The Normal Thing to Be

Routine infant circumcision is one of the few surgeries performed on people who cannot consent, for reasons that keep changing. In the early 2000s, three trials in sub-Saharan Africa appeared to show it could reduce men's risk of acquiring HIV. The World Health Organization endorsed the findings, and what followed was an unprecedented effort to circumcise millions of males across more than a dozen African countries. The CDC and the American Academy of Pediatrics followed, reversing years of institutional skepticism.

These policy shifts did not unfold organically. A small network of circumcision advocates held key positions inside the WHO, CDC, NIH, and a handful of prestigious universities, and the public record shows them coordinating in ways the official account does not reflect. This book draws on new interviews, Freedom of Information requests, and documents that have received little scrutiny.

Few topics in pediatrics have produced as much sustained argument among physicians, ethicists, and parents. The practice is promoted on medical grounds that are widely disputed and sustained by a normative impulse that has little to do with medicine at all.

At its core the controversy is an ethical one. Circumcision permanently alters a person’s sexual anatomy without medical necessity, which is the usual standard for operating on someone who cannot consent. In virtually any other medical context, the routine surgical removal of healthy tissue from a non-consenting patient would invite immediate ethical and legal scrutiny. Circumcision occupies a unique place in American medical culture, an exception so deeply embedded that many practitioners and parents do not think of it as one at all.

That status is starting to erode. Critical coverage has appeared in major outlets. Tens of thousands of circumcised men are actively pursuing methods to undo what was done to them as newborns. In several European countries, legislative proposals and court rulings have sought to ban the practice on minors. The institutions that championed it are beginning to feel the pressure.

Every year, millions of parents are asked to consent to an irreversible genital surgery for their newborn sons. For many it is an unsettling proposition. This book explains how it came to be, which is a story that has stayed largely out of public view.

Inside the book

The American Default. How a practice with no clear medical rationale became the thing you do without deciding to.

Stacking the Room. The committees, the invitations, and who ended up in them.

Scientific Warriors. The researchers who built the evidence base, and the questions they did not ask.

Into the Field. What the mass circumcision programs looked like on the ground.

The Old World Pushes Back. European courts, medical bodies, and the limits of the consensus.

The Ethics, The Law, and The Unraveling. Where the argument stands now, including the task force members who no longer believe what they wrote.