Comments by opponents on the British Medical Association’s guidance on non-therapeutic male circumcision of children seem one-sided and may undermine public health

The British Medical Association(BMA)guidance on non-therapeutic circumcision(NTMC)of male children is limited to ethical,legal and religious issues.Here we evaluate criticisms of the BMA’s guidance by Lempert et al.While their arguments promoting autonomy and consent might be superficially appealing,their claim of high procedural risks and negligible benefits seem one-sided and contrast with high quality evidence of low risk and lifelong benefits.Extensive literature reviews by the American Academy of Pediatrics and the United States Centers for Disease Control and Prevention in developing evidence-based policies,as well as risk-benefit analyses,have found that the medical benefits of infant NTMC greatly exceed the risks,and there is no reduction in sexual function and pleasure.The BMA’s failure to consider the medical benefits of early childhood NTMC may partly explain why this prophylactic intervention is discouraged in the United Kingdom.The consequence is higher prevalence of preventable infections,adverse medical conditions,suffering and net costs to the UK’s National Health Service for treatment of these.Many of the issues and contradictions in the BMA guidance identified by Lempert et al stem from the BMA’s guidance not being sufficiently evidence-based.Indeed,that document called for a review by others of the medical issues surrounding NTMC.While societal factors apply,ultimately,NTMC can only be justified rationally on scientific,evidence-based grounds.Parents are entitled to an accurate presentation of the medical evidence so that they can make an informed decision.Their decision either for or against NTMC should then be respected.

Identifying sex-specific differences in the carotid revascularisation literature:findings from a scoping review

Objective No systematic review of the literature has dedicated itself to looking at the management of symptomatic carotid stenosis in female patients.In this scoping review,we aimed to identify all randomised controlled trials(RCTs)that reported sex-specific outcomes for patients who underwent carotid revascularisation,and determine whether sufficient information is reported within these studies to assess short-term and long-term outcomes in female patients.Design,setting and participants We systematically searched Medline,Embase,Pubmed and Cochrane libraries for RCTs published between 1991 and 2020 that included female patients and compared either endarterectomy with stenting,or any revascularisation(endarterectomy or stenting)with medical therapy in patients with symptomatic high-grade(>50%)carotid stenosis.Results From 1537 references examined,27 eligible studies were identified.Sex-specific outcomes were reported in 13 studies.Baseline patient characteristics of enrolled female patients were reported in 2 of those 13 studies.Common outcomes reported included stroke and death,however,there was significant heterogeneity in the reporting of both periprocedural and long-term outcomes.Sex-specific differences relating to the degree of stenosis and time from index event to treatment are largely limited to studies comparing endarterectomy to medical therapy.Adverse events were not reported by sex.Conclusions Only half of the previously published RCTs and systematic reviews report sex-specific outcomes.Detailed analyses on the results of carotid artery intervention for female patients with symptomatic stenosis are limited.