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April 5, 2005

Anti-circumcision activist on campus discusses his past

He stands on the corner of 58th and Ellis day after day, spreading his word. With his mismatched plaids and tweeds, grizzled beard, and face ridden with the sage lines of experience, he closely fits the prototype of a University of Chicago professor. Although he too shares the desire to teach, his large sign reading, "The forefront of medicine should know that foreskin is not a birth defect," his bright T-shirt with the caption "Circumcision—I didn't give my consent!" and his stacks of informational flyers divulge that this man is no prototypical professor, but rather an antinomian with a very atypical lesson to teach.

Daniel Strandjord aims to put an end to the routine circumcision of baby boys, called RIC (Routine Infant Circumcision). Although more infrequently in the frigid winter months, Strandjord appears on weekdays, from morning until afternoon, outside the Barnes and Noble on Ellis. Strandjord hopes to target the University and Hyde Park community, but particularly those affiliated with the University of Chicago hospital. Strandjord says he "expects better" of the Hospital, which claims to be at the "forefront of modern medicine" Strandjord views this claim as completely erroneous, since the fact that the hospital still performs RIC.

Strandjord's choice to confront the University of Chicago Hospital is not an arbitrary one. His mother and father met while studying at the Law School and Medical School, respectively. They raised him in Hyde Park where he attended the Lab School until college. Now he is a Hyde Park resident once again, and it is no wonder that Strandjord speaks of the school as "my University." Strandjord's father renders his connection to the University, particularly to the Hospital, even deeper. A professor of radiology at the University of Chicago Medical School, his father was the recipient of the McClintock Award for Outstanding Teaching. He has several awards and a student loan fund named in his honor. His picture even decorates one of the hospital's hall walls.

One might think it odd that Strandjord zealously endeavors to protest the conduct of the very hospital that so revered his own father. But the intricacies of Strandjord's personal life help explicate the questionable aspects of his pursuit. Strandjord himself was a victim of a botched circumcision, which occurred at the University of Chicago Hospital. The event remained unspoken of throughout his childhood. Strandjord's father died when he was 15 without ever having acknowledged the complication.

This may explain Strandjord's fervent quest for the excision of circumcision on a personal level—why he has chosen to save not the whales or the children, but the foreskin. However, he emphasized that his own negative experience with circumcision is not the sole reason behind his current mission. Although rage and frustration with his own circumstances with his parents, and by proxy, the medical school that honored his father, may partially motivate his aims, Strandjord does not focus on these issues in communicating his message. He believes that the University is unwilling to publicly defend R.I.C., and "if that is the case," he says, "then the U of C should lead by example and stop RIC The U of C should publicly challenge other hospitals to either defend RIC or also stop."

Strandjord finds it ironic that such an advanced facility would perform what he deems an "outdated and needless procedure." After a brief stint of teaching at another medical facility, Strandjord's father hastily returned to the medical school. Disgusted by the procedures being performed at the other facility, he proclaimed he would not continue to "practice 19th-century medicine." Strandjord takes issue with this assertion, because for Strandjord, circumcision is nothing if not a throwback to a superstitious past.

"The Judeo-Christian-Islamic tradition is afraid of sex," argues Strandjord, citing a few of the routine procedures practiced to stop masturbation, of which circumcision is one, such as the tying of children's hands to the bedposts, chastity belts, and even inflicting acid on children's genitals to make them less sensitive. According to Strandjord, circumcision was partially the result of an anti-masturbation hysteria in the early 1800s, originating with figures such as Fissot, who wrote "The Evils of Masturbation," where he asserted that masturbation could cause such conditions as epilepsy, boils, and eventually death. Even the graham cracker, a seemingly innocuous childhood snack, is but a product of this hysteria: Reverend Sylvester Graham originally marketed the cracker as a masturbation prophylactic, reasoning that because the cracker was "soothing and easy to digest," children would surely lose the urge to touch themselves.

As for popular argument that circumcision is "cleaner," Strandjord considers this a myth wrought from this same stringent religious morality. Originally, it was not sanitary but moral hygiene that was the principal concern. In order to wash an uncircumcised penis, one would have to manually move the foreskin, putting himself at the risk of erection, which would lead to the temptation of masturbation. If a man was circumcised, he could simply let the water run over his body without temptation. In terms of the real clinical hygienic benefits of circumcision, one doctor at the University hospital, Joel Schwab, said "there is no definite evidence one way or another" and again, according to the official statement of the American Academy of Pediatrics, "there is little evidence to affirm the association between circumcision status and optimal penile hygiene."

Judaism is most commonly associated with the religious tradition of circumcision, as the Old Testament covenant between Abraham and God commands that all Jews be circumcised. Strandjord sees a certain irony that unlike many of the Old Testament Jewish laws that have today proven obsolete, such as the forbiddance of contact with menstruating women, circumcision is a tradition that has subsisted. With the possible exception of bagels, it is one of the few aspects of Jewish tradition that has most infiltrated other cultures and society in general. However, according to Rabbi David Rosenberg, director of the Newberger Hillel Center, "Circumcision is one of the most powerful signs of identification with the Jewish people both in biblical context and beyond. The physical aspect of circumcision pales in comparison with the meaning of being a participant in the covenant. For Jews, it is not simply one of many biblical injunctions." Additionally, efforts to prevent Jews from practicing circumcision have often been viewed, according to Rosenberg, as "antagonistic to the ongoing existence of the Jewish people" rather than as a celebration of the human right to in-tact genitalia, as Strandjord views such efforts.

Strandjord reports that Muslims, and not Jews, perform the highest percentage of circumcisions of any religious group. According to his sources, 20 percent of Muslim children ages seven to 11 are circumcised, and 20 percent of Muslims still circumcise their daughters. Although circumcision is not mentioned once in the Koran, the practice is considered to be an act of "sunnah," or fulfillment of the covenant with God. However, circumcision is in no way mandated by Islamic law, so the high rate of Muslim circumcision in males, and indeed females, seems baffling.

In addition to the religious ambiguities surrounding circumcision, such a practice, according to Strandjord, "precedes modern medical ethics and human rights laws." Strandjord argues that circumcision breaches the protection of bodily integrity in the United States Constitution. According to standard medical ethics, one cannot operate on a patient without consent, and proxy consent (in this case, the consent of the parents) is not valid for "unnecessary non-therapeutic procedures." Although there are some conjectural medical justifications for circumcision, doctors do not consider it to be necessary by any means. Pediatrician John Lantos, M.D. of the University Hospital wrote "In my opinion, circumcision is clearly not medically necessary." Schwab explains that when confronted with parents considering circumcision who ask if it is necessary, "The answer has to be ‘no.'" Schwab did explain that circumcised males have a slightly lower chance of contracting urinary track infections, but the rate may or may not be statistically significant. Lantos says that "circumcised children may have fewer urinary tract infections, but this doesn't justify the pain or potential complications of circumcision." Another possible therapeutic aspect of circumcision is that the lack of foreskin might decrease a man's chance of developing penile cancer. But as Strandjord puts it, "We don't cut off breasts because you might develop a tumor. At 18 you can elect to have it done—you make the choice yourself. We would never cut off a baby's fingers to prevent it from getting hangnails." In keeping with Strandjord's logic, circumcision may be not only immoral, but illegal according to established medical and human rights laws.

Strandjord claims that one can also consider RIC to be a gender discrimination issue. The circumcision of the female genitalia, called a cliterodectomy, occurred until the mid-1900s in America. According to Strandjord, the University hospital even performed them up until the 1950s. In 1997, Congress passed the Prevention of Female Genital Mutilation Act. Strandjord remarks that, "The same human rights laws violated by female circumcision are violated by male circumcision. Why, if they understand that you don't cut up a healthy, normal little girl, do they continue to cut up healthy, normal little boys?"

According to Standjord's statistical citations, three out of every 100 boys in the world are circumcised (leaving 97 "intact"), and two out of these three boys is American. Of the English-speaking world, America has the highest circumcision rate, at around 60 percent. The proportions decrease with Canada at less than 20 percent, Australia at 10 to 15 percent, New Zealand at three percent and Britain at nearly zero. Almost no Europeans are circumcised. As Strandjord views it, "When it's part of your culture, you just don't see it. Americans grow up to think that a foreskin is a useless flap of extra skin. They don't know that it's a highly specialized sexual tissue. People deny what is lost, and the baby doesn't know what he is missing."

Strandjord views circumcision as costly not only in the bodily, ethical and medical senses, but financially as well. According to Strandjord, insurance companies spend one billion dollars a year to pay for circumcision. "States won't pay for a kid's glasses, but they will pay for his circumcision. It is abominable that states would use taxpayer money to do the unnecessary when they're not even doing the necessary," he reasons. Medicaid, which only pays for "necessary" operations, does pay for circumcision. "This leads poor people to think that, because Medicaid offers to pay, the procedure is a necessary one. It helps perpetuate the mythology that circumcision is something good." Lantos supports this view, saying, "I would favor changes in insurance reimbursement policies to not cover circumcision. This might lead to a lower (and therefore, more preferable) rate of circumcision."

Despite the current high percentage of circumcision in America, Strandjord seems hopeful that the practice will soon become obsolete. When asked if he thought it would end within the next 50 years, he responded, "Oh it will, and long before then."

Medicaid has already stopped paying for circumcision in 13 states, including California, Oregon, Washington, Utah, and Arizona. Strandjord is part of the Medicaid Project, to get all the states to stop funding what he considers to be "unnecessary and harmful procedures." Additionally, from speaking with medical students outside the Hospital, Strandjord deduced that "many younger doctors won't do it [circumcision]. They say that it is barbaric and unethical." It is the older doctors, Strandjord says, who walk by him with shaking heads and frowns.

As new generations replace the old, questions arise as to whether America will, one day in the future, look back on the ritual of circumcision and equate it with Chinese foot binding, Aboriginal subincisions, or even eugenics. The University's medical facilities may or may not come to the conclusion to stop RIC. "If the University were objective about it, it would stop. The University knows better," says a convinced Strandjord. He continues, "but it is a very emotional issue. It means that people must admit that they have been damaged, and nobody wants to think of themselves as sexually damaged."

Strandjord's pursuit encourages a long-overdue awareness of the ethical implications of circumcision, and highlights more generally the ubiquitous and timeless tension between tradition and necessity. As Lantos opines, "I think this is a case where the ethics of individuality and the meaning of ritual runs into the ethics of child protection and the meaning of medical treatment. Much of what doctors do is more ritualistic than scientific." Strandjord's argument is that the mélange of ritual and science in this case serves as a great expense to ethics and morality. The question which arises from Daniel Strandjord's pursuit is not, "Why shouldn't we continue to circumcise?" but rather, "Why should we?" Strandjord beckons us to consider carefully this latter question.

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