The American Medical Association has issued its first ever guidelines on the practice of travel outside the United States for medical care.  Transportation fuel prices have skyrocketed, raising travel expenses, but health care costs have risen more.  Rational consumers (and those paying the bills) are increasingly finding it is worth all the expenses of travel to procure medical services elsewhere.  The AMA couches its interest as concern for Americans seeking health care, but the primary purpose of the medical association is to serve the interests of its members.  When Americans travel outside the country for big ticket health care, AMA members are cut out of the deal.

“Come on, why be so cynical?” you might think, picturing a kindly old doc who always cracks a smile.  I’ve seen medical associations in the United States put the interests of their members above the needs of their patients before, that’s why.  To this very day, in the United States, the associations give license to their members to make a quick buck at the expense of patients.

Around the world, medical associations have taken strong steps toward enacting a Genital Integrity Policy for newborn patients.  Without demanding their members never perform a non-therapeutic circumcision, their policies make clear that cosmetic surgery on normal male infants should not be standard practice, and may constitute a breach of medical ethics.  They encourage physicians to ensure that parents know circumcision is unnecessary, is not justified on medical grounds, and interferes with normal sexual function.  The consequence has been dramatically reduced rates of neonatal circumcision, and dramatically increased rates of male genital integrity.

The United States lags behind the rest of the world.  Introduced here by doctors before the advent of modern medicine, circumcision of males (and, at the time, females) was thought to help prevent masturbation, which itself was considered harmful, and a myriad of other ills.  Although all the rationales have been discredited, the practice has become so institutionalized that doctors have come to justify its continuance based on its prevalence.  They have come to believe that no medical justification is needed to perform surgery on an infant.  They have not found the fortitude to give up this cash cow.  And since a circumcision is not expensive enough to justify travel overseas, I don’t know what will get them to pay attention.

Ironically, medical tourism outside the United States is something doctors and their associations can’t directly control, but they can preserve the genital integrity of most patients by simply heeding the admonishment: “First, do no harm.”

A non-profit doctors group has issued a policy statement on protecting the genital integrity of male infants and children.  The independent report provides what the group claims major American medical associations have not; An evidence-based policy for the well-being of children, free from conflicts of interest.  The American Academy of Pediatrics (AAP) is deeply conflicted, and its policy statements reflect “an ongoing tug-of-war between the two opposing forces who seek to dominate the AAP’s circumcision policy,” says Doctors Opposing Circumcision.  Consequently, “AAP circumcision policy statements are compromises that have scant relationship to the real evidence.”

The medical literature relating to male circumcision is polarized by the 130-year-old debate between the circumcised doctors and the others; the AAP may be equally polarized with respect to non-therapeutic male circumcision because of the presence of so many circumcised doctors within its fellowship.

The report, which includes review of “the position of the circumcision of male children under international human rights law, domestic law, and contemporary bioethics,” concludes “America needs and is ready for a new policy of genital integrity for its children.”

The Genital Integrity Policy Statement is published at the group’s website and in pdf format.