If a government advisory panel gives the high sign, an unusual product may soon hit the medical marketplace: skin-like tissue made from human foreskins.
The tissue, donated by mothers who had already decided to have their babies circumcised, could be a boon to people with unhealed wounds such as skin ulcers caused by damaged leg veins.
But marketing foreskin-based products may throw more fuel on an already fiery debate – whether circumcision, the surgical removal of the foreskin of the penis, is medically justifiable. To the more ferocious circumcision opponents, the profit motive behind development of foreskin-based medical products makes circumcision more sinister yet.
Among Jews, circumcision is as ancient as Abraham – 4,000 years old. As written in Genesis 17, it is not a health practice but a sign of the covenant with God, says Dr. Robert Levenson, a pediatrician at Harvard Pilgrim Health Care in Wellesley and a mohel, a person who performs ritual circumcisions on Jewish boys when they are eight days old.
It is also an old tradition among Muslims, though it’s often eschewed by Hispanics and blacks.
But for many of the American boys circumcised every year – as about 60 percent of newborn males are – the five-minute surgery is done not for religious reasons but because parents and doctors think it’s the medically enlightened thing to do.
Is it? The honest answer is: Nobody knows.
Consider the flip-flopping of the American Academy of Pediatrics. In 1971, it said there were “no valid medical indications for circumcision.” In 1975, it said there was “no absolute medical indication.”
In the next few years, researchers published a series of studies suggesting that boys who had been circumcised had a lower risk of urinary tract infections, fewer sexually transmitted diseases, less penile cancer and perhaps that their female partners were less likely to get cervical cancer. That evidence prompted the academy, in 1989, to conclude there were “possible medical benefits” to circumcision after all.
Since then, there have been even more studies, prompting yet another review by the academy, this one headed by Dr. Carole Lannon, associate professor of pediatrics and internal medicine at the University of North Carolina at Chapel Hill.
Lannon won’t say how the academy will tilt when its report comes out later this year. But no matter what it says, the report is unlikely to settle things because of the intense emotions swirling around the circumcision debate.
Dr. Thomas Wiswell, a neonatologist at Thomas Jefferson University Medical School in Philadelphia, argues that circumcision prevents urinary tract infections, with circumcised boys having 10 to 30 times less risk. Some data suggest it also reduces the risk of sexually transmitted diseases, though last year a study of more than 1,400 men found no such benefit.
Wiswell’s views have made him such a target of circumcision foes that he has to register at hotels under false names at conferences.
“When I lived in D.C.,” he says, “I had police detectives come to the hospital looking for me because the anti-circumcision people called and said there was a guy named Wiswell mutilating genitalia.” Such fervor, he says, “borders on fanaticism.”
That’s not how circumcision opponents see it. They say removal of the foreskin is barbaric, unnecessary, unnatural, unjustifiable, and harmful, physically and psychologically.
“The US is the only country in the world that circumcises most male infants for nonreligious reasons,” says Ronald Goldman, a psychologist who heads the Circumcision Resource Center in Boston and has written two books on the subject. “It’s hard to believe how strong the case against circumcision is because we have been conditioned culturally to believe circumcision is a good thing or at worst, harmless.”
In fact, there is evidence of circumcision’s harm.
One study of 87 infants published last March in the journal Lancet showed that circumcised infants who received no anesthesia had a stronger response to subsequent routine vaccination than uncircumcised infants or those who were circumcised but received a pain-dampening cream called EMLA.
Another study of 52 healthy infants, published in December in the Journal of the American Medical Association, showed that unanesthetized infants showed more distress during circumcision. The most effective anesthesia, the study found, was a ring block – a circle of injections of lidocaine, a painkiller, halfway down the penis. The next most effective was an injection in the groin on each side. Least effective was EMLA.
The message, says Janice Lander, the University of Alberta psychologist who led the study, is that “under no circumstances should babies have circumcision without anesthesia.”
But Levenson, the mohel and pediatrician, argues that injections are “an inappropriate, difficult, cumbersome, and anxiety-provoking procedure to do in person’s home where you are performing a lofty and celebratory ritual, especially when EMLA cream, though not perfect, does reduce pain in my opinion by 75 to 80 percent.”
But try telling that to circumcision foes, especially in the wake of a recent article in Mothering magazine by circumcision opponent Dr. Paul M. Fleiss, a Los Angeles pediatrician.
Fleiss, the father of Hollywood madam Heidi Fleiss (now in prison for laudering her call-girl profits), extolls the virtues of the foreskin, including its role in sexual pleasure.
“The only time circumcision is necessary,” Fleiss added in a telephone interview, “is if somone has forcibly retracted the foreskin on a newborn. Then a scar forms and sometimes that scar is so tight there has to be surgery to remove it.”
In the article, Fleiss (who pled guilty to making false statements to a bank), contended “the marketing of purloined baby foreskins is a multimillion-dollar-a-year industry.”
Those working on foreskin-based skin substitutes, among them Dr. William H. Eaglstein, chairman of the dermatology department at the University of Miami School of Medicine in Florida, strenuously deny such charges.
So what does the circumcision decision boil down to?
The rule of thumb for Dr. Michael O’Leary, a Brigham and Women’s Hospital urologist, is, “if the dad is circumcised, the son should be” because boys want to look like their fathers.
Whatever you decide, do it mind early, “not sitting there in the hospital still flipping a coin,” says Levenson.
And if propaganda from either side rankles, mellow out. From a medical point of view, it probably doesn’t matter what you do.
Medical uses for foreskin
Researchers are developing skin substitutes made from foreskins.
Working with Organogenesis Inc. in Canton, Dr. William H. Eaglstein, a dermatologist at the University of Miami School of Medicine in Florida, has studied a product called Apligraf made from cow collagen and foreskin cells. Because the cells proliferate in the lab, few are needed, he says.
In tests on 275 people with chronic leg ulcers, those who received the grafts healed faster than those who did not, he says.
Another foreskin product, Dermagraft, is designed for treating diabetic foot ulcers. Made by Advanced Tissue Sciences, Inc. in San Diego, Dermagraft, like Apligraf, it is scheduled for preliminary FDA review on Jan. 29. Last year, another form of Dermagraft, also made from foreskins, was approved by the FDA for treating burns.
To learn more
For more information on circumcision, send a self-addressed stamped envelope to:
- The American Academy of Pediatrics
Dept. C-Circumcision
PO Box 927
Elk Grove Village, IL
60009-0927
You can also call the Circumcision Resource Center, 617-523-0088.