Jewish Telegraphic Agency – March 3, 1999
By Julia Goldman
NEW YORK, March 3 (JTA) — Most Jews aren’t flinching at the medical establishment’s most recent findings on circumcision.
The American Academy of Pediatrics is recommending for the first time that pain relief, such as local anesthetics, be provided to infants being circumcised.
The group, which issued its latest policy statement on circumcision this week, also found the procedure’s potential health benefits are “not significant enough” to recommend the routine circumcision of newborns.
But rabbis and mohels, who perform Jewish circumcisions, alike say the report — which reflects 40 years of medical research — will have little effect on the 4,000- year-old tradition of brit milah, the circumcision ceremony by which Jewish males are accepted into the community.
“Obviously we don’t recommend circumcision for medical reasons, but for religious reasons,” said Ismar Schorsch, the chancellor of the Conservative movement’s Jewish Theological Seminary.
“It is a sign of the bond between Israel and God, a sign of Jewish identity,” he said. “And it will continue to remain a rite of passage for Jews as long as there is an organized Jewish community.”
The covenant of circumcision, first commanded by God to Abraham, was reiterated to the Israelites by Moses at Mount Sinai. The practice is still followed by the majority of Jews around the world.
But some Jewish parents have opted to forgo what they see as a barbaric custom.
It is precisely the pain of circumcision that is at the center of the debate over the necessity of the brit milah, literally the “covenant of circumcision.”
Opponents argue that circumcision inflicts permanent physical and psychological damage.
Some 60 percent of all newborn males in the United States are circumcised, as are 48 percent in Canada, according to statistics quoted in the academy’s report – – down from a peak of 90 percent in the 1960s.
Until recently most circumcisions in hospitals were performed without any anesthesia. The practice among mohels varies considerably both with regard to technique and the level of pain relief provided.
The academy’s policy statement cites new evidence showing that newborn circumcised without analgesia experience “pain and stress.”
But this finding is no surprise to most Jews.
“Suddenly now, pain is a new medical condition?” asked Rabbi Moshe Tendler, a mohel and professor of medical ethics at Yeshiva University in New York.
“Pain has been with us from the time of Adam and Eve.”
Tendler also noted that the academy had issued a report in 1993 on the effectiveness of lidocaine as a topical analgesic for use during circumcision.
The current statement represents the academy’s third official policy on circumcision. In 1971, the group concluded that there was “no absolute medical indication for routine circumcision.”
But by 1989, new research indicated that circumcision did carry potential health advantages.
Among the benefits most widely lauded are reduced incidences of urinary tract infections and penile cancer. Circumcision is also believed to decrease the risk of contracting sexually transmitted diseases.
But debate over the procedure’s benefits and risks as a part of routine medical care continued for a decade, resulting in the most recent recommendations.
The report, which appears in the March issue of the academy’s journal, Pediatrics, indicates that while uncircumcised males are more likely to develop urinary tract infections during the first year of life, the risk is low — around 1 percent.
And while uncircumcised men are three times as likely to develop penile cancer, the disease is rare, affecting only 10 or fewer men in a million each year in the United States.
“There are some medical benefits to circumcision,” said Dr. George Kaplan, one member of the seven-person task force that prepared the latest report.
But “the benefits are not so compelling that the academy feels that it should recommend routine circumcision for everyone,” Kaplan, a San Diego-based pediatric urologist, said in a telephone interview with JTA.
The task force also noted studies that suggest circumcised infants may respond “more strongly to pain of future immunizations” compared to uncircumcised boys.
“Parents should discuss it with their pediatricians and come to some conclusion as to what’s right for their son” on medical as well as religious, cultural and ethical grounds, Kaplan said.
Kaplan, one of at least two Jewish members of the task force, said the doctors had “looked at this strictly from a medical standpoint.”
Dr. Gwenn Robinson, one of some 200 medical professionals certified to perform ritual circumcision by the Reform Movement’s Berit Milah Board, said most parents who request her services have their minds set on the traditional circumcision ceremony.
“I never try to convince people based on medical reasons,” said Robinson, a family physician in Albuquerque, N.M.
“I tell them the medical reasons, but I talk to them more about the important covenant and the establishing of a Jewish life.”
But those who oppose the ritual question why a child’s entry into the Jewish faith requires pain and bloodshed.
“I’m not willing to harm my son just for religious practices,” said Andrew Reiver of Philadelphia, the father of a 3-year-old uncircumcised son.
“Just because I’m Jewish, there are a lot of things I don’t do,” such as follow kosher dietary laws or keep Shabbat,” said Reiver, who volunteers as a phone counselor for the National Organization to Halt the Abuse and Routine Mutilation of Males.
His organization is one of a growing number of national organizations that opposes circumcision on humanitarian grounds.
Some Jewish parents have developed alternative “welcoming” ceremonies that, they feel, incorporate elements of the traditional ritual.
“I believe the debate in the Jewish community is just beginning, so we don’t know where it will go,” said Ronald Goldman, the executive director of the Boston-based Circumcision Resource Center.
Goldman, the author of “Circumcision: The Hidden Trauma,” said recent studies demonstrate that circumcision has traumatic effects and cited decreased sexual activity as one of its significant long-term effects.
The academy’s report, he said, “gives us all pause for thought and reconsidering what is still common in this country.”
But for most Jews, what Schorsch calls the “mark of unique distinction” is essential to the Jewish male identity.
“The bond of circumcision, besides being a covenant with God, is a bond with every other Jew,” Tendler said of the ancient custom, which has parallels in the rites of passage of numerous other cultures.
“The fact that you let out a drop of blood and my son let out a drop of blood makes you members of the same tribe.”
Proponents believe that the procedure, when performed by a skilled mohel, is virtually bloodless and the pain temporary.
“I don’t think Jews ever deluded themselves into thinking that it wasn’t a painful moment,” said Schorsch. “But that’s all it is, a moment.”
Robinson, the mohel from Albuquerque, said she can finish the job in under a minute.
“It is true babies do feel pain,” said Robinson. “Traditionally, we say we’re helping the pain with kosher wine.”
“There have been studies that sugar water” has analgesic properties, “and certainly kosher wine has a lot of sugar. We’re not talking about dry white wine.”
Used together with topical anesthetics, kosher wine usually provides adequate pain relief — to the point that some babies have slept through the ceremony, she said.
Tendler said he has insisted for a decade that topical analgesics be used during the hundreds of circumcisions he has performed or witnessed.
“God gave us the duty to master nature and to improve the lot of mankind,” he said. “And if it’s possible to perform circumcision under anesthesia, why not?”