Last week Intact America announced a campaign to get circumcision added to a list of adverse childhood experiences (ACEs) that harm a child's brain and are associated with harmful adult behaviors.  To support their position Intact America released a paper, "Child Genital Cutting as an Adverse Childhood Experience",  and created a website to promote this agenda.  The website and paper cite the ACE list and a study that were developed by the U.S. Centers for Disease Control and Prevention.
The authors of the paper are identified as "Georganne Chapin, Executive Director of Intact America" and "Dan Bollinger, an independent men’s issues researcher". This partial profile suggests that Bollinger works independent of Intact America. In fact Bollinger is intimately involved in Intact America's presence, both online and in-person at events. He serves as the group's strategy adviser. In addition he has conducted several studies seeking to show that circumcision leads to harmful physical, sexual, and psychological outcomes. Aside from circumcision, it is unclear what other men's issues he has researched.
White Paper is deeply flawed
Bollinger and Chapin's white paper  includes deficiencies and logical fallacies, such as cherry-picking, that are so numerous, it would take a much longer article to analyze all of them. We will discuss a few examples. 
First, they suggest that men don't label their newborn circumcision as an adverse experience because they haven't been specifically asked. Actually few men would consider their newborn circumcision as a negative experience period. A 2015 survey of 1,000 American men found that 86% of circumcised men were happy or unconcerned about being circumcised. Only 10% wished that they weren't circumcised. (By comparison, 67% of uncircumcised men were happy or unconcerned that they weren't circumcised, and 29% wish that they had been circumcised.) 
The authors cite a study to show that circumcision "was found to be closely associated with ... the inability to identify and express emotions." The authors of the study admitted that "results were skewed by self-selection bias", and they asked that readers not extrapolate the results to the general population.  In fact Dan Bollinger himself was one of the coauthors. By using his study to support the generalization that circumcision is a trauma that causes psychological harm, "Bollinger disregarded his own caveats.
Bollinger and Chapin wrote that another study "concluded that [circumcision] trauma had detrimental effects on the child's function and adaptation and that 'the child seeks safety in withdrawal and isolation".  The CDC dismissed this study, finding it "biased toward finding a psychological effect related to circumcision and ignoring perceptions by the parents that their children had not suffered untoward effects of circumcision... Many of the psychological tests used in the study were subject to biases of the psychologist’s cultural interpretations of the children’s responses." 
They cited a British study to show a strong correlation between Sudden Infant Death Syndrome (SIDS) and circumcision.  This study contains significant errors. For example, the author erroneously assumed a 100% rate of infant circumcision in Muslim countries. There is actually a wide age range for circumcision; the average circumcision age in one Muslim country is one year, far too late to be a factor for SIDS.  A Dutch pediatrician dismissed the study as "flawed, biased and unreliable." 
The authors argued that "Adding one more ACE from [circumcision] would identify a larger number of boys likely to perpetuate violence as men than previously known; a finding that would be useful for health and legal authorities." They failed to demonstrate that circumcision is associated with a proclivity toward violence. On the contrary, several countries with low circumcision rates report the highest incidents of rape and violence.  Adding an irrelevant status to the questionnaire wouldn't make the ACE more useful; it would be less useful for health and legal authorities.
Press Release refuted by its own source
The Intact America press release quotes Bollinger saying that "childhood genital cutting is painful, traumatic, and alters adult sexual experience.” Each of these issues was raised during the public comment period for the U.S. Centers for Disease Control 's proposed circumcision guidelines. Last year the CDC published a set of responses. 
Regarding pain: "Appropriate use of analgesia is considered standard of care for male circumcision at all ages, and appropriate analgesia can substantially control pain for infants, children, and adults during and after the procedure." (p 20)
Regarding trauma: "There is no high-quality evidence in the scientific literature that indicates medical male circumcision results in long-term trauma." (p 22) 
Regarding sexual experience: "The bulk of scientific evidence states that men on average do not experience a loss of sexual pleasure or function because of circumcision" (p 17)
The CDC also addressed the issue of complications, reporting that "in the U.S., medical male circumcision is associated with a complication rate of 0.23% among all men circumcised, most of which are very mild and easily treated." (p 10)
Clearly the CDC utterly rejects the assertion that circumcision during childhood is an adverse experience for a significant number of males. Note that this is the same CDC that Intact America accepts as an authority on childhood trauma.
Intact America cites the CDC approvingly and links to CDC material on adverse childhood experiences. If Bollinger and Chapin had simply read the federal government's position statement on circumcision, they would have understood why the CDC doesn't include circumcision in its ACE questionnaire. If Bollinger had reviewed the caveats in his own paper, he wouldn't have cited the study for evidence of anything.
Intact America cannot have their cake and eat it too. They cannot cite the CDC as an authority on adverse childhood events, and then turn around and ignore the CDC's conclusion that circumcision is not an adverse childhood event. When performed under American medical standards, and with pain relief, the procedure is not associated with unmanageable pain, long-term trauma, or sexual deficiency.
We question whether Intact America has a sincere interest in contributing useful information about adverse childhood experiences. It's more likely that this proposal is just a publicity stunt.
For additional examples of Dan Bollinger and Georganne Chapin making false and unsupported claims related to circumcision, see Part 2 of our Intact America series.
 "Intact America Proposes Adding Circumcision and Genital Cutting to List of Adverse Childhood Experiences (ACEs); Launches ACEs Website and Electronic App"; Intact America; August 14, 2019
 Dan Bollinger and Georganne Chapin; "Child Genital Cutting as an Adverse Childhood Experience"; Adverse Childhood Experiences; August 1, 2019
 Other deficiencies in the white paper: Bollinger and Chapin write that "Most baby boys are not given anesthesia." A University of Rochester study found that 97% of residency programs were recommending the use of anesthesia by 2003. And both the 1999 and 2012 AAP task forces recommended that circumcision patients should receive adequate pain relief. "The male foreskin is ...12–15 square inches ... in an adult man." A study in Uganda found that the average area was 6.0 square inches, just 40-50% of the Intact America claim. "Circumcision was a mark of affluence." Ironically intactivists tell black parents that circumcision is a mark of slavery. So which is it? Is circumcision a mark of affluence - or slavery? They can't have it both ways. "Whether or not men consciously recall the surgery, the fact remains that the cutting was painful and traumatic." But that assumes that newborn circumcision is traumatic and has long-term effects, conclusions that contradict the CDC, which the authors themselves have used as an authority on childhood trauma. (This is by no means an exhaustive list of flaws in the paper.)
 YouGov survey of 1,000 men; YouGov; Released February 3, 2015
 Dan Bollinger, Robert S Van Howe; "Alexithymia and Circumcision Trauma: A Preliminary Investigation"; International Journal of Men's Health; May 2011
 Gocke Cansever; "Psychological effects of circumcision"; British Journal of Medical Psychology; December 1965
 "Summary of Public Comments and CDC Responses to Public Comments for Information for Providers to Share with Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV infection, Sexually Transmitted Infections, and other Health Outcomes", p 22; Centers for Disease Control and Prevention: August 2018
 Eran Elhaik; "Adversarial childhood events are associated with Sudden Infant Death Syndrome (SIDS): an ecological study"; University of Sheffield; June 2018
 Andrew Gross; "Does circumcision cause SIDS? A point-by-point response to Eran Elhaik’s study"; Circumcision Choice; August 30, 2018
 "Circumcising babies increases risk of cot death, contested new study suggests"; Jewish Telegraphic Agency; August 17, 2018
 For example: "Here's the list of countries with highest 'Rape Crime Rate' in the World"; Daily Hunt; June 24, 2019
 Also see Andrew Gross; "Does circumcision cause psychological damage?"; Circumcision Choice; February 7, 2019
#IntactAmerica #SelfRefuting #AdverseChildhoodExperience #ACE #CentersForDiseaseControl #CDC #Kaiser #KaiserPermanente