the Washington Post. They must be terrified that the AAP will decide to recommend circumcision - the advert must have cost a fortune! Anyway, I thought it would be instructive and educational to analyse their advertisement, to see what propaganda techniques they're using. So let's dissect An Open Letter to the American Academy of Pediatrics:

American parents trust their pediatricians and rely on them for the best advice in caring for their children. As a matter of ethics, that advice cannot include neonatal male circumcision - a medically unnecessary, potentially risky surgery that no major medical authority in the world recommends.

Let's start with the last point: what Intact America are arguing, in effect, is that the AAP (a major medical authority) should not recommend circumcision because no major medical authorities have done so to date. Now, that's an ... interesting ... argument. It's a good thing that these people weren't around when people invented fire!

(As a point of fact, I'd question whether their assertion is even true. Many African countries are embarking on large-scale circumcision programmes in the fight against HIV, and it seems likely that they're doing so with the assistance and approval of their national medical bodies.)

So what do we have left? A "potentially risky surgery". Well, yes, it is. There are risks, of course, albeit small. But these need to be weighed against the benefits: a reduction in the risk of certain conditions.

Finally, "medically unnecessary". Again, yes, it is. But that's not an argument against it: something can be beneficial, even advisable, without being necessary. Take vaccinations, for example: they're not strictly necessary, but they're certainly advisable.

Their claim that circumcision is unethical seems to be on shaky ground.

That is why Intact America is asking the task force charged with reviewing the American Academy of Pediatrics' current neutral position on infant circumcision NOT to revise that position in favour of the surgery. Further, we ask you to take an ethical stand against the removal of a healthy, functioning body part - the prepuce, or foreskin - from non-consenting newborn babies.

Well, I guess they're entitled to ask, however bizarre the request may be.

The United States is the only western nation today where doctors routinely circumcise infant boys in medical settings. Although the rate has fallen from above 90 percent 30 years ago to below 60 percent today,

This is false. The recorded infant circumcision rate 30 years ago (ie., in 1979) was 64.3%. Figures for today are unavailable, but from the same source, the most recent data (for 1999) indicate a rate of 65.3%.

still, more than one million American babies undergo the surgery every year driving one billion dollars in health-care spending.

And, no doubt, saving comparable figures in disease prevention.

Now, based on studies conducted among adults in sub-Saharan Africa that found reduced transmission of HIV from women to men (though not from men to women, nor men to men), some are suggesting that the AAP - meeting this week in Washington - should recommend circumcision for all newborn boys in the United States.

"Some" is rather vague, but this seems basically correct. News reports over the past year or so have contained similar suggestions.

Doctors have a responsibility to tell parents the truth: circumcision does not prevent disease.

Which? Should doctors tell parents the truth, or should they tell parents that circumcision does not prevent the disease?

Most European nations, with circumcision rates near zero, have lower HIV/AIDS rates than the United States.

Are Intact America really so naive about epidemiology that they think that between-country comparisons constitute a decisive answer to such a question? Evidence-based medicine requires use of the best available evidence (usually randomised controlled trials), not the least (ecological analyses such as this are considered one of the weakest methodologies, and for good reason).

Circumcision rates in America do not correlate with HIV rates in any ethnic population or geographical region.

Yes, they do. The CDC cited several American studies in which such correlations were observed in their factsheet (see the section entitled "HIV Infection and Male Circumcision in the United States"). Are Intact America unaware of this, or are they intentionally making false claims?

Furthermore, circumcision has significant risks, including infection, bleeding, impairment of sexual function, and even death. Earlier this year, an Atlanta family was awarded $2.3 million because a physician accidentally amputated much of their infant son's penis during a "routine" hospital circumcision. A Canadian baby bled to death in 2004, after being circumcised in a British Columbia hospital. In 2008, a baby from South Dakota bled to death, and his parents have filed suit against the hospital where he was circumcised, as well as the doctor who performed the surgery.

Yes, accidents happen, and of course they're tragic. But let's be sensible. If we're going to consider the risks associated with circumcision, we also have to consider the risks associated with non-circumcision. Babies die of urinary tract infections - and circumcision reduces the risk. Adults die of penile cancer (again, the risk is reduced) and of HIV (and again).

Infrequent though complications may be, because the surgery is performed on healthy babies who have no need for it, each injury and death is utterly indefensible.

This is illogical. If you choose to avoid the risks associated with circumcision, you choose the risks associated with non-circumcision. It's impossible to avoid risk altogether.

Growing numbers of medical professionals and expectant parents are saying "No" to infant circumcision.

There's no convincing evidence that this is the case.

We urge members of the AAP's circumcision task force, and all pediatricians, to make the same decision on behalf of the babies who are their patients.

They're entitled to urge, but how convincing do they imagine they are? It's easy to put together a bunch of illogical arguments and false claims, but a persuasive argument requires factual accuracy and logical reasoning.