Female Genital Mutilation, Ivy League Edition

Originally published at David Horowitz’s NewsReal

Should surgeons promote an aesthetic standard for little girls’ genitals? Pediatric urologist Dix Poppas thinks so, and he’s more than happy to slice and dice away any deviations in the size and shape of your daughter’s clitoris.

This elective butchery of little girls isn’t based on the edict of some Muslim cleric in Yemen or Egypt. Instead, this is medical advice from a respected, board certified Cornell University researcher who performs these partial clitoridectomies on infants and children at New York-Presbyterian Hospital.

Poppas carries out these surgical assaults on girls born with cosmetically atypical genitalia that he deems masculine or ambiguous in appearance.  Some of his patients undergo this cosmetic procedure at under six months of age after Poppas tells their parents that with surgical “correction,” a “normal physiologic, emotional, and sexual development can be achieved.”

But is there evidence that girls with large clitorises are at risk of developmental problems?  Not at all, say Alice Dreger and Ellen K. Feder in a new Bioethics Forum commentary:

For over a decade, many people (including us) have criticized this surgical practice. Critics in medicine, bioethics, and patient advocacy have questioned the surgery’s necessity, safety, and efficacy.  We still know of no evidence that a large clitoris increases psychological risk (so is the surgery even necessary?), and we do know of substantial anecdotal evidence that it does not increase risk. Importantly, there also seems to be evidence that clitoroplasties performed in infancy do increase risk – of harm to physical and sexual functioning, as well as psychosocial harm.

This isn’t the equivalent of surgically treating a disabling cleft palate; it’s the risky, medically unnecessary reduction of a sexual organ.  It doesn’t improve function or hygiene; instead, it jeopardizes future sexual sensation for the frivolous goal of ensuring these girls fit in with the other kids when they play “I’ll show you mine.”

Columnist Dan Savage writes, “There’s lots to be outraged about here: there’s nothing wrong with these girls and their healthy, functional-if-larger-than-average clitorises; there’s no need to operate on these girls; and surgically altering a girl’s clitoris because it’s “too big” has been found to do lasting physical and psychological harm.”  And Slate‘s Rachael Larimore observes, “One doesn’t have to be a doctor to realize that this is nothing less than the same genital mutilation that women regularly undergo in Africa and the Middle East. But it’s happening at one of our top institutions of higher learning.”

Indeed, sterile blades and lip service paid to the preservation of clitoral sensation are the only things distinguishing this genital mutilation from the ritual excisions that permanently scar millions of women around the world.

Dr. Poppas contends that his clitoral reduction surgery isn’t misogynist quackery because it utilizes a “nerve-sparing” technique designed to minimize sexual dysfunction.  How does he know? He uses vibrators to stimulate the girls’ clitorises during followup exams.

At annual visits after the surgery, while a parent watches, Poppas touches the daughter’s surgically shortened clitoris with a cotton-tip applicator and/or with a “vibratory device,” and the girl is asked to report to Poppas how strongly she feels him touching her clitoris. Using the vibrator, he also touches her on her inner thigh, her labia minora, and the introitus of her vagina, asking her to report, on a scale of 0 (no sensation) to 5 (maximum), how strongly she feels the touch. Yang, Felsen, and Poppas also report a “capillary perfusion testing,” which means a physician or nurse pushes a finger nail on the girl’s clitoris to see if the blood goes away and comes back, a sign of healthy tissue. Poppas has indicated in this article and elsewhere that ideally he seeks to conduct annual exams with these girls. He intends to chart the development of their sexual sensation over time.

I guess that’s one way to explain why you have a lifetime supply of Trojan Vibrating Touch personal massagers stashed in your closet:  “But officer, they’re for the children!”

Unsurprisingly, Dreger and Feder were unable to find another pediatric urologist who uses this “ground breaking” post-surgical kiddie diddling technique.  What’s more, Poppas knows that inflicting this sort of trauma on children is far beyond the bounds of acceptable scientific practice.  That’s why he didn’t bother to obtain IRB approval for his unorthodox use of “vibratory devices.”  Dreger explains:

If he had sought IRB approval for the “sensory testing,” the ethics staff might have sat up and asked him what the heck he thought he was doing to these girls, and they would have tried to make sure the parents were informed about the unknowns and risks, and the girls could have refused to participate.

Perhaps Dix Poppas (whose name could inspire an entire Freudian treatise) thinks his work is so important that ethical boundaries don’t apply. Maybe he’s simply a child molester who takes sadistic pleasure in mutilating and traumatizing the most vulnerable among us.  Either way, we can’t allow his battery of little girls to go on, not for one more day.


Rosemary Kraemer, PhD
Director, Human Subjects Protections
Weill Cornell Medical College Institutional Review Board
E-mail: rtkraeme@med.cornell.edu
Telephone: (646) 962-8200

And please call on the American Board of Urology and the American Academy of Pediatrics to condemn Dix Poppas’ unethical research and clinical practices.

Thanks to Rachael Larimore and @sarahbellumd for alerting me to this story on Twitter.


Follow me on Twitter and visit NewsReal to read more of my work.

I’m a Fiend at Heart

Misfits Fiend ClubOkay, confession time. At some point in my youth, it’s entirely possible that I thought I was pretty hardcore with my Misfits Fiend Club button fastened to my black leather MC.  And I just might have spent hours on end combing through used record stores for additions to my collection of The Misfits on vinyl.

The Misfits are still my favorite band of all time, so I’m excited that Bobby Steele, one of the first guitarists for The Misfits, is now writing for Parcbench.  And not only that, he’s conservative on health care.

It’s like Halloween in February!

Anyway, check out Bobby Steele’s piece on health care reform, and how his childhood experiences as a spina bifida patient gave him firsthand insight into the insurance and medical industries.

This fangirl moment has now concluded.

Keep Government Out of Health Care, Say … Liberals?

Want a clear indication that the federal government has no business getting into the health insurance industry? Look no further than the Stupak amendment, the measure that attached tight abortion funding restrictions to the House health care bill.

Democratic consultant Karen Finney called the Stupak amendment “an attack on our personal freedom and liberty as guaranteed by the constitution.” Rep. Barbara Lee (D-CA) said the amendment “attempts to dictate to women how to spend their own money.” And liberal columnist Michelle Goldberg lamented, “Health-insurance reform was supposed to end the sort of hideous cruelties our system inflicts on patients, not create them.”

To call Finney, Lee, and Goldberg tone deaf would be a grand understatement.

The only reason the abortion restrictions in the Stupak amendment are so intrusive is because health care reform is so intrusive. When we increase the role of government in health care, our freedoms and choices become more vulnerable to politics. Period.

Funding for every aspect of the doctor-patient relationship, every medical test and procedure, and every health care guideline becomes susceptible to pressure from special interest groups and moral scrutiny by taxpayers.  If guys who can’t get it up have enough money to throw around, erectile dysfunction drugs make the cut.  If taxpayers think acupuncturists are predatory quacks, no reimbursement for them. And after the reconciled bill is signed by the president, an unelected body will make these decisions for all of us.

Liberals cheered when President Obama appointed an executive pay czar, reasoning that companies like AIG have no right to determine pay packages if taxpayers are footing the bill.  But somehow they missed the obvious lesson.  There are always strings attached to government handouts.

Welcome, liberals, to the hazards of government subsidy.  Either private insurance is restricted by health care reform, as with the Stupak provisions, or abortion receives some form of federal funding, thus changing the status quo.  There’s no in between.

Objectionable restrictions abound when we seek increased state participation in our lives through regulation or subsidy.  Just ask members of a United Methodist Church group that refused to make a beachfront pavilion available to a lesbian couple for a civil union ceremony.  The group lost its state property tax exemption for failing to make the venue available to everyone on an equal basis.  But that’s how it works: if you want state subsidies, you have to play by the state’s rules.

We’ve seen the impact on coverage in states that are experimenting with models of universal health care.  In Massachusetts, legal immigrants no longer have state-subsidized coverage for dental, hospice, and skilled nursing care. And if you’re a Medicaid patient, prisoner, or public employee in Washington state, don’t expect your government to cough up the cash for knee arthroscopy for osteoarthritis – it’s one of several treatments no longer covered.

Speaker Nancy Pelosi has said that “the power of Congress to regulate health care is essentially unlimited.”  Do liberals really believe that those regulations will exist to make their wildest dreams come true, now and forever?

When you invite the government to become more deeply involved in health care, you’re also inviting greater government interference in personal choice. Medical decisions become political decisions. That’s how it works, and it’s why philosophical opposition to the growth of government isn’t the crazy-eyed wingnuttery progressives make it out to be.

Proponents of liberal health care reform deliberately lured a bloodthirsty vampire over their thresholds, and now they’re shocked – SHOCKED – to find they have fangs buried deep in their necks.  I’m not one to blame the victim, but it sounds like they might be getting exactly what they were asking for.

Hope & Change in America, Mammogram Edition

Who could have predicted a new federal recommendation calling for less frequent mammograms?

Oh wait, I did. In May I wrote at length about how American mammography recommendations differ from those in places like Canada and the United Kingdom where cost containment goals determine testing guidelines:

Of women who receive annual screening mammography beginning at age 40, six out of 10,000 over a decade will have their lives saved.  Breast cancer will be detected and cured in many more, but regular mammograms will only make a life or death difference for six of every 10,000 women in that group.  Mammograms are of extremely high value to those women and their families, but don’t offer much bang for the buck when it comes to the other 9,994 women.

And wringing more bang from every health care buck is reason enough for Canadian and British recommendations that women wait until age 50 to begin receiving screening mammographies.  In these countries where cost-effectiveness studies influence health policy and medical practice, six saved lives aren’t worth the substantial costs associated with all those extra mammograms and the false positives they sometimes produce.

It is hardly shocking that the breast cancer mortality is 9 percent higher in Canada and 88 percent higher in the United Kingdom.  Nine of 10 middle-aged American women (89 percent) have had a mammogram, compared to less than three-fourths of Canadians (72 percent).  And British and Canadian patients wait for care about twice as long as Americans.

There are indeed valid criticisms American health care, but one area in which we excel is that we don’t base guidelines for care on cost-utility analysis. That’s why the U.S. ranks first in providing the “right care” for a given condition and has the best survival rate for breast cancer.

Obamacare may force Americans to give up those bragging rights.

Starting right about … now:

“We’re not saying women shouldn’t get screened. Screening does saves lives,” said Diana B. Petitti, vice chairman of the U.S. Preventive Services Task Force, which released the recommendations Monday in a paper being published in Tuesday’s Annals of Internal Medicine. “But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully.”

Those “important and serious negatives” are anxiety and the risk of false positives. Shockingly, not everyone agrees that the risks outweigh the benefits of early detection.

But the American Cancer Society, the American College of Radiology and other experts condemned the change, saying the benefits of routine mammography have been clearly demonstrated and play a key role in reducing the number of mastectomies and the death toll from one of the most common cancers.

Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it,” said Daniel B. Kopans, a radiology professor at Harvard Medical School. “It’s crazy — unethical, really.

As I wrote in May, “I’ll be saving up for a date with a mammography machine in one of those thriving medical tourism meccas.”

Memeorandum has much more from the blogosphere on the new federal guidelines. Ed Morrissey reminds us that the very same federal panel developed the mammography guidelines we’ve been using, and Sister Toldjah asks, “What’s changed? Hmmmm….

Yes, what could it be?

Two Thumbs Up, Social Cons!

Media reports have hailed Saturday’s passage of the Stupak amendment – a measure to impose tight restrictions on federally subsidized abortions – as a great triumph for pro-life Republicans.

What a crock.

The bipartisan vote was not a Republican coup. It was the final bit of lubrication needed to help the House health reform bill squeak through in a 220-215 vote. Without the passage of the Stupak amendment, Nancy Pelosi would not have had enough pro-life Democrats on board to pass her bill.  So at best, the Stupak amendment was a Pyrrhic victory for pro-life Republicans. But more accurately, it was a demonstration that House Republicans are hopeless marks, skillfully manipulated into providing political cover for pro-life Democrats.

Even with the passage of the amendment, this pro-life “triumph” is destined to be short-lived should the bill make it to conference committee.  More than 40 pro-choice Democrats are threatening to sink the final bill if it contains the abortion funding restrictions, and President Obama wants the amendment language nixed as well.   With weeks or months for House Majority Whip James Clyburn to bargain with pro-life Democrats, there’s a good chance he’ll gather enough votes to pass a final reconciled bill without the Stupak language.  Few Democrats will want to block History in the Makingâ„¢.

Republicans had just one opportunity to derail Nancy Pelosi’s bill on Saturday: all they needed to do was hold their noses and vote “present” on the Stupak amendment.  But only Rep. John Shadegg (R-AZ) had the stones to do so. The rest voted “aye” and now the Democrats have momentum, courtesy of the House GOP.

Votes in favor of the Stupak amendment amounted to nothing more than pro-life window dressing.  No unborn lives will be saved by this vote, and in the end, all House Republicans will have to show for their “courage” are their pro-life bona fides. The vote was devoid of any true value to the pro-life cause, and if the reconciled bill passes, abortion will no longer be just a right women can choose to exercise; it will be an entitlement.

If a meaningless political gesture is enough to let these politicians sleep at night, it’s time to find new representatives.

Transparency, Accountability, and Personal Responsibility in Health Care

Following a series of semi-unplugged staycations, I’ve been doing too much reading and not enough writing. Since I haven’t quite managed to recover my blogging mojo tonight, let me point readers to David Goldhill’s article on the problems with American health care and why the reforms working their way through congress are unlikely to improve outcomes and lower costs.

Goldhill is a Democrat who recognizes that his party’s proposed solutions are, at best, mommy kisses and a Dora the Explorer Band-Aid applied to a critical systemic illness.  His piece is very, very long, but very much worth your time.  He proposes a transparent, consumer-centered health care market in which comprehensive health insurance is no longer the primary mechanism for financing routine and predictable care.

While Goldhill characterizes his ideas as “radical,” they’re hardly as extreme as, say, tossing out the Constitution and starting over.  I don’t necessarily agree with his implementation recommendations, but the article is thoughtfully constructed and his ideas (thankfully) don’t hinge on the false notion that prevention of diabetes and heart disease would be a cost-controlling panacea.  Here’s a taste:

Some of the ideas now on the table may well be sensible in the context of our current system. But fundamentally, the “comprehensive” reform being contemplated merely cements in place the current system—insurance-based, employment-centered, administratively complex. It addresses the underlying causes of our health-care crisis only obliquely, if at all; indeed, by extending the current system to more people, it will likely increase the ultimate cost of true reform.

I’m a Democrat, and have long been concerned about America’s lack of a health safety net. But based on my own work experience, I also believe that unless we fix the problems at the foundation of our health system—largely problems of incentives—our reforms won’t do much good, and may do harm. To achieve maximum coverage at acceptable cost with acceptable quality, health care will need to become subject to the same forces that have boosted efficiency and value throughout the economy. We will need to reduce, rather than expand, the role of insurance; focus the government’s role exclusively on things that only government can do (protect the poor, cover us against true catastrophe, enforce safety standards, and ensure provider competition); overcome our addiction to Ponzi-scheme financing, hidden subsidies, manipulated prices, and undisclosed results; and rely more on ourselves, the consumers, as the ultimate guarantors of good service, reasonable prices, and sensible trade-offs between health-care spending and spending on all the other good things money can buy.

Take the time to read the whole thing.

Hat tip: Peg Kaplan

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