Confessions of Cultural Heretics

"When the whole world is running headlong towards the precipice, one who walks in the opposite direction is looked on as being crazy." T.S. Elliot

Archive for the month “January, 2013”

A Few Thoughts on Circumcision

So I was asked (and have been asked many times) what my thoughts are concerning circumcision.  For just a little background, during my month on the pediatric service I performed about 50 circumcisions over approximately 24 working days using both of the Mogen clamp and the gomco.

To start, I must say I think it can be very easy to get caught up in the emotions surrounding this topic.  As a father who has two boys, one who is circumcised and who is not, and also as a physician who has performed many circumcisions, I find myself feeling rather neutral on the whole issue. For one, I think the idea that it is a ‘brutal and abusive’ action is a bit overstated. The procedure is actually very quick and clean, with pain medication given to the infant. That doesn’t mean the child doesn’t throw a fit during the procedure, but I have also had many infants act the same way when I was changing their diaper.  Infants are fairly easily consoled and are seem to be able to tolerate a fair amount of pain and discomfort for short periods of time.  I simply state this, not as justification, but as an observation that reflects that this procedure is not nearly as brutal as many try to make it out to be.  So moving beyond the procedure itself,  I think it is important to consider the motivations for circumcision.

Many parents do it simply to ensure that the son “looks like his father” or “looks like his brothers”. These motivations exist, for better or  for worse, and may not be the best intentions. There are other reasons to be circumcised.  Recently the American Academy of Pediatricians issued a policy statement

The policy statement and accompanying technical report from the AAP will be published in the September 2012 issue of Pediatrics (published online Monday, Aug. 27). The documents update the previous policy that the AAP published in 1999 and reaffirmed in 2005.

Since the last policy was published, scientific research shows clearer health benefits to the procedure than had previously been demonstrated. According to a systematic and critical review of the scientific literature, the health benefits of circumcision include lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis. Circumcision also lowers the risk of penile cancer over a lifetime; reduces the risk of cervical cancer in sexual partners, and lowers the risk of urinary tract infections in the first year of life.

The AAP believes the health benefits are great enough that infant male circumcision should be covered by insurance, which would increase access to the procedure for families who choose it.

“Ultimately, this is a decision that parents will have to make,” said Susan Blank, MD, FAAP, chair of the task force that authored the AAP policy statement and technical report. “Parents are entitled to medically accurate and non-biased information about circumcision, and they should weigh this medical information in the context of their own religious, ethical and cultural beliefs.”

Pediatricians are one of the major providers of circumcisions (along certain groups of family physicians and some obstetricians).  This is not about generating more revenue or business, because in most cases I think it would be safe to say that pediatricians would prefer to avoid the trouble of circumcision.  This new statement, in my humble opinion, is a reflection of evidence based medicine.  But note that the AAP still states that the final decision is to be left in the parent’s hands (now if only they would approach vaccines the same way….).

With that said, I think we need to keep a few historical, and biblical, facts in mind. For one, Jesus was circumcised.  In fact, many of us still celebrate the Feast of the Circumcision on the eighth day after Christmas.  Also, circumcision is never condemned in scripture, rather Paul writes “In Christ Jesus neither circumcision availeth any thing, nor uncircumcision: but faith that worketh by charity” (Galatians 5:6) So basically, it doesn’t matter if you are or are not, as long as your faith and salvation are in Christ.

I do not think it is a procedure that should be banned, nor should parents be condemned for having it done. Nor should the uncircumcised (or their parents) be shunned or ostracized either.  This really comes down to parental choice, a choice that should be made with full knowledge of the risk and benefits of the procedure, and a reasonable motivation for having it done.

Let me know if you have more specific questions regarding this topic.

Once again, thank you for your attention!

In Christ,

Dr. Burke

Attack of the Influenza!!

We are in middle of a pretty bad influenza season.  No doubt about that.  From the CDC, 29 States are reporting high influenza like illness (ILI) activity and 41 states are reporting widespread geographic activity of ILI.  There is an increase in the rate of hospitalization and even deaths, with 18 pediatric deaths having already occurred this season (compared to 34 in all of the 2011-2012 season).  Working in healthcare, evaluating patients as the present in the emergency room or the clinic, it is safe to say that the Flu is no laughing matter.   Now there are a lot of articles out in the InterWeb about all of this, and I am seeing a recurrent theme stated at the end all the articles:  Vaccination is the best way to protect yourself from Influenza.

Now, I take a little issue with this, and here is why:

This graph shows the level of ILI outpatient visits so far in 2012-2013 as compared to previous flu seasons:

national levels of ILI and ARI

Pretty bad, right?  It looks like we are on track for either a early moderate season, or a pretty terrible flu season.  So no wonder there are so many more cases as compared to last year.  So based upon the articles out on the InterWeb, you must think that if so many people are getting sick this early, people must not have gotten vaccinated like they did last year!  Well, let’s take a look:

Figure 1. Flu vaccination coverage estimates from November 2012  compared to estimates from November 2011 and March 2012, National Immunization Survey, National Internet Flu Survey, and National Flu Survey

For all persons there were actually 0.2% more adults vaccinated! And the Children? 3.2% higher rate of vaccination as of November!    And keep in mind, the peak in the season so far came in December, after these numbers were compiled, and theoretically late enough for the vaccine to take effect, if it were going to take effect, that is…. I’m no statistician, but my thought is that if vaccine rates are the same as last year, yet we are having a worse flu season, then a couple of possibilities exist:

1) The Flu vaccine is the wrong one for this season

2) The Vaccine is the right one for the season but just flat out doesn’t work


3) A whole lot more people would have gotten sick if they didn’t get vaccinated

Personally, I lean towards 1 or 2.    The point of this little exercise is simply to make it known that we shouldn’t be relying solely on the vaccine to get us through this flu season.  In fact, I’m not sure I would necessarily recommend it as first line protection. (Note: I only got the vaccine (the first in my life) because I was ordered to by my Command)

So what can be done, you ask?

1) WASH YOUR DIRTY HANDS!  Wash them all the time, use the purell, just keep them clean.

2) Get plenty of sleep and rest

3) Eat healthy! yes, actually eat what is good for you and for your immune system

4) Consider using things like Vitamin C and Echinacea and Zinc.  The data is sparse on the first two, but they sure wont be detrimental in most people

5)Keep exercising and keep your body in shape

6) And lastly, but far from least important, if you are sick or feeling ill at all, PLEASE STAY HOME AND STOP SPREADING THIS DISEASE

That is all, thank you for your attention.


UPDATE: Just found this image on laboratory confirmed Influenza hospitalizations. This continues to support above statements




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