The CDC/AAP Project [Archived]

The AAP issued their 2012 revised statement on circumcision in late August, which has widely been panned as contradictory and failing to address the issues presented or to uphold the principles of the AAP. This page will remain for archival reasons and as a point of reference.

An email address that you may use IN ADDITION TO the email addresses of the individuals below is circumcision@cdc.gov.

You may also call Dr. Peter Kilmarx at the CDC at (404) 639-8998. Ask for Dr. Kilmarx and politely tell him why infant circumcision is a bad idea.

The American Academy of Pediatrics is reconsidering their policy statement on neonatal circumcision. The United States Centers for Disease Control had a meeting late last year to consider the implications of the African circumcision studies viz HIV/AIDS for the United States.

At the CDC meeting, consideration was given to a study by Millett et al. (Download PDF, JAIDS 2007 Millett, Circumcision HIV among MSM, abstract, here.) that confirmed the Sydney study that male circumcision has no value for gay men, who are the major risk group in the United States. Then there was this presentation (dead link) that seems to recommend mass infant male circumcision anyway on a wildly speculative cost-effectiveness basis. No human rights issues were discussed or apparently even contemplated in recommending genital surgeries on children. The meeting attendees left with a proposal to formulate a policy and work closely with AAP to promote said policy. It isn’t clear what that policy will be yet.

The essential issue is: Do you want public policy makers to assert any price, no matter how costly or unethical, is worth a potential, incremental reduction in HIV risk? Do you want public policy makers to make it easier for misinformed, misguided, or poorly educated parents to choose circumcision for their children with no immediate value and certain physical and psychological costs and risks?

In regards to your letter to the AAP, consider the following issues in your letter:

  • If you are a medical professional and have observed circumcisions or dealt with complications, be sure to mention this.
  • If you have a child, partner, or friend with circumcision complications, be sure to mention them.
  • If it is a recent circumcision with complications, done in the USA, be sure to mention place/date, so it is clear that these complications are happening in current medical practice.
  • Less than one page is best, just make your point!

THANK YOU to Camellia May for this contribution.

I urge everyone who believes it is a mistake and a tragedy for the Centers for Disease Control to recommend neonatal circumcision to fight the spread of HIV/AIDS to write a letter to the director of that agency today. I also urge you to cc your Senate and Congressional representative. Further down, you will find names, addresses and email addresses of individuals you should contact.

This is my letter.

December 10, 2007

Julie Louise Gerberding, M.D., M.P.H. [follow link for background on the director]
Director, Centers for Disease Control and Prevention
Office of the Director
Centers for Disease Control and Prevention
1600 Clifton Rd Atlanta, GA 30333

RE: Recommendations viz neonatal male circumcision and HIV

Dear Dr. Gerberding:

I have learned with grave concern that you and the Centers for Disease Control are considering recommending neonatal circumcision as public health policy in the effort to stem the spread of HIV/AIDS in the United States. I oppose this recommendation in the strongest possible way.

Letter to AAP/CDC Neonatal circumcision has run into national grassroots opposition from a sizable and highly active group of people for at least the last 25 years. This opposition on human rights grounds has resulted in the major medical organizations gradually moving away from support of a marginal procedure that damages sexual response and violates the individual human rights of the infants on the receiving end.

Whatever marginal gain individuals may receive from male circumcision must be in the context of informed consent and voluntariness. Infants can provide neither. The variables involved in the effectiveness of such a procedure over the longer term are many, including the changing dynamics of the disease, changes in provision of healthcare impacting cost-effectiveness, the possibility of new treatments, prevention technologies, and eventually a vaccine. Male circumcision has not served the United States well heretofore in comparison with non-circumcising countries and regions where the HIV/AIDS rate is much lower, e.g. Japan, most of Europe, and Latin America.

I urge you to reject neonatal male circumcision as public health policy in order to safe guard your credibility with the American people and throughout the world. The United States can ill-afford another dubious policy with scant input from American stakeholders.

Very truly yours,

/DWilton/

DAVID WILTON, Esq.
Editor
http://www.circumcisionandhiv.com/


If you would like to email all of the below individuals with a single email, you may copy the following to your email client.

“Katrina Kretsinger” kkretsinger@cdc.gov,
“Thomas R. Frieden” txf2@cdc.gov,
“Renée Jenkins” rjenkins@aap.org,
“Jay Berkelhamer” jay.berkelhamer@choa.org,
“David T. Tayloe” dtayloe@aap.org,
“Errol Alden” ealden@aap.org,
“Peter H. Kilmarx” pbk4@cdc.gov,
“Andrew Freedman” andrew.freedman@cshs.org,
“Doug Diekema” diek@u.washington.edu,
“Dawn K. Smith” dks0@cdc.gov,
“Lee Warner” dlw7@cdc.gov,
“Lee Warner” lee.warner@cdc.hhs.gov,
“Michael T. Brady” michael.brady@nationwidechildrens.org,
“Patrick Sullivan” patrick.sullivan@cdc.hhs.gov,
“Thomas Peterman” thomas.peterman@cdc.hhs.gov,
“Allan Taylor” allan.taylor@cdc.hhs.gov,
“Allyn Nakashima” allyn.nakashima@cdc.hhs.gov,
“Mary Kamb” mary.kamb@cdc.hhs.gov,
“Stephanie Bailey” stephanie.bailey@cdc.hhs.gov,
“Timothy Mastro” tmastro@cdc.gov,
“Stephen Blount” stephen.blount@cdc.hhs.gov,
“Kevin Fenton” kevin.fenton@cdc.hhs.gov,
“Dan Walter” dwalter@aap.org,
“Roger F. Suchyta” rsuchyta@aap.org,
“Circumcision Task Force” circumcision@cdc.gov,
“Committee on Bioethics” bioethics@aap.org

Below are addresses and emails for key people at the CDC and the AAP. Please both e-mail and snail mail letters to the addresses below.

Katrina Kretsinger, MD
Lieutenant Commander
US Public Health Service
1600 Clifton Road NE
Atlanta, GA 30333
404-639-8544
kkretsinger@cdc.gov

Jeff Crowley, MPH, Director
Office of National AIDS Policy
Comments line: 202-456-1111

To send a message directly to Mr. Crowley and to President Obama, use the White House contact page.

Dr. Helene Gayle, President and CEO
CARE USA
151 Ellis Street, NE
Atlanta, GA 30303

Judith S. Palfrey, MD
President, AAP
Children’s Hospital Boston
300 Longwood Avenue
Hunnewell 201.3
Boston, MA 02115

Click on Judith Palfrey to email her.

Thomas R. Frieden, MD, MPH
Director, Centers for Disease Control and Prevention
Office of the Director
Centers for Disease Control and Prevention
1600 Clifton Rd
Atlanta, GA 30333
(404) 639-7000
txf2@cdc.gov

Susan Blank, M.D.
Chairman
AAP Task Force on Circumcision
New York City Department of Health and Mental Hygiene
125 Worth St.
New York, NY 10013

Timothy Mastro, M.D.
Vice President
Health Development Sciences
Family Health International
P.O. Box 13950 Research Park, NC 27709
tmastro@cdc.gov

Committee on Bioethics
American Academy of Pediatrics
bioethics@aap.org

Renée Jenkins, M.D.
President
American Academy of Pediatrics
Professor and Chair
Department of Pediatrics and Child Health
Howard University Hospital
2041 Georgia Ave, NW, Room 6B02
Washington, DC 20060
executivecommittee@aap.org
rjenkins@aap.org

Jay Berkelhamer, MD, FAAP
Past-President
American Academy of Pediatrics
Children’s Health Care of Atlanta
1600 Tullie Circle
Atlanta, GA 30329
jay.berkelhamer@choa.org

David T. Tayloe, Jr., MD
President-Elect
American Academy of Pediatrics
2706 Medical Office Place
Goldsboro, NC 27534
dtayloe@aap.org

Errol Alden, MD
Executive Director
American Academy of Pediatrics
141 Northwest Point Blvd,
Elk Grove Village, IL 60007
ealden@aap.org

Peter H. Kilmarx
Branch Chief
US Centers for Disease Control
Corporate Square, E45
Corporate Blvd.
Atlanta, GA 30329
Tel (404) 639-8998
Fax (404) 639-6127
pbk4@cdc.gov

Dr. Andrew Freedman,
Pediatric Urologist
Cedars-Sinai Medical Center
8635 W. Third St., Suite 1070
Los Angeles, CA 90048
Tel (310) 423-4700
Fax (310) 423-4711
andrew.freedman@cshs.org

Dr. Freedman’s biography can be found here: http://www.cedars-sinai.edu/15611.html.

Freedman has said, “… The older a child gets, the less benefit there is, and the greater the risk. I would ask parents of an older child to strongly reconsider if the only reason they’re doing this is cosmetic.”

On circumcising his own son (which he did himself!) he has said, “I didn’t make any excuses that this was to avoid a UTI, or for medical reasons. My rationale was this: As a Jewish male in a long line of tradition, I didn’t want to be the link in a chain that broke.

“Rest assured. No matter what decision parents make for their son, most men think whatever they have is just fine.”” – March 31, 2008 LA Times

One might consider asking that he recuse himself from the Task Force based on personal and religious bias. However, these statements may also demonstrate amenability to reason and ethics. It’s a judgment call you will have to make when you write your letter.

Dr. Doug Diekema
Pediatrician
Department of Emergency Services
Children’s Hospital and Medical Center
4800 Sand Point Way NE
Seattle WA 98105
diek@u.washington.edu

This may be an additional address: 1100 Olive Way MPW 8-2, Seattle, WA 98101-0000

Dr. Diekema is the AAP Chairperson for the Committee on Bioethics and is on the AAP task force developing the new policy.

Dr. Dawn K. Smith
Division of HIV/AIDS
Centers for Disease Control and Prevention
Mailstop E-45,
1600 Clifton Rd.
Atlanta, GA 30333
Tel (404) 639-6146
Fax (404) 639-6118
dks0@cdc.gov

David S. Janssen, MD, Director
Division of HIV/AIDS
Centers for Disease Control and Prevention
Corporate Square Building, Room 5170
8 Corporate Square
Atlanta, CA 30329

Lee Warner, Ph.D
Centers for Disease Control
Division of Reproductive Health
4770 Buford Hwy NE
Mail Stop K-34
Atlanta, GA 30341
dlw7@cdc.gov

Michael T. Brady, M.D.
Nationwide Children’s Hospital
700 Children’s Dr, AB 7048
Columbus, OH 43205
michael.brady@nationwidechildrens.org

Additional CDC Committee Member Emails:

Patrick Sullivan
patrick.sullivan@cdc.hhs.gov

Thomas Peterman
thomas.peterman@cdc.hhs.gov

Allan Taylor
allan.taylor@cdc.hhs.gov

Allyn Nakashima
allyn.nakashima@cdc.hhs.gov

Mary Kamb
mary.kamb@cdc.hhs.gov

Lee Warner
lee.warner@cdc.hhs.gov

Stephanie Bailey
stephanie.bailey@cdc.hhs.gov

Stephen Blount
stephen.blount@cdc.hhs.gov

Kevin Fenton
kevin.fenton@cdc.hhs.gov

Additional AAP Committee Member Emails:

Dan Walter
Senior Health Policy Analyst
Division of State Government Affairs
847-434-4086
dwalter@aap.org

Roger F. Suchyta, MD
Associate Executive Director
American Academy of Pediatrics
rsuchyta@aap.org

Several different versions of form letters have been received from the CDC so far. Here is one of them:

Department of Health & Human Services
Public Health Service
Centers for Disease Control and Prevention

February 6, 2008

[Addressee omitted]

Dear Ms. [name omitted]:

Thank you for your recent correspondence to the Centers for Disease Control and Prevention (CDC) regarding male circumcision as it relates to HIV prevention in the United States. The potential role of adult and neonatal male circumcision in addressing health outcomes in the United States, including HIV infection, is currently an important consideration for public health.

In the past year, male circumcision has been identified as an effective HIV prevention method, based on clinical trials in Africa. Researchers found that circumcised men were at least 51% less likely than uncircumcised men to acquire HIV during sex with women. While there are distinct differences between the HIV/AIDS epidemics in Africa and the United States, it is critical that we examine the potential role of male circumcision in HIV prevention efforts in the United States.

CDC acknowledges that male circumcision is associated with reduced risk for HIV acquisition via heterosexual exposure, and that additional consideration is needed to determine its relevance to the epidemic in the United States. We are committed to ensuring that evidence-based HIV prevention strategies are promoted. CDC is continuing to receive input on this issue, and we appreciate the information you have provided. We believe that a comprehensive approach to HIV prevention is the best way to reduce the impact of HIV on America’s communities.

CDC is committed to working with public health partners to evaluate the role of male circumcision for HIV prevention in the United States. In April 2007, CDC consulted with a broad range of experts to explore the role of male circumcision in preventing HIV transmission in the United States. Participants examined the best scientific evidence to assess the relevance of male circumcision to the epidemic in the United States and explored factors such as potential cost-effectiveness, cultural and safety concerns, and integration with existing prevention methods. CDC believes it is critical to examine the best scientific data and take into account a variety of perspectives on health policies as we develop recommendations on male circumcision. Once CDC has developed draft recommendations, they will be published in the Federal Register to provide an opportunity for the public to comment through a formal public review period.

CDC continues to support a combination of evidence-based prevention strategies. We believe that the promotion of safer sexual behaviors, including condom use, should continue and will contribute substantially to reducing HIV infection rates, especially when combined with other effective interventions. We are also taking into account the potential risks and harms of male circumcision, and are aware of concerns regarding human rights and changes in sexual sensation resulting from male circumcision.

Thank you again for contacting CDC and for your continued commitment to HIV prevention.

Sincerely,

Timothy D. Mastro, M.D.
Deputy Director for Surveillance, Epidemiolgy, and Laboratory Science Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention