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| NDBME 1999 More Complaints to NDBME Chancellor of Higher Ed. Child Protection Services ASAPT |
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1995 letter to
the NDBME filling a legal complaint against circumcisers. First, 1995,
Letter to the 3/3/95 (resubmitted, 5/21/1997; hyperlinks added 4/2001) North Dakota Board of Medical Examiners To the North Dakota Board of Medical Examiners We place the following Accusation before the Board:
Routine infant circumcisers (if individuals need be cited: Roger Allen,
MD and Manuel Neto, MD, Minot) are practicing quack medicine, namely, a
pattern of inappropriate and fraudulent care. Request: that the NDBME discipline circumcisers
(namely, Roger Allen, MD and Manuel Neto, MD, Minot) for practicing
quackery (request made under NDCC 43-17.1-05: “All residents have the
right to make or refer complaints to the commission...”). Accusation’s Legal Basis: NDCC 43-17.1-07 (Sec. 4) and 43-17-31 (Sec. 6 and 7): “The board of medical examiners may revoke or suspend a physician’s license to practice medicine in this state or may attach conditions or restrictions thereto on any one or more of the following grounds:... 4. A continued pattern of inappropriate care, including unnecessary surgery, in the performance of his duties as a physician.” (emphasis added)
“The board may refuse to grant a license
to practice medicine in this state or may suspend or revoke such
license...upon any of the following grounds:... 6. The performance of
any dishonorable, unethical, or unprofessional conduct likely to
deceive, defraud, or harm the public. 7. The use of any false or
fraudulent statement in any document connected with the practice
of medicine.” (emphasis added) Basis for Board’s Authority and Need for
Action: A. Michael Booth, MD, PhD, in testimony, 2/13/95, that
helped defeat ND HB 1381Note
1 argued this Bill would “cripple the State Board of
Medical Examiners” by restricting its ability to “act against a
physician by suspending or revoking his or her license on the simple
finding of a continued patternNote 2 of inappropriate care.”Note 3 We must assume Dr. Booth, as a member of NDMA and
its Commission on Legislative Affairs, and as President of the ND
Chapter of the American College of Surgeons, has a good sense for the
powers of the NDBME. One of these is the power to determine what “appropriate
care” means. Dr. Booth pointed out that quackery
is inappropriate care. He quoted the U.S. Congress Select Committee on
Aging’s definition of a “quack” in its 1984 report on quackery. A
quack is “anyone who promotes medical schemes or remedies known
to be false, or which are unproven, for profit” (emphasis
added). He pointed out North Dakota has not been free of quacks, but “the
Board has acted appropriately to remove them.” This is fortunate,
according to Booth, or the expected and needed trust in physicians would
have been seriously eroded. “Indeed, had the Board failed to act, the
public would have had every reason to believe that the relationship of
trust between patient and physician had been knowingly violated.”
(emphasis added) Dr. Booth pointed out that “These practitioners of quack medicine [have] always been difficult to deal with.” They are successful (a) because of their ability to “take a bit of scientific fact and then extrapolate [it] to incredible proportions to justify the use of their therapy, oftentimes ignoring the very real toxic potential that their treatments involve...” and
(b) because “too often, the victims of these practitioners fail
to take action, out of embarrassment....” Summary of
Accusation A. Circumcision is quack medicine. Routine infant circumcision meets every definition of “quack medicine” and is, therefore, “inappropriate care.” It is: (1) based on “a bit of scientific fact” which is “extrapolate[d] to incredible proportions to justify the use of their therapy, oftentimes ignoring the very real toxic potential that their treatments involve....” When all the evidence is examined, it is seen to be physically and psychologically harmful to the infant, his parents and society at large. (2) fraudulent since the circumciser fails to provide full information, either from lack of knowledge or deliberate misrepresentation. (3) at least a quarter billion dollar business in the U.S.
(4) a subject that
embarrasses people, so corrective action is not taken. B. Circumcision violates human rights. Infant circumcision, however, is more than just the usual form of quack medicine. Circumcision does not just defraud the person who is persuaded by misleading information to consent to the procedure for him or herself. The patient, in this case, has no say at all. The amputation is forced upon a completely non-consenting individual. No one has the right to unnecessarily alter an infant’s physical integrity. Supporting
Arguments for Accusations Support for point A: Circumcision is Quack Medicine: Support for A1–Circumcision is harmful, not
beneficial: "care" based on inadequate evidence: Published studies, considering all the known
so-called physiological and cost benefits, show no positive balance of
actual benefit can be determined, even when these studies ignore the
negative weight of psychological damage and human rights violations.Note 4 For example, in an article in Family Medicine, “Circumcision: A Decision Analysis of its Medical Value,” Oct-Dec 1991, Dr. Lawler writes, “We conclude there is no medical indication for or against circumcision. The decision may most reasonably be made on non-medical factors such as parent preference.”
We would like to suggest that the child’s preference is the
only one that counts. In another article in Medical Decision Making, Oct-Dec 1991, Dr. Ganiats states: “Circumcision has essentially no effect on either dollar costs or health. For this reason, personal factors could justly be brought into the decision process.”
Even though those doing these studies have not faced the human
rights issue, nor long-term psychological or sexual effects, they make
clear, that circumcision is not a procedure to be justified on medical
grounds. Thomas Wiswell’s urinary tract infection studies
is a typical example of those who take “a bit of scientific fact and
then extrapolate to incredible proportions to justify the use of their
therapy.” He even claims God made a mistake providing men with this
erotic and protective tissue. One has to circumcise 99 infants to
prevent one UTI, even if Wiswell’s retrospective study on military
babies is accurate, which other researchers question because
catherization was used to gather urine samples and may have contaminated
them, and because of invalid statistical analyses. Girls are four times
as prone to UTIs as boys in any case. 100,000 infants must be circumcised to prevent one
penile cancer. Who explains to parents that more infants die of
circumcision complications in the U.S. than older men are saved from
penile cancer (about 200)? We still hear about the cervical cancer study––proved
invalid decades ago. This is just some of the persistent misleading
information the quacks dispense or fail to correct. Their approach
allows them to hood-wink a trusting public into a procedure with “very
real toxic potential.” In fact, all national and international healthcare
and medical organizations, including the American College of
Obstetricians and Gynecologists and the American Academy of Pediatrics,
say these amputations are not medically necessary. How can they,
therefore, be defined as “preventive medicine” when imposed upon a
non-consenting person? They are unnecessary surgeries, and
as such must be censored by Board action pursuant to NDCC 43-17.1-07
(Sec. 4). Surgical amputation of normal tissue can only be
called “mutilation.” Perhaps we do have a right to mutilate
ourselves, but not others. As Ron Miller, MD, Fargo, says, “What risk
is acceptable when one is tampering with something that is normal?”
The following is a list of a few more North Dakota people and
organizations that have recognized the non-necessary nature of routine
infant circumcision:Note
5 • Rhonda Ketterling, MD, Chair, ND Board of Medical Examiners, Medical Director for U.S. Healthcare, Bismarck, and practicing physician, Rugby. • Arlene Mack, RN, Vice President, Medcenter One, Support Services (speaking for Medcenter One, she said their physicians have agreed not to recommend circumcisions and will explain the risks). • Shari Orser, MD, Chair, Department of Ob/Gyn, Medcenter One, Bismarck. • Robert Wentz, MD, pediatrician, former ND State Health Officer, now Deputy Insurance Commissioner. • Jon Rice, MD, ND State Health Officer. • Sister Mary Margaret Mooney, PBVM, RN, Professor and Chair, Department of Nursing, University of Mary. • Gladys Cairns, Director, ND Child Protective Services and Chair of the Alliance for Sexual Abuse Prevention and Treatment. • Craig Shoemaker, MD, Director of Neonatal Services and Chair, Department of Pediatrics, Fargo Clinic MeritCare. • Ron H. Miller, MD, pediatrician, Fargo Clinic MeritCare. • Alan Lindemann, MD, Ob/Gyn, Fargo. • Thomas W. Mausbach, MD, former President, ND Chapter of the American Academy of Pediatrics (in a letter to the NDBME). • Charles Severn, MD, Chair, Department of Neonatology, St. Alexius Medical Center, Bismarck. • Connie Kalanek, MSN, RNC, Associate Professor, Medcenter One College of Nursing. • Robert Roswick, MD, and Jeffrey Smith, MD, Family Medical Center, Bismarck. • Judy Haynes, PhD, UND Counseling Center and clinical psychologist, Grand Forks. • Robert Pathroff, MD, urologist, Bismarck. • Roger Allen, MD, neonatologist, Minot. • BlueCross BlueShield of North Dakota. • Medicaid (does not pay for this unnecessary surgery in North Dakota according to state policy). Even Roger Allen, MD, Minot, cited above as being a
circumciser, said parents make up their minds about circumcision, not on
any scientific or medical basis, but on emotion, one of the hallmarks of
quackery. In a television interview (KMOT, 11/92) he said “There is no
compelling reason to do a circumcision, but on the other hand, there is
no compelling reason not to.” The only adequate response to such a
self-serving statement was made by Janet Wentz, North Dakota Republican
Legislator, “If there is no compelling reason to do a
circumcision, that is a compelling reason not to do one.”
This, we hope, will be the appropriate response of the NDBME. Since science, not custom, must be the final
arbiter of appropriateness for procedures forced upon non-consenting
individuals, circumcisers must scientifically justify their practice, or
it simply stands as a quack procedure. We ask you, where are the
studies to justify this painful, disfiguring and sexually
de-sensitizing practice? Support for A2–Fraudulent or incompetent
practitioners and practices: Perhaps there are circumcisers who do not know the
facts. But ignorance can no longer justify the continuation of
this practice. It certainly cannot be a basis for not censoring
them. It is a reason that makes Board action more imperative, since
well-meaning practitioners, who believe in their own quack procedures,
may work their damage even more insidiously on society. The prestige of the medical profession is truly at
stake here. Numerous and angry people can be brought before the
Commission to testify to how little information they were given, or how
misleading it was, before giving uninformed consent to
maim their sons. They know they were defrauded, and some are even
looking into law suits. Some did not provide written consent to the
unnecessary surgery. Support for A3–Financially self-serving at
amputee’s expense: Journals providing medical statistics use the
quarter billion dollar figure. It does not include the multi-million
dollar law suits arising out of “botched jobs” nor the
reconstructive costs to the 1 in 500 which are seriously botched,
according the American Academy of Pediatrics.Note 6 Of course, any
unnecessary amputation is a “botched job,” as so well put by the obstetric nursing staff at St.
Vincent Hospital, Sante Fe, NM, who refuse to participate in the
procedure. Their conscientious objector status has just been negotiated
into a legally binding agreement. Support for point A4–Embarrassment prevents
exposure: Discussion of genitals is taboo in our society.
Acquiring and dispensing accurate information on any taboo subject is
difficult. Circumcisers, and all quacks, profit from lack of exposure.
The media has a hard time providing information from fear of offending
the public. Once someone has been circumcised, has allowed it or done
it, the ritualization of the act often keeps one from publicly admitting
a wrong. Passing an act on to the next generation is often easier than
admitting the act was wrongfully done to oneself. B. Support for Accusation that
Circumcision Violates Human Rights. Parental rights do not extend to unnecessary
genital amputations. Now, it is true that “Parents, guardians, and
custodians are authorized to consent to healthcare on
behalf of children” (NDCC Sec. 23-11-13, emphasis added),
but routine infant circumcision is not a healthcare issue. No study with
its “bit of scientific fact” (Booth) offered to support the
purported positive effects of prepuce amputation, has ever been able to
establish that the negative physiological effects are not more
significant, not to mention other physiological and psychological
effects that result from functioning with a violated body. Historically, medical rationalizations are a
recent approach used by quacks. Except for the last hundred years in the
U.S., circumcision has never been done for health reasons. The appeal to
scientific evidence to justify it as a healthcare issue is major
healthcare fraud.Note 7
Since most men in the developed and underdeveloped countries of the
world are intact and do not have the dire problems circumcisers threaten
will occur, the procedure in the U.S. is obviously a non-medical ritual.
This is understood by many North Dakota physicians. Medical ethics clearly requires
physicians to decline to do follow a parent’s wish to alter a child
surgically for non-medical reasons. The physician is even required
to prevent others from doing so! (see NDCC 50-25.1-03–Persons
required to report child abuse and neglect). No one in our society can
morally (and we believe, legally) alter another surgically against his
will for non-medical reasons, even if he is one’s own son. Property
rights do not extend to one’s son or daughterNote 8. Sexism is inherent in the present practice. The physician’s responsibility to protect a helpless patient is recognized when it comes to all other operations and for genital amputations on female childrenNote 9 (which has now been formalized in ND SB2454, 1995) along with NDCC 50-25.1-03. Summary and
Request for Action Information and testimony to support this
allegation will be gladly provided.Note 10 However, we ardently maintain the
evidence is such, despite the cultural conditioning and prevalence of
prepucial amputations, that circumcisers are the ones who must justify
their actions to the Board on sound medical and scientific evidence.
They must prove routine infant circumcision is in line with the
physician’s oath: First Do No Harm. This justification must not be the
little piece of scientific evidence that quacks use. It must be the
whole spectrum, including the physical injuries and deaths as well the
increasing evidence of negative long-term psychological effects and
diminishment of sexual function. The citizens of North Dakota have a right to expect
the Board is monitoring and preventing unnecessary surgical procedures
and fraudulent practices. Amputations of healthy prepuces from
non-consenting individuals is unnecessary surgery, or more accurately,
contraindicated, surgery. It harms our children and violates
their human rights. It is a practice international community views as
abhorrent as we do female genital mutilations. Now that North Dakota is
taking the lead nationally in outlawing FGM, a move supported by the ND
Medical Association, citizens and legislators are asking why male
circumcisers are allowed to traumatize our male infants. They want to
know why our appointed state officials and medical associations do not
advocate for protection of male infants. Yet, with the recognition that in some way we are
all victims of the anti-masturbation hysteria which established the
practice of routine infant circumcision a hundred years ago, we ask not
that circumcisers (namely, Neto and Allen) be harshly disciplined for
past acts, but we do ask the Board to declare the procedure to be
inappropriate care and to warn potential circumcisers that future
amputations of a healthy prepuces will be treated by the Board for what
they are: quack medicine. If the Board or Commission does not declare routine
infant circumcision to be inappropriate care, the citizens of North
Dakota deserve a point by point explanation why not, giving
scientific evidence to support the points. We trust the Board
will act to protect those who are too helpless to protect themselves. History will not be kind to us in our perpetuation
and tolerance of this grave violation of human rights and dignity. Sincerely, Duane Voskuil, PhD [and other signatories] Enclosures: “Quotations and Comments
by Some North Dakotans” Endnotes to 1995 Letter: (1) Defeated HB 1381 read: “A physician’s use of
complementary or alternative therapies does not constitute a continued
pattern of inappropriate care, unless there is demonstrable physical
harm to patients.” Return to Text (2) Ralph Kilzer, MD, in response to a question, 2/27/95,
from the ND House Human Services Committee as to why the state needed a
bill outlawing FGM when this seems like an issue the NDBME should be
able to handle, responded that the NDBME generally looks for a pattern
of inappropriate care, whereas one unnecessary amputation of normal
female genital tissue would be grounds for criminal action. He said “for
normal tissue there is no useful medical purpose for amputating
[female?] genital tissue.” Circumcisers who do prepuce amputations
routinely have such a pattern of inappropriate care. Return to Text (3) In this regard, the letter from the ND Commission on
Medical Competency to Ramona T. Goheen, 11/29/94, responding to her
complaint against Manuel Neto’s inappropriate handling of her son’s
genitals, fails once again to address the real issue. Even if it were
true that the Commission could, somehow, find no law (such as battery)
under which to discipline Neto for a single act of forcibly separating
the immature preputial tissue from the glans (against the express wishes
of Ms. Goheen) and recommending circumcision for a child with
hypospadias (contrary to textbook recommendations), and doing so while
saying it must be done so he doesn’t get picked on by other boys and
so he will to do better in school, still Neto has been following “a
pattern of inappropriate care” in
forcible retraction of immature prepuces and in surgically removing
healthy functioning tissue from non-consenting people. The law is clear
enough on this. What is at issue here is not whether a law exists, but
whether the Commission has the will to apply it. No law gives physicians
the right to remove healthy functioning tissue from non-consenting
people, be it the male genitalia or any other tissue. Circumcision, in
Neto’s mind, it seems, as in many others, is surgical alteration to
accomplish psychological
ends. Return to Text (4) See, for example, “Birth Complications Combined
with Early Maternal Rejection at Age One Year Predispose to Violent
Crime at Age 18 Years,” Achieves of General Psychiatry, Adrian Raine,
DPhil; Patricia Brennan, PhD; Sarnoff A. Mednik, PhD, Vol. 51. No. 12.
Dec. 1994, pp. 984-988. Return to Text (5) See appended list of North Dakota Quotations. Return to Text (6) These figures are likely at the low end. The
following quotation is from the Journal of Family Law (copy enclosed),
Vol. 23, No. 3, 1985, by William E. Brigman, PhD: “Not only is routine
surgery unwarranted, but an article published in 1966 in The Canadian
Medical Association Journal [‘The Problem of Routine Circumcision’]
reported a complication rate running as high as 55% for
hospital-performed routine neonatal circumcision. Other studies showed
that approximately 10% of all circumcisions had to be repeated [Id.].
While most of the surgical complications were minor, Dr. Robert L.
Baker, writing in a 1979 issue of Sexual Medicine Today calculated that
229 infants died in the United States per year as a result of
circumcision [Baker, ‘Newborn Male Circumcision: Needless and
Dangerous,’ Sexual Medicine Today, Nov. 1979]. Return to Text (7) The fraud began over a hundred years ago as people
were persuaded to mutilate genitals in many ways in order to discourage
masturbation. Quacks played on people’s fear that “self-pleasuring”
would cause nearly every known ailment. Circumcision was actually
thought to be one of the least painful ways prescribed to “cure”
masturbation. Females were also genitally maimed, one we know of had her
clitoris excised by a Wahpeton, ND, physician forty-some years ago. Return to Text (8) Rights of parents to do what they will with their
children must be limited, testified Burleigh County States Attorney
Patricia Burke opposing HCR3036, otherwise the law would not be able to do anything
about the father “who initiated this teenaged daughter into sex
because he wanted her to learn about it from ‘someone who really
cares.’” Quoted from the Bismarck Tribune, 3/2/95, Sec. B. Also see
an excellent article in the California Law Review, “Parents’
Religion and Children’s Welfare: Debunking the Doctrine of Parents’
Rights,” Dec. 1994. The notion that a person can own another only
survives in some court judgments (since the freeing of slaves and wives)
in the parent/child relationship to the child’s detriment. Return to Text (9) Ralph Kilzer, MD, speaking for the ND Medical Association in support of SB 2454 said the NDMA endorsed the AMA’s Policy Recommendations which read: “1. That the AMA support legislation to eliminate the performance of female genital mutilation in the United States and to protect young girls and women at risk of undergoing the procedure. “2. That physicians who are requested to perform female genital mutilation on a patient provide culturally sensitive counseling to educate the patient and her family members about the negative health consequences of the procedure, and discourage them from having the procedure performed. Where possible, physicians should refer the patient to social support groups that can help them cope with changing societal mores.”
The AMA’s policy statement ends with an Action Recommendation:
“That the AMA join other organizations, including the World Health
Organization, the World Medical Association, interested national medical
societies, UNICEF and the International Federation of Gynecology and
Obstetrics in strongly opposing all forms of medically unnecessary
surgical modification of the female genitalia, promoting awareness of
female genital mutilation to the public and health care workers, and
education health professionals around the world to eliminate the
practice of female genital mutilation.” (emphasis added) No reasons
were given for the exclusion of males in this formal statement. Return to Text (10) See the enclosed, “A Review of Medical Literature
Exposes Circumcision Myths.” Return
to Text _________________________________________________ NDBME's Response
to the 1995 Letter Above:
September 19, 1995 Duane Voskuil, Ph.D. Re: Manuel V. da Costa Neto, M.D. Roger L. Allen, M.D. Dear Dr. Voskuil: This is in response to your letter of August 10, 1995. I
apologize for the [six months] delay in responding. Your complaints against the above named physicians were
discussed during a recent meeting of the North Dakota Commission on
Medical Competency. The complaints against Dr. Neto and Dr. Allen were
considered individually. In each case, the members of the Commission
determined that disciplinary proceedings would not result from this
complaint. I should perhaps point out, that at the time of this meeting,
the members of the Commission were aware that on the following day, the
Board of Medical Examiners would be considering what position, if any,
it should take on the subject of routine infant circumcision. As I
believe you are aware, the Board decided that: 1) We will include an
article on this subject in our next issue of the Examiner. That article will clearly state
that at this point, the Board has not yet adopted a position on this
issue [but they finally said they will not prosecute which is the same
as approving of the procedure]; 2) We will suggest to the NDMA [North Dakota
Medical Association] that a presentation on the pros and cons of routine
infant circumcision might be beneficial [this never happened]; and, 3)
We will poll the other states to determine which of them, if any, have
taken a position on this subject. I am distributing copies of all your recent correspondence to
each of the members of the North Dakota Board of Medical Examiners and
the North Dakota Commission on Medical Competency. Sincerely, ROLF P. SLETTEN RPS:km __________________________________________ The following is what was actually written in Routine Infant Circumcision
Some comments: (Also see the 1999 letter which has not received a reply from the NDBME.) Legislators have told us this is an issue left up to physicians and parents even though, when they passed the first FGM law, they did so without poling all the other states to see whether the law was needed, and they were not concerned about stepping on those parents who have strong feelings that FGM is necessary and beneficial, even a religious duty. Never has the NDBME given any reason why MGM is not covered by the Medical Practice Act's prohibition on unnecessary surgery. The legislature has already told the Board it has the jurisdiction and the responsibility to decide these issues. Will the Board now look to the legislature to further micro-manage what is and what is not appropriate medical procedures? The medical issue is settled: There is no justifiable medical purpose for amputating normal, healthy foreskins that is not equivalent to pulling teeth to prevent cavities or removing prepubescent breasts to prevent breast cancer. Every amputee has the "benefit" of no longer having to worry about the amputated body part becoming diseased or injured. If an adult requests a healthy body part be amputated, this is his or her individual choice. To forcefully cut off normal, healthy tissue from another is unconscionable. The Board must act according to the best scientific information and the rule of law. It is not the protector of outmoded and ethically questionable social practices that would quickly be branded quackery and battery were they to be instituted today. If anyone were to start this forced cutting today, they would be jailed as batters and sexual perverts. That this is not the case, only demonstrates the power of enculturation to blind people to the truth. If the Board does censure circumcision, and the legislature does not like the Board's action, then the law can be changed. For now, however, it is long past time the Board stops putting its finger up to test the wind and fulfills its legal, legislative mandate. When will the NDBME take a position on whether infant circumcision is "unnecessary surgery"? And if it does, and then unfortunately concludes circumcisions forced upon infants is not unnecessary surgery according to the Medical Practice Act, will it then clearly state the legal reasons why not? Will it tell us why it is not sexist--and why it is not a violation of a male child's right to a whole, intact and fully functioning body?
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been approached by a small but committed group of individuals
who would have the Board declare the practice or routine infant
circumcision to be "unnecessary surgery" within the meaning of
the Medical Practice Act. At this point[1996], the Board has neither
embraced nor condemned this practice [It still hasn't in 2001--why
not?]. The Board's research indicates that no other state medical board
has any rule, statute, or policy statement on this point either.
Nevertheless, it is a troubling and emotional issue. In the eyes of some
people, routine infant circumcision is nothing less than the wholesale,
unjustifiable mutilation of innocent infants by a violent society. Some
people see this question as being only medical issue, but to others it
is essentially a social issue and for some this practice has strong
religious significance. For all of these reasons, it is the conclusion
of the Board of Medical Examiners that this issue would be best debated
in the state legislature.