Monday, August 24, 2009

Nip the tip as public policy 

Apparently Amy Klobuchar wouldn't have taken this question, but I would like to see someone ask a Congressperson somewhere about whether circumcisions would be mandated under Obamacare.
For now, the focus of public health officials in this country appears to be on making recommendations for newborns, a prevention strategy that would only pay off many years from now. Critics say it subjects baby boys to medically unnecessary surgery without their consent.

But Dr. Peter Kilmarx, chief of epidemiology for the division of H.I.V./AIDS prevention at the C.D.C., said that any step that could thwart the spread of H.I.V. must be given serious consideration.

�We have a significant H.I.V. epidemic in this country, and we really need to look carefully at any potential intervention that could be another tool in the toolbox we use to address the epidemic,� Dr. Kilmarx said. �What we�ve heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks.�
You think I jest about this mohel full employment act? Read on from the American Journal of Public Health (2009):
Results. The mean neonatal male circumcision rate was 55.9%. When we controlled for other factors, hospitals in states in which Medicaid covers routine male circumcision had circumcision rates that were 24 percentage points higher than did hospitals in states without such coverage (P < .001). Hospitals serving greater proportions of Hispanic patients had lower circumcision rates; this was not true of hospitals serving more African Americans. Medicaid coverage had a smaller effect on circumcision rates when a hospital had a greater percentage of Hispanic births.

Conclusions. Lack of Medicaid coverage for neonatal male circumcision correlated with lower rates of circumcision. Because uncircumcised males face greater risk of HIV and other sexually transmitted infections, lack of Medicaid coverage for circumcision may translate into future health disparities for children born to poor families covered by Medicaid.
From your mouth to the Center for Comparative Effectiveness Research's ear! Should make for some great bumper stickers for the 2012 election: Proleteriat of the world, unite! You have nothing to lose but your foreskin!

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