Unethical studies hide tissue issue

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 laterwas 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 anormal, functioning, erogenous part of their bodies.

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