Science is more than intervention

Posted: November 11th, 2014 | Author: | Filed under: Ethics, Logic, Science | No Comments »

This thread fascinates me. I read as much as I could stand and was repeatedly amazed at the logic and tactics, especially those from self-professed “skeptics”. It’s also a useful insight into why I don’t use Facebook for activism. (To those who agree with me that non-therapeutic child circumcision is unethical, please don’t engage in the vitriol and name-calling in this thread. It’s wrong and hurts our efforts.)

In response to a picture (used without permission) of a man holding a sign¹ explaining his opposition to circumcision, the moderator for a group called “I fucking love vaccines” posted this:

Those evil “doctors”!!111! Performing minor operations on infants in sanitary conditions with proper pain relief, giving the lifelong benefits of prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. A procedure that would be significantly more complex and painful for an adult male.

If that’s a skeptic’s analysis, skepticism means nothing. Discussion of non-therapeutic child circumcision needs a thorough cost-benefit analysis because that is appropriate for proxy consent and demonstrates the ethical failing, not just the question begging of the benefit recitation provided above.

In response, a pediatrician² responded with a deeper analysis:

So I have to disagree with the sentiment here. I am a Board-Certified Pediatrician. When we look at the benefits of a procedure, we need to consider the Number Needed to Treat (NNT). In other words, how many boys do we need to circumcise to prevent one case of…something?

For HIV in the highest-prevalence regions of Africa, the answer is 72. 72 circumcisions must be done to prevent one case of HIV. That number hasn’t been calculated in the US, but with our much lower HIV prevalence and the fact that HIV in the US is primarily transmitted by anal intercourse, the number would be orders of magnitude higher. Even for unprotected anal intercourse, the NNT is over a thousand. For UTI in the United States, the answer is 200-300. For penile cancer the number ranges into the millions.

I can show that routine appendectomy reduces the risk of acute appendicitis by 100% and that routine tonsillectomy reduces the risk of tonsillitis by 100% and yet we don’t routinely perform either. So why are we performing a mutilating procedure on infant boys on a routine basis? It’s the only such elective operation we do. It flies in the face of medical ethics that we perform routine circumcisions on infant boys. And for that reason, I refuse to do them.

And yes, it’s mutilating. That isn’t a judgmental or emotionally-charged term in my usage. Any procedure that changes the appearance of the body is mutilating. That includes a medically necessary appendectomy. Now, I would never argue against a medically necessary appendectomy, but the key words are: “medically necessary.” Circumcision isn’t. And the proof is Europe, Asia, Australia, and New Zealand where these things aren’t done and yet their overall epidemiology for related conditions stay the same.

I do agree, however, that equating circumcision with female “circumcision” or “rape” is insulting to people who have been subjected to these things. I find that absolutely disgusting that any man would equate his circumcision to rape and complete excision of the clitoris.

I disagree that equating male and female genital cutting is insulting. The comparison is more complex than and focused on principle than “removal of the male prepuce is the same as removing the clitoris.” Non-therapeutic genital cutting on a non-consenting individual is unethical. That’s the principle. Everything else in the doctor’s comment is spot-on.

The moderator replied to the last paragraph:

Yeah, that is my issue with this actually and the whole reason I posted it. This does nothing but trivialize male violence against women.

Then why not post about that relevant issue instead of providing the one-sided, non-skeptical benefit recitation? But that isn’t the curious response. This is:

I also remain skeptical of your claims of being a pediatrician when you come into a socially charged thread never having commented on my page before and going against official recommendations in the US, but no biggie.

This is embarrassingly free of skepticism. It’s skepticism as a label rather than a process. I’m supposed to trust someone offering only the benefits of a non-therapeutic surgery on a child when that person can’t be bothered to do even a minimal amount of research to confirm a commenter’s identity? It took me about 60 seconds to find evidence that the Facebook profile matches a real person who is a pediatrician. This does not prove that the Facebook profile isn’t an elaborate scam to post biased, misleading comments on a random Facebook community’s rant. It could be, but that seems to require a few too many (convenient) assumptions.

Anyway, his job title is interesting, but there’s more than just an appeal to authority. Google exists for more than just verifying a random doctor’s identity. Does what he wrote hold up? Number Needed to Treat is a topic anyone can research. Is he explaining it correctly? Are his numbers accurate? What are the implications to the question of non-therapeutic child circumcision? But maybe I’m wrong and a skeptic doesn’t need all the information.

Of course, the moderator seems to value the appeal to authority fallacy. Better still would be to read the AAP’s technical report to see what it omits instead of merely regurgitating the inadequate abstract. I read the technical report. It is lacking.

Also, the “official” recommendation is that parents should decide, not that circumcised males are incorrect if they’re unhappy.

Next is a string of comments from people who don’t seem to understand that words have meaning and should be applied in a way consistent with their definitions. For example:

Consent is given by the parents. It is not forced when the parents give consent on their son’s behalf.

And:

Because the surgery is for the benefit of the child not to create harm. The use of the term “mutilation” is hyperbole to generate a negative emotional response. This dishonest technique is used by intactivists because the facts do not support their position.

Parents consent. The surgery is forced on children who do not consent. This is not complicated. It’s the essence of proxy consent. The question is whether that consent is valid on this topic. And the surgery is not harmless and cost-free merely because the parents don’t intend to do harm. I agree they don’t intend harm. But harm is inevitable, despite their intentions.

Nor is the use of the term “mutilation” hyperbole. The doctor made the case, but here it is in the context of another post from the moderator:

There were of course the inevitable hysterical people saying circumcision of infant males is equal to FGM, most of which occurs in the developing world in unsanitary conditions, and which offers ZERO health benefit, serious long term health complications and is considered a violation of the human rights of girls and women. There is no comparison between circumcision and FGM.

I am seriously skeptical of the skepticism of a lot of these commenters on what is supposed to be an anti-woo page are caricaturing medical doctors as being “savage” and “barbarians”… this is no better than what people against “Big Pharma” and the “Medical Establishment/”Western” medicine/Allopathy caricaturize doctors as.

I am offended by it and I do not even have any family members in the healthcare professions. Here is a link to some fact these hysterical/testerical dimwits should know about or stop ignoring.

http://www.who.int/mediacentre/factsheets/fs241/en/

*The procedure has no health benefits for girls and women.*
*The procedure has no health benefits for girls and women.*
*The procedure has no health benefits for girls and women.*

Not only do you show your lack of scientific understanding but you also engage in vile misogyny when you compare to FGM, a HUMAN RIGHTS VIOLATION to basically harmless infant circumcision.

That link is full of gender-neutral principles arbitrarily assigned a gendered difference. When the WHO states that “[i]t involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls’ and women’s bodies”, we can ask ourselves if we’d dismiss that if its preceding sentence stated “FGM has health benefits…” I believe the overwhelming response would be “no”, as it should be. Change the pronouns. The principles remain the same. Genital cutting without need or consent is mutilation.

I also invite anyone to read through my archives to see if I’m a dimwit who doesn’t know about or who ignores the facts about FGM.

More on mutilation:

Except that circumcision is not an act of physical injury that degrades appearance or function, so once again, your own definition does not support calling circumcision mutilation.

Assuming the perfect form comes at birth is rather ridiculous when you consider evolution does not select for perfect. If the foreskin was perfect there would have not been the need to make surgical improvements starting several millennia ago.

“Degrades appearance” is subjective to the individual circumcised. That it degrades function is not up for debate, or at least not that it alters function. If you change the form, you change function.

The evolution bit is mere question begging. There is no “need” to alter healthy genitals. Evolution didn’t screw up. Most males (and females) live normal, healthy lives with their prepuce. And notice how circumcision becomes a “surgical improvement”. It’s always “heads I win, tails you lose” on every subjective question.

Next comes the tired false dilemma fallacy about how only one side loves science:

You would advocate against a procedure with medical benefits? OK. I admire your honesty in admitting that even though it makes you look like a callous jerk.

“Why do you want babies to get UTI-laden HIV Cancer, you monster?” Except, that’s not the only choice or the only (or likely) outcome from leaving a child with all of his (or her) normal, healthy genitals.

Finally:

the big mean doctor touched my wee-wee!

“[T]he big mean doctor touched my wee-wee with a scalpel without medical need” is the scenario. If you must offer unfunny ridicule, at least attempt to ridicule what’s happening. That’s if this community’s form of skepticism involves facts, which I’m unconvinced it does.

¹ I’ve made my opinion clear on the accuracy and value in calling circumcision “rape”. I stand by that here.

² I’m not using names here because they’re irrelevant for my purpose here. Click through the links, if you wish.



Leave a Reply

  • *