Information deleted in subsequent editions with no coherent explanation

The 1984 American Academy of Pediatrics pamphlet for parents titled, “Care of the Uncircumcised Penis” described foreskin functions, which include shielding the glans (head) from irritation and infection. “The foreskin protects the glans throughout life.”

This information was deleted from subsequent editions of the pamphlet. Ronald Goldman, Ph.D. inquired eight times to four AAP officials about this deletion. The sequence of communications is posted below.

Why does the AAP omit information about foreskin functions it previously thought was useful?

January 2, 1996 letter from Ronald Goldman, Ph.D. to Kara Taff

Kara Taff

Division of Physicians Payment Systems

American Academy of Pediatrics

141 Northwest Point Blvd.

P.O. Box 927

Elk Grove Village, IL 60009-0927Dear Ms. Taff:I have been referred to you for response to a question concerning AAP publications on circumcision. It has come to our attention that the 1984 edition of the pamphlet “Care of the Uncircumcised Penis” included the following information:”The glans at birth is delicate and easily irritated by urine and feces. The foreskin shields the glans; with circumcision, this protection is lost. In such cases, the glans and especially the urinary opening may become irritated or infected, causing ulcers, meatitis, and meatal stenosis. Such problems virtually never occur in uncircumcised penises. The foreskin protects the glans throughout life.”The latest edition of this pamphlet does not include this information. Why was this information deleted?

Thank you for your prompt response to this question.Very truly yours,Ronald Goldman, Ph.D.

Kara Taff Division of Physicians Payment Systems American Academy of Pediatrics 141 Northwest Point Blvd. P.O. Box 927 Elk Grove Village, IL 60009-0927Dear Ms. Taff:I have been referred to you for response to a question concerning AAP publications on circumcision. It has come to our attention that the 1984 edition of the pamphlet “Care of the Uncircumcised Penis” included the following information:”The glans at birth is delicate and easily irritated by urine and feces. The foreskin shields the glans; with circumcision, this protection is lost. In such cases, the glans and especially the urinary opening may become irritated or infected, causing ulcers, meatitis, and meatal stenosis. Such problems virtually never occur in uncircumcised penises. The foreskin protects the glans throughout life.”The latest edition of this pamphlet does not include this information. Why was this information deleted? Thank you for your prompt response to this question.Very truly yours,Ronald Goldman, Ph.D. January 23, 1996 letter response excerpt from Susan McCarthy, Division of Public Education

“Unfortunately, I am unable to determine why it was taken out. . . . Since the brochure is currently being revised, I will send a copy of your letter to the pediatricians assisting us with the review of this brochure to determine if any, all or part of the information should be reinstated.”

“Unfortunately, I am unable to determine why it was taken out. . . . Since the brochure is currently being revised, I will send a copy of your letter to the pediatricians assisting us with the review of this brochure to determine if any, all or part of the information should be reinstated.” February 5, 1996 letter excerpt from Ronald Goldman, Ph.D. to Susan McCarthy

“Since you do not know why the information was deleted, can you refer me to someone who does know? Surely, someone in the organization would have the answer. The deleted information could have been reinstated in the latest edition of the brochure. I would like to know why this was not done.”

“Since you do not know why the information was deleted, can you refer me to someone who does know? Surely, someone in the organization would have the answer. The deleted information could have been reinstated in the latest edition of the brochure. I would like to know why this was not done.” February 16, 1996 telephone call from Ronald Goldman, Ph.D. to Susan McCarthy

McCarthy said they would look at their files and try to find out at what point or by whom the information was deleted. She did not know the initial response of the reviewers to the Jan. 2 letter and would try to get a response.

McCarthy said they would look at their files and try to find out at what point or by whom the information was deleted. She did not know the initial response of the reviewers to the Jan. 2 letter and would try to get a response. May 9, 1996 letter from Ronald Goldman, Ph.D. to Kara Taff restating questions about deletion

May 14, 1996 letter response from Edward Zimmerman, Division of Physician Payment Systems, stating that Kara Taff resigned from the AAP and that he would respond to my questions about deletion

May 17, 1996 letter from Ronald Goldman, Ph.D. to Edward Zimmerman, restating questions along with copy of January 2 letter

July 15, 1996 letter from Ronald Goldman, Ph.D. to Edward Zimmerman after no response to May 17 letter

August 6, 1996 telephone call from Ronald Goldman, Ph.D. to Mary Claire Walsh, Division of Public Education

Walsh said she sent a copy of the deleted information to the reviewers and let them know that it was previously in the brochure. When the brochure came back after their review the information was still left out. She did not know the reason and whose decision it was. When asked, she would not be more specific.

Walsh said she sent a copy of the deleted information to the reviewers and let them know that it was previously in the brochure. When the brochure came back after their review the information was still left out. She did not know the reason and whose decision it was. When asked, she would not be more specific. August 28, 1996 letter to Mary Claire Walsh restating question and asking for response

September 3, 1996 letter excerpt from Mary Claire Walsh

“The reviewers felt it was not necessary to reinstate the paragraph because the revision of the brochure included a complete reorganization of the information contained in previous editions.”

Note: A comparison of new and previous editions did not show “complete reorganization of the information.” In any case, such a reorganization would not justify the omission of previously published useful information.