Dr. Douglas Diekema: Still Inconsistent on Circumcision

Inevitably, whenever a new study suggests that circumcision may not be a panacea of benefits without costs, dismissal follows swiftly. That isn’t the problem. Skepticism is always warranted, and sometimes, criticism is also warranted. I do wish more people, particularly journalists, would adhere to that when pro-circumcision studies are published, but c’est la vie. The facts are on our side in this (unfortunately) long effort. The key is getting to facts.

With the recent study confirming “the importance of the foreskin for penile sensitivity, overall sexual satisfaction, and penile functioning”, the refutations have begun. When Dr. Douglas Diekema criticizes, odd bouts of cognitive dissonance are almost guaranteed. Here, Dr. Diekema joins the rebuttal¹ to this study with his unique way of missing a much-needed chance for self-examination.

“The study is pretty flawed,” said Douglas Diekema, a pediatrics professor at the University of Washington, who was part of the American Academy of Pediatrics 2012 task force on circumcision. “I read the conclusion and then I read the study, and I said, ‘Wow, they went overboard in what they’re concluding.'”

If only Dr. Diekema, a member of the American Academy of Pediatrics (AAP) Task Force on Circumcision, always cared about having the details match the conclusion, with not going overboard in a conclusion. For example, in the AAP’s revised policy statement on circumcision, the technical report states (page 759):

… Reasonable people may disagree, however, as to what is in the best interest of any individual patient or how the potential medical benefits and potential medical harms of circumcision should be weighed against each other. …

That’s the core truth for any non-therapeutic intervention, which clarifies the ethical flaw in proxy consent for non-therapeutic circumcision. What does the individual who doesn’t need circumcision want for himself?

Yet, in the abstract for its revised policy, the AAP bizarrely concludes:

Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; …

The statements in the technical report and the abstract do not say the same thing. The details do not support the conclusion. The abstract states an opinion that the technical report makes clear is not universally true or applicable to any specific individual male. Dr. Diekema once stated (correctly) that “not everyone would trade that foreskin for that medical benefit.” Yet, he stands behind the revised policy that encourages proxy consent for non-therapeutic circumcision while maligns those who criticize the report for its obvious flaws. He’s made these contradictory statements for more than a year. At some point maybe he’ll stop doing that, or he could even embrace the ethics involved that require rejecting non-therapeutic genital cutting on a non-consenting child. I can hope.

¹ The study may be flawed, and perhaps in exactly the way Dr. Diekema states. I don’t wish to engage in confirmation bias merely because I like the findings. Anyway, I don’t need the study. The principled ethics matter more than whether circumcision is “good” or “bad”, both subjective to the individual foreskin owner.

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