Brit mila – time to cut the debate

The time has come to end the debate surrounding circumcision.

A man prepares the items needed for a circumcision. (photo credit: REUTERS)
A man prepares the items needed for a circumcision.
(photo credit: REUTERS)
I am saddened and frustrated at the periodic attacks on the practice of brit mila, which produce unwarranted and inappropriate distress among parents of Jewish newborn boys about whether or not to circumcise their sons. These anxieties are based largely upon distortion of data and on misinformation on the part of a small but vocal group of opponents of infant circumcision.
The recent article “The heated debate surrounding circumcision,” which appeared in the December 22 issue of the Jerusalem Post Magazine, is a typical example of this literature.
Lest there be no misleading of the readers, I am an Orthodox Jewish physician who supports infant circumcision of Jewish boys because it is an important biblical command, and not for medical reasons. Nevertheless we Jews are fortunate that this biblical injunction is accompanied by clear medical advantages, and the data supporting these advantages are currently increasingly supported by ongoing medical research.
Just in the past two months there have appeared several review articles confirming dramatically the health benefits of male circumcision. The authors in the most recent issue of British Journal of Urology International reviewed 49 studies on the effect of male circumcision for the prevention of HIV with the conclusion of the remarkable effectiveness of the procedure. The World Health Organization is deeply involved in promoting the procedure in countries with high prevalence of HIV infection.
The average reduction in infections is about 60%. In heterosexual males the reduction reported in the latest summary of research reports is 72%.
Opponents of circumcision often assert that many of these studies took place in Africa, and have limited relevance for Western countries. But nothing could be further from the truth. In this day of globalization, and remarkable mobility of individuals and populations, we now live in one world, and diseases are not geographically confined.
Another major publication appeared in the November issue of Lancet Global Health, systematically reviewing the association between male circumcision and women’s health outcomes. The studies were not restricted to Africa. They reviewed some 60 publications.
High-consistency data showed that male circumcision protected women against cervical cancer, cervical dysplasia, herpes simplex virus type 2, chlamydia and syphilis. There were also positive data, but of lower consistency, regarding the protective effect for other sexually transmitted diseases.
With respect to penile cancer the Post article quoted Ronit Tamir stating that this was a minor consideration because “the treatment of that kind of cancer is circumcision anyway, so what’s the point of doing it in advance?” Unfortunately her information is misleading. Penile cancer, while rare, can affect 1 in 400 to 1 in 1,000 uncircumcised men and has a remarkably high mortality, not prevented by circumcision after the disease has appeared. Its incidence is virtually zero in those men who have undergone infant circumcision.
There are numerous other benefits to infant circumcision, but I will not elaborate. The detailed documents by the American Association of Pediatrics, the World Health Organization and the Centers for Disease Control all agree that the medical benefits of the procedure outweigh the risks.
The article in the Post uses the pejorative word “mutilation” and describes the suffering of the baby as a result of the procedure. As a sensitive physician I have always advocated palliative medicine even before it became popular. As a father, grandfather and great-grandfather to over 70 progeny in whose circumcisions I have participated closely, I would certainly not wish to impose any suffering on any infants. But in watching experienced mohalim perform their procedure, I continue to be amazed and impressed at the rapidity of the procedure and at the relatively short period of infant crying as a result of the procedure.
If one thinks for the moment of the total number of hours the average infant cries during the first month of life, the addition of a few minutes should hardly be considered a form of torture. And think of how many painful injuries the average normal active boy sustains in his youth. The “traumatic” circumcision pales by comparison.
In addition the bit of wine administered pre- and post-procedure, plus the anesthetic cream used, reduce the “suffering” to a real minimum. Obviously a new mother justifiably would like to eliminate any and all pain and suffering of her newborn, but let us not exaggerate the negative aspects of the procedure.
The opponents then throw in a few more attacks. They cite the oral suction by the mohel, a procedure performed indirectly using a sterile glass tube by most mohalim today. Then they add the “criminality” aspect, “the assault on a helpless minor and with a weapon no less.” With this kind of rhetoric it is no wonder that anxious and ill-informed parents begin to hesitate to welcome their newborn boy into the historic covenant of Judaism.
As I indicated in the beginning of my article I advocate brit mila as a biblical imperative, whose performance Jews have undertaken for millennia often at great sacrifice, and at great personal risk. But what about the secular Jew, the atheist? One may ask – what does this “primitive” ritual mean to them? Well, the non-religious Jew will assert that he/she are Jews by culture, by historical experience.
If so, there is no question that for better or worse ritual circumcision has been a hallmark of Jewish identification for millennia, in Warsaw and in Yemen, in Berlin and in Tangier.
Rejection of infant circumcision represents a major severance of the child from the continuity of his culture.
When one of the hesitators quoted the in Post article states that her grandmother would turn in her grave if she heard that her descendant would be denied circumcision, she expressed the tragedy of cutting off her progeny from their Jewish heritage. In the words of the Bible, “Ask your elders and they will tell you” (Deuteronomy 32:7).
The time has come to “cut the debate.”
The author is a professor (emeritus-active) and MD at the Jakobovits Center for Jewish Medical Ethics, Ben Gurion University of the Negev.