Australian Gambling Statistics 30th Edition

Welcome to Lost in the Sauce, keeping you caught up on political and legal news that often gets buried in distractions and theater… or a global health crisis.
I am doing a separate post for the insurrection and related events. I think it is important to make sure the news in this post doesn't get overlooked.
Housekeeping:

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Russia

A new report by the Office of the Director of National Intelligence (ODNI) found that Trump political appointees politicized intelligence around foreign election interference in 2020, resulting in significant errors. ODNI analytic ombudsman Barry Zulauf delivered the report to Congress on Thursday: “Analysis on foreign election interference was delayed, distorted or obstructed out of concern over policymaker reactions or for political reasons.” The biggest misrepresentation of intel involved diminishing the threat posed by Russia and overstating the risk of interference from China.

“Russia analysts assessed that there was clear and credible evidence of Russian election influence activities. They said IC management slowing down or not wanting to take their analysis to customers, claiming that it was not well received, frustrated them. Analysts saw this as suppression of intelligence, bordering on politicization of intelligence from above.”

WaPo: Zulauf, a career official, also found an “egregious” example of attempted politicization of the Russian interference issue in March talking points on foreign election threats, prepared “presumably by ODNI staff” and “shaped by” then-Director of National Intelligence Richard Grenell.

The Justice Department and the federal judiciary revealed that the Russian Solar Winds hack also compromised their computer systems. 3% of the DOJ’s Microsoft Office 365 were potentially affected; it does not appear that classified material was accessed. The impact on the judiciary seems much more significant, jeopardizing “highly sensitive confidential documents filed with the courts.”

The sealed court files, if indeed breached, could hold information about national security, trade secrets and wiretap transcripts, along with financial data from bankruptcy cases and the names of confidential informants in criminal cases...

Appointees

D.C. Attorney General Karl Racine has accused U.S. Agency for Global Media Director Michael Pack of funneling $4 million in nonprofit funds to his own for-profit company. In a civil lawsuit filed last week, Racine states that for over 12 years, Pack used a nonprofit company he owned to direct money to his private documentary company, enabling “Pack to line his company’s coffers with a stream of tax-exempt dollars without...a competitive bidding process, public scrutiny, or accounting requirements regarding its spending.”
Employees at Voice of America have filed a whistleblower complaint accusing Pack of using the agency “to disseminate political propaganda in the waning days of the Trump administration. The staffers take issue with a planned speech by Secretary of State Mike Pompeo to be broadcast from VOA headquarters. The event, to be attended by a live audience, “is a specific danger to public health and safety” in the middle of a pandemic. Finally, the whistleblowers say the event is “ a gross misuse of government resources,” costing at least $4,000 in taxpayer funds to date and using 18 employees who would otherwise be producing VOA content.
Acting Defense Secretary Chris Miller has announced his appointees to the panel set to rename confederate military bases and plan the removal of confederate symbols/monuments. Most controversially, Miller named White House liaison Joshua Whitehouse, who oversaw the purge of the Defense Policy Board and the Defense Business Board last month. The other three Miller-appointees are former acting Army general counsel Earl Matthews, acting assistant secretary of Defense Ann Johnston, and White House official Sean McLean. The remaining four members will be appointed by the Senate and House Armed Services Committees.

The 10 Army posts named in honor of Confederate generals are Camp Beauregard and Fort Polk in Louisiana, Fort Benning and Fort Gordon in Georgia, Fort Bragg in North Carolina, Fort A.P. Hill, Fort Lee and Fort Pickett in Virginia, Fort Rucker in Alabama, and Fort Hood in Texas.

Trump

The Trump Inaugural Committee, a nonprofit, improperly paid a $49,000 hotel bill that should have been picked up by Trump’s for-profit business. D.C. Attorney General Karl Racine revealed the allegation in an existing lawsuit against the committee, which already accuses Trump’s hotel of illegally pocketing about $1 million of donors’ money. “The Trump Organization was liable for the invoiced charges...The [Committee’s] payment of the invoice was unfair, unreasonable and unjustified and ultimately conferred improper private benefit to the Trump Organization.”
The Professional Golfer’s Association voted last night to move the 2022 PGA Championship from Trump’s Bedminster course. Jim Richerson, PGA of America president, said in a statement that “it has become clear that conducting” the championship at Trump’s property would “be detrimental to the PGA of America brand” and put the organization's ability to function "at risk."
Amid speculation that Trump may spend inauguration day at his Scottish golf course, Scotland First Minister Nicola Sturgeon warned him that even presidents can’t break the country’s pandemic restrictions. “We are not allowing people to come into Scotland now without an essential purpose, which would apply to him, just as it applies to everybody else. Coming to play golf is not what I would consider an essential purpose,” she said.
Trump is on a Presidential Medal of Freedom spree, giving out the award to sports figures and Republican allies. Last Monday, Trump awarded the medal to Rep. Devin Nunes for his work undermining the FBI’s investigation of Russia’s election interference. “Devin Nunes’ courageous actions helped thwart a plot to take down a sitting United States president,” the White House press release states. Likewise, Trump gave the medal to Rep. Jim Jordan (R-OH) for his “effort to confront the impeachment witch hunt” and “exposing the fraudulent origins of the Russia collusion lie.”

The day after Trump supporters rampaged through the Capitol, Trump awarded the medal to retired professional golfers Annika Sorenstam and Gary Player. The president planned on giving New England Patriots coach Bill Belichick the medal on Thursday, but he declined the offer, saying that “the tragic events of last week occurred and the decision has been made not to move forward with the award.”

Courts

Dominion Voting Systems filed suit against pro-Trump lawyer Sidney Powell for defamation. Powell falsely claimed that Dominion had rigged the election, that Dominion was created in Venezuela to rig elections for Hugo Chávez, and that Dominion bribed Georgia officials for a no-bid contract,” the lawsuit states. Citing millions spent on security for employees, damage control to its reputation, and future losses, Dominion requests damages of more than $1.3 billion.

Dominion's lawyer told reporters last week the lawsuit against Powell “is just the first in a series of legal steps.” Ari Cohn, a free speech and defamation lawyer, told WaPo: “If I had to guess I would say that [Poulos] wants a very public vindication with a ruling establishing that Sidney Powell defamed them and that her statements were baseless...That's not something you generally get in a settlement agreement.”
Just last week, Trump again said at a rally that Dominion machines allowed “fraudulent ballots” to be counted during the 2020 election (clip).

The Supreme Court declined to fast track eight Trump-related cases related to the 2020 election, ensuring they won’t be taken up before Biden’s inauguration. The cases include one brought by attorney Lin Wood against Georgia’s Secretary of State, the so-called “Kraken” cases, and three brought by Trump’s campaign. It is possible the lawsuits will be declared moot after Biden is sworn in.
The Supreme Court has agreed to hear two cases alleging that the Treasury Dept. incorrectly distributed Coronavirus aid meant for tribal governments. The Lower 48 Tribes argue that Alaska Native Corporations (ANCs) are not eligible for CARES Act funding, while the Trump administration wants to divvy up the money between tribes and ANCs.

Immigration

A federal judge blocked the Trump administration’s final attempt to restrict U.S. asylum laws. District Judge James Donato (Obama appointee) ruled in favor of advocacy groups who argued that acting Homeland Security secretary Chad Wolf lacked authority to impose the new rules, which would have resulted in the denial of most asylum applications.

“The government has recycled exactly the same legal and factual claims made in the prior cases, as if they had not been soundly rejected in well-reasoned opinions by several courts,” Donato wrote. “This is a troubling litigation strategy. In effect, the government keeps crashing the same car into a gate, hoping that someday it might break through.”

On Monday, acting Homeland Security secretary Chad Wolf submitted his resignation, citing the recent court ruling that he is not a valid appointee to the position. His resignation letter does not cite the Capitol riots or Trump’s language inciting the insurrection. FEMA Administrator Pete Gaynor will be the new acting secretary.

"Unfortunately, this action is warranted by recent events, including the ongoing and meritless court rulings regarding the validity of my authority as Acting Secretary. These events and concerns increasingly serve to divert attention and resources away from the important work of the Department in this critical time of a transition of power," Wolf added.

A new Immigration and Customs Enforcement policy will make it harder for immigrant minors to obtain asylum in the U.S. The change was made at the end of last month by then-acting agency leader Tony Pham, who served in the position for less than five months.

Beginning Dec. 29, ICE officers were told that they must review whether an immigrant child is still “unaccompanied” each time they encounter the minor… The memo indicates that the evaluation by ICE officers can come at any time, including when an officer is reviewing immigration court records of a child, and if it’s determined that an immigrant is no longer unaccompanied, they will move to change their status.
Such a change could lead to making some children ineligible to have their asylum claims initially heard and processed… “If implemented aggressively, this policy could significantly decrease the number of children who ultimately receive asylum in the United States,” said Sarah Pierce, an analyst at the Migration Policy Institute. “They are really putting the onus on ICE officers to do everything they can as frequently as they can to remove these designations.”

The Trump administration is still awarding border wall contracts, even in areas where private land has not yet been acquired. The move will make it more difficult for Biden to stop construction of the border wall.

Attempts to halt construction completely, as Biden promised, will prove difficult, particularly if contracts continue to be struck -- a challenge [acting Customs and Border Protection Commissioner Mark] Morgan acknowledged Tuesday. "They could terminate those contracts if they want to, but that's going to be a very lengthy, messy process," Morgan said.
"We're going to have to go into settlement agreements with each individual contractor," Morgan added, noting, that payments will have to be made for what they've already done, as well as for materials produced. He estimated the process could cost billions.

Trump is set to visit Alamo, Texas, today to celebrate the completion of more than 400 miles of the border wall. You can watch the event on YouTube at 3:00 pm eastern.

Miscellaneous

Stories that didn’t fit in the above categories...
The Trump administration auctioned off leases to drill oil in Alaska's Arctic National Wildlife Refuge last week. Only two private companies bid, each winning large tracts of land. Knik Arm Services, from Alaska, paid $1.6 million for a 50,000-acre tract along the Arctic Ocean. A subsidiary of Australian company 88 Energy paid $800,000 to win the smallest tract.
One of the Health and Human Services Department’s final acts under Trump was finalizing the removal of Obama-era regulations barring discrimination among HHS grantees. The change will allow recipients of federal grant money - like adoption and foster agencies - to discriminate against LGBTQ people and those of a different religion.

Human Rights Campaign: “Statistics suggest that an estimated two million LGBTQ adults in the U.S. are interested in adoption… Further, research consistently shows that LGBTQ youth are overrepresented in the foster care system, as many have been rejected by their families of origin because of their LGBTQ status, and are especially vulnerable to discrimination and mistreatment while in foster care. This regulation would only exacerbate these challenges faced by LGBTQ young people.

An Industry Deep Dive on How Games Became a Service

Disclaimer: All facts stated in this essay are verifiable and have been researched beforehand.
2013 marked a big year in many aspects for the video game industry, it was a good year for new IPs and (some) sequels if you were a AAA developer. Sony fans may remember being introduced to The Last of Us for the first time as you embarked on a journey as Joel Miller through a post-apocalyptic United States, or if your name was Artyom continued a post-apocalypse Soviet Russian adventure in Metro: Last Light. Reboots were also in affair; Tomb Raider and Devil May Cry made their comebacks with flair and breathed new life into some of gaming's historic franchises. It was also a year that marked the end of certain beloved trilogies with titles such as Bioshock: Infinite and Crysis 3. These were times of big feels, new beginnings, and more importantly: new ideas to create the proverbial ten year cash cows.
You see while all this time you were reminiscing about a heartbroken Joel crying to the tune of Gustavo Santaolalla’s emotional guitar riffs in the background, 2013 was also a year that changed gaming in subtle ways you may not have realized. GTA V made its meteoric rise to the top of the unquenchable stream of revenue in digital media history, meanwhile Valve was setting the stage when it released Dota 2 that was the first ever video game to introduce the concept of a Battle Pass: a name which will live in infamy.
There is a lot to unpack here so we’ll try our best to go in a coherent order. GTA V answered a key question that has been lingering for a long time in the AAA video game business model: can you make games as a service?
Picture yourself tearing down the freeway in the supercar of your dreams, the sun is shining and you are blasting your favourite tunes, to your right is the horizon of a crystal blue pacific ocean, you receive a call from one of your “business partners” about a proposition to earn some tax-free income so you can pay for a superyacht at some point in your career, why? Because crime pays and the fun never ends. Rockstar had perfected the model of what unfettered freedom looks like in a virtual world, and in a genius move, released GTA Online in just two weeks after initial release. Needless to say it was a success, in fact it was more than just that, it became the envy of video game business executives.
The question is often raised and answered, and then forgotten about, and then asked again about why AAA companies don't make one-and-done IPs anymore. At least, very few of them seem to do it.
If $595 million in 2019 from GTA Online alone doesn’t answer the question for you, I don’t know what else will. You see Rockstar didn’t intend for its online component to be as successful as it is. The addictive gameplay loop and highly-detailed compelling world that seduced a large portion of its players (and by extension: the market) was just the elevator pitch. Like any great formula, it needs constant improvement as our old Bethesda buddy Todd Howard always likes to parrot “Great games are played, not made” by that logic then how do you keep a game great then? You keep playing it? How do you keep playing a game? (Well according to Todd its by letting your community of modders finish the game for you)
What Rockstar did was added weekly updates, paid close attention to the needs of its community, had a look at the graphs and noticed only 27% of its players had actually completed the single player campaign (keep in mind this statistic is over 7 years old and may have changed significantly). For the first time GTA broke its tradition by not making expansions for the single player, which is what it was always known for. The Beach Bum update was released for free the following month for GTA Online players and the rest is history. Just kidding GTA Online is releasing a new free game update this December which will expand the playable game world, oh and it's got military submarines and a new plot “a la James Bond”. Seeing the… evolution of what was a game about stealing cars has been an interesting journey so far.
According to gamstat.com and Steam charts, a conservative number of 1.4 million players across PC, PS4, XB1 log-in daily to play GTA Online. The game - even 7 years later - stays consistently in the top 10 of most played games across both consoles.
So this was the Rockstar Games model: forget about single-player because statistically, nobody really cares, let's just focus on our multiplayer because its getting more attention, free updates for everyone to keep them busy, we’ll gradually inflate the fuck out of everything seven years down the line because there’s just gonna be so much content that you’ll need 800 of your real dollars at some point in a recent update if you want to buy all the content, what was that you want to grind for it? Jokes on you, you'll be there forever. This game will be your second job after you come home from your first job, you’ll be too lazy to grind for hours to get a car so why not just buy a shark card? You’re gonna get paid at the end of the month anyways, it's not a big deal.
Well lo and behold, it just works. (Shut up Todd, you’re partly to blame here!)
It is a sound business model, and one that even overshadows Red Dead Redemption 2 which has witnessed a significant dwindling in its online engagement.
In this second part we’ll look at Valves' introduction of the Battle Pass or “Compendium” system in Dota 2 and how 4 years later, it would be adapted and popularized by Epic Games’ Fortnite. Before we dive in, let’s take a little trip to 2004.
You’re on the computer in the living room of your parents house and you’re playing South Korean based Wizet studio’s MapleStory. You don’t have a console and you’re not allowed to play violent video games because your mom is too strict and also because she’s listening to mainstream media rant on how Halo 2 is making children too violent. So you’re stuck with MapleStory, it’s nothing to speak of graphically because it's a 2D side scrolling RPG, but hey it’s free to play and it's Massively Multiplayer Online so at least it has other real people playing it. While you’re playing it, you’re having fun because you find out you can actually do a variety of things even though it's just an innocent 2D looking game. You can chat, trade things with real players, perhaps even band together in a party and go on quests in MapleWorld. One thing is making you envious though: you can’t stop going back to the Cash shop because of all the dope looking outfits you think would look good on your character, and also because other folks are flexing them in your party. In come the “Gachapon tickets” (now for historical accuracy we’ll pretend you’re an expat living in Japan because at the time it was just a japanese thing), a Gachapon is basically a machine that sells capsules containing little toys in them, what capsule you got after inserting your coin was completely random - remember the word Gachapon as we’ll get to it later - MapleStory in Japan allowed for users to pay just 100 measly yen ($1.00) for a Gachapon ticket so you could buy whatever you wanted at the Cash shop, you convince your mom because it’s cheap and because you somehow convinced her that it was not a scam?
Hooray you can finally impress your party with the new gear you just got! You can continue playing the game to your heart's content.
Little did you know that MapleStory would be the inspiration for a special surprise in your gaming experience which we’ll get to in a moment.
Across Asia in the late noughties, it was the free to play titles that generated a considerable amount of income because of their popularity with internet cafe goers and people who weren’t wealthy enough to afford expensive tech. The games were free, accessible because of the growing mobile market in exchange it offered cheap but optional microtransactions to recoup for its development costs. ZT Online (2007) was a chinese developed game that took full advantage of the free to play model, offering optional microtransactions for its committed players and raked in a reported $15 million per month. The first ever mobile game to hit the $1 billion milestone was Puzzle & Dragons released in 2011. In North America and Europe during the social-network heyday saw Zynga develop free to play mobile games such as FarmVille, Zynga Poker, Words with Friends, etc.
Now it’s been a good few years since you were playing shitty 2D side scrolling games, you want to be a part of the big leagues and play some shooters! The year is 2010 and you’re having the time of your life whooping ass in Team Fortress 2, a pioneer of the “hero shooter” genre. It’s September and you are eating a sandvich (nom) while watching your favorite YouTube gaming channel talk about crates containing random loot that can be accessed by purchasing keys, it’s exciting! You’re old enough and mature by your moms standards to be playing TF2 so you use your pocket money allowance to buy these keys so you can later brag to your school friends or online forums. You also learn that Valve is transitioning the game to free-to-play so that it can attract more users. (Are you noticing the pattern here?)
Valve has always been ahead of the curve when it comes to monetization in video games and it’s remarkable how they achieve this, because if you were following the news at the time you’ll remember that when Valve made Team Fortress 2 free-to-play, it dominated the Steam charts f2p list for a reasonable time. 3 years after it became free-to-play, TF2 was reported making $139 million per year alongside Counter Strike which is also a beefy 9-figure earner for the company. This is notwithstanding the fact that Valve has the monopoly on the PC gaming market with Steam which takes a 30% cut of every video-game sale. You really cannot stop the Gaben.
During the time that Valve were transitioning to the free-to-play model they hired Greek-Australian economist and former Greek finance minister, Yanis Varoufakis to research virtual economies. What occurred a few years later was a growing trend of MMOs and MOBAs transitioning to a free-to-play model, starting in 2011 with popular games such as Star Trek Online and Lord Of The Rings Online, adding microtransactions as a means to stay sustainable.
The TF2 crates and keys were another way of interpreting the Gachapon philosophy, get a key to open your “capsule” but leave it to RNG to decide the fate of your purchase.
Valve were the first of the AAA gaming industry to popularize this practice but also to have perfected the art of recurrent user spending, of course what we also saw was a decline in release of new games but we’ll get to that in a bit. Now other video game publishers took notice of Lord Gaben’s business savvy and decided to find their own ways to create additional revenue streams.
Electronic Arts, the founders of “surprise mechanics” decided to monetize FIFA Ultimate Team in 2010 by offering players the opportunity to purchase virtual trading cards as a means to generate extra revenue on a reliable IP with a loyal fanbase. This worked predictably in EA’s favour as of recent 2020 financial reports they have generated $1.49 billion in revenue from FUT alone.
EA being EA wanted to further inflate their sense of pride and accomplishment by using the Gachapon philosophy (a philosophy which worked with free-to-play titles for reasonable causes) by creating their first loot-boxes, now because they’re EA, didn’t bother to transition their games to the free-to-play model, that idea probably got laughed at during a board meeting. These motherfuckers literally decided to have their cake and eat it for all the public to see.
2 years later in 2012 at the release of Mass Effect 3, EA implemented loot boxes into the multiplayer component of the game, in fact they did so with all of their multiplayer IPs: Battlefront, Battlefield. The reason why loot-boxes is a perverted version of the Gachapon ticket (and sorry if I use this word a lot) is because it contains cut content that allow for in game advantages so the gamers ™ have no other option but to gamble their money for something that is not even guaranteed they’ll have because grinding for it will take some ridiculous hundreds of hours of your time.
EA popularized the loot-box which I like to keep separate from Gachapon because the two are fundamentally different. Loot-boxes are gameplay/XP modifiers you have to pay for on top of the full retail price of the game you already bought. Gachapon tickets is a means to support a developer that made a base game free-to-play.
What happened following the increase in quarterly earnings for Electronic Arts after their loot-box boom were a bunch of other companies copying the exact same thing ad nauseam but putting their own “creative” spin on it: Counter Strike: GO did it with weapon cases, Battlepacks for Battlefield 4, COD: AW with Supply Drops.
Overwatch went as far as including loot-boxes to be part of its meta in 2016, other core AAA games following suit, COD, Halo 5, LoL, you name it it probably has it. Fast forward to 2017 and EA are in legal battles with governments about loot boxes and the industry is now getting cold feet. Fortnite becomes the latest trailblazing success. Which is where Valve were once again: ahead of the curve.
You remember at the beginning of this case study where Valve were the first to come up with the concept of a Battle Pass? So in 2013, Dota 2 devised what they called “The Compendium” a business model based on the Season pass or Season ticket used in sports for NFL or Baseball. The models are basically identical: you pay a one time fee for access to an event that typically lasts 3 months. This model works far better than the loot box because it incentivizes players to grind for content they know are guaranteed to get. The player only pays a one-time fee (usually in the $10 price point) giving them a sense of getting their money's worth, I fall for this myself because it is marketed incredibly effectively.
Furthermore the seasonal model “drip-feeds” content, so these may be gameplay modifiers, XP enhancements, unique limited edition content (weapons, shaders, armours) so the more you progress, the greater the benefits.
Now Dota 2 uses the proceeds of Battle Pass sales towards the seasonal tournaments prize pool. For other companies like Bungie it is most likely towards development of new seasonal content or Eververse items.
So during the whole loot-box orgy that lasted a good 5-6 years. Valve were profiting from the seasonal model, Epic Games took note and decided it would use the same thing for their new shooter. In Summer of 2017, Fortnite broke records as one of the highest-grossing free-to-play battle royale titles of the decade, having been downloaded a recorded 350 million times and generating $1.8 billion in revenue in its first year. It was clear at that point the free-to-play model with a season pass and microtransactions store guaranteed a stable platform. 3 years later, Fortnite is projected to make $5 billion at the end of this fiscal year, and has registered 3.2 billion hours of playtime. Now this is important because it took GTA V seven years to break through $6 billion and GTA V (for now) still remains the highest-grossing video game of all time.
We can see Call of Duty Warzone made its Battle Royale mode free-to-play as a direct response to the trend. Bungie followed suit after their recent move to make Destiny 2 a free-to-play model with a seasonal pass built-in to last until 2022.
It’s only a matter of time whether we see more companies and AAA titles decide to do the same for it to determine the “games a service model” will be the dominant market trend. We can safely assess Microsoft is emulating this with its Game Pass Ultimate program which acts as a “Netflix for video games” having recently merged with EA Access expanding its library of “free-to-play” games at the cost of a monthly installment.
If you have made it this far, you are a mad lad. I thought I’d take some time to illuminate the direction in which the video game industry seems to be heading by highlighting the patterns. This is also in an attempt to answer the question of: why are video games the way they are in 2020? It wasn’t easy to write but I hope it was easy for you to read. Once again thank you for taking the time of your day, now what are you waiting for? Go play some video games!

Circumcision: The Uniquely American Medical Enigma | Edward Wallerstein

The continuing practice of routine neonatal nonreligious circumcision represents an enigma, particularly in the United States. About 80 percent of the world's population do not practice circumcision, nor have they ever done so. Among the non-circumcising nations are Holland, Belgium, France, Germany, Switzerland, Austria, Scandinavia, the U.S.S.R., China, and Japan. People employing circumcision do so either for "health" reasons or as a religious ritual practiced by Muslims, Jews, most black Africans, non-white Australians, and others.
The origin of the ritual practice is unknown. There is evidence of its performance in Israel in Neolithic times (with flint knives) at least 6000 years ago.³⁸ Jews accept the Old Testament origin as a covenant between God and Abraham,¹⁸ although it is generally agreed that the practice of circumcision in Egypt predated the Abrahamic Covenant by centuries.⁵⁵ Ritual Circumcision is not germane to this discussion except insofar as the surgical ritual impinges upon accepted medical practice.⁶⁵
So called "health" circumcision originated in the nineteenth century, when most diseases were of unknown etiology. Within the miasma of myth and ignorance, a theory emerged that masturbation caused many and varied ills. It seemed logical to some physicians to perform genital surgery on both sexes to stop masturbation; the major technique applied to males was circumcision. This was especially true in the English-speaking countries because it accorded with the mid-Victorian attitude toward sex as sinful and debilitating.⁶⁴
The most prolific enumerator of the health benefits of circumcision was Dr. P. C. Remondino.⁵⁰ In 1891 this physician claimed that the surgery prevented or cured about a hundred ailments, including alcoholism, epilepsy, asthma, enuresis, hernia, gout, rectal prolapse, rheumatism, kidney disease, and so forth. Such ludicrous claims are still disseminated and possibly believed. The book was reprinted in 1974, without change, and the Circulating Branch Catalogue of the New York Public Library (1983) listed the Remondino book, showing a publication date of 1974. One physician, writing in Medical Aspects of Human Sexuality (1974), called the book "pertinent and carefully thought out."⁶³
Remondino was not the only one expounding such views. In 1911, Dr. Joseph Preuss, in a monumental tome, Biblical-Talmudic Medicine, claimed that Jewish ritual circumcision endowed health benefits; his sole source was Remondino⁴⁶ Some espoused more extreme views; in 1910 an article in J.A.M.A. described a new circumcision clamp. The authoinventor claimed that with this device, the operation was so simple that men and women could now circumcise themselves.³⁰
In the 75-year period (1875 to 1950) there was virtually no opposition to routine circumcision in the United States. Instead there were many articles in medical journal and textbooks extolling the practice; the issue was ignored in the popular press. Yet in the more than a century of acceptance of routine circumcision in the English-speaking countries, from 1870 to the present, no other country adopted newborn circumcision.
The first serious questioning of the practice did not occur until late 1949 (in England with the publication of Gairdner's "The Fate of the Foreskin."¹⁷ which began to affect the practice of circumcision by the British. In 1963, an editorial in J.A.M.A. called the attitude of the medical profession paradoxical and confused, and admitted that the facts about circumcision were still unknown.¹⁴ This was followed by several critiques of circumcision such as those by Morgan (1965 and 1967)³⁸ and Preston (1970).⁴⁵ In 1968 Øster confirmed Gairdner's findings,⁴² as did Reichelderfer and Fraga,⁴⁹ who presented a comprehensive study of circumcision. Yet some physicians continued to support circumcision for surprising reasons. For example, Dr. Robert P. Boland, writing in The New England Journal of Medicine in 1969, compared circumcision with tonsillectomy, calling both procedures "ritualistic," and "widely performed on a non-scientific basis." He opposed routine tonsillectomy but concluded vis-a-vis circumcision: "Little serious objection can actually be raised against circumcision since its adverse effects seem miniscule."⁵
Table 1. Estimated Newborn Nonreligious Circumcision Rates in English-Speaking Countries.

Great Britain	New Zeland	Australia	Canada	America
1	10	30	30	80

In the 1970's, a change seemed in the offing. In 1971 and 1975, the American Academy of Pediatrics Task Force on Circumcision declared: "...there are no valid medical indications for circumcision in the neonatal period."² In 1978, the position of the American Academy of Pediatrics was endorsed by The American College of Obstetricians and Gynecologists.⁶⁴ In 1983 both groups jointly reaffirmed their positions.¹ The "firm" firm declarations should have caused a marked drop in the United States circumcision rate. They did not.
To explore the circumcision rate in the United States, it is essential to compare the American experience with the other English-speaking countries. Anticircumcision articles appeared in the medical press in all of these countries. Gairdner¹⁷ and Øster⁴² were published in journals in England; Morgan (1967) was published in Australia.³⁹ In 1971, the Australia Paediatric Association recommended: "Male infants should not as a routine be circumcised."¹³ In 1975, the Canadian Paediatric Society stated, ". . .there is no medical indication for circumcision in the neonatal period."⁵⁷
Although there is no precise data on circumcision from any country,approximated rates for the English-speaking countries reveal that in Great Britain, the practice has virtually been abandoned; New Zealand follows closely behind. (In a 1982 visit, a number of physicians were apologetic for the "inordinately high" rate of 10 percent. Several physicians stated categorically that they refused to perform routine circumcisions.) The rates in Canada and Australia appear to be declining at about 10 percentage points per decade. The United States stands alone as the only country in the world in which the majority of newborn males are circumcised, purportedly for health reasons.
Before addressing the phenomenon of circumcision in the United States let us examine the Canadian and Australian data. In Canada (Table 2), there are considerable rate differences among the provinces but the overall rate is clearly declining, and in Quebec the practice has been virtually been discontinued. In Australia (Table 3), unlike Canada, the rates by states are relatively uniform, but clearly declining. In 1978, the Australia government recommended that payments for circumcision be reduced or eliminated.⁷¹ (In a visit to Australia in 1982, I was told that a national campaign was planned to reduce unnecessary surgery; circumcision was high on the list.)
Table 2. Hospital Inpatient Male Newborn Circumcision in Canada by Province (data from British Columbia and Newfoundland not reported)* 1970 to 1978 by Rank Order of Percentage change

	1970	1979	Change (% rounded)
Total	64,015	44,853	-30
Quebec	12,995	3,077	-76
Nova Scotia	2,477	1,004	-60
New Brunswick	1,543	673	-43
Alberta	10,857	9,608	-12
Manitoba	5,006	4,424	-11
Ontario	24,476	26,283	+4
Saskatchewan	3,276	3,655	+12

Table 3 Estimated Neonatal Circumcision Rate in Australia by State, 1973-74 to 1979-80(%)* Adapted from Wirth, J.L.: Current circumcision practices in Australia. Med. J. Aust., 1:179, 1982.

	1973-74	1979-80	% Decrease
Total	49	39	10
New South Wales	52	42	10
Victoria	39	28	11
Queensland	62	51	11
South Australia	47	41	6
Western Australia	51	38	13
Tasmania	68	43	25

Although nationwide data on circumcision for Canada and Australia are admittedly imperfect, precise data for the United States are virtually non-existent. The H.E.W. Hospital Records Study excludes neonates.⁷⁰ The Cycle III Health Examination Survey, conducted from 1963 to 1965 among youths aged 12 to 17, reflected the practice of circumcision in the early 1950's.⁷⁰ The total circumcision rate was 765 (whites, 80 percent; blacks, 45 percent); regional differences were also noted.
In 1980 Wallerstein provided a crude compendium of circumcision rates reported in the literature.⁶⁴ This was updated in 1981 by King and Roebuck.²⁹ Since these compendia, other reports from individual hospitals have been noted in the literature (Table 4).²⁵ Of the five hospitals reporting, the lowest rate was 80.7 percent; the other rates ranged from 90 to 98 percent. These data are static, that is, reported within a fixed period, making it impossible to discern a trend. Several hospitals reported longitudinal changes. One New York City maternity center stated that "in the past" the rate was 90 percent; in 1980 it was 60 percent.³⁵ Other reports are more precise, indicating changes from 1978 to 1980, and 1975 to 1979 (Table 4, last two hospitals).³ The year-to-year changes were negligible; clearly there was no precipitous decline. This stability of rate was confirmed by the Commission on Professional and Hospital Activities, which publishes annual data based on projections from atypically large hospitals.⁷² They show a 1970 rate of 88 percent and a 1980 rate of 86 percent. The mean rates from 1970 to 1975 and from 1976 to 1980 are identical (86 percent).⁵⁴
Table 4. Circumcision Rates, Selected Hospitals
References: ^{25, 29, 27, 34, 3, 41} respectively

Hospital	Years	Rates(%)
New Britain General Hospital, Connecticut	1976-77	80.7
Southern Illinois Hospital	1979	95
John Hopkins Hospital	1980	97.6
St. Agnes Hospital, Baltimore	1981	96-98
Hershey. Pennsylvania Hospital	1983	90-96
George Washington University Medical Hospital	1979	79
	1979	77
	1980	81
Largest Hospital in Salt Lake County, Utah	1975	92
	1976	93
	1977	92
	1978	92
	1979	93

In 1982 Slatkowski and King approached the question of circumcision rates specifically with respect to the pronouncements of the American Academy of Pediatrics on the practice of circumcision in Illinois.⁵⁴ They obtained data from 18 Chicago-area hospitals; the rates ranged from 27 to 92 percent (mean 78 percent). Five of the hospitals reported rates from 80 to 88 percent; five from 90 to 92 percent; the rates ranged from 74 to 97 percent, with a single exception: one hospital reported a rate of 4.5 percent. Upon further query, that hospital reported a circumcision rate decline beginning after 1974-75.
These United States data reveal no significant national decline in the circumcision rate desperate the pronouncements of the American Academy of Pediatrics or the American College of Obstetricians and Gynecologists. However there are instances of sharp declines in several hospitals. Dr. Joan Hodgman, director of the Newborn Division of the Los Angeles County University of Southern California Medical Center, reported in 1983 that their circumcision rate is zero. Similarly, J.H.T. Chang, pediatric surgeon at the Parkland Memorial Hospital in Dallas, the largest in the city, stated in 1983 that circumcision is not performed even if the parents demand it.²⁴
Why have most United States physicians persisted in the practice? One reason is that the medical and popular literature abounds in serious errors of scientific judgment, equivocation, and obfuscation. Space limitations permit a brief examination of four issues: pain, venereal disease, cancer, and hygiene.
PAIN
Pain of circumcision is not a debatable question; it is a fact.²¹ However, a perusal of writings in the popular press (1982 and 1983) reveals confusion. Proctor and Gamble, one of the nations largest advertisers, promotes Pampers to parents by offering the Expectant Parents Information Kit (1982), which contains the following statement: "You may be surprised to learn that circumcision will not be painful to your baby because, at this early stage of development, the penis does not yet have functioning nerve endings."¹⁵
A contrary view was found in American Baby (May 1983), in which parents were told that "Newborns who undergo circumcision experience a great deal of stress and pain . . ." Parents were advised that it was now possible to employ local anesthetics to alleviate such pain.³⁶
Mother's Manual (1982) argues against local anesthesia because ". . . it swells the area to the extent of making an unsatisfactory circumcision too likely."⁷ Genesis, published by the American Society for Psychoprophylaxis in Obstetrics, carried an article in 1982 in which two writers who attended a Jewish ritual circumcision described the surgery as bloodless, painless and stressless. They suggested that non-Jewish parents explore the possibility of employing ritual circumcisors.¹¹
Parents who read such an array of literature are bound to be bewildered.
VENEREAL DISEASE
Prior to the turn of the century, little was known about venereal disease, either causes or cures. Understandably, the false claim could be made with impunity that circumcision prevented sexually transmitted diseases.⁶⁴ These claims persisted beyond the middle of the twentieth century: Urologist A. Ravich titled his 1973 book Preventing V.D. and Cancer by Circumcision.¹⁸
Within the past decade there has been virtually no statement that circumcision prevents syphilis or gonorrhea; the present day "whipping boy" is genital herpes. Even a cursory exploration of a link between circumcision and herpes reveals that such claims are without foundation; the presence or absence of the foreskin neither aids nor deters the transmission of herpes. A definitive statement regarding this claim was made in 1979 by Y.M. Felman, director of the New York City Bureau of Venereal Disease Control: ". . . I don't believe that circumcision is of any value in preventing genital herpes, as this disease is quite common in circumcised males and their female sex partners."¹⁶
Yet in 1981, Warner and Strashin wrote: "Herpes genitalis appears to be the only sexually transmitted disease associated with circumcision status."⁶⁷ Strashin defended his statement the following year.⁶⁸ If circumcision prevents herpes or deters its transmission, how can we explain the phenomenal rise in the incidence of this disease to epidemic proportions, particularly among the most sexually active males, ages 15 to 25, of whom perhaps 75 percent are circumcised? Nevertheless, the 1975 American Academy of Pediatrics Task Force reported: "Adequate studies to determine the relationship between circumcision and the incidence of venereal disease have not been performed." This statement is obvious outdated.
PENILE CANCER
Few diseases strike greater fear than cancer, and no site is more potentially alarming to males than the penis. It is not surprising, therefore that when newborn circumcision is presented as an absolute prophylaxis against penile carcinoma, it is a potent argument for circumcision. Wolbarst wrote in 1932: ". . . cancer of the penis does not occur in Jews circumcised in infancy. There is no case on record."⁷³ Subsequent research indicate that there are such cases on record.⁴
The understatement of the incidence of penile cancer in Jews should be contrasted with the overstatement in regard to the uncircumcised people of India and China. In 1973, deKernion and colleagues wrote: ". . . the disease accounts for 12 percent of all malignancies among the Hindus of India."¹² In 1977 Kaplan claimed, "In China, penile carcinoma accounts for 18 percent of all carcinomata."²⁸ In a visit to the Peoples Republic of China (1976) and India (1982) the incidence of penile cancer was discussed with health officials. They stated that no nationwide health data was available; more specifically, no National Cancer Registries were maintained (much as they would like to do so). They remarked that no reputable scientist in their country would provide such data. Precise data on penile cancer are available from countries in which a National Cancer Registry is maintained. The United States does not maintain such a Registry, and so its data are imprecise. The data from Japan, Norway, and Sweden are compared with the United States' estimates (Table 5). The largest difference in incidence is between the United States and Sweden, three cases per million males; for death rates, the difference between the United States and Japan is one case per million males, small differences indeed. It is worthy of note that in countries in which a National Cancer Registry is maintained and precise incidence or death rates is known, routine circumcisions continues not to be practiced. There is no acceptance of the claimed epidemiologic relationship between circumcision and penile cancer.
Table 5. Penile Cancer: Comparison of Approximate Incidence and Death Rates per 100,000 Males for Selected Countries*
*Data from Cancer Deaths 1980 Ministry of Health and Welfare, Tokyo, Japan for Japan. For other countries; Wallerstein, E.: Circumcision an American Health Fallacy. New York, Springer Publications. 1980.

Country	Year	Incidence	Death Rate
America	1972	0.8/100,000	0.3
Japan	1980	N/A	0.2
Norway	1967	1.1	N/A
Sweden	1968	1 1	N/A

It could be argued that in Japan, Norway, Sweden, high standards of hygiene are maintained. The variable in penile cancer prophylaxis may be hygiene, not retention of foreskin. This is essentially the position taken by the 1975 American Academy of Pediatrics Task Force, which denied a relationship between circumcision and prostatic cancer and stated that "non-circumcision is not of primary etiological significance" in cervical cancer.² In regard to penile cancer, they wrote: "There is evidence that carcinoma of the penis can be prevented by neonatal circumcision. There also is evidence that optimal hygiene confers as much or nearly as much protection" (emphasis added)² In 1981, 6 years later, Grossman and Posner took a more forthright position. Writing in Obstetrics and Gynecology, they stated: "No one today seriously promotes circumcision as a prophylactic against cancer in any form. No significant correlation between cancer and circumcision has ever been proved."²²
The claim that circumcision is related to penile cancer is based upon the "fact" that smegma is a carcinogen. Smegma in infancy consists solely of desquamated epithelial cells, and in adulthood additionally of the secretions of the Tyson's glands. Many attempts have been made to prove a simple cause and effect between smegma and cancer; all failed but one. In 1947 Plaut and Kohn-Speyer "demonstrated" that smegma was a carcinogen. Of the animals examined, 27 percent of those treated with smegma developed cancer whereas 15 percent of the animals treated with cerumen developed cancer.⁴⁴ Is it now possible to claim that cerumen is also a carcinogen with only one half of the carcinogeneity of smegma? This study is deficient in conceptualization, methodology, execution, gathering of data, and analysis.⁴⁴ Understandably, the study has largely been ignored; however, as recently as 1981 it was accepted in one medical journal article without question.²³
Penile cancer scare techniques are still with us. In 1980, Kochen and McCurdy stated that ". . . uncircumcised men are uniquely at risk . . ." They "demonstrated" that the predicted lifetime risk among uncircumcised men was one in 600.31 They did not address why 599 out of 600 at risk" males will not contract penile cancer in their lifetime. More importantly, Kochen and McCurdy based their calculations on the 1968 Stern and Lachenbruch study of one cancer detection center in Los Angeles.⁵⁹ Their 1968 data are obviously skewed in age, ethnicity, religion, social class, and so forth, and are admittedly non-random. Such inadequate local data should not be extrapolated to a national statistic.
The threat of penile cancer hangs over the discussion of circumcision like some mystical demon. It deserves to be exorcised, not circumcised.
PENILE HYGIENE
In several studies, mothers were asked why they agreed to their son's circumcision. The answer given most frequently was "hygiene."⁵³ (In a 1981 United Nations study of female genital surgery in Africa, one reason given for such surgery was "hygiene."¹⁹ ) Why is male genital hygiene viewed with such alarm in the United States that prophylactic surgical intervention is necessary?
For over a century, and to this day, mothers have been warned that proper penile hygiene involves full retraction of the foreskin to clean the glans of smegma, and this procedure should start almost at day one. Such a task is virtually impossible, because in almost all infants the foreskin is attached firmly to the glans. Separation occurs normally within a few months or several years. Separation may be forced but this literally involves tearing the tissues apart, which is usually painful and may result in bleeding. No sane mother enjoys causing distress to her child. No wonder there is fear and reluctance about retraction of the foreskin. This has created a foreskin phobia. Forced retraction of the foreskin may lead to complications, and may well be the reason for so many postinfancy circumcisions (only in the United States).
The problem with this hygienic technique is that it is totally in error. Care of the foreskin is not exceedingly difficult; it is exceedingly simple: leave it alone. The foreskin in infancy should not be retracted. In 1977 Kaplan wrote, " . . . freeing 'adhesions is tantamount to cruel and unusual punishment and is unfounded physiologically or medically."²⁸ Development of the foreskin and the inadvisability of forced retraction was noted by Gairdner (1949),¹⁷ Øster (1968),⁴² Reichelderfer and Fraga (1968),⁴⁹ and others.
Many, if not most, American physicians are ignorant of proper care of the foreskin. This was demonstrated by Osborn and colleagues in 1981, who queried Utah pediatricians and found that 67 percent estimated that the foreskin should retract easily by one year.⁴⁰ This is contrary to all findings of studies of the foreskin. Only 3 percent said the newborn foreskin should never be retracted. In interviewing a small sample of mothers of uncircumcised boys, Osborn and colleagues also found that retraction of the foreskin caused such anxiety that 40 percent of these mothers stated that they would have their next male infant circumcised.
The problem is not limited to Utah. In a study of physicians in the Chicago area, Patel and colleagues reported in 1982 that "only 49 percent of the physicians [in the total sample] were aware of the AAP's [American Academy of Pediatrics position."⁴³ Among the pediatricians and obstetricians in the sample, 62 percent were aware of this position. The major reason given for recommending circumcision was "hygiene" (90 percent). In a 1982 study by Stein and colleagues conducted in San Diego, they noted, "Only 36 percent of the responding physicians were aware that the newborn's foreskin is characteristically not found retractable."⁵⁸ When asked "if a nonretractable foreskin is an indication for circumcision," 47 percent of all respondents answered incorrectly. Such incorrect responses were mare likely to be given by those in family practice (50 percent), obstetrics (55 percent), and general practice (67 percent) than by those in pediatrics (13 percent). At the Spring 1983 meeting of the American Academy of Pediatrics in Philadelphia, an exhibit on circumcision was conducted. The most frequently asked question related to proper care of the foreskin.
If physicians are ill-informed about care of the foreskin, how can parents be well informed? There are thousands of books, pamphlets, and articles available to parents relating to child care. Almost none devotes attention to proper care of the foreskin. Discharging a circumcised child without informing the parents of proper wound care constituted negligence. Discharging an uncircumcised child without informing the parents of proper care of the foreskin is equally negligent. Osborn and colleagues reported that the only written information they could find on the subject was this statement in a 1978 book: " . . .retract the foreskin gently and return the foreskin to its normal position to prevent constriction and swelling."⁸ To begin to correct this lack of information, in 1982 Wallerstein wrote a pamphlet entitled "When Your Baby Boy is Not Circumcised."⁶⁶ Boyce also addressed the subject in an article entitled "Care of the Foreskin (1983).⁶ The American Academy of Pediatrics has issued a pamphlet entitled "Care of the Uncircumised Penis" (1984).
The issue of hygiene is obfuscated by the American Academy of Pediatrics Task Force Report in two ways. As noted earlier, the Report stated that to prevent penile cancer, "optimum hygiene was necessary. The reader, lay public or physician may ask: What constitutes "optimum hygiene? Can parents guarantee such optimum care? If not, isn't it better to play it safe and circumcise? The Report also cautions that retention of the foreskin requires "lifelong" hygiene. This statement is not incorrect; it is incomplete. All body parts require lifelong hygiene, body bathing, hair shampooing, oral hygiene, labial hygiene, and so forth. The discontinuance of any aspect of hygiene may well have deleterious effects. Why single out the foreskin?
The crux of the circumcision/hygiene rationale had its origin in the fear of the "effects" of masturbation; this may persist in attenuated form. Today, however, it is basically a lack of knowledge: the foreskin and glans in infancy are essentially fused, and should not be retracted forcibly, and smegma is not a carcinogen.
Another claimed hygienic benefit is that thousands of United States servicemen, particularly in the South Pacific required circumcision. Would it not be better to circumcise in infancy and thereby avoid the more troublesome operation in adulthood? However, Japanese soldiers were fighting in the identical environment, and the Japanese did not practice newborn circumcision. When Japanese health officials were visited by Wallerstein (1982), they stated that to the best of their knowledge, Japanese military surgeons did not find it necessary to circumcise after World War II. More to the point, in the event of thermonuclear war, the role of the foreskin will pale to insignificance.
Thus, much of the current circumcision misinformation, both lay and professional, is false and misleading. In 1971 and 1975, the American Academy of Pediatrics appeared to take definitive positions; actually they did not. The American Academy of Pediatrics Committee on the Fetus and Newborn noted in 1971 that "there are no valid medical indications for circumcision in the neonatal period."² in 1975, the American Academy of Pediatrics Ad Hoc Task Force on Circumcision reported that there was no basis for changing this statement and concluded, "There is no absolute medical indication for routine circumcision of the newborn."²
However, as previously noted, the use of the words "optimum" and "lifelong" with regard to to penile hygiene and the stated uncertainty of a possible link between circumcision and venereal disease represented equivocation. An additional equivocation is found in the 1975 Report: "A diagnosis of phimosis cannot be made with assurance in the newborn period because the cleavage plane between the glans and the deep preputial layer of the penis is not developed at birth. There is a real need for research which will improve diagnostic accuracy in this area."²
In 1983, this statement was challenged by Thompson, who chaired the ad hoc Committee. He wrote: "One major reason used to justify neonatal circumcision - correction or prevention of phimosis has been shown to be untenable by serial studies from birth to adulthood."^{62 Furthermore,} overwhelming epidemiologic evidence from countries that never adopted circumcision or abandoned the practice obviates the need for further study.
Thompson also provided the setting for the equivocation and the absence of a more definitive position: "The ad hoc commmittee was sharply divided in its opinions, and the resulting statement was a compromise that stated that there was no absolute medical indication for routine circumcision of the newborn.' The words absolute and routine were meant to convey a different impression from the conclusion of the AAP Committee on the Fetus and Newborn, but this has no always been the interpretation of readers."⁶²
If the American Academy of Pediatrics Committee was sharply divided and the report subject to misinterpretation, how can physicians and parents take an unequivocal position on circumcision? They cannot. And if the position of the American Academy of Pediatrics is equivocal, the position of the American College of Obstetricians and Gynecologists is even more so. When the American Academy of Pediatrics committees reported, the statements were published.⁵⁶ The endorsements of the American College of Obstetricians and Gynecologists were not published in their journal.⁶⁴ Moreover, in 1978 Grimes raised an unanswered question: " . . . the American Board of Obstetrics and Gynecology, Inc., warns that 'physicians who assume responsibility for the health of male patients for operative or other care will not be regarded as specialists in obstetrics-gynecology . . .'"²⁰ It is well known that obstetricians perform a large percentage of circumcisions.
The acceptance of circumcision was noted by Herrera is 1983, who reported on a nationwide survey of 400 pediatricians and obstetricians; 50 percent believed circumcision indicated in the newborn, 33 percent opposed, and 17 percent were undecided.²⁶ As to advice to parents, there was acquiescence; 15 percent encouraged it, 19 percent discouraged it, and 66 percent remained neutral. "This is one reason why nearly every male neonate is circumcised," Herrera wrote.²⁶
Ambivalence on the part of physicians about circumcision was illustrated in one study by a Canadian hospital in 1983 where there were two patients with a serious complication of circumcision, denuding of the penile shaft that required plastic surgery. A formal proposal to suspend neonatal circumcisions was made but rejected because of anticipated adverse community reaction. However, the circumcision rate in that hospital dropped from about 40 to 20 percent as a result of the mishaps.⁶¹
Judging from the record, American medical professionals are not truly opposed to circumcision; they perform about 1.25 million annually. Some continue to insist that there are health benefits. Some physicians place the responsibility on the parents. In 1983 Maisels and colleagues wrote, "If circumcision practices are ever to be changed, such changes will likely result from organized advocacy of lay groups . . . rather than from the efforts of the medical profession."³⁴ However when physicians demonstrated that routine tonsillectomy and adenoidectomy were unwise, the rate dropped. No amount of parental pressure would cause an ethical physician to perform such an operation if it were unnecessary.
Some charge venality, possibly true for some physicians, but not for all, and impossible to document. Some of the highest circumcision rates are to be found in military hospitals, where the doctors are salaried. Contrast this with the abandonment of routine tonsillectomy; some physicians had reduced revenues, but no one clamored for the reinstatement of the procedure to refill the coffers. Venality may not be dismissed entirely; in private practice, circumcision results in a fee, and there is loss of time convincing parents not to have their sons circumcised.
Then there is the Jewish question. Some non-Jewish physicians may be hesitant to question routine "health" circumcision in the mistaken belief that this stance may offend Jews. However, according to Jewish theologians, the Jewish ritual has nothing to do with health.⁶⁴ Obversely, occasional private comments suggest that Jews are responsible for nonreligious circumcision. This is a canard.
The "enigma" lies in the United States medical profession's apparent inability to come to grips with the simple fact that there are no demonstrable health benefits of circumcision, and there are risks. (Space limitations preclude delineation.) It should also be noted that the foreskin is useful erogenous, and protective tissue. Smegma, both clitoral and penile, is beneficial, not detrimental. Meatitis is not uncommon in circumcised males; rare in the uncircumcised. Moreover, the penis is the only organ subjected to routine prophylactic surgery.
One explanation for holding to outmoded views was provided by a medical professor who told his students, "It takes less than five minutes to print an article in a medical journal and 50 years to erase it." In 1979 Colletti approximated this estimate. He noted that efforts to reverse current circumcision practice "will need at least a generation of widespread education, coaxing, and encouragement to succeed."¹⁰ Warner and Strashin are even more pessimistic, based upon an erroneous premise: "As for the likelihood of a successful hygiene education program we can only point to our own profession's impotence in combating smoking and obesity."⁶⁸ This approach overlooks the fact that hundreds of millions of dollars are expended annually to promote smoking and food intake. No such effort on behalf of circumcision exists.
As scientific evidence mounted to dispute each of Remondino's exaggerated claims, physicians clutched at straws to retain at least one "health" benefit. Now that all such claims have been refuted, circumcision today has become cultural surgery, not very different from ear- and nose-piercing and tattooing. The extreme to which such cultural surgery is carried may be found in the 1983 warning given by the British Social Service Secretary to Harley Street surgeons who charged up to $1500 for a clitoridectomy performed on young girls from Africa, where such surgery is traditional.⁶⁹ More serious examples were found in France in 1982.⁵²
The medical profession was successful in eliminating routine tonsillectomy and adenoidectomy. This is precisely what is needed for routine circumcision. It is necessary to overcome ignorance and the emotional superstructure surrounding the penis, not very different from ancient (and present phallic worship. It is necessary to accept scientific facts; it is necessary to discard myths about circumcision: the foreskin causes premature ejaculation, it keeps the penis from growing, some disaster will befall the uncircumcised child, the uncovered glans is more esthetically pleasing (that is the foreskin is ugly). The special myth that the boy's penis must be identical to his father's ignores the historic truth that no objection was raised, and no problem arose when circumcising millions of boys whose fathers were uncircumcised.
To resolve the problem, the positions of the American Academy of Pediatrics and American College of Obstetricians and Gynecologists should become definitive statements that circumcision is unnecessary surgery, not to be undertaken except in rare medical circumstances. Endorsements of this position should be obtained from all relevant medical groups. This information should be disseminated to the entire medical profession, to all hospitals, nurses and nursing associations, childbirth educators, and most certainly to parents via the popular press. Meetings professional and lay persons should be called on local, state and national levels to discuss circumcision. With such an approach, routine newborn nonreligious circumcision will soon pass from the scene to join blood-letting and cupping in medical history.
As Prucha observed in 1980, "The history of these few millimeters of skin is utterly fascinating."⁴⁷

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Human Anatomy & Physiology Laboratory Manual: Making Connections, 2nd Edition: Catharine C. Whiting
Quality and Safety in Nursing: A Competency Approach to Improving Outcomes, 2nd Edition: Gwen Sherwood & Jane Barnsteiner
Public / Community Health and Nursing Practice: Caring for Populations, 2nd Edition: Christine L. Savage
The Ethical Life: Fundamental Readings in Ethics and Contemporary Moral Problems, 4th Edition: Russ Shafer-Landau
Bailey & Love's Short Practice of Surgery, 27th Edition: Norman S. Williams & P. Ronan O'Connell & Andrew McCaskie
Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice, 20th Edition: Courtney M. Townsend & R. Daniel Beauchamp & B. Mark Evers & Kenneth L. Mattox & Courtney M. Townsend & R. Daniel Beauchamp & B. Mark Evers
Shackelford's Surgery of the Alimentary Tract, 7th Edition: Charles J. Yeo & David W McFadden & John H. Pemberton & Jeffrey H. Peters & Jeffrey B. Matthews
Equine Veterinary Nursing, 2nd Edition: Karen Coumbe
West's Respiratory Physiology: The Essentials, 10th Edition: John B. West & Andrew M. Luks
A Manager's Guide to Financial Analysis: Powerful Tools for Analyzing the Numbers and Making the Best Decisions for Your Business: Eliot H. Sherman
The Wiley International Handbook of History Teaching and Learning, 1st Edition: Scott Alan Metzger & Lauren McArthur Harris
Differential Diagnoses in Surgical Pathology: Genitourinary System, 1st Edition: Jonathan I. Epstein & George J. Netto
Lab Manual and Workbook in Microbiology: Applications to Patient Care, 12th Edition: Josephine Morello & Paul Granato & Verna Morton
Neuroscience: Exploring the Brain, Enhanced Edition, 4th Edition: Mark Bear & Barry Connors & Michael A. Paradiso
Above the Fold: Understanding the Principles of Successful Web Site Design, Revised Edition, Brian D Miller
Essentials of Clinical Radiation Oncology, 1st Edition: Matthew C. Ward & Rahul D. Tendulkar & Gregory M. M. Videtic
Introductory Chemistry, 5th Edition: Nivaldo J. Tro
Principles of Microeconomics, 12th Edition, Global Edition: Karl E. Case & Ray C. Fair & Sharon E. Oster
Mosby's Diagnostic and Laboratory Test Reference, 14th Edition: Kathleen Deska Pagana & Timothy J. Pagana & Theresa N Pagana
Guyton and Hall Textbook of Medical Physiology, 13th Edition: John E. Hall
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Stroke: Practical Management, 4th Edition: Charles P. Warlow & Jan van Gijn & Martin S. Dennis & Joanna M. Wardlaw & John M. Bamford
Pulmonary Embolism, 3rd Edition: Paul D. Stein
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Chemistry & Chemical Reactivity, 10th Edition: John C. Kotz & Paul M. Treichel & John Townsend & David Treichel
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Racial Formation in the United States, 3rd Edition: Michael Omi
Ethics and Politics in School Leadership: Finding Common Ground: Jeffrey Brierton & Brenda Graham & Daniel R. Tomal & Robert K. Wilhite
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Stevens' Handbook of Experimental Psychology and Cognitive Neuroscience, Learning and Memory, 4th Edition: John T. Wixted & Elizabeth A. Phelps
Research Methods in Psychology, 10th Edition: John Shaughnessy & Eugene Zechmeister & Jeanne Zechmeister
The Chemistry of Superheavy Elements, 2nd Edition: Matthias Schädel & Dawn Shaughnessy
Chemistry for Today: General, Organic, and Biochemistry, 8th Edition: Spencer L. Seager & Michael R. Slabaugh
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Organic Synthesis, 4th Edition: Michael B Smith
Human Genetics Concepts and Applications, 12th Edition: Ricki Lewis
Ethics: Discovering Right and Wrong, 8th Edition: Louis P. Pojman & James Fieser
Cognition: Exploring the Science of the Mind, 7th Edition: Daniel Reisberg
Psychology: A Journey, 5th Edition: Dennis Coon & John O. Mitterer
Psychological Testing: Principles, Applications, and Issues, 9th Edition: Robert M. Kaplan & Dennis P. Saccuzzo
Research Methods, Design, and Analysis, 12th Edition, Global Edition: Larry B. Christensen & R. Burke Johnson & Lisa A. Turner
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australian gambling statistics video

This edition of Australian Gambling Statistics contains 2016–2017 gambling statistics for all Australian states and territories. To see how Victoria compares with the rest of Australia on gambling expenditure, see Gambling in Victoria on the Foundation's website.. This comprehensive set of data covers the entire range of legalised Australian gambling products such as pokies, casino, race Australian gambling statistics is a comprehensive set of statistics related to gambling in Australia, covering the entire range of legalised Australian gambling products. The publication has been produced since 1984, and is compiled annually by the Queensland Government Statistician's Office in co-operation with all Australian state and territory governments. Here are a few other key gambling statistics from the Australian Institute of Family Studies: There are 6.8 million regular gamblers in Australia – 39% of the population Participation in lotteries was most common (76%), followed by instant scratch tickets (22%) and electronic gaming machines (EGMs) (21%) This edition of Australian Gambling Statistics contains 2017–2018 gambling statistics for all Australian states and territories. To see how Victoria compares with the rest of Australia on gambling expenditure, see Gambling in Victoria on the Foundation's website.. This comprehensive set of data covers the entire range of legalised Australian gambling products such as pokies, casino, race The statistics were obtained from cross-sectional analysis of Household, Income and Labour Dynamics in Australia (HILDA) Survey data, wave 15, which is the first wave to include gambling questions. The HILDA Survey was designed so that participants' responses (17,606 participants in wave 15) could be generalised to the Australian adult population. It can also lead to stress, mental health issues and loss of control. In fact, 0.5-1.0% of Australian adults are problem gamblers according to Central Coast Gambling Help, and a further 1.4-2.1% Australian Gambling Statistics 30th Edition chances of winning. The best way of taking advantage of the top casino bonuses is by finding a promotion or an offer that best suits you. Also ensure that you have checked the terms and conditions of a given bonus well in advance. The gambling industry provides roughly 86,000 jobs throughout the country. Also, Australian tax revenue and the enjoyment of gambling are valued around AU$12.1 billion to AU$15.8 billion a year. Much of the Australian gambling industry heavily focuses on bringing international players to our shores which constitutes a huge source of foreign revenue. We look at the latest Global Gambling Statistics: Comparing revenue, popular games & personal data to discover the world's best Gambling nations in 2021. Australian Gambling Statistics (AGS) AGS comprises statistics on turnover, expenditure and government revenue from gambling activities conducted in Australian states and territories.< The publication has been produced since 1984, and is compiled annually by the Queensland Government Statistician's Office in co-operation with all Australian state and territory governments.

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Australian Gambling Statistics 30th Edition