UNETHICAL STUDIES HIDE TISSUE ISSUE

by Deborah Pearce

Perhaps you noticed the headline in last Saturday's Times Colonist:
"Infants feel pain as intensely as adults, circumcision study
suggests." Doctors and other researchers at Toronto's Hospital for
Sick Children and the Women's College Hospital took 68 baby boys,
smeared an over-the-counter analgesic cream on the penises of 38 of
them, but used an inert cream on the other 30. Then they amputated
their foreskins the normal way: by strapping the baby down on a
plastic board, and pinching, crushing, tearing, and slicing the
delicate organ.

Surprise, surprise, the babies who'd been given the analgesic screamed
less and contorted their tiny faces into fewer agonized expressions.
The researchers admitted, however, that their pain was by no means
eliminated. Still, their recommendation was the "routine use" of the
analgesic for circumcision. The scientific team, by the way, includes
some of the same researchers whose work, reported last month in the
British medical journal Lancet, "discovered" that cutting away a
newborn's foreskin heightened their sensitivity to pain months later,
with or without anesthetic.

Let me now remind you of something else recently in the news: the case
of John-Joan, circumcised during the `60s at a Canadian hospital. The
doctor had used an electrical device which burned John's entire penis
off. His testicles were then removed in a failed attempt to turn 
him into a girl.

His case is one of five accidental amputations in Vancouver NOCIRC
activist James Loewen's files. Loewen also has pictures taken in
Seattle two years ago of an infant flayed from navel to knees because
gangrene set in after circumcision. Every scrap of skin was removed to
stop the gangrene's spread and save the baby's life.

Now let's look at what the Canadian Pediatric Society said last year,
bearing in mind the real possibility that damage done by circumcision
is under-reported: "The overall evidence of the benefits and harms of
circumcision is so evenly balanced that it does not support
recommending circumcision as a routine procedure for newborns," the
Society's Fetus and Newborn Committee said. The Australasian
Association of Pediatric Surgeons has gone further. Responding to the
Toronto researchers' work, the Association said, "We do not support
the removal of a normal part of the body, unless there are definite
indications to justify the complications and risks which may arise. In
particular, we are opposed to male children being subjected to
procedure which, had they been old enough to consider the advantages
and disadvantages, they may well have opted to reject the operation
and retain their prepuce."

Is something wrong with this picture? A lot of things, really.

Medical ethicist Dr. Eike Kluge says the Toronto studies violate
ethical guidelines which have been in place since 1989, and which were
reiterated by the Medical Research Council of Canada and two other
research bodies last year. It comes as no surprise that babies feel
pain as adults do, or that early experience of pain intensifies later
suffering, says Kluge, who teaches bioethics at the University of
Victoria. Since the late `60s it's been clear that pain is a
conditioned response: the fact that infants who suffered the agony of
circumcision would react more intensely to a vaccination shot six
months later was entirely predictable. 

And it's been seven years since studies proved that infants experience
pain just as adults do, and doctors stopped performing open heart
surgery on infants without anesthetic as a result. "We had known this
for a long time: therefore to do a controlled study under these
circumstances is unethical," Kluge says. "It's been very well
established since the Nuremberg trials that you don't do research if
you in fact know which option is better."

Over the years, circumcision has waned in Canada, and Manitoba is the
only province still funding it. Some 35 percent of boys born there are
subjected to this surgery; in Victoria, it was 30 percent in '95 -
'96, for a total of 430.

In the U.S., where circumcision is a thriving industry, including the
use of foreskins to make artificial skin, the rate is 70 percent. The
American Academy of Pediatrics is still waffling on its position. Its
Canadian counterpart, however, is unequivocal that circumcision is not
medically justified. And by focusing on pain, the Toronto studies
obscure the real issue: That of doctors risking babies' lives to rob
them of a normal, functioning, erogenous part of their bodies.