Circumcision and Organic Food

I don’t want to write about the  AAP’s revised Policy Statement on circumcision , but I know I should…  When I read  this week in an Annals of Internal Medicine article  about organic food, I thought, “Darn, I want organic food to be healthier for my kids than food laced with unpronounceable chemical additives and pesticides I have to wash off.”  But as T he Rolling Stones sing , “you can’t always get what you want… but if you try sometimes… you get what you need.”

I need to find a hook quickly in this article to connect policy statements on circumcision with advice about organic food, and bear with me… Mick Jagger’s in here, too.  Let’s start with the circumcision debate.  As a pediatrician, I am often asked for my opinion on circumcision.  If the truth be told, I used to say that ‘there is no medical indication for the procedure…’ and now it seems I will have to say that ‘there may be a medical indication for the procedure…’

What I really want to say to the soon-to-be parent is “please don’t care too much about what I think.  Yes, I’m a medical insider and a mother of three sons, but my opinion should matter very little to you.”  Parents should make this decision for their sons acknowledging that personal, religious and cultural reasons are as valid as medical ones.  What I do always say to parents is, “if you are not 100% confident in the choice you are making, please wait and involve your son in the decision.”

I can’t say I fully understand why the AAP has chosen to revisit its policy statement on circumcision now.  The new one is only slightly less wishy-washy than the old one, and it doesn’t look like too much has changed in the science of it all.  A few small studies have shown that the benefits may outweigh the risks, but both risk and benefit are small.  Considering a boy’s overall health, benefits like fewer UTIs or lesser risk of spreading HIV, are trivial compared to the benefit of healthier eating habits (and we are eventually getting to organic foods.)  Many argue that we don’t really know the risk statistics for circumcision, but they are very small, too.  That leaves  the ethical debate , and it is true, babies don’t get a vote.  If you are a staunch opponent of circumcision, it seems appropriate to refer to the procedure as genital mutilation and to want to protect the babies.  Having been invited to a patient’s bris and also having been trained to do the procedure during my residency, I know that those descriptive words are chosen to unfairly evoke emotional disdain.  It’s hard to know whether a parent’s religious or cultural choices should win out over an infant’s future choice for his foreskin.

As parents, we make many decisions on behalf of our children, and most of us try to do it in the best way we know how.  That brings me to organic food.  I love  Whole Foods  Market, and I admit it:  it feels good to shop there.  But are there health benefits to exclusively eating organic food, and if so, what are they?   The Annals of Internal Medicine article calls itself  ‘A Systematic Review ‘ but there are not a large number of double-blind, placebo controlled studies to look at organic food choices and their role in longterm, overall health.   In fact, there are none.  This article is a retrospective look at what we know, and it’s definitely only a glimpse.  So what’s a parent to do if you don’t love hanging out with us at  Ellwood Thompson’s Market  celebrating community and food?

You do the best you can.  If I am trying to parent in a purposeful way and if I’m honest, I know that my decisions are based on everything from my own parents’ values to the chatter I hear in the carpool line… and OK, to medical science.  While the decision to circumcise is vastly different than the decision to shop at Whole Foods, both matter, and we want to make the ‘right’ choice for our families.

And therein… is the hook.  There IS more than one right answer.  The AAP and the Annals of Internal Medicine may not have the completely 100% correct answer.  Regardless of what medical science reports on circumcision and the importance of buying organic, I have to believe that when I make a decision on either topic, it is the right one for my family, and it may not be the same decision that’s right for yours.  That said, when you want me (in the role of pediatrician) to tell you what to do, Mick Jagger will remind us both, “You can’t always get what you want.”

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