It isn’t difficult to see how Brian Morris’ process works. He publishes a “new” paper making bold, biased, often-unsupported claims citing his prior work doing the same, and receives circulation for his ideas from unquestioning journalists acting as stenographers. His latest, with Stefan Bailis and Thomas Wiswell, is a good opportunity to assess the reporting within consideration of an excellent article by Ian Sample, “How to write a science news story based on a research paper“.
1. Find a good paper
That rules out anything written by Professor Morris, but I’ll grant that his focus on non-therapeutic infant male circumcision satisfies the criteria that the work be “controversial”.
2. Read it
You cannot cover a paper properly without reading it. The abstract [ed. note: Or the press release] will give the barest essentials. You need to read the introduction for context, the discussion and conclusions for take-home messages. Check the methods. Was the experiment well designed? Was it large enough to draw conclusions from? Find weaknesses and flaws. You will probably need help to work out how fatal they are. Spend time on the results. Have the authors omitted key data? Look at odds ratios, error bars, fitted curves and statistical significances. Are the results robust? Do they back up the scientists’ conclusions? …
Given that Morris’ latest paper is only 10 pages (pdf), including references, this shouldn’t be hard. Yet, I found no initial article covering it that suggested the reporter bothered to read beyond the press release, or perhaps the abstract. For example, both of these articles cite the “benefits exceed risks by at least 100 to 1” line as truth, despite there being no support within the paper for this preposterous claim. It’s merely a statement. Where is the support for this in the paper? The questions Mr. Sample suggest provide a path for investigating this paper further. There is a table of potential benefits cited for circumcision, but no data offering how these are weighted to produce an objective mathematical conclusion.
Within the key table listing claimed benefits, Table 4, Morris cites a study by Dr. Jonathan Wright while omitting the necessary qualification that the study found a correlation, not a causal link. As Dr. Wright stated, “‘These data suggest a biologically plausible mechanism through which circumcision may decrease the risk of prostate cancer,'” said study researcher Dr. Jonathan Wright, an assistant professor of urology at the University of Washington School of Medicine. He noted that the study was observational; it did not show a cause-and-effect link.” How much does this correlation contribute to the “100 to 1” number?
4. Get context
Science builds on science. Know the previous studies that matter so you can paint a fuller picture. …
Like Dr. Wright’s study, for example. Or the way Morris previously used a study by Dr. Kimberly Payne to support a claim that the “highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.” Yet, Dr. Payne’s study, which Morris (and Krieger) rated as the highest quality, resulted in Dr. Payne stating that “[i]t is possible that the uncircumcised penis is more sensitive due to the presence of additional sensory receptors on the prepuce and frenulum, but this cannot be compared with the absence of such structures in the circumcised penis.”
5. Interview the authors
Get them to explain their results and justify their conclusions. What do the results mean in plain English? What do they not mean? Ask your questions in simple language to get answers you can quote. Run phrases you might use past the authors, so they can warn you of howlers. Do not ask multi-part questions: you will not get full answers.
Perhaps Morris should justify making up rights when he says “[d]enial of infant male circumcision is denial of his rights to good health, something that all responsible parents should consider carefully”. Do parents who do not circumcise their healthy son violate his rights?
This is especially interesting in light of a comment in the press release. Professor Morris said (emphasis added):
“The new findings now show that infant circumcision should be regarded as equivalent to childhood vaccination and that as such it would be unethical not to routinely offer parents circumcision for their baby boy. Delay puts the child’s health at risk and will usually mean it will never happen.“
If not circumcising an infant male “will usually mean it will never happen”, that demonstrates that circumcision will usually not be necessary. Is this one surgery, and the ethical implication, somehow different than withholding from a healthy child every other surgery that will usually never be required?
This also shows the sleight-of-hand in “half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin,” which is included in the paper (and on Morris’ site). Requiring treatment is not the same as requiring circumcision.
In footnote e of Table 4, Morris cites a figure for risks associated with neonatal circumcision where “data show that risk of an easily treatable condition is approximately 1 in 200 and of a serious complication is 1 in 5000”. So, a complication is not an argument against non-therapeutic infant male circumcision because it will probably be easily treatable. And treatable medical conditions associated with the foreskin will usually not require circumcision, as Professor Morris states, but somehow also justify non-therapeutic infant male circumcision. That’s “Heads I win/Tails you lose” nonsense. Professor Morris is engaging in propaganda.
When the New York Times quoted Morris about this paper, he said: “Just as there are opponents of vaccination, there are opponents of circumcision. But their arguments are emotional and unscientific, and should be disregarded.” That is demagoguery, and should reflect on Professor Morris’ reputation. The argument against non-therapeutic infant male circumcision is rooted in ethics, but it is also rooted in the science of normal human anatomy. The foreskin is healthy, just as every other body part usually is. And opponents of non-therapeutic child circumcision support condoms, soap, and antibiotics, for example, which are all scientific inventions and discoveries.
6. Get other scientists’ opinions
Such as Professor Kevin Pringle, of New Zealand, and Dr. Russell Saunders, pen name for a New England pediatrician. While I disagree with the latter’s conclusion on parental choice, for my purpose in this post, he wrote: “Having reviewed Dr. Morris’s study, I find his statements about the benefits of circumcision as a routine procedure overblown, and the comparison with vaccination baseless.”
7. Find the top line
How about this, from page 7 of the paper:
The timing of circumcision is crucial. Medical and practical considerations strongly favor the neonatal period (Table 4).16 Surgical risk is, thereby, minimized and the accumulated health benefits are maximized.14,16 …
As Morris’ statement about the likely lack of need demonstrates, circumcising in infancy is not usually crucial for the male’s health to the point of circumcision becoming necessary. There isn’t a justification for non-therapeutic infant circumcision. It can wait until the male can choose – or reject – non-therapeutic circumcision for himself.
8. Remember whom you are writing for
This is where Morris gets what he needs most. The headlines encourage readers who only skim headlines to believe that Morris has proven that the potential benefits exceed the risks 100 to 1, that circumcision is similar to a vaccine, and that there is some case for mandatory circumcision of infants. It’s all absurd and does a significant disservice to readers and truth.
9. Be right