The Editor
Canadian Medical Association Journal
P O Box 8650
Ottawa ON K1G 3Y6,

Dear Editor,

Thanks to Eleanor LeBourdais for her accurate article, Circumcision No Longer a Routine Surgical Procedure (CMAJ 52: 1873-1876, June 1, 1995). Indeed, Canadian Provincial Health agencies have come to recognise that circumcision should no longer be paid for. In 1975, forty­four percent (44%) of males born in Canada were circumcised and paid for by Provincial Health agencies. By 1995, only four percent (4%)of male births had circumcisions paid for by Provincial or Territorial health agencies. (The number of recent circumcisions paid for privately is not known.) In a country where virtually all health care is paid for by Provincial or Territorial health agencies, these agencies have come, one by one, to the same significant conclusion, that the routine removal of normal penile tissue is contra­indicated.

There remains but one country in the world (United States of America) where the removal of normal penile tissue for non­religious reasons is inflicted on significant numbers of unconsenting minors. This activity still has the tacit acquiescence of physicians in this country.

Very truly yours,

George C. Denniston MD, MPH

A tragedy is occurring in Canada right now. Canada's health services have recognized that circumcision is not worth paying for. It has no value as a health measure. Yet parents, out of ignorance, are insisting that it be done. They are going to greedy health practitioners, who, for the first time, are getting paid directly for doing a procedure. These practitioners may occasionally be submitting requests for payment to the Provincial Health agencies under the "medical necessity" clause.

If "medical necessity" is claimed, we suggest that this claim is invariably fraudulent. Since in Finland, the risk of getting a circumcision at birth is zero, and the risk of needing one later is one in sixteen thousand, six hundred and sixty­seven (1/16,667), every claim for "medical necessity" should be fully investigated, and denied.

As for the practitioners performing a procedure that is not covered, and that is harmful, they may soon have to answer to the law.

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