The Lie Feeds Itself -PrePex and Unethical Circumcision

Posted: June 19th, 2016 | Author: | Filed under: "Voluntary", Ethics, HIV, Media Marketing | 3 Comments »

Note: I updated the title after posting this entry.

I wrote this in December 2011:

… And to be fair to Circ MedTech, it promotes PrePex for adult male circumcision. We’ll see if their focus remains on voluntary, adult male circumcision.

And this, in February 2012, in a footnote:

This is where I’ll invoke the articles on the PrePex as an example. My objection to the recent pieces about it centers on the poor journalism rather than the device. I expect the device will eventually be tweaked to allow for infant circumcision at some point. That would be wrong. For now it’s a device for voluntary, adult circumcision. I have no objection to that. The claimed risks involved with the device are low. The claim that adult circumcision is more dangerous than infant circumcision doesn’t appear to hold up, generally, regardless of the method. This claim is a framing device of dubious quality rather than a fact to be [sic] negate ethics.

I expect the device will eventually be tweaked to allow for infant circumcision at some point. And four years later, this press release, from last month (emphasis in original, footnote added):

The World Health Organization (WHO) expanded the Intended Use of the currently-prequalified PrePex device to include adolescents aged 13 years, and above. Effective immediately, the PrePex device, manufactured by Circ MedTech, can be offered for adult and adolescent males in the 14 priority countries in Southern and Eastern Africa. PrePex was the first male circumcision device to receive WHO Prequalification on 31 May 2013.

Circ MedTech’s CEO, Eddy Horowitz said: “The expanded use of PrePex for younger ages will sustain Voluntary [sic] Medical Male Circumcision (VMMC) programs in the 14 Sub-Saharan Africa priority countries and will serve the new UNAIDS Sustainable Development Goal (SDG) of an additional 27 Million male circumcisions by the year 2020.

Circ MedTech Ltd. is in the advanced stages of adapting its PrePex technology for use with infants¹ and children, thus offering safe male circumcision services to all ages, worldwide.

At least they dropped their lie about “voluntary” in the last paragraph. But they still include it in their FAQs.

Why is it called “Voluntary Medical Male Circumcision?”

“Voluntary Medical Male Circumcision” is a term used by the global health community to emphasize that circumcision is a personal choice.

“Voluntary Medical Male Circumcision” is a term used by the global health community for propaganda. The global health community (i.e. public health officials) does not care, has not cared, and apparently will not care, about “voluntary” (or even “medical”, since this surgery is “medicalized”, not medical, circumcision). The expansion of PrePex to children who can’t consent demonstrates this. Volunteer and volunteered are not synonyms here. The global health community legitimizes whoever’s choice results in a statistic, the removal of another normal, intact male’s foreskin. Remember, the measure of success in these campaigns is “male circumcisions”, not something relating² to HIV infection rates, the alleged, stated aim of “Voluntary” “Medical” Male Circumcision.

If those involved with PrePex cared about ethics, this expansion of the product line wouldn’t occur. But here we are with the above evidence and the questions raised by more from their FAQs, such as:

What is Voluntary Medical Male Circumcision? (click to read answer)

In 2007, the World Health Organization (WHO) and UNAIDS announced recommendations,based on extensive studies, to scale up Voluntary Medical Male Circumcision (VMMC) to men in areas of high risk for heterosexual HIV transmission. The studies showed that men with a circumcised penis are approximately 70 percent less likely to contract HIV from heterosexual intercourse than men with an uncircumcised penis–in addition to other health and hygiene benefits.

This finding, replicated in rigorous, repeated studies across several countries, has led doctors and public health professionals to recommend that men in high-risk areas have access to VMMC.

Imagine a person who doesn’t know what Voluntary Medical Male Circumcision is. Now imagine that person reading the answer PrePex gave to his question, “What is Voluntary Medical Male Circumcision?”. Does he now know what Voluntary Medical Male Circumcision is? Circ MedTech already showed they don’t know what “voluntary” or “medical” mean. They should be able to pretend better than the word salad they provide.

Let me try:

What is Voluntary Medical Male Circumcision?

Male circumcision is the permanent removal of the foreskin (i.e. male prepuce), the fold of skin covering the penis. This may also involve removal of the frenulum.

The procedure is voluntary and only offered to males able and willing to consent. This consent is achieved by providing a detailed explanation of the benefits, costs, and risks associated with male circumcision. The medical provider will emphasize what is guaranteed versus what is possible for the benefits, costs, and risks. With this knowledge, the individual may decide for himself if he wishes to proceed and be circumcised or not. The procedure is carried out only with his affirmative consent.

Circumcision is best carried out in a medical setting. It is recommended that, if the individual consents, this be performed in a sterile setting with trained professionals to minimize risks and negative outcomes. The risk of complications cannot be completely eliminated.

They can’t say that because it’s true and rules out the option to circumcise healthy children. Instead, they ramble about the perceived benefits. One should assign a level of trust corresponding to how forthcoming they are on the risks, so not much.

The lesson remains the same. When public health officials (i.e. the global health community) promotes “voluntary” (“adult”) male circumcision, they never mean “voluntary” (or “adult”).

¹ WHO TECHNICAL ADVISORY GROUP ON INNOVATIONS IN MALE CIRCUMCISION: “Providers must be trained to recognize when an adolescent is not eligible for the PrePexTM device due to inability to retract the foreskin or discomfort while attempting to do so, or when there are adhesions or phimosis. …” The inability to retract the foreskin is normal at birth because it adheres to the rest of the penis.

² Even where it is something related to HIV, do we have enough to determine causation rather than correlation? Possibly. I don’t know. And to repeat, I don’t care if adults choose circumcision for themselves. What each person does with his body is up to him. Nor do I state unequivocally that all potential benefits are illegitimate. The argument for imposing circumcision on a healthy child in pursuit of those potential benefits is, though. Always. The removal of his foreskin is a price the individual may not wish to pay.


The “Hacking Away at Perfectly Healthy Genitals is Bad” Principle

Posted: February 5th, 2016 | Author: | Filed under: Ethics, FGM, Logic, Parenting | No Comments »

How many times have we seen a quote like this?

In Jacksonville, Dominic Morris, a 30-year-old father of two, said he did not understand what all the fuss was about. He said he was not mutilated during his circumcision, didn’t bleed at all and felt nearly no pain during or after the procedure. “Mutilation is horrible, but it’s not true that it happens here” in America, Mr. Morris said. “They cannot stop us. It’s our tradition.”

That’s said every time an activist discusses circumcision for what it is rather than what people think it is. It’s accepted thought. We’re told we owe complete deference to it. Who are we to tell people their dismissal of inconvenient facts is wrong? We’ll assume they’re informed, whatever they’ve been told or choose to believe. Parents have this absolute right to have their healthy children cut for whatever reason they desire. Sons only. Obviously.

Except, wait. I just noticed an error. I transcribed that quote wrong. Here’s the real quote from that story:

In Jakarta, Fitri Yanti, a pregnant 30-year-old mother of two, said she did not understand what all the fuss was about. She said she was not mutilated during her circumcision, didn’t bleed at all and felt nearly no pain during or after the procedure. “Mutilation is horrible, but it’s not true that it happens here” in Indonesia, Ms. Fitri said. “They cannot stop us. It’s our tradition.”

We will never accept that defense in the context of female genital cutting. Rightly so, of course. But I choose not to be a hypocrite, so I don’t accept it for male genital cutting, either. The basic fact is the same. It’s non-therapeutic genital cutting on a non-consenting individual. Therefore, the principle is the same. They are both unethical. Opposition to one necessitates¹ opposition to the other².

We should also be clear on what Ms. Fitri may be arguing.

Experts in Indonesia said the practice there had largely involved a less drastic version of cutting, usually a surface scratch or nick, as compared with more severe disfiguring. The Indonesian government’s survey asked parents if their young daughters had undergone circumcision. Ms. Cappa said it was possible that there were some more severe cases in Indonesia, but she said the official Indonesian government definition of female circumcision was “an act of scratching the skin that covers the front of clitoris without injuring the clitoris.”

That is objectively less harmful than male circumcision. Still, the official government definition could be irrelevant to the reasons parents are answering “yes”. The parents could be openly admitting something much more severe. This possible difference matters for prevention and response. In principle, it’s irrelevant. We recognize even “a surface scratch or nick” on a female minor’s genitals, which will likely heal without permanent injury or scarring, as unethical and worthy of prohibition. The WHO’s definition of FGM is effectively “any genital injury for non-medical reasons”. The universal principle is obvious and applies without regard to sex. We must all reject the silly, biased distinction the WHO and others demand. Possible health benefits are not a “medical” reason for non-therapeutic male genital cutting. (“Medicalized” is not the same as “medical”.)

What happened to Ms. Fitri is unethical. What will/did happen to Ms. Fitri’s children is unethical. For every male who was/is the hypothetical Dominic Morris as a child, what happened to them as a child is unethical.

(Title reference here.)

¹ Opposition to both does not necessitate equal activist efforts from everyone. Care more about FGC/M? Agitate for change. Care more about MGC/M? Activate for change. The cumulative effort will work itself out. Just don’t dump on those agitating more for one than the other, or for making the logical comparison of the two.

² Or it necessitates support for both, but I assume no one reading this wishes to be horribly wrong and unethical.


I Guessed What Phase Two Involves

Posted: September 7th, 2015 | Author: | Filed under: "Voluntary", Control, Ethics, HIV | No Comments »

Oh, what could this transition be?

The National Voluntary Medical Male Circumcision taskforce has rolled out the second phase of circumcision on regions with a high burden of HIV this time targeting over 1 million men.

The chairman of the Inter County Taskforce on Male Circumcision Dr Ojwang Lusi said the program is transitioning to the second phase of implementation that will run to July 2019.

We all guessed what this means.

The second phase will lower the circumcision age of boys to between 10-14 years.

I assume there’s a Phase Three – or an undocumented aspect of Phase Two – involving infant “men”. Predictably, it’s obvious why.

Lusi further noted that some challenges emerged in the first phase that they will strive to address as the second phase.

He said most of the men above 25 years declined to go for the exercise with limited number of women getting involved in the exercise with their husbands.

Men won’t volunteer, so child men get “volunteered”. As always with those who are unethical, because outcome matters instead of consent.


Joint Government Effort to Eradicate Consent

Posted: June 19th, 2015 | Author: | Filed under: "Voluntary", Control, Ethics, HIV, Public Health | 2 Comments »

As always:

The Ministry Of Information and Communication Technology in partnership with the Ministry of Health and the centre for Disease Control in America are collaborating on a National Strategic framework known as the Voluntary Medical Male programme which is a joint government effort to eradicate the long struggle of HIV/AIDS infections.

HIV/AIDS has always been the countries top priority with the health ministry being pressured to reach their ambitious 2030 vision to bring HIV/AIDS infections to zero in the country.”The Centre for Disease Control and the Ministry of health have had three randomised controlled trial runs of the voluntary medical male circumcision programme prior to it’s launch in 2009. With the success of the programme around 20,000 sexual active males have been circumcised to date thus raising 80% awareness to men to encourage more males in considering medical circumcision,”said programme specialist Mr Dan Rutz of CDC.

Somehow success is measure in “males circumcised” without giving any statistics on HIV rates¹. So it’s easy to predict what “encouraging more males to consider ‘medical’² circumcision” means:

“Medical male circumcision has been found to be cost effective, as well as all procedures are free at clinics it has been known that healthy employers increases work productivity within any work environment which leads to a steady healthy work environment that enables the economy to grow,” added Rutz.All males that have not been circumcised are encouraged to do so as procedures can be performed at all local regional clinics in the country as government want to achieve it’s target to circumcise 330,000 men between 15 to 49 years by the end of 2016.The Ministry would also like to implement a national policy programme known as an Early Infant Circumcision strategy in the near future that will enable newly born babies to be circumcised.

“Enable”. Newborn males won’t get to consider or volunteer. They will be considered and volunteered, their needs, preferences, and preventative options deemed irrelevant. They are only pieces by which public health officials measure their own professional success.

As always, when public health officials discuss voluntary or adult circumcision, they never mean voluntary or adult.

¹ A drop in HIV infections would be welcome. It cannot justify violating ethical obligations to protect the rights of non-consenting individuals.

² Circumcision in this context is medicalized, not medical. Merely performing non-therapeutic genital cutting in a sterile operating environment does not make it necessary. This is also not a defensible term to justify performing non-therapeutic genital cutting on a person who does not offer explicit consent.


Put Health Before Politics

Posted: June 10th, 2015 | Author: | Filed under: Ethics, Public Health | No Comments »

I’ve never had much respect for public health officials when it comes to infant circumcision. When they say adult or voluntary, they never mean it. It’s also seemed clear for a long while that they’re not much interested in health, either. The latest example is New York City Mayor Bill De Blasio’s approach to protecting infants from herpes transmitted during metzitzah b’peh. I’m ignoring for now the horrible optics of the new makeup of the New York City Board of Health. The actual proposal allegedly aimed at protecting the health of infant males:

The mayor’s proposal, which requires approval by the board and will be presented on Wednesday, is … would waive a requirement that parents sign a consent form before the ritual, which involves sucking blood from the incision on a baby’s penis.

Instead, the mayor’s plan would create an alternative system that would test a circumciser, or mohel, for herpes, although only after a baby is found to be infected. If the circumciser tests positive, penalties would be pursued if DNA tests can prove that the mohel and the baby were infected with the same strain.

We know infection happens with metzitzah b’peh. We know that herpes can have devastating effects on infants. That alone should be enough to demand a proactive rather than reactive approach to protecting the health of infants. The case for a potentially effective plan, not this proposal, is impossible to ignore when also remembering that infants have rights that the government and Board of Health are no less obligated to protect.

The consent rule, introduced under Mayor Bloomberg, was assailed by Orthodox leaders as an infringement of their religious rights. Mr. de Blasio pledged to rescind the rule, and his aides later said the consent forms had been difficult to enforce, saying that herpes infections linked to the practice actually rose in 2014.

“This approach hasn’t been working in the past, and we need a new approach to truly reduce the health risk for infants,” Mr. de Blasio’s press secretary, Karen Hinton, said in a statement on Tuesday. Ms. Hinton added that the mayor had an “obligation to ensure that the Board of Health is fully staffed with highly qualified health experts.”

Protecting the bodily integrity rights of all infants is a new approach to reduce the health risk for infants. We haven’t tried that yet. And trying that is the ethical approach.

I don’t pretend protecting the rights of all infants, the correct approach, will be easy. Even with the “consent” document Mayor Bloomberg implemented, infections increased. Protecting the rights of infants in law and in reality are separate issues. The former would not guarantee the latter. But public health officials, ostensibly entrusted to (ethically) protect the health of all members of society, must aim for effectiveness, not politics.


The Trauma of Small Numbers

Posted: May 26th, 2015 | Author: | Filed under: Ethics, Logic, Regret | No Comments »

At The Washington Post’s Wonkblog, Christopher Ingraham crunches through a few statistics about circumcision, with the headline writer concluding that “Americans truly are exceptional — at least when it comes to circumcision”. In the implied context of outlier for exceptional, yes, we are exceptional in our ability to ignore ethics and logic. Let’s not celebrate.

Most of the post is working through numbers. While relevant and informative, virtually everyone reading this will not be surprised by any of it. The encouraging aspect is in the access young people have to information.

Survey data indicate that we may see these declines continue. A YouGov survey conducted earlier this year found that young people were more skeptical about the practice than their elders: only 33 percent of 18-to-29 year-olds said that male children should be routinely circumcised, compared to 43 percent of 30-to-44 year-olds, 52 percent of 45-to-64 year-olds, and nearly two thirds of seniors.

This is why it’s critical to continue highlighting and objecting to garbage initiatives like the CDC’s recent draft proposal that focuses on infants. We’re convincing people that it’s time to stop circumcising.

The end of the post provides the information necessary to grasp the ethics.

… Overall, men who have been circumcised don’t appear to have many regrets about it: only 10 percent of circumcised men said they wished they hadn’t been circumcised, according to YouGov.

Since the number-crunching doesn’t quite get there, I want to open the perspective to what the numbers mean. At the time I’m writing this post, the U.S. Population Clock stands at 320,952,250 Americans. That means there are approximately 160,476,125 American males. Given that infant circumcision rate spent decades in the 90% range but is now lower, I’ll estimate that 75% of American males were¹ circumcised. That estimate results in 120,357,093 circumcised American males. Applying the survey’s 10%, I wish to restate Mr. Ingraham’s conclusion to consider whether his analysis should survive further number-crunching.

Overall, men who have been circumcised don’t appear to have many regrets about it: only 12,035,709 circumcised men said they wished they hadn’t been circumcised.

We mistakenly think about circumcision in terms of statistics and probabilities. That hides the violation involved, and allows society to believe we’re doing something good. But there is an individual at the tip of every scalpel. I think one is an exceptional, too-large number in the context of a male regretting non-therapeutic circumcision without his consent. However, it’s easy to imagine that ten percent is a small, inconsequential number. It is neither small nor inconsequential. We must realize that twelve million males² is a large, inexcusable number.

¹ Some might argue I should say are circumcised. I criticize the act of circumcising healthy males without their consent, not the state of being circumcised, however the male got to that point. It’s the ethics against circumcision, which includes the ethics against body shaming. I support any male’s decision to be content being circumcised.

² It’s worth remembering that some number of the content 90% would be content with their foreskin. It’s a mistake in the ethical evaluation to conclude that contentment by itself is a justification. That is dealing only with what is seen. Do not ignore what is unseen.


Revising Tactics

Posted: May 15th, 2015 | Author: | Filed under: Ethics, Logic, Mission | No Comments »

This excellent post on activism by Freddie deBoer captures what I’ve been thinking lately. The context is different, and I largely disagree with his politics, but the larger theme remains activism and convincing people of ideas. If you only have time to read Mr. deBoer’s post or what’s below, click that link.

I’ve been frustrated about the direction of activism for genital integrity rights for a longer time than I’m willing to accept. I’m not going anywhere. I haven’t changed my mind. But it’s difficult to expend the effort when so many are fighting those who agree on the goal and demonizing those who we need to convince. Maybe there’s a cause where a punch in the nose is the right activism. This isn’t it. Doing so only makes the process harder and further pushes out the day we achieve full protection for all children, male, female, or intersex.

I remember many political fights over the last decade-plus that I was sure would turn out a specific way. The most recent example is the general election in the United Kingdom last week. I was convinced Labour were going to win. “Go Labour” was all I saw on Twitter. The Rise of Ed Milliband was everywhere in my news feeds. And then the election happened. David Cameron remains Prime Minister, but with an actual majority instead of a coalition government. The exact opposite of the expected result occurred.

British Politics Twitter melted down from the moment the first exit poll leaked. “How could this be? Impossible! We’re doomed!” And so on. I reacted this way in years past, and I felt justified in doing so. I’m right, after all. Except when this happens enough times, it’s wise to step back to figure out why expectation and result don’t match. We need to examine that chasm for genital integrity rights.

I believe the explanation for this experience is the same for politics and genital integrity. The Internet is not society. The Internet is a specific, motivated subset of society. It will change the world, probably. But this change will occur only if we realize that most of the people we need to convince don’t care about our obvious intellectual win in a long-running feud with oppositional trolls.

It isn’t that a large percentage of society is being obstinate, refusing to change. For most people the issues important to activists aren’t merely unimportant. They aren’t real. How many times have we heard, “I don’t know any men who miss their foreskins/regret being circumcised”? The answer is always, accurately, “Yes, you do. You don’t know who they are because it isn’t safe to say such a thing in most company.” Consider the immediate reaction in the UK election: “Why were Tories so afraid to tell pre-election pollsters that they’re conservatives?” It’s more reasonable to recognize that some people will not tell another their truth if they believe it will be dismissed or ridiculed.

That’s the crux. People aren’t evil. They’re unaware. It’s ignorance in the purest definitional reality. Perhaps there is a better way for them. We can show them. Will we show them?

With politics, we all believe that our views are correct. Maybe. With genital integrity, the truth is clear rather than subjective. Society should already be where we are on this issue. Of course. But it would be foolish to use that to inform our activism. We must educate. Antagonizing only keeps us out of the experience of those we need to convince. As I’m sure I’ve written before, would we rather be right or victorious?

It would be wonderful if we could explain ourselves to a sufficient number of judges and legislators. Boom, everything changes. That isn’t how change happens. Courts and legislatures lag society. Justice derives from those who refuse to participate in injustice any longer, not those who would command us not to participate. This is true even though providing legal protection for the inherent right to genital integrity to all citizens is the only ethical stance. The burden of proof shouldn’t be on us. The burden of proof is on us.

Where do we go from here? I wish I had the magic words that would fix this. However, if you read Mr. deBoer’s post, magic words are the opposite of what we need. We have too many magic words now. Cutter. Circumfetishist. Rape. Sexual crime. And so on, even to mutilation in many contexts. Using these words signals to a preferred segment of activists that only we understand how truly awful circumcision is. Perhaps. And it feels so good, right, so it doesn’t matter what the cutters and circumfetishists think, except what the people called cutters and circumfetishits think is all that matters. They have all the power to stop circumcision. We need to stop aiming to convince those who are already convinced.

How do we educate the people who need to be convinced?


Unsettling the settled

Posted: February 11th, 2015 | Author: | Filed under: Ethics, Politics, Public Health, Science | 1 Comment »

This has no direct connection to circumcision or genital integrity. But it has pertinent implications right now.

The nation’s top nutrition advisory panel has decided to drop its caution about eating cholesterol-laden food, a move that could undo almost 40 years of government warnings about its consumption.

The group’s finding that cholesterol in the diet need no longer be considered a “nutrient of concern” stands in contrast to the committee’s findings five years ago, the last time it convened. During those proceedings, as in previous years, the panel deemed the issue of “excess dietary cholesterol” a public health concern.

The new view on cholesterol in the diet does not reverse warnings about high levels of “bad” cholesterol in the blood, which have been linked to heart disease. Moreover, some experts warned that people with particular health problems, such as diabetes, should continue to avoid cholesterol-rich diets.

After decades of one recommendation, the U.S. government discovers that settled science isn’t quite as settled as it led citizens to believe. This lesson arrives in the lull between the comment period and issuance of the CDC’s circumcision recommendation. The ethics of genital integrity dictate against its proposal. Of course. But looking forward, how much of the “settled” science of circumcision rests on speculation and guesswork? What might change over the next few years and decades? What will the CDC (or AAP or WHO or…) say if, in 2035, something unsettles¹ the science so many (almost exclusively American) authorities eagerly endorse today? Will the boys born today accept an “Ooops” for what is being forced on (i.e. taken from) them today if something unsettles the science tomorrow?

¹ The ethics of non-therapeutic genital cutting without the individual’s consent “unsettles” it now by making the application of the science in that manner inherently wrong. The availability of more effective, less invasive preventions and treatments for maladies involving the foreskin already unsettles the science, as well.


Activism is always about marketing

Posted: February 4th, 2015 | Author: | Filed under: Ethics, FGM, Mission | No Comments »

I like this post by Jonathan Friedman:

Friday, February 6 is International Day of Zero Tolerance for Female Genital Mutilation (FGM). There is a lot of positive momentum in the UK and around the world for education and prosecuting those who practice or aid FGM. This is a day for us to learn more about FGM, to listen to the victims and to learn how FGM is being eradicated. Many of us know very little about it and have never even met victims of FGM.

That’s correct. It’s too easy to forget that children are violated, not just boys, because of what is most familiar. It’s also critical to remember this reality:

Unfortunately, there’s also a great deal of sexism within the discourses on FGM, especially coming from cultures practicing male genital mutilation (MGM). Great care is taken to state that MGM and FGM aren’t comparable, while intersex genital mutilation (IGM) is virtually ignored. MGM has recognized health benefits, FGM does not, they point out. MGM is a religious requirement, FGM is a cultural practice. And so on.

Many women’s organizations recognize MGM for what it is and speak out. On December 12, 2012, I attended my first Bloodstained Men & Their Friends demonstration in Berlin, Germany, the day the German Parliament passed a new law enshrining MGM as a religious right. The event was co-organized by Terre Des Femme, a women’s rights organization. I can’t express how comforted I felt getting up there on stage in a bloodstained suit with a group that included a woman.

People are complicated. I trust that anyone opposed to FGM is – or can be – receptive to the truth that boys have the same rights as girls. We should challenge mistaken beliefs where possible. But we can’t make enemies of potential allies because it feels good to launch these wide, careless attacks. Everyone involved is justifiably angry to some extent. Some are angry, and others are more angry. It’s natural. We can’t allow that anger to become so righteous that we lose control. Don’t be an accelerant:

So to them I say: don’t be an accelerant. Be a passionate advocate when necessary. Speak truth to power when you feel it’s right. But train your powerful tools of criticism of others on yourselves, and be ruthless when it comes to your own good intentions. Ask yourself: when I intensify this conflict, when I beat my chest and declare someone evil, when I throw fuel on the fire, am I really helping the people of color and women I claim to speak for? When I go for the jugular again and again, am I actually helping to solve injustice? Is this kind of engagement from me an instrument of political progress? If not, why am I doing it? How am I contributing to this cause?

The context is different, but the same. It never helps protect children when someone spews hatred at a group of people united only by the attacker’s presumption of the group’s hatred of boys. Pick a group targeted for vitriol, whether it’s women as in the tweet linked above, or Jews, or doctors, or any group, really. When did smearing someone achieve a single helpful thing? Lazy accusations of misandry don’t help. How many times do any of us need to see images from issue two of Foreskin Man in news stories and blog posts to understand how damaging that vileness is? You think you’re making the point that circumcision is awful and how dare you not understand that circumcision is awful. You’re making the point that you’re unhinged and scary and best ignored.

Back to Mr. Friedman’s post, in this paragraph he states exactly what activism should be:

When space is created for talking about FGM, we need to respect the intentionality of that space. When that space is used to defend MGM or IGM, we must raise our voices as appropriately as possible. We have been accused of minimizing FGM by comparing it to MGM and taking resources away from FGM, as if we’re all in competition. Whether or not these allegations are true, people perceive these as being true (on the whole I think they’re false, but I can’t speak for everyone).

It’s correct for discussions of FGM. The concepts of appropriateness and respect are broadly applicable. That willingness to consider others and to understand that we need to explain our position will achieve more than “Shut up” ever could. Do we want to feel superior or do we want to protect children?


Flawed Circumcision Defense: Children’s Urology, Austin

Posted: February 3rd, 2015 | Author: | Filed under: Ethics, FCD, Media Marketing, Parenting, Surgery | 1 Comment »

Hey, a press release (Links omitted):

New Austin parents wishing to heed the American Academy of Pediatrics and the Centers for Disease Control recent guidance on circumcision, which endorse the procedure because of resulting health benefits, have access to a new in-office resource dedicated to circumcision — the Newborn Circumcision Clinic at Children’s Urology.

The CDC’s draft proposal aimed at medical providers has not been formalized as a recommendation. It says so in the public notice (emphasis added):

“… The draft recommendations include information about the health benefits and risks of elective male circumcision performed by health care providers.”

Even though the press release acknowledges the draft status of the proposed recommendations, Children’s Urology uses the draft proposal to sell non-therapeutic circumcision. That’s odd.

It’s odder still because the CDC’s draft proposal ignores the direct physical costs of circumcision to the patient. The CDC’s draft proposal stumbles on the ethical analysis of applying the potential benefits to healthy children. The CDC’s draft proposal fails to mention or evaluate many options for prevention and treatment of maladies that are less invasive and more effective than circumcision, such as the HPV vaccine. The CDC’s draft proposal is half-baked. Half-baked is a poor basis for eliciting any level of informed consent.

There’s a reason this next paragraph closes the Notice document:

In addition to obtaining public comment on the draft Recommendations, CDC considers this document to be important information as defined by the Office of Management and Budget’s (OMB) 2004 Information Quality Bulletin for Peer Review and, therefore, subject to peer review. CDC will share the summary of public comments with external experts who conduct a peer review of the evidence on this topic. Their review will include an evaluation of completeness, accuracy, interpretation, and generalizability of the evidence to the United States and whether the evidence is sufficient to support the draft counseling recommendations.

No worries, though. The Newborn Circumcision Clinic at Children’s Urology is ready to sell new Austin parents surgery for their healthy sons. It says so in their press release. Jillian Moser, PA-C, or someone on the circumcision provider team, will circumcise the healthy baby if he’s six weeks old or younger, weighs 10 pounds or less, and has normal appearing anatomy. The circumcision provider team does not require a boy to need any form of intervention before they’ll perform surgery. One might be inclined to think that a strange requirement to dismiss. However, lest healthy newborn boys worry they might not be in good hands, Children’s Urology knows what healthy newborn boys care about most for their genitalia: the comfort of their parents.

“Our Newborn Circumcision Clinic offers a comfortable, in-office experience for families interested in following the recommendations and pursuing circumcision for their son,” said Leslie McQuiston, MD, pediatric urologist at Children’s Urology.

Of course, it’s curious that Leslie McQuiston, MD, believes the CDC’s draft proposal a) targeted parents and b) recommends circumcision of newborns. Either of those beliefs suggests that Dr. McQuiston hasn’t read the CDC’s draft proposal (or the longer document that supports the draft proposal). The claimed link to the CDC’s draft proposal in her clinic’s press release loads a PDF announcing the draft proposal for public comment. Since Children’s Urology doesn’t seem to know where the actual draft proposal is located, it’s possible they haven’t read the draft proposal, which would be understandable. Who has time for reading dense material when so much science needs urgent applying to healthy children? Healthy children can’t possibly wait for the draft proposal to be finalized, much less wait until they might have a need for the most radical intervention. The science of newborn male genital anatomy isn’t scientific without a scalpel, after all. Duh. Everybody knows that.

Maybe the confidence of new Austin parents wouldn’t be so high after considering the totality of evidence from Children’s Urology’s press release. Trust them, though. Right in the press release, it says their clinic is “the premier pediatric urology practice in Central Texas,” and that it “specializes in the medical and surgical treatment of genitourinary conditions from birth through adolescence.” That’s great, and probably true, but we’re all now thinking the same thing. Okay, maybe the folks at Children’s Urology aren’t thinking this, but most of us not selling surgery on healthy children to parents using a flawed draft proposal are thinking it. Circumcision isn’t a genitourinary condition. I know, right? It seems obvious. But, on the contrary, we’re all wrong. It says so right on Children’s Urology’s site, under Conditions We Treat.

Genitalia

  • Ambiguous Genitalia¹ (DSD)
  • Chordee
  • Circumcision
  • Concealed / Hidden Penis
  • Epispadias
  • Hypospadias
  • Labial Adhesions
  • Meatal Stenosis²
  • Micropenis
  • Phimosis

I know, I know. It’s weird that circumcision is offered to treat the genital condition, “circumcision”. It’s weirder, I guess, because Children’s Urology convinced me we agree. Parents, doctors, activists, the AAP, the CDC, and Children’s Urology all need to work together to eradicate this awful scourge, circumcision, that somehow persists for healthy boys in modern society.

¹ I’ll refrain from speculating on this item because I do not know what Children’s Urology recommends for these children.

² It’s worth remembering that meatal stenosis and adhesions are possible complication from circumcision (i.e. the treatment for the condition, “circumcision”).