March 22, 2019
This was a preliminary version of the article. Click HERE for the current version or visit CircumcisionChoice.com/single-post/tinari
Guest contributor Melanie Schaab analyzed a 1998 study. Reprinted by permission.
MRI Scans and Circumcision Brain Damage?
The Lie That Just Won’t Die
Intactivists like to claim that brain scans prove that circumcision causes permanent brain damage. The entire source of this claim is a blog post alleging that a certain doctor attempted to conduct a study on the topic but was stonewalled by a medical conspiracy. [1] In other words, there’s no actual research to view that found brain damage on brain scans.
You would think that alone should be enough for anyone who has read the original blog post (which you can read for yourself here). But this lie just won’t die. So I put together the responses I’ve given on multiple previous occasions for easier linking and sharing.
The short version is that the study didn't happen. But if it had happened, it would not have proven anything. Here are some of the reasons why.
(1) Biased Researchers, Patient, and Methods
First off, the researchers state that the 1998 study was performed specifically to prove their hypothesis. They weren’t testing a hypothesis, and they weren't trying to disprove it. They were trying to prove it right. When researchers are already decided on a given topic, they will generally find the answer they’re looking for. (A notable exception was Dr. Thomas Wiswell, who was opposed to circumcision and conducted research trying to prove his position right, but instead found that circumcision saves lives and uncut boys are at greater risk of UTIs and hence became pro-circumcision.) [2]
The author of this study, Dr. Paul Tinari, claims that he was forcefully circumcised by a Catholic priest and a Jewish mohel for masturbating. [3] [4] I don’t doubt that he was abused by his caretakers, growing up as a Native orphan in a very racist society in Canada in the mid-1900's. However, it’s a common intactivist lie that circumcision was introduced into modern society by Dr. Kellogg in the late 1800's to prevent masturbation. In reality, no medical text repeated Kellogg's theory, and the circumcision rates didn’t change after he proposed his theory. It did not have widespread support by any stretch of the definition, so the likelihood that such circumcisions occurred in the mid-1900s is basically zero.
At any rate, Tinari became an anti-circumcision advocate and hopes to have circumcision abolished. While his bias doesn't automatically discredit his work, one should be skeptical when a researcher reports study results that support his own partisan agenda.
(As an aside, one could question Paul Tinari's own ethics. At a 2006 anti-circumcision conference in Seattle, he suggested a strategy that is both anti-Semitic and Islamaphobic. Assuming that all Muslims hold negative feelings about Jews, his strategy was to exploit those prejudices by telling Muslims that if they circumcise their sons, "Well I guess you want your kids to look Jewish." Tinari also said that doctors and hospitals could be sued under a "nanobacteria" theory that had no scientific basis; medical doctors at the conference were skeptical.) [5]
Dr. Tinari stated he was firmly anti-circumcision and decided to conduct this study to prove himself right. He found a mother who herself was anti-circumcision to agree to this unethical experiment. What mother would allow her child to be used in an experiment where she believes that the risks include serious brain damage?
(2) Obsolete Technique
Tinari claimed he conducted the circumcision procedure without pain medication - no analgesia or anesthesia. A study without pain relief would be irrelevant because this is not how circumcision is typically done today. Circumcision conducted without any anesthesia is not the standard of care recommended by the American Academy of Pediatrics and is contrary to the recommendations of every major medical organization. Medical ethics require that an individual not be subjected to unnecessary harm. There’s no reason why a newborn in a medical setting should experience circumcision without pain relief.
(3) Unauthorized Use of Medical Equipment
The researcher wrote that he conducted the circumcision with the patient in an MRI (magnetic resonance imaging) machine. He claimed that the operator of the MRI machine was a personal friend who agreed to operate it after hours. As someone who has worked closely with the radiation department in a hospital for years, I’m uniquely qualified to explain the many problems with this story.
A) One doesn’t get permission from the machine operator. Whether he knows the operator or not is irrelevant. The machine doesn’t belong to the operator and the operator cannot give permission for medical scans. One gets permission from a physician for routine MRIs and from the ethics committee for anything related to a study (see below).
B) One doesn’t just borrow an MRI machine. These machines cost millions of dollars. When something in the radiology department breaks, it’s a big deal. Other departments have to get permission to spend a few hundred dollars, but the radiology department spends thousands or millions of dollars. One doesn't just borrow the use of one of these machines without permission because one “knows the operator.” That fact alone tells me this story is fake.
(4) Lack of Permission from the Ethics Committee
Anyone who has conducted any research would know that one has to get permission from the appropriate ethics committee for anything related to a study. Only an ignorant moron would think he doesn’t need to contact the ethics committee about a study. Even Dr. Andrew Wakefield got permission from the ethics committee at his hospital before performing colonoscopies and examining colon specimens. Wakefield lost his license partly because he failed to get permission from the ethics committee to draw blood.
Again, I want to emphasize the importance of the fact that they didn’t have permission from the ethics committee. This is utterly ridiculous. No matter how benign your study, you still must obtain ethics committee permission. This is a serious matter, as failure to get permission can result in jail time. In this case, they had to alter the procedure — putting the patient in an MRI machine, using plastic tools, forgoing numbing medication, etc. So it’s unbelievable that university researchers would be so unutterably ignorant as to believe that ethics committee permission would be unnecessary.
Seeing what happened to Dr. Wakefield, how can any physician think he would not lose his license to practice medicine for drastically altering a surgical procedure and eliminating pain relief for a study — without first obtaining ethics committee permission? Also, they didn’t go to jail for this or at least lose their licenses?
(5) Pointless Study
Tinari reported that he conducted follow-up measurements for only one month, and he had no uncircumcised "control group" patient. [6] So how can he call the changes on the MRI scan “permanent”? Even if they had a control patient, just one patient in each group and one month of follow-up observation would be insufficient to draw any conclusions. In other words, if this were an actual study, it has no value.
(6) Canadian Bias?
The researcher claimed that they were prohibited to study adverse effects of circumcision. The circumcision rate in Canada has dropped about 40% from where it was previously.
Roughly half of Canadian males are circumcised, and about one-third of newborn boys are circumcised today, Circumcision isn’t popular, and though the Canadian Paediatric Society affirms the benefits of circumcision in its most recent policy statement, [7] [8] the Canadian government largely doesn’t cover circumcision in its insurance. Needless to say, circumcision is not a sacred cow in Canada. It's ludicrous to think that a study that showed adverse effects of circumcision would be considered unethical.
(7) Deletion of Medical Records
They say that their records were deleted. Plain and simple: it’s illegal to destroy medical documents. Are we to believe that in the process of writing their results for their article, with images seen by numerous people and therefore (by nature of medicine, whether dealing with electronic or physical copies) stored in numerous places, there were no copies kept anywhere?
The fact that hospital administrators did not go to jail for destroying medical records also tells me that this entire story is implausible.
Conclusion
This story suffers from numerous deficiencies. The author is a biased and unreliable narrator. The researchers had no permission to use the equipment or conduct the study. The technique without pain relief is obsolete. A sample size of one and the lack of a control group make it impossible to draw conclusions. There was insufficient follow-up observation to enable a conclusion. And the notion that hospital administrators would have authorized the destruction of medical records is implausible. This story preys on people who have little knowledge of the intricate inner workings of the medical profession. If this study had occurred, it wouldn’t give any indication of the effects of circumcision on the brain.
RELATED
[1] Dr. Paul D. Tinari; "MRI Studies: The Brain Permanently Altered From Infant Circumcision"; Peaceful Parenting; 2008
[2] R and I Hutter Epstein; "Circumcision Controversy"; Washington Post; October 7, 1997
[3] Dave Dean; "Forcible Circumci8sion Turned This Man Into An Anti-Circumcision Activist; Vice; August 3, 2013.
"Wiswell conducted a study that showed circumcision reduced the incidence of urinary tract infections by twentyfold. The study followed 200,000 boys born in U.S. Army hospitals from January 1985 to December 1990. By combining the results with the findings of other investigations, researchers concluded that the procedure reduced the rate of urinary tract infections from about 1 percent among uncircumcised men to 0.1 percent among the circumcised.
[4] Circumcision Choice consulted an experienced mohel on this story. After reading the article, he couldn't believe that any mohel would participate in the forced circumcision of an 8 year-old boy at the request of the Catholic Church. He called it "a blood libel".
[5] Dave Maass; "No Skin Off My Dick"; The Stranger; August 31, 2006
[6] Anne Marie Helmenstein, PhD; "What Is a Control Group?" ThoughtCo; April 23, 2018
[7] "Position Statement: Newborn male circumcision"; Canadian Paediatric Society; September 8, 2015 [8] The Canadian Paediatric Society policy statement in effect in 1997 did not affirm the benefits of circumcision, so Canada was significantly more hostile to circumcision then than today.