All it takes to popularize an elective preventative surgery with questionable health benefits is a mix of perverse incentives, personal bias, and ignorance.
It helps to know a bit of history. The circumcision procedure is both deeply personal and a bit taboo (no one really likes talking about genitals), few people even discuss it at all. Grown men who have never known life with a foreskin are disinclined to mourn it.
David Gollaher explains in his book Circumcision: A History of the World’s Most Controversial Surgery, a circumcised penis swiftly became a mark of distinction, a sign of good breeding, sound hygiene and the best medicine money could buy.
Cleanliness - Neo Natal Routine Surgery:
At the time, surgical interventions of all kinds were becoming more popular, owing to better anesthesia and greater concern over cleanliness, which reduced hospital contagion. Doctors began recommending the operation as part of the neonatal routine. Not only did the procedure prevent phimosis, but it was also believed to make the penis more hygienic and less tempting for wayward masturbating boys.
Lack of knowledge:
Although religious practitioners have been snipping foreskins for thousands of years, the medical practice dates from the late 19th century—a time when the causes of most diseases were poorly understood.
Surgeons believed circumcision cured insanity:
Mystified by everything from epilepsy to madness, some physicians in both America and England began to suspect that the real trouble was phimosis, a condition when an overly tight foreskin hinders normal function.
By removing the foreskin, surgeons believed they could heal all sorts of maladies, from hernias to lunacy.
In the UK circumcision became a habit of the upper classes, including the royal family. Anyone who could afford to have a child delivered by a doctor rather than a midwife was keen to heed the latest scientific advice. In 1948 British doctors could not agree that circumcision was necessary, and practice was not covered. At a time when most Brits were financially strapped, few cared to pay for something that suddenly seemed frivolous. Circumcision rates swiftly dropped.
If circumcision is covered by health insurance the % stays high if not the % drops:
In America, however, the postwar boom years created a glut of jobs, and employers often wooed workers with plush health benefits, which typically covered circumcision. A growing number of Americans could suddenly afford to give birth in hospitals, and routine infant circumcisions spiked.
Intact Foreskin is rare these days:
Nearly six out of ten newborns are released from hospitals foreskin-free. The practice is so widespread, in fact, that one study of 90 active American medical textbooks and models found that less than a third featured a penis with foreskin intact.
Similar to the Vaccine discussion:
Most Americans assume the practice is medically useful, like a vaccination. The medical community agrees: both the U.S. Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) claim the benefits of circumcision outweigh the risks, citing evidence that circumcision lowers a man’s risk for HIV, urinary-tract infections and penile cancer. But a closer look reveals that, at least in the industrialized world, the health benefits of circumcision may be negligible.
Risk of Urinary Tract Infection:
Circumcision, for example, does slightly lower the risk of a urinary-tract infection in male newborns. But UTIs affect fewer than 1% of uncircumcised infants and are easily treatable with antibiotics. For every six urinary-tract infections prevented through circumcision, at least one infant is likely to suffer a complication from surgery, such as hemorrhage.
This helped entrench an elective medical practice, creating generations of foreskinless fathers and doctors who were inclined to believe it was best for their sons, too. It is a trend that America’s unwieldy fee-for-service health-care handily reinforces, as doctors and hospitals have incentives for offering interventions deemed unnecessary most everywhere else.
Circumcision Makes BIG Money:
Johnson, the University of Michigan professor of obstetrics and gynecology, observes that the procedure is “highly remunerative” for the pediatricians at his hospital.
“I think the professional charge in our state is somewhere between $150-200,” he says. “That’s real money if you can do four or five circumcisions in an hour.” In states where Medicaid does not cover the practice, rates have fallen fast.