One foreskin, two opinions.
That’s how it goes when it comes to divergent attitudes toward circumcision, even among Jewish physicians.
A proposed citywide ban on circumcision has garnered enough signatures to qualify for the San Francisco fall ballot. Whether it is ultimately certified and approved for the fall election is yet to be determined, but meanwhile the debate on the practice — including its medical benefits — is heating up.
Two prominent local Jewish doctors have long fought the circumcision wars on opposite sides of the barricade. Dr. Edgar Schoen, a retired Oakland pediatrician and former chair of the American Academy of Pediatrics, wrote a book supporting circumcision. Former KGO radio host Dr. Dean Edell has condemned it, appearing in a video produced by NOCIRC, a national anti-circumcision group.
Beyond religious-freedom arguments Jewish groups and others have used to attack the proposed ban, Schoen touts the medical benefits of the procedure which, he says, range from reduced incidence of urinary tract infections, herpes and genital cancers to lowered risk of contracting HIV.
He doesn’t believe the ban will pass or take effect, although he’s not surprised it has gotten this far.
“In Middle America, a bill like this would be laughed out of town, but in San Francisco it’s different,” Schoen said. Of Lloyd Schofield, the leader of the ban effort, Schoen added, “If this guy wanted 7,000 signatures to say the Earth was flat, he could get it.”
He scolds the pediatric establishment for ignoring data that suggest long-term benefits of circumcision. Schoen attributes some of that to suspicions about a procedure originating in religious ritual. “Most physicians haven’t been trained and don’t know about the research that’s been done,” he complained.
Schoen said the data show, for example, that penile cancer is a disease limited almost exclusively to uncircumcised men. It’s not an unheard-of disease. The famous Mexican muralist Diego Rivera died from it.
Schoen cited a “10-1 [reward-to-risk] benefit ratio” with circumcision. “You practically never see that,” he added. “It’s past cardiac bypass surgery. Circumcision is a preventive health measure, like immunizations. You do something now that will help you later. To say a parent does not have a right to do a preventive health measure for their kids is ludicrous.”
To Edell, “ludicrous” is cutting off a sensitive part of a baby boy’s anatomy on the chance it might benefit him later in life.
Trained as an ophthalmologist, Edell has been a prominent medical reporter, with the syndicated radio segment “Medical Minutes,” his longtime KGO and syndicated show and countless appearances on local TV news. The affable Sonoma doctor said he understands Jewish resistance to any infringement on circumcision.
But to him, that doesn’t make it OK.
“I think it’s an unnecessary operation,” he said. “If a law like this were to pass, it wouldn’t upset me much. I can’t imagine it being enforced heavily, but it does make a statement. I don’t like government intruding in our lives, but I think the operation has proven not to have medical support.”
He’s right, in that circumcision rates among the general public have slipped — according to one survey, by health care data analysis company SDI Health, the number dropped from 56 percent of newborn boys in 2006 to 32.5 in 2009. The numbers are even lower in some places, such as the Bay Area.
The American Academy of Pediatrics has declared the procedure “not absolutely medically necessary.” Schoen attributes that to pediatricians not paying enough attention to data regarding adult diseases such as HIV and penile cancer.
Edell does not challenge the stats. But he challenges the conclusion that circumcision, which he considers a mutilating surgery, is the best and most efficient way to prevent disease.
“It doesn’t matter if I accept the data,” Edell said. “Infant girls have many times more [urinary tract infections]. You don’t alter a child’s genitals. How many preventive procedures do you do? You don’t do 100 surgical operations to prevent a single case that probably could be prevented if we had effective hospitals and antibiotics.”
When it comes to Jewish concerns about circumcision, the two doctors have a little more overlap.
Schoen believes religious and parental rights trump the concerns of anti-circumcision activists, though he has noted that many Jews have been persuaded to keep their boys intact.
“You see [anti-circumcision activism] on both coasts,” he said, “in enclaves like Berkeley, Marin, the suburbs of New York and L.A. That’s about it. It’s [people who are] educated, secular, white, liberal middle class, suspicious of Western medicine. Unfortunately a lot of Jews fall into that category.”
Edell knows that a majority of Jews would resist any attempt to criminalize circumcision, acknowledging that for most Jews a brit is “primary to their identity,” but he takes comfort in Judaism’s malleability over the centuries.
“Judaism survived because of its ability to adapt and change,” Edell noted. “The potential is there for a day where the ritual of the bris is sustained, but the removal of foreskin is not accomplished.”
He also says it’s hypocritical of those Jews who insist on having their sons circumcised but who then rarely or never observe other mitzvahs, such as keeping Shabbat.
Despite the controversy, Schoen doesn’t worry about circumcision in the U.S. going the way of cupping, leeching and bleeding. “It’s like apple pie,” he said. “It’s part of being American.”
Not anymore, if Edell has his way.
He calls it egotism that “only American doctors know stuff. Doctors in Europe and Asia must be idiots — how come they have ignored this important [medical] literature? They’ve looked at the same literature and decided against it. [Circumcision] is a purely American phenomenon.”
But is it American to issue bans?
“When you bring the issue up,” Edell said, “when people talk about it, I like that better than laws.”