Tuesday, August 9, 2011

Dollars & Sense: the Business of Circumcision

You might be surprised to learn how lucrative infant circumcision in America is for the doctors, hospitals, clinics, and vendors who take part. Believe it or not, there is big money to be made in the business of circumcision. When money is involved, it becomes more important to question the motives of the one who stands to profit. “It is difficult to get a man to understand something when his salary depends on his not understanding it.” [Upton Sinclair]


I know better than to think a used car salesman is looking out for MY best interests instead of his own commission. Like a used car salesman, doctors will gloss over or completely ignore the facts that would turn you away from what they're selling. That's business.

Circumcision is a cash cow for doctors and hospitals. An OB might make a couple thousand dollars for every pregnant woman under their care, and that’s over the course of nine months. Circumcision takes about five minutes and you can charge over a grand each! I’ve searched high and low and found quite a range of prices for the surgery itself. The cost to have your son circumcised comes out to $704.83 on average. If a doctor circumcised just five boys each week at that rate, they can pull in $176,208.20 annually, and that is if they take two weeks vacation!

 
To put that in perspective, that is about 25 minutes of work per week (as opposed to the 2400 minutes per week the rest of us work), for which the doctor and/or hospital are paid over 4 times the national average wage index for 2009


If you take that five minutes of work at $705 and extrapolate that into an hourly charge (5 goes into 60 twelve times), that’s $8,458 per hour. Per HOUR. Granted, this assumes 5 minutes per circumcision. We could expand it to 30 minutes per circumcision, which gives time for set up and clean up. That would turn this into a $1409.67 per hour charge.


Of course, we should take into account the fact that doctors and hospitals and clinics have expenses associated with performing circumcisions. The circumstraint immobilizer  (essentially the board they strap your baby to) costs anywhere from $200 - $400 each. I’ve found one for quite a bargain. This one is $298.70, marked down from $343.50.

The seller brags, In less than 30 seconds, a nurse can immobilize the struggling infant securely in the correct position with Circumstraint. The immobilizer works on a proven principle of positive 4-point restraint. Soft wide Velcro straps encircle the infant's elbows and knees, depriving him/her of leverage. The child is held safely and securely without danger of escape. Circumstraint's comfortable contoured shape positions the infant, hips elevated, perfectly presenting the genitalia. The platform between the infant's legs provides support for a circumcision clamp. Without pins, towels, plastic shells or the threat of strangulation, Circumstraint snugly and securely immobilizes the infant with their entire torso visible.”

Sounds great, right? And when the straps wear out from having restrained hundreds of thrashing newborns, eBay has replacements on sale for $23.95 plus shipping.

There are plenty of other tools these clinics and hospitals have to pay for. The Gomco clamp, a popular tool for circumcision, runs about $150 plus shipping (marked down from $210). Of course, you have to buy two different sized clamps if you intend to circumcise both newborns and older children.

The Mogen clamp is a little more high-end, coming in around $400 apiece. I can’t tell the difference between the Moore Medical Mogen Clamp and the Skylar Mogen Clamp except that the Skylar Mogen Circumcision Clamp is more expensive: $543.44. Thank goodness both of these clamps can be used multiples times - otherwise it might really cut into profits!

The PlastiBell circumcision device is single use, so doctors and hospitals buy these in packs of 25 for around $150 or in bulk (125 devices) for about $650 If you’re planning on performing at least 125 circumcisions with this device, you’ll save $100 by buying in bulk. It’s a deal you just can’t pass up!

But really, doctors recoup their costs pretty easily. One father complained that the triple antibiotic ointment the hospital used on his child, the same ointment you can get at any drugstore for $4.95, was listed on the itemized bill at $166. That’s a 3354% mark-up.

And if the mark-ups on supplies and services don’t satisfy, there’s always money to be made from the discarded foreskins. Wait, what’s that? They can SELL foreskin? You betcha.

There are actually two different markets (that I know of) for human foreskin. One is the cosmetics industry. You may have heard that Oprah Winfrey uses a face cream made with human foreskin. It’s a pretty lucrative business when you consider that a bottle of this face cream will sell for a hundred bucks.

The other market for foreskins is in the medical field. Did you know that you can buy a milliliter of frozen foreskin for $399.00 to $559.00? These fibroblasts have many applications. The website of ATCC (the  biological resource center selling these fibroblasts) says they can be used in response to pathogens, skin aging, wound healing, gene delivery and skin diseases. One single foreskin can actually pull in $100,000 in total. Bet the owner of that foreskin won’t see a dime, poor kid. He could go to college a few times on that amount of money!

So the doctors, hospitals, clinics, and vendors are pulling in a pretty penny. And American parents? They’re paying someone anywhere from $300 to $3,000 to cut away a healthy body part from their newborn sons. They might pay hundreds or thousands more on follow-up “circumcision revision” surgeries. One way or another, the math isn’t adding up on their side.

How about instead, you take the $705 and put it in the stock market for your son. That way, if in 18 years he decides that his natural body is "icky," he can use that money to get circumcised. Or to buy a car. I bet he'll choose the car.

18 comments:

  1. Ugh. That advertisement for the circumstraint was so grim... it's actually like selling a torture device. And the fact that something so harmful and unnecessary has been turned into a multi-million dollar industry is disgusting beyond words.

    Great blog by the way!

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  2. Aren't you going to get into the money being spent on spreading circumcision in Africa? PEPFAR, Bill Gates, NIH, CDC etc. are all investing big money in circumcision "studies" and in "mass circumcision" campaigns across Africa under the guise of HIV prevention. So not only are doctors in America making a pretty penny from circumcisions, but "researchers" in Africa are getting money for producing "studies" that show "benefits" in circumcision, to be used back home where people are beginning to wonder what the point of circumcision is. Gotta keep the circumcision machine well-oiled and running...

    Thanks to WHO endorsement of circumcision as HIV prevention policy, Circumstraint, Gomco, Plastibell and Mogen are in Africa, earning these companies millions. Not to mention off-brands such as TaraKlamp, which hasn't even been approved by the WHO yet, and which are already being sold to Africans, causing many botched circumcisions and embarrassing the KwaZulu Natal Ministry of Health. Israeli-developed PrePex is getting ready to cash in on the circumcision/HIV gravy train; just as soon as the WHO endorses them they can sell their devices in Africa.

    Oprah's TNX Recovery complex has already been mentioned. Synthetic skin grafts are also created from the foreskins of newborns, including Dermagraft-TC, Apligraf and AlloDerm. The corporations that stand to gain from the harvesting of infant foreskins are Advanced Tissue Sciences (ATS), Organogenesis, BioSurface Technology, Genzyme, Ortec International, LifeCell Corporation (Nasdaq:LIFC) and SkinMedica.

    Americans have got to start asking themselves about our tax dollars being used in Africa; is this REALLY about HIV prevention and "health benefits?" Or is it just another ploy to plunder the resources of Africa? Do western "humanitarian aid" organizations really care about people's healths? Or is it about establishing a steady flow of foreskins? The fact is that Americans are beginning to shun circumcision; these corporations must secure their foreskins from elsewhere. Could it be these "studies" are being cooked for this purpose? There needs to be an investigation into who is funding all this circumcision "research" and why. WHY aren't "researchers" investigating HIV prevention methods that do NOT require cutting off parts of children?

    Instead of seeking to make circumcision obsolete, WHY are "researchers" seeking to validate it, necessitate it, and even make it indispensable?

    Cash is the only reason I can think of. That and personal investment. (IE, the researchers and their donors are circumcised, they want to use pseudo-science to legitimize a procedure that is ever coming under scrutiny... see San Francisco Ban...)

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  3. Joseph, thank you for pointing out the bigger picture of circumcision on an international level. My time is pretty limited, so to address the concerns you point out would probably take quite a while to put together and publish. If you have any links to share of your own writings on this topic, I would love to share them in the Intactivist Resource List on Saving Babies. You can leave links in a comment or e-mail us at SavingBabies.Blog@Gmail.com.

    Thanks again!

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  4. I posted a link to your article and received this question "Is that $704.83 pure profit for the doctor? Or does that include the hospital costs? Because I'm pretty sure that most doctors are paid a salary that isn't defined by the number of circumcisions they perform" So I was wondering if you knew how much of that profit usually goes to the doctor, and if most are paid per-procedure or salary. From any reading I've done I've gathered that they are paid for each circumcision, but I wanted to double check before responding. Thanks!

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  5. Metis, it's different for every location. Some are done in hospitals where the doctor is paid a salary and the hospital is the one directly profiting. Others are done in clinics and doctors offices. There is a great deal of variation. Often the doctor AND the hospital get paid for the circumcision. It all depends on their business structure and contract agreements.

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  6. "One of the big problems we have with the American circumcision dilemma is that most of the circumcisions are performed by OB/GYNs. Not by pediatricians. Not by urologists. The surgery is performed by doctors trained to deal with female reproductive anatomy. And on top of that, the patient of the OB/GYN is the mother, not the infant. If the patient, the mother, request the circumcision, the OB/GYN concludes that the "patient" has given consent for the surgery. The OB/GYN does not see the infant as his/her patient and, therefore, sees no need to take the impact of the surgery on the infant into consideration.

    Since performing circumcisions is a large part of the income stream for OB/GYNs, they have no interest is learning about the male penile anatomy, or in changing their unethical practices. They do not have to deal with any of the complications stemming from their circumcision surgery--a pediatrician does that. They never see the later-in-life consequences of their surgery--a urologist does that. They make their money up front and walk away.

    Intact America has attempted, for the past couple of years, to sign up for a booth at the ACOG Annual conference. They have been rejected as an exhibitor each time. These doctors simply do not want to face any opposition to their cash cow. Intact America is welcome at the annual Pediatrician conference and at the American Medical Student conference. But the group that is responsible for the largest number of routine infant circumcisions (RIC) simply wants to ignore the nationwide groundswell that is opposing RIC."

    One "Dr. Ron"

    http://www.foreskin-restoration.net/forum/showthread.php?t=7542&highlight=ACOG

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  7. I would definitely have chosen the car.

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  8. The picture you have painted is absolutely correct-- and the OBs I work with are not shy about saying so. In our facility, circs are charged at about $750 for 5 minutes work-- tops. None of our docs use Plastibells; they use Gomcos and Mogens. We put nothing on the babies' wounds except petroleum jelly. Only one of our MDs insists on 4-point restraints; generally we use 2. The whole procedure makes me physically ill; I die a little every time I'm forced to participate. The worst is when a father asks to watch, and the OB lets him. I always wonder about that... what kind of sadomasochist wants to be part of his son's mutilation???

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  9. I should add that we discard the pitiful little bits of foreskin. I'm pretty sure that if they figured out that those bits were worth money, the docs would pocket those as well.

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  10. Speaking of Mogen... I thought they went out of business. I wonder why I keep hearing about them... must be Mogen's Ghost...

    http://joseph4gi.blogspot.com/2011/07/ghost-of-mogen.html

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  11. Willow, can't you refuse to participate as a conscientious objector? I was pretty sure that you could.

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  12. Joseph, the names of the 2 Mogen clamps I mention are hyperlinked to the websites selling them.

    Willow, I think Joseph is right on this one - you have the right to opt out. Check out the Whole Network on Facebook for support from other anti-circ medical professionals. There is also http://www.doctorsopposingcircumcision.org/ and http://nurses.cirp.org/

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  13. Thank you Saving Babies for discovering and sharing that:

    * The average price of a routine infant circ is now $700;

    * A major Seattle-area hospital charges $3000 to do a routine circ. At that price, not many takers. If that is typical of Washington state, no wonder its circ rate is 20% and falling. No wonder that Washington Medicaid won't cover it.

    @Willow, thank you for sharing that the rate in your hospital is $750.

    When the typical circ costs $1000 or more, most private insurers will stop covering it, and few parents can afford to be out of pocket for an amount that high. It is possible that hospital charges alone will stamp out circumcision over the next 20 years.

    @Joseph: in my view, the facts you share about the American medical profession are telling ones.

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  14. And they SELL the foreskin and profit off of it. They charge parents to do it and then they can sell it! http://www.motherful.com/boysforprofit.html

    Great post. I love the last sentence.

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  15. Something I find interesting from the Apligraf website (http://www.apligraf.com/professional/what_is_apligraf/how_is_it_made/):

    "Human keratinocytes and fibroblasts are derived from neonatal foreskins obtained for use under informed-consent guidelines"

    Informed consent?

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  16. Excellent post! I must thank you for this informative read. I hope you will post again soon.
    Kind regard
    Neonatology Equipment Manufacturers

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  17. This article is SO ridiculous- doctors doing 5 circumcisions a week making more than 176,000 a year. Only the dumb-headed will believe this crap.

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  18. 5 circumcisions per week at $700 each is $3500 per week. The doctor takes two weeks off and works 50 weeks a year. $3500 X 50 = $175,000.

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