Influencing health debates through letters to the editor: the case of male circumcision.

In this article I use the case of male circumcision (MC) to examine how grassroots activists, medical professionals, other stakeholders, and ordinary people employ letters to the editor (LTEs) to influence public health debates. I also show how journalistic practices affect the use of LTEs. Seventy LTEs about MC from U.S. newspapers between 1985 and 2006 are analyzed using qualitative methods. Pro-MC, anti-MC, and neutral LTE writers supported their stances on similar grounds, described adversaries as biased, and stressed medical and scientific authority. Yet only MC advocates and neutralists trivialized MC and declined to justify their stances, suggesting distinctive dynamics for LTEs about widely accepted practices. The prevalence of debated practices and activists' efforts to piggyback on related issues also affect LTE content. Editors chose LTEs to address readers' critiques, enact news values like balance and controversy, and showcase writers with strong claims to legitimacy, thereby mediating public health debates.