Flawed Circumcision Defense: Barbara Kay

Posted: October 18th, 2016 | Author: | Filed under: Control, Ethics, FCD, FGM, Hygiene, Logic, Media Marketing, Pain, Science | No Comments »

[10/19 Update: Edited for clarity and to reduce speculation since late night posting is imperfect and probably unwise.]

National Post columnist Barbara Kay used Brian Morris’ latest rehash on circumcision to repeat her ignorant thoughts on the subject. She begins by regurgitating claimed benefits, which can all be conceded here for the sake of time because they’re irrelevant to the only issue, ethics. Then:

… Dr. Morris and his American co-authors state, “We found that up to 65% of uncircumcised males might experience at least one of these [medical conditions] over their lifetime.” …

Until May 2015 Morris claimed the number as 33%. Since June 2015 he claims it’s 50% in a brochure on his website. And it’s apparently 65% in this new review. When will he settle on 100%? But more to the point, it’s obvious he likes whichever way he can claim this number because it’s flashy. “Ooooooh, 33/50/65 percent is high. Such danger!” But it’s a meaningless number in the context of non-therapeutic circumcision of boys. I assume Morris knows this. I assume Kay doesn’t, so a review of Morris’ history could help. Instead of those numbers, this is what is worth discussing here, from Morris:

Up to 10% of males reaching adulthood uncircumcised [sic] will later require circumcision for medical reasons.

Not only is the number only 10%, it’s only up to 10%. Medically necessary circumcision is rare, at any age. There is no ethical case for imposing the most radical solution without consent when at least 90% of males will never need it.

She continues:

… Their risk-benefit analysis of the procedure led them to conclude the benefits exceed the risks by about 100 to one. (In another study, published in the Journal of Sexual Medicine, Dr. Morris and colleagues found circumcision produced no adverse affect on sexual function or pleasure, a charge often leveled by anti-circumcision activist groups.)

Much like when Yair Rosenberg accepted Morris’ claim unexamined, Kay doesn’t appear to know the primary source.

But in a study Morris and Krieger rate as [highest quality], Payne et al [12], this:

… It 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. …

Payne’s study published in 2007. In 2011 Kay wrote:

Set aside the rights-based rhetoric. It’s about sex: Circumcised men have greater pre-orgasmic endurance; non-circumcision permits more frequent ejaculations. …

So, circumcision either delays orgasm, assumed to be positive for all men, or has no effect on sexual pleasure. Like Morris, she appears to play “heads I win, tails you lose”.

Kay goes on to write:

… The AAP states: “The new findings 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.”

That quote is not from the AAP. It’s from Prof. Morris. He wrote it in a press release more than 18 months after the AAP published its revised position statement. Kay doesn’t bother to fact check the most basic statement. [ed. note: Kay asked the online editor to correct her error.] Nor does she pursue how Morris’ quote undermines their case for non-therapeutic neonatal circumcision since he acknowledges that circumcision is rarely necessary.

Thus, while it’s inexcusable, it’s hardly shocking when she continues:

The CPS could not condemn the practice on grounds of increased morbidity. After thousands of years of what is essentially a controlled study with virtually all Jewish men, with a large percentage of Muslim men on one side, and uncircumcised men on the other, it has been unequivocally concluded that circumcision presents no health risks; quite the contrary, as we shall see.

Even Morris doesn’t pretend that circumcision “presents no health risks”. He understates them, and ignores the guaranteed harm from the removal of the foreskin (and possibly frenulum) in 100% of circumcisions. But he’s not so biased that he’ll posit such an obvious untruth. Yet, there’s Kay’s indifference masquerading as hyperbole for all to see.

… Morris’s team estimates the combined frequency of adverse events at 0.4% overall, arguing that “the cumulative frequency of medical conditions attributable to [having an intact foreskin] was approximately 100-fold higher” than the cumulative risk of circumcision.

Even if we accept the numbers, he’s arguing frequency of medical conditions attributable to the foreskin, not the frequency of medically necessary circumcision. It’s fascinating, perhaps, but a transparent obfuscation. The anti-science charge is often leveled at activists here, but soap, water, antibiotics, steroids, condoms, and so on are also science. To start with the most extreme solution at the tiny prospect of a problem sometime in the future is ridiculous.

When she gets to the comparison of male and female genital cutting, she ignores the principle.

The single most irrational argument one often sees is the charge of moral equivalency between circumcision and female genital mutilation. FGM is a phenomenon that is, apart from both affecting the genitals, …

Apart from both affecting the genitals, indeed. Affecting the genitals of a healthy child who does not need or consent to the permanent alteration of said healthy genitals. Non-therapeutic genital cutting on a non-consenting individual is unethical. The individual has inherent rights to bodily integrity and autonomy from birth. Non-therapeutic circumcision violates those rights.

… quite separate from circumcision. Unlike circumcision, which removes an unnecessary piece of skin, …

Unnecessary circumcision removes a piece of skin. It’s the same words, but made objective rather than subjective. It’s the fact-based opposite of “heads I win, tails you lose”.

… in no way prevents natural and satisfying sexual function, …

In addition to calling back to the Payne study and Kay’s earlier comments about delayed orgasm, circumcision removes the foreskin, a natural part of the body. That is “natural”. Its mechanism is gone, so circumcision certainly prevents that function. And “satisfying” is subjective. Would all men prefer delayed orgasm and the loss of the foreskin? (I don’t.)

… FGM is a misogynistic practice created as a means for men to control women, …

Circumcision controls men. Its imposition is another’s assessment that the male’s body should be the way someone else prefers. It is then made that way (hopefully, except when complications occur, including possible death). The male is never asked. He is to say “thank you”, praise the imposition, and impose it on his sons as soon as they’re born.

Kay’s argument rests on control as intent rather than action. I doubt she would accept that parents cutting their daughter’s genitals for the reasons we allow them to cut their son’s genitals. She assumes their intent is always evil, but is it the intent or the act that matters here? If she believes intent with FGC is only what she writes, as she appears to believe, she should read more¹ on the topic. And then extrapolate back to the disparity in the intent and the violence of male circumcision.

… meant to prevent sexual desire and gratification in women to ensure their fidelity, and which removes a portion of the genitals absolutely vital to gratification. It is the very epitome of patriarchy, whereas circumcision is a rite of passage conceived by males for other males, and for thousands of years rooted solely in spiritually contractual language and meaning. Women who have been subjected to FGM invariably come from countries in which extreme misogyny is the norm. Circumcision carries no moral or gender-injustice baggage of this kind whatsoever.

I agree that FGM is awful. But it’s silly to repeatedly claim a definitive knowledge that male circumcision does not remove of portion of the genitals absolutely vital to gratification. She ignorantly cites bad summaries of studies and only uses groups of males circumcised at birth or as young children as reference points for this opinion. She doesn’t appear interested in males as individuals with rights and preferences of their own for their foreskins. (“Conceived by males for other males”.) Preference for the foreskin or circumcision is an individual decision. What other males prefer is only valid for themselves.

She closes by misunderstanding the ethics involved one last time, in a disgusting manner:

Parents deserve to be informed of all the evidence, pro and con, when the issue of circumcision arises. It is not necessary for the CPS to actively recommend circumcision to keep to the path of ethics and professional responsibility, but given the accumulation of evidence demonstrating the positive effects of circumcision, it would be unethical of the CPS – or any pediatricians individually – not to present the science available, or worse, to recommend against the procedure.

She’s dancing close to the silly proposition that boys have a right to grow up circumcised. The only ethical position is absolute opposition to (and prohibition of) all non-therapeutic genital cutting without the patient’s consent. It’s the right she recognizes for females. Her source (inadvertently?) recognizes that circumcision is rarely needed ever and can be (but likely won’t be) chosen later. She cites evidence of males who are dissatisfied with circumcision and being circumcised. But she ignores these in favor of her own biases. Cognitive dissonance (and a non-sequitur) is the best she can offer. She is ignorant. She should aim to be less ignorant.

¹ Consider Fuambai Sia Aahmadu, and from 2008.


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”).


Not every male would have foreskin anxiety

Posted: January 31st, 2015 | Author: | Filed under: Ethics, FCD, Hygiene, Locker Room, Logic, Parenting, Regret | No Comments »

It’s rare that I read something providing both confirmation and frustration. Such is the case with this interview with Aaron Calloway, a man who chose circumcision for himself as an adult. Some of Mr. Calloway’s thinking precedes the Q&A in the interview:

“I have been in a couple of social circles where people would be talking and say, ‘Ugh, yeah. He was uncut,’ and I, like, didn’t want that,’” Calloway told me, when we spoke a second time about his circumcision. “And I’m sitting there with an uncut penis. People don’t really assume you may not be [cut]. They just assume that you’re cut and if you’re not, it’s kind of like this abomination.”

I’ll assume everyone is familiar with this because it certainly matches my experience. Americans generally assume every male is – and should be – circumcised. It’s what we do. It’s “good”. I take a different view on what to do with society’s perception. Of course I don’t have the same experience Mr. Calloway does. Mine is people assuming I’m happy with being circumcised, because why wouldn’t I be? It’s strange, and annoying because I don’t care what other people think about my preference. I’d rather have my normal body, which I had until my parents made my choice.

Early in the interview, Jenny Kutner, asks a question that expands on this:

How would you say it’s perceived to be uncircumcised [sic]?

It’s strange because it really depends on being asked. If you are someone who prefers a cut penis, or to be circumcised, it’s weird because the preference — they automatically associate it with cleanliness. It’s considered a more proper penis and uncircumcised is like, weird. But it makes me think, it’s weird to actually be born and have your penis hacked at. I am glad that I made the decision on my own to do it. There’s something empowering about that.

I’m glad Mr. Calloway had his choice, even though I don’t (emotionally) understand – and wouldn’t make – the choice he made. He’s correct that it’s weird to be born and have your (healthy) penis hacked at. That weirdness is why I dreaded this excellent, necessary question:

Since you found it empowering to decide yourself, what do you think you would do for your son if you had one?

I would probably get him circumcised, only because I wouldn’t want him to deal with the social embarrassment of [not being circumcised], because it can come off that way. I’ve been in situations where if I let myself, I could’ve felt embarrassed, but I chose to own it. I think I had enough resilience where it didn’t get to me, but I think that some people in that situation, it does get to them.

I wanted to turn off my monitor, unplug it, and throw it in the garbage when I read this, just so I’d never be able to read that answer again. Because the obvious question is obvious: What if that hypothetical son wouldn’t be embarrassed by social pressure to be circumcised? Or, what if the social pressure is no longer the same 15+ years after that hypothetical son is born in the future? And, I still remember, “I am glad that I made the decision on my own to do it” from the previous question. Is there a reason to assume a hypothetical son wouldn’t want his choice, too?

My frustration with Mr. Calloway’s answer grew later in the interview when the question turned to Mr. Calloway’s results:

Aside from not being able to ejaculate for a while, were there any other negative side effects?

Besides the desensitization –

So you do have less sensation now?

Yes, and that is something that I’m a little bit sour about. I used to have very intense orgasms–my legs would curl and my head would go back. It was cool. I was very into it. Now, I’ll cum or whatever, and it’s just more calm. It’ll feel good, but it’s not as dramatic as before, which was nice, because it felt sexual and passionate, and now it’s just like, get out.

Is it worth it?

Is it worth it? I would say, in my situation, and my experiences, yes, it is to me, because I just personally feel better about it. I was with some friends who were talking about the word “smegma” and making jokes about it, and now I don’t have to feel uncomfortable in that situation, and that’s really nice. I think for me and my personal psyche, it is worth it. I’m not saying that when I cum I don’t feel anything. No. That’s not the situation either. I still get horny. I want to have sex. It still feels great and I still have an orgasm. Is it to a lesser degree? Yes. Is it an orgasm nonetheless? Definitely.

It’s consistent to say “I’m a little bit sour about” it and “in my situation, and my experiences, yes, it is [worth it] to me.” All preferences are unique to the individual. Mr. Calloway values the aesthetic and social benefits more than the healing process and diminished sensitivity. Given that I only advocate for each person to make his own choice, not that no one be circumcised, I’d be a hypocrite to criticize his conclusion. I criticize his current thinking that he would circumcise a future son. There’s also time for him to see the error in his thinking there.

To the possible objection with this interview, of course Mr. Calloway’s claim is subjective and anecdotal. This does not prove that adult or infant circumcision leads to desensitization. I think the inference is logical, given how circumcision changes the normal penis. Still. No, this isn’t proof.

It does support my focus on individuals rather than groups. We must remember how critical this is when reading generalized garbage such as what the CDC offers on page 26 of a detailed supporting document for its proposed recommendations to teens, adults, and parents of newborns.

… However, in one survey of 123 men following medical circumcision in the United States, men reported no change in sexual activity and improved sexual satisfaction, despite decreased erectile function and penile sensation. [Abstract and study]…

From the results section of the study’s abstract:

A total of 123 men were circumcised as adults. Indications for circumcision included phimosis in 64% of cases, balanitis in 17%, condyloma in 10%, redundant foreskin in 9% and elective in 7%. The response rate was 44% among potential responders. Mean age of responders was 42 years at circumcision and 46 years at survey. Adult circumcision appears to result in worsened erectile function (p = 0.01), decreased penile sensitivity (p = 0.08), no change in sexual activity (p = 0.22) and improved satisfaction (p = 0.04). Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised.

As the study concluded, and the CDC’s use failed to understand, “adult circumcision appears to result in worsened erectile function, decreased penile sensitivity and improved satisfaction.” Again, those don’t have to be inconsistent for an individual. But it’s indefensible to assume infant circumcision results in a different outcome, or that results one and two ethically coexist with result three for healthy children.

Even in this study supposedly supporting the CDC’s recommendation, only 62% of men were satisfied. The other 38% matter, too. In the absence of need, the only relevant issue is always individual choice. And looking at the math, the results show that far fewer than 100% of men circumcised for (probable) need were satisfied. Remember this every time someone implies every male should¹ be satisfied with non-therapeutic circumcision because some males are satisfied with therapeutic circumcision.

I appreciate what Mr. Calloway has done with his interview. His honesty is informative in both its insights and its flaw. We need more honest, focused discussion like that. I don’t assume all men circumcised as adults would report reduced sensitivity. I know there are enough that it might help break through the societal barriers we maintain against ethical protections for the normal bodies of male children.

¹ Consider Mr. Calloway’s results in the context of a recent silly lifestyle trend piece. It concludes with a man from Staten Island named Boris who had himself circumcised at 33. Okay, fine, good for him. Even though he said that “[t]he next six months weren’t normal,” everything is apparently okay with circumcision because now “[w]e’re expecting a baby next month — everything works just fine!” Clap, clap, except no one is making the argument that circumcision prevents ejaculation or climax (Except in those rare cases of death where it prevents that). “Sex still feels good” is the most persistent and most pernicious straw man in the circumcision debate.

Read this response instead.


Flawed Circumcision Defense: Karin Klein

Posted: December 10th, 2014 | Author: | Filed under: Ethics, FCD, FGM, Science | 1 Comment »

Encouraging half-baked opinions, like this one by Los Angeles Times reporter Karin Klein, is the inevitable result of the CDC’s proposed recommendation. The opinion piece is titled, “It’s time to end inaccurate criticisms of male circumcision”, which suggests its author should not offer an incomplete analysis in defense of male circumcision. That is what Ms. Klein offers.

The recent report by the U.S. Centers for Disease Control and Prevention should quell the unfounded arguments that male circumcision is no better than or different from female circumcision, also known as female genital mutilation. According to the draft guidelines released by the CDC, the benefits of male circumcision clearly outweigh the risks, in the form of reduced risks of urinary tract infection as infants and penile cancer later in life, and lower risk of contracting HIV and other sexually transmitted diseases.

The short version of her essay is “Shut up.” It’s her introduction and conclusion. Alas¹, no.

“According to the draft guidelines released by the CDC” involves undue weight for the recommendation. The CDC’s conclusion is subjective. The equation is not merely benefits versus risks. There is a direct cost (i.e. harm) in the loss of the foreskin. That matters, yet it isn’t factored into the CDC’s analysis (or the AAP’s before it or Ms. Klein’s here). And the CDC ignores the individual foreskin owner’s preferences. Someone might value his foreskin more than reduced risks of future maladies. As I do. It isn’t defensible to declare that the potential benefits “clearly” outweigh the risks, for everyone, or that this demonstrates anything conclusive.

The comparison of male circumcision to female genital mutilation rests on the principle involved, not indifference to the disparity in recognized potential benefits. Non-therapeutic genital cutting on a non-consenting individual is unethical. Minimal or maximal cutting is relevant for punishment, but not for whether the individual’s human rights are violated. A female owns her body from birth, including her genitals. A male owns his body from birth, including his genitals.

It’s understandable that circumcision has become controversial. It’s a permanent change made to the body, usually in infancy. (It should be noted that parents make all kinds of decisions that affect their children’s lives permanently; circumcision happens to be a particularly visible one.) …

It’s a permanent change made to the healthy body. Defending this removes any limitation on what parents may do. It isn’t that it’s a particularly visible effect. It’s that circumcision alters the child’s body without need. Proxy consent requires the patient’s need, not the proxy’s preference. Non-therapeutic circumcision is still cosmetic surgery, contra the silliness Ms. Klein will shortly suggest.

Nor is non-therapeutic circumcision acceptable because parents make all kinds of decisions. This common argument rests on the flawed premise that a) Parents make decisions for their children, b) Non-therapeutic genital cutting is a decision, therefore c) Parents may cut the healthy genitals of their children sons. It’s ridiculous. Treating all decisions equally to defend an extreme, gendered decision makes no sense. It imagines a strange scope of parenting we don’t accept, as evidenced by the required strikethrough in c) to narrow the conclusion to what parents may legally decide on non-therapeutic genital cutting. It’s about parental rights only to the convenient extent that it maps to what we want to do. It’s arbitrary.

The CDC report won’t end the debate, nor should it necessarily do so. Perhaps its most important short-term good will be to increase the likelihood that the procedure will be covered by health insurance, because circumcision could not be viewed as solely a cosmetic procedure, but rather one that carried health benefits backed by the most current scientific research. That gives parents the option — either way.

It is still cosmetic surgery, even with potential health benefits backed by the most current scientific research. It is backed by an incomplete analysis of all factors involved. Arguing only from potential benefits and risks without factoring in the costs (i.e. harms), as well as preferences for how an individual weighs those three aspects for himself, is biased, inaccurate nonsense. The CDC shouldn’t peddle it. Ms. Klein shouldn’t defend it.

But it should end the scurrilous argument that male circumcision, with its very low complication rate, is mutilation on par with female circumcision. There are no known health benefits to female genital circumcision and a long list of not-uncommon consequences, including fistulas, abscesses and childbirth complications.

If Ms. Klein is going to use a word like scurrilous to criticize critics, she should first understand mutilation. Should we assume that a case of non-therapeutic female genital cutting without the girl’s consent that doesn’t result in a complication, or at least only a “very low complication rate”, isn’t actually mutilation? I assume Ms. Klein’s answer is the correct answer, which is “obviously not”. We can also search for the unifying principle that shows how weird it is to argue that parents should have the choice to surgically alter the bodies of their children, except this choice is for sons only because we’ve researched that. For example, in the WHO factsheet on Female Genital Mutilation, this:

Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.

Partial removal or other injury to the genital organs for non-medical reasons? As long as you don’t foolishly suggest “reduced risk of X” is somehow a medical reason² for non-therapeutic circumcision, removing the foreskin is clearly such an injury.

And:

FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls’ and women’s bodies.

Removing and damaging healthy and normal genital tissue, and interferes with the natural function of bodies? Male circumcision fits that, too. Without need or consent, male circumcision is indefensible genital mutilation. Awareness of potential benefits does not change the equation. It is mere question-begging.

Of course, even religious traditions shouldn’t outweigh health concerns. Just as female genital mutilation is outlawed in this country no matter what the religious beliefs of the parents, if the CDC report had found similar complications with male circumcision, then there should be serious conversations about whether the procedure should be allowed. But that’s not what the science shows; until there is solid evidence to contradict the CDC report, conversations about restricting parents’ ability to make this decision for their sons should end.

It makes sense to ask if the boys who suffer the complications, including the most serious outcomes, could be considered mutilated, or is it merely based on the intent we assume for the parents? (The simplistic, “Male genital cutting is well-intentioned. Female genital cutting is ill-intentioned.”) But complications and consequences are unique. Consequences includes the costs (e.g. loss of the foreskin). That ignored aspect is what makes non-therapeutic male circumcision an unacceptable parental choice. Again, using the subjective conclusion that the benefits outweigh the risks while excluding the factual harms and the child’s preference is an incomplete analysis. Demanding, as Ms. Klein does, that we guide policy on this subjective opinion is ludicrous.

The CDC’s recommendation and Ms. Klein’s demand aren’t made better by using SCIENCE! as an incantation. Å normal, healthy foreskin is science. The numerous methods short of circumcision to prevent and/or treat maladies are science. A condom is no less SCIENCE! than circumcision. Antibiotics are no less SCIENCE! than circumcision. Soap and water are no less SCIENCE! than circumcision. It might be interesting that parents prefer SCIENCE! to SCIENCE!, but the issue involves ethics. The ethics are the same, whether it’s daughters or sons. Non-therapeutic genital cutting on a non-consenting individual is unethical. We all have the same basic rights. Non-therapeutic genital cutting without the individual’s consent violates her – or his – basic human rights.

¹ The piece includes a “Shareline” suggestion to tweet out a link to it with propaganda, “There are reasonable debates about male circumcision — but not about its benefits vs. risks”. That’s also nothing more than “Shut up”. It poisons the conversation by setting boundaries on what’s “reasonable” to debate. It’s also incorrect.

² The factsheet makes it clear that this would not be accepted for any non-therapeutic female genital cutting, as the law against FGM in the United States also makes clear. There is a principle, and it doesn’t negate the principle of equal rights simply because we’ve agreed to study the possible benefits of cosmetic surgery.


Cutting matters more than the “why”

Posted: November 17th, 2014 | Author: | Filed under: Ethics, FCD, FGM, Media Marketing | 1 Comment »

Mona Eltahawy writes in The New York Times:

I am a 47-year-old Egyptian woman. And I am among the fortunate few of my countrywomen whose genitals have not been cut in the name of “purity” and the control of our sexuality.

This is an important topic. She explains it well as it pertains to Egypt. But this paragraph bothers me:

The practice is sometimes erroneously referred to as circumcision. According to the World Health Organization, it “comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for nonmedical reasons.” The procedure has no health benefits. We hack away at perfectly healthy parts of our girls’ genitals because we’re obsessed with female virginity and because women’s sexuality is a taboo. This cutting is believed to reduce a girl’s sex drive. And families believe their daughters are unmarriageable unless they are cut.

“Sometimes erroneously referred to as circumcision” is meant to distinguish FGM from male genital cutting. “No health benefits” demonstrates this point for the few readers who didn’t catch the “male circumcision is okay” implication¹. That’s nonsense. It’s reasonable to state that the two inflict different degrees of harm in common practice, and that difference can be significant. It is not reasonable to distinguish the two as “acceptable” and “unacceptable”. The World Health Organization quote she used describes male genital cutting, too.

The end of the paragraph demonstrates this point. Were I to write the second half of that paragraph, I’d write it from this perspective:

We hack away at perfectly healthy parts of our girls’ genitals.

That sentence doesn’t need the because. She was correct to include it. It’s relevant for explanation. But the sentence as I wrote it does not need a “because”. It doesn’t matter why we do it, hacking away at a child’s perfectly healthy genitals is always wrong. Get the principle right and the comparison takes care of itself.

For example, does anyone believe Ms. Eltahawy would change her mind if someone discovers health benefits for any form of FGC? Would she be okay with research studies to determine if there are benefits? I wouldn’t. I don’t believe she would. What about cases where her “because” is wrong and parents are honest-but-mistaken in their intent? Nothing changes. The truth that we shouldn’t hack away at a girl’s healthy genitals is clear. There is no excuse for making or endorsing an implication that hacking away at a boy’s healthy genitals is somehow acceptable. People who make the argument Ms. Eltahawy makes in that paragraph advocate for special rights, not human rights.

¹ See also.


Who won here?

Posted: November 4th, 2014 | Author: | Filed under: Ethics, FCD, HIV, Media Marketing, Politics | 1 Comment »

This video is interesting to me:

The doctor’s evidence-free accusation at the end, “anti-Semitic like you”, is both disgusting and interesting. I side with Brother K’s response and outrage on that charge. The problem is that no one in that video was talking to anyone else. Everyone was talking at each other. I assume all four people walked away thinking they won the interaction. Instead, I want the video where the doctor’s question gets a response rather than an information dump. Show him how his question – and by extension, his view of circumcision – is broken.

His question is excellent: “If there was a vaccine for HIV that reduced the rate by 50%, would you be okay or would you be protesting?” It provides insight into what concerns the doctor professionally. It provides a chance to discuss more about HIV than just this isolated 50% claim. It provides a direct way to distinguish the ethics of vaccination and removing body parts. It provides the doctor an opportunity to experience someone who has thought about this more than just “don’t hurt the babies”.

Non-therapeutic child circumcision is indefensible. The burden of proof should be on those who want to circumcise. They propose intervention. They haven’t proven their case. They can’t prove it because it’s flawed. But society puts the burden of proof on those who challenge tradition, not those who wish to intervene on the healthy body of a non-consenting child. It’s wrong, yes, but we have to work with society tilting at this windmill. Do we want to change society or do we merely want society to know we’re better? My preference is for the former, and especially so when seeing how little the doctor in the video agreed to the latter.

**********

It’s a valid expectation, so my answer to the doctor’s question is this:

Yes, I would be okay with it (qualified by verification of both efficacy and safety of the vaccine within some reasonable bounds). Circumcision isn’t a vaccine. Vaccine’s work with the body’s immune system to trigger a response that then protects the individual from infection. Circumcision removes skin. It operates on the theory of “less skin, fewer entryways”. This is relevant, too, since the mechanism for the claimed risk reduction from circumcision is unclear. Perhaps it’s a confounding factor not yet understood and/or researched? There’s also the scientific fact that condoms work better and do not involve the violation of human rights. And, what about the possibility that removing bits of female genitals could reduce risk? Are we ethically bound to allow that, too, or does it reveal the ethical question we don’t wish to consider? We know it’s unethical to investigate, because the answer doesn’t matter. Our societal fear is convenient, not justified, when it comes to HIV and circumcision.


Flawed Circumcision Defense: The indecipherability of “ga ga goo goo ooga bahfah fum”

Posted: August 3rd, 2014 | Author: | Filed under: Control, FCD, Parenting | 3 Comments »

Daulton Gatto asked to interview me. I agreed on the condition that he first answer a question from my last post. In response to Daulton’s alleged critiques of my “stupid arguments which claim to show that Mike Gatto likes to cut up baby boys’ wieners with surgical instruments,” I asked: “Why do you state my claim as something unconnected to what I’ve written?” I got something resembling an answer.

“Tony” seems to have taken issue with a statement I made in a previous post, which spoke to his implied belief that Mike Gatto likes to cut up baby boys’ wieners with surgical instruments. While I will acknowledge that Tony never actually stated such a belief in so many words, it is my position that his distorted interpretation of California AB 768 provides ample justification to draw such a conclusion.

The link you provide to California AB 768 doesn’t contradict my interpretation of the bill, which you excerpted in your answer. The rest of your answer appears to recognize that I interpreted the bill correctly. Instead, you’re agitated about this:

… I stated that [Mike Gatto] believes male minors do not have the same rights to their bodies as every other citizen of California. … But he incorrectly believes he and every other parent has the valid authority to choose, and, in his capacity as a legislator, to protect that authority in law.

That is the gist. The authority to impose non-therapeutic genital surgery on a child is illegitimate.

To which I respond:

Of course parents have the authority to have their infant children circumcised. Do you really expect a newborn baby to make this decision for himself? Or do you think that every single male in the world should be forced to wait until they gain legal control over their own medical care to have their stinky, ugly foreskin snipped off? As the proud owner of a smooth, polished penis … I can unequivocally state that my own experience with circumcision has been overwhelmingly positive …

Your thinking on this is too narrow. It’s absurd to imagine¹ that parental authority is specific within genital cutting so that it only applies to the healthy prepuce of a son but not the healthy prepuce of a daughter. As I wrote before, if parents have the authority you say they possess, that applies to control over their daughters’ genitals, too. It would be about the parents, not the child. Yet California law already prohibits this for exactly the reasons I state that non-therapeutic male circumcision is not a legitimate parental choice. Non-therapeutic genital cutting is an individual rights issue for the child (i.e. the surgical patient), which trumps this supposed parental right to proxy consent for sons only. The right to bodily integrity is the core of self-ownership and includes the genitals, even for male minors.

I don’t expect a newborn baby to make this decision, or any decision. But the standard for proxy consent (i.e. parental authority) is not “babies can’t make decisions for themselves”. And you have a curious understanding of what “force” entails. I think that every single male should be able to choose, absent medical need before he is able to decide for himself. No male should be forced to live with a circumcision he does not need, probably won’t need, and may not want. I don’t think this requires that he wait until he’s an adult to choose, but it should never be forced on him without need or his consent.

I’m happy for you that your experience with your circumcision has been positive. You don’t have to share my preference for my body. I don’t have to share your preference for your body. That’s the uncomplicated thing about individual preferences. They’re all subjective to the individual. A presumption of shared circumcision preference between a child and his parents is too convenient for public policy. It assumes away the value of self-ownership to the individual himself.

Parents have the legal right to make decisions about the medical care of their children until their children come of age. Otherwise, emergency rooms around the country would be filled with blubbering infants going “ga ga goo goo ooga bahfah fum” when doctors ask them whether or not they want their booster shots. …

I haven’t said anything suggesting otherwise about a general approach to parenting and its interaction with the State. I didn’t write that parents do not have the authority to make medical decisions, period. You’re not claiming I did, but this isn’t a good buildup for where you’re going with it.

… This legal right necessarily extends to circumcision, …

Necessarily? We agree that parents may choose circumcision where there is medical need, although I’ll add that there is an ethical duty to exhaust less invasive solutions first. This legal right does not “necessarily” extend to non-therapeutic circumcision. All you’ve done here is argue “Parents make decisions, Circumcision is a decision, Parents may decide on circumcision.”

… and the only objections are coming from a small minority of extremist demagogues who erroneously believe that Mike Gatto’s protection of parental rights is tantamount to supporting genital mutilation. …

I recommend that you look up the definition of demagogue again, and perhaps reread our series of posts after doing so, before tossing it around like that.

Mike Gatto protected genital mutilation. I do not know if he supports genital mutilation. Again, if AB768 bill protects a valid parental right, then the California penal code violates parental rights. Mike Gatto is duty-bound to try to correct that if he and you are correct about a parental right to have a child’s healthy genitals cut to satisfy their own preferences.

… I see no reason to offer a more thorough explanation, as it is my firm belief that your argument critiques itself by its circular and misguided nature. It’s Sunday, I’m hung over, and I can’t be bothered to make an exhaustive list of the endless number of logical fallacies you’ve and your supporters have committed.

Don’t worry, you were thorough enough to show the gaps in your argument.

¹ I take it as a given that you oppose female genital cutting, as prohibited in California law. Please correct me if I’ve assumed too much on that point.


Mike Gatto has fans. Mike Gatto is still wrong about circumcision.

Posted: July 30th, 2014 | Author: | Filed under: Ethics, FCD | 6 Comments »

I’m still convinced he’s probably doing nothing more than a form of weird trolling, but I’m still fascinated by what Daulton Gatto is doing with this. Yesterday I got two posts, including my promised addition to the “enemies” list. It’s as ridiculous as I expected. Awesome.

First, BREAKING NEWS: Mike Gatto Has a New Enemy, and His Name Is, uh, “Tony”:

Our blog’s loyal readers will be familiar with the antics of “Tony,” another incoherent babbling lunatic who lives in a bizarre fantasy world where Mike Gatto supports genital mutilation. Well, as you can see in the next two links, Tony insists on posting cowardly pingbacks to my brilliant and devastatingly well-reasoned critiques of his stupid arguments which claim to show that Mike Gatto likes to cut up baby boys’ wieners with surgical instruments.

Daulton:

My earlier points about ad hominem apply again, above and on the “enemies” list post. What I really enjoy, though, is that my “stupid arguments claim to show” something I have not written or implied. I do not believe “Mike Gatto likes to cut up baby boys’ wieners with surgical instruments.” Why do you state my claim as something unconnected to what I’ve written? Is it poor reading comprehension? Is it willful misrepresentation? Maybe it’s just lazy trolling? I’m curious and don’t want to assume an answer, but there is an explanation for why you’re punching a strawman. What is it?

With AB768, Mike Gatto introduced legislation stating that male circumcision in California can only be regulated at the state level. AB768 protects the practice of male circumcision and the exercise of parental authority to have a child circumcised for any reason throughout California. I stated that he believes male minors do not have the same rights to their bodies as every other citizen of California. I don’t even assume that he and his wife would have any sons circumcised. Maybe they would, maybe they wouldn’t. But he incorrectly believes he and every other parent has the valid authority to choose, and, in his capacity as a legislator, to protect that authority in law.

The flaw is easy enough to understand. AB768 does not include critical information about the risks, harms, and ethics of non-therapeutic child circumcision. The practice of male circumcision involves individual human rights. If this parental authority to impose non-therapeutic genital cutting were legitimate, it would apply to their daughters, as well. California already prohibits this, correctly. AB768 permits the violation of human and constitutional rights of California citizens. Mike Gatto should not have introduced it. No one should’ve voted for it. Gov. Brown should not have signed it.

**********

True to his word, he added me to his enemies list. The last paragraph introduces an amusing assumption about what I believe based on what I wrote.


Will I be an enemy of Mike Gatto because he’s wrong on circumcision?

Posted: July 29th, 2014 | Author: | Filed under: Ethics, FCD | 3 Comments »

After my post yesterday morning, I can give credit where it’s due. Daulton Gatto responded with something resembling an argument. “Tony” Comes Back for More addresses an aspect of my original criticism of alleged sweet dude Mike Gatto and the unprincipled legislation he introduced.

To the fun, with all commentary directed to Daulton:

Yesterday, I published an insightful commentary on an anti-circumcision/Mike Gatto attack article written by some dumb douche named Tony. Today, I discovered that Tony posted a cowardly pingback rather than an actual comment on my critique, then did the digital equivalent of hiding behind his mommy by running back to his own stupid website to thump his chest amid the supportive grunting of his fellow anti-circumcision wackos.

I used a “cowardly” pingback for two reasons. One, I know how the Internet works. The pingback to your post alerted you that I responded. The cowardly move there would’ve been to disable my pingback so I could reply to your post without you knowing about it. Anyway, I’m not sure that “This post sucks and the guy who wrote it is a douche.” deserves much more credit than a mere pingback.

Two, in my experience people who engage in ad hominem and/or link to sketchy sources tend to delete unfavorable content. I don’t assume you would do this. I also don’t assume you would not. I don’t know you. This way, my side of the record stays.

It’s funny — no wait, it’s hilarious – to hear you throw around terms like “ad hominem” when it’s crystal clear that you lack even a basic understanding of sound logic and reasoning. …

Ad hominem: “You attacked your opponent’s character or personal traits in an attempt to undermine their argument.” Pussy. Giant douchebag. Stupid. Douche. Dumb douche. Foreskin crusaders and wackos dance pretty close, although the former probably just demonstrates how little you seem to understand about what I’m for and against. And my anonymity matters how to the validity of my position? You didn’t rebut any part of my original entry in your first post.

… Consider the following statement from your original post, which is without doubt the single dumbest one amid a burgeoning torrent of stupidity:

The part you excerpted was clunky. It isn’t embarrassing or shameful like AB768, but I should’ve been clearer. Still, the point expressed later in the original post was the key, based on that intentionally ludicrous analogy. Is the legal age of majority the valid line for when forced genital cutting is no longer acceptable on males? There is obviously a younger, informal age at which we think it’s unreasonable to impose circumcision on a healthy boy without his consent. The correct age is birth. We must recognize the mistake in treating this human right as if it’s a permission granted to boys by society at its discretion.

Every part of an individual’s body belongs to the individual from birth. Proxy consent requires a stricter standard than the subjective and speculative “wide array¹ of health and affiliative benefits.” There is no asterisk within self-ownership for “foreskin of male minor offspring”. Removing normal, healthy bits without a person’s consent – at any age – violates that person’s human rights, which California already recognized and protects for female minors. Mike Gatto legislated propaganda to strengthen protection for this human rights violation of male minors. That is not sweet behavior.

Another word out of you and you’re going on the enemies list. You’ve been warned.

It will be an honor.

¹ “Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision” by Morten Frisch, MD, PhD, et al. (pdf)

… The conclusions of the AAP Technical Report and Policy Statement are far from those reached by physicians in most other Western countries. As mentioned, only 1 of the aforementioned arguments has some theoretical relevance in relation to infant male circumcision; namely, the questionable argument of UTI prevention in infant boys. The other claimed health benefits are also questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves. …

This was published after Gov. Jerry Brown signed AB768 into law. Its logic was expressed numerous times in various forms long before Mike Gatto wrote his ignorance into his bill.


Flawed Circumcision Defense: Daulton Gatto defends Mike Gatto (no relation)

Posted: July 28th, 2014 | Author: | Filed under: Ethics, FCD, First Amendment, Law, Logic, Politics | 4 Comments »

Remember back to the ballot initiative in San Francisco that sought to protect the same genital integrity rights for boys in San Francisco that are already protected for girls throughout America. In response to that, California Assemblyman Mike Gatto drafted a bill in 2011, AB768, which Gov. Jerry Brown signed into law that October. That’s when I wrote about Mike Gatto:

California Assemblyman Mike Gatto is an authoritarian. He believes that male children do not have human rights equal to the rights of their fellow citizens. Mike Gatto believes that freedom and liberty involve parental ownership of the genitals of their male children. He believes that the individual right involved in child genital cutting is exclusively the right to cut a male child without medical need. He believes that subjective, non-medical “affiliative benefits” are enough to justify surgery on a child, even if the child does not or might not want to be forcibly affiliated. California Assemblyman Mike Gatto prefers mindless, unquestioned deference to parental choices about non-therapeutic male child genital cutting.

California already established that there is no arbitrary, unspecified age before which parents own the genitals of their female children. They may not allow someone to take a scalpel to the genitals of their daughters for non-therapeutic reasons, even if those reasons include a parental preference for forced “affiliative benefits.” The only factor involved in any decision to cut female minors is the presence or lack of medical need. That is the ethical, scientific view, which succinctly demonstrates that genital integrity exists within human rights. Mike Gatto believes that male children have only a mere subset of human rights, a subset that does not include genital integrity. It is a flaw in his character that Mike Gatto believes the full range of human rights only belong to male adults, female adults, and female children.

That is still accurate upon current reflection almost three years later. Look at the bill proposed and signed into law. It states that “[m]ale circumcision has a wide array of health and affiliative benefits.” Even if the first argument is assumed robust and true, discussion of the risks and costs of circumcision is nowhere to be found. Gatto, those who voted for it, and Gov. Brown all willingly enacted propaganda into law. Without a full consideration of what’s involved, including costs and the implications to human rights, they abdicated their responsibility to represent the interests and rights of every California citizen in favor of only those with power. That was, and remains, unethical.

Yesterday, I received a comment (#4 on the post) and pingback on that article from Daulton Gatto, who states that he is unrelated to Mike Gatto. The best writing is brief, so in that respect, Gatto’s comment succeeds. He uses the first twelve words of his comment to offer a brilliant insight into its author. Bravo.

The pingback is to his blog post, And Now, Another Episode of “Mike Gatto vs. the Bizarre Foreskin Crusaders”, which is in response to “Flawed Circumcision Defense: California Assemblyman Mike Gatto”. It’s a pretty good troll job, with plenty of ad hominem and not a word of rebuttal to my criticism of Mike Gatto’s flawed argument. It’s impressive. I suspect he’s having a laugh to amuse himself. Whatever. Taking it “seriously” will be interesting. The relevant part (graphic, immature, dudebro language, but you probably guessed that):

Which brings me to this piece of shit blog post, written by some crackpot wacko identified only as “Tony.” Tony is evidently a large pussy and a giant douchebag too frightened to admit full authorship of his own work and too stupid to employ anything resembling sound logic in his juvenile and laughable arguments. I will let his barely comprehensible babbling speak for itself while I cackle in laughter at the very suggestion that “Tony” is capable of recognizing a flawed argument in the first place.

In the meantime, I just want to once again explain on behalf of Mike Gatto and whatever cool dudes are still left in this douchebaggy world we live in just why it is that foreskin sucks and isn’t sweet at all.

Chicks much prefer dudes with circumcised dicks. Circumcised dicks get more pussy and they get to jizz on more chicks’ big tits. That’s a proven scientific fact. Mike Gatto, as a well-established sweet dude and charismatic stud, is clearly working harder to ensure the next generation of Californians get to fuck as many of the hot-ass chicks walking around this state as possible.

Now please tell me, “Tony,” just what the hell is wrong with that?

I’m not convinced by that long-winded version of “nuh-uh”. But it’s still sweet trolling ad hominem.

There is a question for me at the end. So, Daulton, just what the hell is wrong with that? You haven’t linked to anything suggesting this stunted fantasy is a scientific fact. Generalizations based on whatever gave you that limited worldview don’t eliminate the risks or direct harms from circumcision. They don’t discredit the human rights principle already in California law. You haven’t made any argument applicable to anyone other than yourself or someone who shares your particular preferences. That isn’t a valid basis for laws permitting the violation of the rights of others.

You did manage to link to a circumcision fetish website. It’s the same site with a history of endorsing¹ female genital cutting as a fetish. Good job.

If you have a coherent rebuttal, I’m willing to listen. If you only have more ad hominem, I’m always up for another good laugh. If your trolling was a limited, one-time engagement, thanks!

¹ The Internet is forever, no matter how vigorously Circlist’s operator(s) tried to hide the past with the content you see today. I’ll guess that research is a mysterious stranger to you. Convince me I shouldn’t guess that.