Posted: December 30th, 2013 | Author: Tony | Filed under: "Voluntary", Ethics, FCD, Logic, Media Marketing | No Comments »
It won’t come as a surprise to read that I don’t think much of Yair Rosenberg’s lazy approach to analyzing non-therapeutic infant male circumcision. Add another example. This time he’s misreporting the findings of another meta-analysis by Brian Morris. Mr. Rosenberg quotes from a Daily Mail article that amounts to little more than a press release.
But first his introduction:
Across Europe, pushes to ban circumcision have rested on its supposedly deleterious effects on a child’s body, and lack of demonstrable benefits. Anne Lindboe, Sweden’s child welfare adviser, has gone so far as to label the practice “violence against children,” claiming that parents who perform it do so out of “ignorance.” She and her counterparts in Denmark and Finland have classified child circumcision as a “human rights violation” and called for it to be criminalized. A German court similarly banned the procedure on the grounds that it caused “bodily harm.” The only problem with these stances? They completely contradict everything science has found about circumcision’s impact on children’s health.
Findings of potential benefits from voluntary, adult male circumcision do not contradict the ethical, rights-based position against non-therapeutic infant male circumcision. Proxy consent is not the same as the consent given by adult volunteers to this permanent, irreversible surgery. Circumcising healthy minors violates their rights to bodily autonomy and integrity, just as any other permanent, non-therapeutic intervention is a violation. It’s the same principle that applies to even the tiniest, less-invasive-than-male-circumcision cut on a female minor’s genitals, which we’ve rightly criminalized. Potential benefits and human rights violation are not mutually exclusive. The presence of potential benefits does not eliminate the fatal ethical flaw. Nor does deciding that circumcision diminishing sexual function, sensitivity, or satisfaction is a “myth”, as Mr. Rosenberg claims of the new meta-analysis by Prof. Morris and Dr. John Krieger.
With that misguided frame, Mr. Rosenberg presents the study:
“The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction,” Professor Brian Morris told The Daily Mail. Morris and his co-author looked at 36 studies covering 40,473 men, half circumcised and half not. They ranked each in terms of scientific rigor and quality, according to accepted official guidelines. And they found that circumcision “had no overall adverse effect on penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, duration of intercourse, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration.” Indeed, after 24 months, 99.9 percent of men were satisfied with their circumcisions–and 72 percent said sensitivity had increased.
There’s a lot to unpack there. The largest point is that Mr. Rosenberg clearly didn’t read the 12 page paper because he regurgitates the results in the digestible (i.e. misleading) package given in the news article. Reading it might reduce his confirmation bias. There are enough obvious limitations, as well:
While the review considered a large body of evidence, there are some factors that may be influencing the findings.
For example, many studies were surveys, and the recruitment process for them is not described. It could be the case that men who have a satisfying sex life may be more willing to participate and answer questions on sexual performance and satisfaction that those who aren’t.
Also, most of the responses in the study are subjective, and what one person considers to be a sexual problem or sexual satisfaction, another might not. There may also be differences in the culture and ethnicity of the participants of certain studies, meaning that their findings cannot be so easily transferred elsewhere.
Beyond that, focus on the conclusion from the study. They state that their analysis suggests this conclusion. Suggests is not a synonym for proves. Yet, even though the Daily Mail article doesn’t use the word in quoting Morris, Mr. Rosenberg states:
Morris told The Daily Mail that he saw his study disproving circumcision’s adverse effects as complementary to those showing its benefits. …
He repeatedly misses the critical issue of consent versus force. In a previous article Mr. Rosenberg summarized a finding that “[i]t would have been unethical to continue without offering circumcision” to the remaining intact volunteers in a study with a simple statement that it would be “[u]nethical not to circumcise the men.” It appears that Mr. Rosenberg is not a reliable filter for news pertaining to circumcision.
There are obvious problems in the current meta-analysis. I will accept their methodology and reasoning as presented, which lead to their “suggests” conclusion. Assuming it is accurate, so what? The findings were not 100%. Of course, 99.9% is presented as essentially the same thing, which is even better than the result we’d expect from a dictator’s latest popular election. From the Krieger et al. Adult Male Circumcision study in Kenya ¹, 8.9% of circumcised men identified their penile sexual sensation as something other than “increased” or “the same” 24 months after circumcision. It’s ridiculous to pretend that these men don’t matter and that their experience should be ignored to allow a perceived universal defense for circumcising male minors.
Mr. Rosenberg concludes:
Yet the findings of science have done little thus far to deter Europeans politicians and health officials from seeking to criminalize circumcision, and labeling those who practice it “ignorant” and “barbaric.” It remains to be seen if this study will alter their course.
A utilitarian defense for violating human rights is ineffectual because the defense relies on using only a preferred subset of factors to reach a conclusion. “It’s mine” is a sufficient reason for a male to want his foreskin. He owns his foreskin as much as he owns any other part of his anatomy. Potential benefits valued by his parents are irrelevant while his body is healthy. Proxy consent for this non-therapeutic intervention is invalid because the net benefit or harm is subjective to the individual himself.
This is obvious if considering the question Morris and Krieger asked. Does male circumcision affect sexual function, sensitivity or satisfaction? In order, yes, maybe, and maybe. The findings suggest as much if we look at the participants in the included studies as individuals with their own unique tastes and preferences rather than as statistics. The paper’s focus is sex as a measurable number, which is an idiotic way to reach a conclusion about a subjective topic like human sexuality.
For sexual function, the foreskin is removed. That changes function. Maybe that’s “good”, maybe it’s “bad”. Each person must decide before circumcision what he thinks he wants. What his parents prefer is meaningless.
As for sensitivity, the results are equivocal. I’m willing to accept the negative findings as lower-quality studies for this purpose. But in a study Morris and Krieger rate as 2++, Payne et al , 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. …
Yet, for Morris and Krieger, this is support for their “suggests” conclusion because:
… More circumcised participants reported an increase in their level of sexual arousal, while more uncircumcised men reported being unaffected by the erotic stimulus. …
They want to believe, so they believe. That’s the only way I can reconcile the source study with their analysis.
In certain aspects sensitivity is quantifiable, but there is a an element of experience to human sexuality that a generalized “yes” or “no” here dismisses. That same element of experience, but without the ability to quantify in a utilitarian summary, exists in personal evaluations of satisfaction. This is why I don’t state that someone is wrong for preferring circumcision or believing it improves their experience of sex or life, in general. But that is also why it’s wrong for Morris, Krieger, Rosenberg, or anyone else to support parental choice (i.e. proxy consent) for non-therapeutic circumcision. Declaring one’s own preference as a truth applicable to someone else – without concern for the individual’s preference for himself – is the critical mistake inseparable from their argument.
One final point: It’s important to read the abstract and the study rather than just the abstract, even as a layman. Doing so reveals a lot of nuance, as the AAP’s revised position statement in 2012 so embarrassingly showed. It avoids the “It’s official!” conclusion too many (like Mr. Rosenberg here) want to staple to the evolving science involved in circumcision. The Payne  study is another example of the importance of this maxim, as are the remaining studies reviewed by Morris and Krieger, probably.
¹ Bracketed numbers correspond to the same-numbered footnote in the Morris/Krieger review.
Posted: October 11th, 2013 | Author: Tony | Filed under: "Voluntary", Control, Ethics, FCD, FGM, Logic, Media Marketing, Pain, Parenting, Science | No Comments »
At The Good Men Project Renee Lute makes a request: Please Respect Our Circum-Decision. It only requires a short response: No. Still, her essay is worth analyzing to explain why the only answer is “no”.
Circumcision on a healthy child is a permanent body alteration without the child’s consent. I’m under no obligation to respect that. I do not believe anyone should respect that. If Lute understood circumcision as well as she claims, she’d understand how absurd it is to request respect for her decision from someone who recognizes this surgical intervention as the human rights violation it is.
She is, of course, due a respectful rejection of her request. I will not engage in ad hominem, nor will I call her names as a result of what she intends to do. Anyway, facts and logic are enough to demonstrate her errors.
… I’m apologizing to [my unborn son] for writing this piece, because now the world will know just a little bit about the future state of his penis, and most little boys don’t have to deal with that. …
This common theme is strange. Intact genitals are the human default. Unnecessary intervention is the only reason the status of a child’s genitals is considered an issue if people know, as if knowing is a Big Deal. Or, rather, unnecessary intervention is the only reason the status of a boy’s genitals is considered an issue if people know. This bizarre reality is the result of intervening, not some inherent shame in having others know we have human genitals.
That gets to the reason why I won’t respect her and her husband’s decision for their unborn son. A daughter’s normal, healthy genitals are off-limits for surgical intervention, and rightly so. Those who recognize the ethics involved as gender-neutral must stand against the opinion that a son’s normal, healthy genitals can be subjected to surgical intervention. (There will be more on the valid comparison below.)
She discusses Mark Joseph Stern’s terrible Slate piece (my post) and Brian Earp’s reply at The Good Men Project. She writes:
Neither of these articles really threw me. I know the arguments against circumcision, and I know the arguments for circumcision. What did surprise me, however, was what I found in the comments section under The Good Men Project article. …
Never read the comments. We know that doesn’t mean “never read the comments”. But it’s a reminder that the Internet is a place for bad manners and emotional responses. That’s particularly true in comment sections. Discussion of circumcision is no different. I’m not excusing the behavior. The rude, hateful, and misogynistic garbage is wrong and needs to stop. But reasoned proponents of bodily integrity, as I aim to be, have our argument harmed only in the sense that someone is willing to generalize about those who disagree based on the miscreants that any group has.
… I am not a circumcision enthusiast. In fact, I could not care less whether other people circumcise their sons or not. Do it if you want! Don’t if you don’t want! But I am begging you—begging you—to not make families who choose to circumcise their sons feel like they are abusers of children, or human rights violators.
“Do it if you want! Don’t if you don’t want!” is the false argument. What does the child who will live with the circumcision want? That is the core. Without knowing what he will want, imposing it as a non-therapeutic intervention is a human rights violation. I suppose it’s unfortunate if that makes someone feel bad about circumcising their healthy son(s). But I recognize that my parents violated my rights when they circumcised me. I won’t pretend¹ that someone else circumcising their son isn’t violating his rights because stating a truth makes them feel bad about the choice they make. (I do not take a position on how individual males should feel about being circumcised.)
Why am I going to have my son circumcised? Because his father and I have done our reading. We’ve talked about it, and we’ve made our decision. There are legitimate reasons. Circumcision eliminates the risk of phimosis (in which a foreskin is tight and cannot be fully pulled back, which makes cleaning and passing urine difficult, and increases the risk of penile cancer). This affects 1 in 10 older boys and men. Circumcision reduces the risk of inflammation and infection of the head of the penis and the foreskin, and greatly reduces the risk of urinary tract infections in infants. Uncircumcised men have a 15-60% increased risk of prostate cancer (which affects 1 in 6 men).  We are not uneducated about circumcision. …
That last line is not necessarily true, given what comes before it in that paragraph. The sole source cited for this knowledge is a pamphlet by Brian Morris, which contains no sourcing of its own. (Some of the material in this excerpt is verbatim from Morris, without quotes to indicate as much.) It contains information that is biased and exaggerated.
To the claim that circumcision eliminates the risk of phimosis, this is incorrect. Contrary to the risk of phimosis being a “legitimate reason” to circumcise a healthy child, the ethical standard is that the risk of complications is a legitimate reason to refrain from intervening on a healthy child. Remember, too, that Brian Morris is the cited source for the 1 in 10 claim. He’s stated that all boys are born with phimosis, which is false. Even if the statistic is true, it is that phimosis will affect 1 in 10, not that it will require circumcision in 1 in 10. This mirrors his claim in the pamphlet that “the foreskin leads to 1 in 3 uncircumcised boys developing a condition requiring medical attention.” A condition requiring medical attention is not a synonym for circumcision. This is a rhetorical sleight of hand. The true incidence of medical need for circumcision within an intact male’s life is approximately 1%, which includes for phimosis.
As for the “15-60% increased risk of prostate cancer” statistic, that is a correlation, not a proven fact. “Circumcision before first sexual intercourse is associated with a reduction in the relative risk of PCa in this study population.” To quote the author, “‘These data suggest a biologically plausible mechanism through which circumcision may decrease the risk of prostate cancer,’ said study researcher Dr. Jonathan Wright, an assistant professor of urology at the University of Washington School of Medicine. He noted that the study was observational; it did not show a cause-and-effect link.”
… One of the aforementioned commenters wrote that anyone who would have their child circumcised should have to experience it themselves, first. Well, my husband has experienced it (and remarkably, he gave me his permission to tell the world just now), …
I don’t like that pointless suggestion because it invites that pointless rebuttal.
…and while I have not gone through the completely incomparable horror of female circumcision (I am not going to detail why it’s incomparable here, but I do encourage you to research the differences if you don’t know what they are. You’ll find some information here), …
I know what the differences are. I know what the similarities are. The difference is in degree, not in kind. That difference in degree can be great, of course, but non-therapeutic genital-cutting on an individual without the individual’s consent is not a gendered principle. The WHO defines female genital mutilation as “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.” The perceived difference², including in the link Lute provides, rests on what constitutes a medical versus non-medical reason. If we assume the “no known health benefits” argument against FGM turned into “known health benefits”, would people change their mind and decide it’s no longer mutilation? Some might say “yes”. They’d be wrong. I suspect most people would not change their conclusion. As the WHO states, FGM “also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.” That would still hold true if their were potential benefits. It holds true for male circumcision, as well.
… My husband and I aren’t unfamiliar with pain, and we are willing to put our child through a moment of discomfort for the benefits this procedure provides. Kind of like we’re willing to put our child through a moment of discomfort for the benefits that vaccinations provide.
But is their
child son willing to have the moment (i.e. 1+ week) of discomfort and a lifetime without his foreskin for the potential benefits this procedure provides? (Remember from above that the Lutes do not appear to understand the benefits.)
Circumcision is not like a vaccination. Vaccinations work with the body’s immune system to trigger disease resistance. Circumcision merely removes a part of the body because it might cause a problem later. The comparison needs critical thinking beyond “prevents disease”, lest we further open parental decision-making to other ridiculous interventions.
This piece is both explanatory and pleading. I am pleading with you. Don’t make these perfectly well intentioned families—like us—feel like monsters because you’ve decided to go a different way with your own sons. We’re doing something different, and that’s okay. We each have our reasons. I don’t care whether you breastfeed or formula feed. I don’t care whether you co-sleep or have your babies in their own cribs, and I don’t care whether you’ve named your child something completely traditional (like Kate) or whether she’ll be answering to Zenith for the rest of her life. I’m asking for the same courtesy.
It’s okay to do something different. It is not okay to do this something different. You can’t respect one right of your son less than the same right of his sister and brush it aside as “parenting”. If someone asks me to respectfully tell them they’re wrong, I agree with that request for decency. But I will not respect what is obviously indefensible and deeply offensive to basic human rights.
¹ I don’t call circumcision “abuse”. (c.f. Truth and Loaded Words)
² The other mistake is in thinking that FGM is designed to control sexuality, but that male circumcision isn’t and doesn’t. It controls male sexuality because it forces a specific form on the child for his genitals. (e.g. It’s more aesthetically appealing to women.)
There is also a history, up to the present, in circumcision reducing sexuality. Read Moses Maimonides or this.
Posted: September 19th, 2013 | Author: Tony | Filed under: "Voluntary", Ethics, FCD, FGM, Hygiene, Logic, Media Marketing, Parenting, Public Health, Science | 1 Comment »
It takes a special commitment to ignorance to cherry-pick evidence to prove that opponents cherry-pick evidence. Mark Joseph Stern possesses that special commitment.
There are facts about circumcision—but you won’t find them easily on the Internet. Parents looking for straightforward evidence about benefits and risks are less likely to stumble across the Centers for Disease Control and Prevention than Intact America, which confronts viewers with a screaming, bloodied infant and demands that hospitals “stop experimenting on baby boys.” Just a quick Google search away lies the Circumcision Complex, a website that speculates that circumcision leads to Oedipus and castration complexes, to say nothing of the practice’s alleged brutal physiological harms. If you do locate the rare rational and informed circumcision article, you’ll be assaulted by a vitriolic mob of commenters accusing the author of encouraging “genital mutilation.”
One paragraph in, and there’s so much to unpack. First, the obvious point is that Mr. Stern is another in a long line of lazy writers who thinks that the ability to type a word into Google proves much of anything for a story. If it’s just “a quick Google search away”, in a paragraph filled with links, it’s reasonable to expect an author to include the search he used to get to the evidence of alleged malfeasance. When I use Google to search circumcision, I get Wikiepdia, news articles, KidsHealth.org, the Mayo Clinic, the government’s Medline Plus, Intact America, Jewish Virtual Library, NOCIRC, and so on. I’ll point out that only the results for Intact America and NOCIRC are to something decidedly against non-therapeutic child circumcision, but so what? It’s a search algorithm. That’s easily gamed. It doesn’t prove Mr. Stern’s silly angle.
That “rare rational and informed circumcision article” is another in Hanna Rosin’s string of awful circumcision defenses.
As for the vitriol, this is the internet. Never read the comments. That doesn’t excuse the comments. They’re often offensive and uninformed and the people who engage in that behavior are wrong, even if they’re ostensibly on my side. But you’ll find them on both sides. It doesn’t prove anything on the argument. Using it as evidence against the argument is ad hominem.
So. There are facts about circumcision. Circumcision is the “surgical removal of the foreskin of males”. The foreskin is the “loose fold of skin that covers the glans of the penis”. Those are facts. But he’s implying the context of non-therapeutic male child circumcision. What should parents want?
Parents shouldn’t want anything, of course, because this is not their decision. Just like we don’t allow them to cut off any other normal body parts of their children, they do not possess a right to circumcise their sons for any reason other than immediate medical need that can’t be adequately resolved with less-invasive methods. Proxy consent is not sufficient for non-theratpeutic circumcision. But because our society doesn’t yet grasp the full implication of an equal right to bodily integrity, parents want information. Fortunately, there is scientific evidence against non-therapeutic circumcision!
The normal, healthy foreskin is normal and healthy. If parents leave it alone, as they should, statistics demonstrate that their son(s) will almost never need any intervention for his foreskin, and much less a medically-necessary circumcision.
Of every 1,000 boys who are circumcised:
- 20 to 30 will have a surgical complication, such as too much bleeding or infection in the area.
- 2 to 3 will have a more serious complication that needs more treatment. Examples include having too much skin removed or more serious bleeding.
- 2 will be admitted to hospital for a urinary tract infection (UTI) before they are one year old.
- About 10 babies may need to have the circumcision done again because of a poor result.
In rare cases, pain relief methods and medicines can cause side effects and complications. You should talk to your baby’s doctor about the possible risks.
Of every 1,000 boys who *are not* circumcised:
- 7 will be admitted to hospital for a UTI before they are one year old.
- 10 will have a circumcision later in life for medical reasons, such as a condition called phimosis. Phimosis is when the opening of the foreskin is scarred and narrow because of infections in the area that keep coming back. Older children who are circumcised may need a general anesthetic, and may have more complications than newborns.
Those numbers, from the Canadian Pediatric Society, are hardly compelling in favor of circumcising healthy children. Non-therapeutic circumcision prevents 5 boys (0.5%) from being admitted to a hospital with a UTI in the first year of life. Yet, between 20 and 30 (2-3%) boys will suffer a surgical complication, and another 2 to 3 (0.2-0.3%) will suffer a more serious complication.
The really curious statistic is the last in each group. About 10 (~1%) babies may need to have the circumcision done again due to a poor result. If normal, healthy boys are left with their normal, healthy foreskin, 10 (1%) of them will need a medically-necessary circumcision later in life. Those numbers look curiously similar.
So, to recap the facts in this context, circumcision is the permanent removal of a normal, healthy foreskin from a boy who can’t offer his consent to eliminate the 1% lifetime risk that he’ll need a circumcision.
There are other potential benefits, which Mr. Stern links in great detail. I have no problem including them, regardless of how weak or stupid I think they may be. That still isn’t enough to permit non-therapeutic child circumcision. The inputs into the decision are facts, but their value is not. Each person is an individual with his own preferences that his parents can’t know. What Mr. Stern values is not automatically what I value. Or to make the more appropriate connection, what parents value is not automatically what their son will value. That is why proxy consent requires a stricter standard than consent. A surgical decision that permanently alters a healthy child’s body can’t be permitted within proxy consent.
Mr. Stern writes this curious statement among many curious statements:
… Yet in the past two decades, a fringe group of self-proclaimed “intactivists” has hijacked the conversation, dismissing science, slamming reason, and tossing splenetic accusations at anyone who dares question their conspiracy theory. …
What a specific subset of people do is hardly the entirety of the argument or proof in favor of his position. Again, this is just silly, indefensible ad hominem. But what he says is also untrue. Dismissing science? Not here. I’ll accept any claimed benefit. The argument against forcing circumcision on a child is still as powerfully conclusive. Slamming reason? Stating that normal, healthy children should not undergo surgery is the position using reason. Conspiracy theory? Nope. Parents who circumcise, and people who support that option, are generally well-intentioned. I can show examples where that isn’t true, but I’m aware that such evidence is isolated. It’s surely true that some doctors circumcise for the money. I assume most circumcise because they believe it’s acceptable or believe parents should choose, even if the doctor wouldn’t. It’s important to understand how we got here, but I don’t much care about placing blame for that. I care about moving forward. There are any number of like-minded individuals Mr. Stern could find and talk to rather than write the wrong things he wrote.
… For doctors, circumcision remains a complex, delicate issue; for researchers, it’s an effective tool in the fight for global public health. But to intactivists, none of that matters. …
All of that matters. No one I know believes that adult (or older teen) males shouldn’t be able to volunteer for non-therapeutic circumcision.
Mr. Stern’s tactic here is what he’s complaining about. It’s similar to when Dr. Amy Tuteur goes on a tedious rant about “foreskin fetishists”. Smear your opponents because they smear you. “They”, of course. Internet comments are a part of humanity, not representative of it.
… The first rule of anti-circumcision activism, for instance, is to never, ever say circumcision: The movement prefers propaganda-style terms like male genital cutting and genital mutilation, the latter meant to invoke the odious practice of female genital mutilation. (Intactivists like to claim the two are equivalent, an utter falsity that is demeaning to victims of FGM.)
I’ve written circumcision a whole bunch above. But circumcision is genital cutting, because facts. The comparison is in the principle of those facts. Non-therapeutic genital cutting on a non-consenting individual is unethical. It’s also genital mutilation if we are to accept the WHO definition of female genital mutilation:
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.
… It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.
The issue is human rights, not a specific subset of human rights from which male minors are somehow exempt.
Anti-circumcision activists then deploy a two-pronged attack on some of humanity’s most persistent weaknesses: sexual insecurity and resentment of one’s parents. Your parents, you are told by the intactivists, mutilated you when you were a defenseless child, violating your human rights and your bodily integrity. Without your consent, they destroyed the most vital component of your penis, seriously reducing your sexual pleasure and permanently hobbling you with a maimed member. Anti-circumcision activists craft an almost cultic devotion to the mythical powers of the foreskin, claiming it is responsible for the majority of pleasure derived from any sexual encounter. Your foreskin, intactivists suggest, could have provided you with a life of satisfaction and joy. Without it, you are consigned to a pleasureless, colorless, possibly sexless existence.
Some take that approach. I only speak for myself on being unhappy with circumcision. I’ll quote myself on his generalization:
… The problem is not that circumcision is bad, per se. Healthy men who choose to have themselves circumcised are correct for their bodies. Men circumcised as infants who are happy (or indifferent) about being circumcised are also correct for their bodies. …
But if you only dive into comments sections, it’s easy to believe that’s the only opinion. It’s not excusable to believe that, but it’s easy.
Intactivists gain validity and a measure of mainstream acceptance through their sheer tenacity. Their most successful strategy is pure ubiquity, causing a casual observer to assume their strange fixations are widely accepted. Just check the comment section of any article pertaining to circumcision. …
Take, for example, the key rallying cry of intactivists: That circumcision seriously reduces penis sensitivity and thus sexual pleasure. …
My “key rallying cry” is that circumcision is medically unnecessary and violates the child’s basic rights to bodily integrity and autonomy. That holds up even if the rest of his paragraph’s citations hold up. Sexual satisfaction is a subjective evaluation to each individual. The ability to orgasm is not the full universe of sexual satisfaction. And any change to form changes function. The individual may view that change as good. He may view it as bad. Parents can’t know. That’s the ethical flaw in circumcising healthy minors.
… Study after …
Surely Mr. Stern read through the studies to understand exactly what they say. I have my doubts. I read it. That study is problematic when viewed as conclusively as Mr. Stern cites it. It requires nuance the study’s author provided. Does an appeal to authority sweep away any concerns about limitations?
… study after …
“Adult male circumcision does not adversely affect…” Is that proof that circumcision of male minors doesn’t affect sexual satisfaction, with the glaring caveat against surgery that such a male can’t know?
It’s also worth noting that Mr. Stern linked that same study again later in the paragraph. He also linked another study in consecutive sentences. And a third. That’s deceptive and improperly gives an impression about “an entire field of resarch”, no?
… ([No adverse effect] fits with what my colleague Emily Bazelon found when she asked readers for their circumcision stories a few years ago.) …
Ms. Bazelon’s premise and finding were ridiculous.
So much for circumcision’s supposedly crippling effect on sexual pleasure. But what about its effect on health? Intactivists like to call circumcision “medically unnecessary.” In reality, however, circumcision is an extremely effective preventive measure against global disease. …
The potential benefits don’t render non-therapeutic circumcision “medically necessary”. Earlier he complained about propaganda-style terms. Pretending that “medically unnecessary” doesn’t have an accepted, factual meaning is propaganda-style question begging.
… Circumcision lowers the risk of HIV acquisition in heterosexual men by about 60 to 70 percent. … [ed. note: (Later in this paragraph, he uses the WHO link again.]
The “60″ link states “male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence.” Not one of those three criteria matches a Western nation. Those studies also involved adult volunteers, not unconsenting minors.
As both a personal and public health matter, circumcision is clearly in men’s best interest. …
Ethically, as a personal health matter, each healthy individual should decide for himself what body alterations are in his best interest based on his own preferences.
… Anyway, to intactivists, mutilation is mutilation; what does it matter if it’s for the greater good?
“The greater good” doesn’t matter because individuals are humans with rights, not statistics to be treated without regard for what they need or want. Life is full of risks. Because we seemingly can mitigate that does not mean we may or should.
Posted: August 18th, 2013 | Author: Tony | Filed under: Media Marketing | No Comments »
Proponents of non-therapeutic infant circumcision are a curious group to me. Almost universally, I find them to be sincere in their belief that circumcision is beneficial, even though they are misguided for reasons based in objective facts. But I assume they’re well-intentioned rather than malicious. They don’t think circumcision harms. Even if I’m wrong about an individual’s approach and justifications, it’s both respectful and responsible to assume they’re well-intentioned rather than malicious. This is my standard.
University of Sydney Professor Brian Morris is a curious case within the curious group. I still think the above applies to him. I’m not quite sure why he makes the mistakes he does, though. He is prone to assign any criticism of non-therapeutic infant circumcision as fanatical lies. I believe he should’ve been educated in the course of his PhD work against making such disprovable declarations. Perhaps he was and missed its importance. I do not know.
That brings me to this otherwise irrelevant article on the question of whether or not Britain’s Prince George will be circumcised based on royal tradition. In the comments to the article, someone who appears to be Professor Morris commented on the article. To be fair, I can’t prove it’s Morris. The commenter logged in from a Facebook account, which includes what appear to be personal pictures of Professor Morris. The commenter’s writing appears similar to Professor Morris’ style. The evidence suggests a conclusion that the commenter is Professor Morris. But I work to avoid declaring what I can’t prove. I understand how declarative statements work and what they’re intended to do. Despite its clunkiness, I will attribute the comments to “the person claiming to be Professor Morris” rather than to “Professor Morris”.
Here’s the first comment on the story from the person claiming to be Professor Morris. It is why I link to the story.
Despite Dianna’s initial reluctance after her first baby was born, William and Harry were circumcised, in accordance with Royal tradition which Dianna acceded to.
I’ve seen no evidence supporting that claim. The article states that Princess Diana “reportedly would not allow her sons, William and Harry, to be circumcised.” I am, at best, marginally informed about royal gossip, so maybe there is evidence to support a claim that the consensus opinion is wrong. I don’t know. My point is that the “Princes William and Harry were circumcised” claim should have some support if the person claiming to be Professor Morris is willing to make it so definitive. When challenged, the person claiming to be Professor Morris responded:
William and Harry are almost certainly circumcised as is traditional in the British Royal family and upper classes. It is likely that Prince George is already as well, or soon will be. If there is genuine (‘undoctored’) photographic evidence to the contrary re William and Harry then please produce it. Otherwise what you say can be regarded as just another typical propaganda-based lie of circumcision opponents.
Now the person claiming to be Professor Morris says the princes were “almost certainly circumcised” rather than they “were circumcised”. Why make the original declarative statement? Or, why back off now? And notice how the person claiming to be Professor Morris demands photographic evidence that disproves his unsupported claim to demonstrate that the challenge isn’t “just another typical propaganda-based lie of circumcision opponents”.¹ The standard of fact employed here is only a one way requirement.
In response to a follow-up comment linking to ambiguous tabloid evidence, the person claiming to be Professor Morris responded (NSFW link at the original comment):
You have just proven to the world that Prince William IS circumcised.
Notice the return to a declarative statement. You may decide for yourself if the pictures are clear enough to warrant a declarative statement. You don’t have to bother. It isn’t important to my point because I’m interested in the “everything is pro-circumcision” argument offered in those comments by the person claiming to be Professor Morris.
The person claiming to be Professor Morris continued:
You haven’t examined the photographs adequately. The link of the fence gives the ILLUSION that it is the end of a foreskin, but a close look shows it isn’t, and you seem to be able to see the ridge of the glans.
The fence is an impediment, as is the distance of the photo. It’s a tabloid photo, not a documentary. Either theory could be defended on something in the photos. Just after saying it proves his point, the person claiming to be Professor Morris states that “you seem to be able to see the ridge of the glans”. Seeing the ridge of the glans proves nothing, especially in these unclear photos. A normal foreskin can be rolled back to expose the glans and possibly would be for urination. But to the person claiming to be Professor Morris, what you “seem to be able to see” is enough to justify a declarative statement. According to that approach, anything that supports circumcision is true, while anything that opposes circumcision is false. Contrary to the person claiming to be Professor Morris’ understanding, that is an actual example of propaganda, in the pejorative sense the comment quoted above intended.
¹ I am not a circumcision opponent. I oppose non-therapeutic genital-cutting (e.g. circumcision) on non-consenting patients, whatever their age or gender.
Posted: May 13th, 2013 | Author: Tony | Filed under: Media Marketing | No Comments »
Anyone who pays attention to circumcision in the news has seen some version of this silly attempt at “cute”, because “haha we’re talking about wieners, amirite”:
I’ve always disliked this image for the obvious reason that non-therapeutic child circumcision is neither cute nor funny. The image also irks me because it’s inaccurate. The reality would involve a banana that isn’t yet ripe. For example:
The visual also requires a look at the changes to the banana as it “matures” after removing part of its protective covering:
What’s left of the banana changes, which is a fair representation of circumcision.
All of this is a ridiculous simplification because that’s what the original image is. I don’t expect my images to do any significant work for me. They only show how the original “circumcised” banana is a distraction. Non-therapeutic child circumcision is an ethical violation that deserves better than a superficial image that doesn’t tell the truth.
¹ I re-read Hanna Rosin’s drivel in “The Case Against the Case Against Circumcision”. I dismantled it in “Hanna Rosin Is Still Wrong On Circumcision, Revisited“. My primary point struck me again when re-reading the Rosin opinion piece. She cribbed straight from Edgar Schoen and Brian Morris, with no apparent research from a person who doesn’t vigorously advocate for circumcising healthy infants. She started with her conclusion and packed a bizarre subset of facts, omissions, and distortions into that neat box.
Posted: February 25th, 2013 | Author: Tony | Filed under: Ethics, Media Marketing, Mission | No Comments »
There’s a circumcision flowchart floating around that needs to be addressed. Here it is:
It fails from the start. The right first question is “Is there a medical problem with the foreskin?”, or something similar. That will get the circumcision decision process started.
“Do you have a penis?” is never a relevant question. It’s a sexist approach that fails to promote the critical, universal genital integrity rights involved. Fathers and mothers are equally capable of offering good and bad arguments on non-therapeutic child circumcision. We must address individuals, not generalizations. The latter leaves us making ineffective arguments to proponents who might be willing to change their mind to protect their son(s).
To put it in perspective, am I not allowed to denounce non-therapeutic female genital cutting because I don’t have labia or a clitoris? The idea is ridiculous. The human rights issue is first. We’re all capable of using our intellect and reason to understand genital integrity. Let’s use them and expect others to do the same.
If we start with awful premises, we interfere with our objective of protecting the bodies and rights of children. If we promote the idea that some people are inferior, they will tune us out when we state that all people should be treated equally. Please, stop promoting this flowchart. We can be better than this. We must be.
P.S. Shut up also needs to go.
Posted: February 11th, 2013 | Author: Tony | Filed under: "Voluntary", HIV, Media Marketing, Public Health | 3 Comments »
Anyone familiar with the way voluntary, adult male circumcision is being promoted as a way to reduce the risk of female-to-male HIV transmission in high-risk populations already knows how it’s promoted. The brochure excludes context-specific qualifiers. That mouthful in the first sentence is always shortened to “circumcision reduces the risk of HIV”, even though that broad statement isn’t supported by the studies. In addition, voluntary, adult male circumcision loses words over time. Adult was the first word to go. Voluntary is still used, but that word doesn’t mean what it’s used to represent. Consent must only come from the patient when the circumcision is non-therapeutic. Absent that consent, the surgery shouldn’t be imposed on a healthy minor. In a discrediting move, no one adheres to that. It took six days from the 2006 release of the major HIV study on voluntary, adult circumcision in Africa for the U.N. to propose targeting infants first among all males in HIV-ravaged parts of Africa. Perpetuating circumcision via physical indoctrination is the new standard. Voluntary disappeared a long time ago as anything more than a marketing word.
I do not wish to suggest I think this is a conspiracy. Public health officials believe they are acting nobly. A well-meaning focus on one’s own preferences explains this at least as well. We must do something to reduce HIV. Circumcision is something. Therefore, we should circumcise. That’s bad logic, and relies too heavily on the nonsensical idea that someone happy with being circumcised proves everyone will be happy being circumcised. It treats the individual as a tool to achieve some public goal. That’s mistaken but it seems rooted in good intentions.
Now, knowing all of this, I’m difficult to surprise with how public health officials promote circumcision. I expect dumb, offensive strategies. I still can’t believe this from the opening of a new circumcision clinic at Tshepong Hospital in Klerksdorp, South Africa:
The clinic is called Gola Monna, or “Grow up Man” in Setswana. Its founder, Dr Limakatso Lebina, said: “This clinic will circumcise men and will ensure that they have lifelong partial protection against HIV.
“The removal of the foreskin clearly can’t stop all HIV infections but it certainly prevents most. [ed. note: dangerous misinformation] We tell all the men that we circumcise that they must continue to condomise,” she said.
Asked why women should be included, Dr Lebina explained: “Women should be involved in decisions about getting a safe circumcision. As mothers of boys and partners of men, they must ensure that the males in their lives are protected from HIV”
A quick pause to note how easily both adult and voluntary are missing as concepts in Dr. Lebina’s approach. This is more curious because MEC Dr. Magome Masike said that “communities must encourage men aged from 15 to 45 to come to this new clinic for circumcision.” A newborn male is not a man.
This, though, is absurd and offensive:
She added: “There is data to show women prefer circumcised men.[¹] So take a Valentine’s day decision to get a love cut and come in for male circumcision at the clinic.”
Rather than “voluntary” male circumcision, we have a “love cut”. This is no different than asking opponents “why do you want people to get HIV?,” as if one can’t be opposed to both non-voluntary forced circumcision and the transmission of HIV. Here, Dr. Lebina implies that an intact man who won’t have himself circumcised doesn’t love his partner as much as someone who would have himself circumcised. It’s preposterous. It also encourages parents to circumcise their sons because they love them. That’s twisted. Circumcision is not a gift.
Public policy needs to return to voluntary, adult male circumcision and mean it. Euphemisms like this, however well-intentioned, are Orwellian distortions that hide the ethical issues from those promoting and from those deciding on circumcision.
¹ The standard “women prefer circumcised men” is as expected here as it is irrelevant. Women (and men) are entitled to prefer whatever they want from a partner. They are not entitled to have it. What a partner prefers does not require a person to agree to have it done. Preference does not excuse imposing it on an individual in response to or as speculation about what a current or future partner prefers about his genitals.
Posted: February 6th, 2013 | Author: Tony | Filed under: Ethics, FGM, Law, Media Marketing, Public Health | No Comments »
Today is International Day of Zero Tolerance to Female Genital Mutilation. The WHO statement on this is lacking, which I don’t find surprising. (emphasis added)
The International Day of Zero Tolerance to Female Genital Mutilation is observed each year to raise awareness about this practice. Female genital mutilation of any type has been recognized as a harmful practice and violation of the human rights of girls and women. WHO is committed to the elimination of female genital mutilation within a generation and is focusing on advocacy, research and guidance for health professionals and health systems.
Female genital mutilation (FGM) refers to all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. Female genital mutilation has no known health benefits. On the contrary, it is associated with a series of short and long-term risks to both physical, mental and sexual health and well-being.
FGM is affecting about 140 million girls and women, and more than 3 million girls are at risk every year. A special focus for WHO this year, is the troubling trend of health-care providers increasingly being the ones performing female genital mutilation, and thereby contributing to legitimize and maintain the practice.
Today, I’m not going to discuss the comparison to male circumcision beyond the one inherent in this sentence. I am going to use WHO’s approach to male circumcision to compare why its last sentence shouldn’t be a surprise.
Stating that FGM has no known health benefits works from the premise that the possibility of benefits could justify FGM. No benefit could justify forced FGC (i.e. mutilation). The human rights principle is superior. WHO should state that as its foundation, and be consistent and repetitive. In reminding readers about this lack of benefits, WHO almost apologizes for being against FGM. The absence of benefits is not why this shouldn’t be done.
Think back to when the AAP issued a revised policy statement on FGC, later retracted. As I wrote here and here, I didn’t/don’t think it said what people read into it. But the reaction was universal and swift. On the idea that permitting limited forms of genital cutting could prevent greater harm to females, activists stood on the absolute principle. Whether or not this makes sense is a worthwhile discussion. (My posts linked above set out my thoughts on the issue. The principle still matters more.) Regardless, that incident demonstrates that activists would never excuse FGC/M if benefits were proposed or found. Can anyone imagine a scenario where any scientific committee allowed research into possible benefits? For those inclined to accept possible benefits as a justification, everyone else must discourage this thinking. Lazy statements that lack the courage to defends what is morally and ethically correct fail that goal.
WHO’s approach, which informs its stance on male circumcision, enables the predictable problems described in the last sentence. Because the organization refuses to stand for principle where courage is necessary, it creates the conflict of legitimizing genital cutting through “medical” male circumcision programs. I know of no populations that cut females that don’t also cut males. So, WHO drives campaigns to legitimize genital cutting while driving campaigns to delegitimize genital cutting. The flaw is obvious. The principle and consistency matter.
Posted: November 12th, 2012 | Author: Tony | Filed under: Ethics, Logic, Media Marketing, Mission | No Comments »
If you’ve read my work here (or on Twitter) for any length of time, you know that I don’t agree (e.g.) with every tactic used to argue for genital integrity. I’m not arrogant enough to assume I’m always correct, but my experience has to inform the means I endorse in pursuit of the necessary, noble goal. Where I think we’re making mistakes, particularly predictably ineffective mistakes, I speak out. I know enough people within the genital integrity movement to know that the principled, decent strategy is the most common.
That said, I’m not willing to paint broadly based on the actions of individuals. This can be either good or bad actions. One person expressing an idiotic excuse for circumcision do not mean everyone who shares a characteristic would defend that excuse. I do this because it’s fair and because I do not want this approach applied to me. It will always be possible to find genital integrity activists who engage in inexcusable behavior, such as anti-Semitism. I can make my case without that, as can most activists. Principles and tactics are associated, but the former exists apart from the latter.
This is why the website The Case Against Intactivism frustrates me so greatly. It is run by blogger “paper0airplane”, who is against routine infant circumcision while lumping any bad behavior by those opposed to circumcision into the “intactivism” category. This is wrong. For example, I spoke out when issue #2 of “Foreskin Man” appeared, long before it made news during the San Francisco ballot initiative in mid-2011. I was not alone. Should we all be blamed for this comic book, or are individual – sometimes egregious – mistakes inevitable in any decentralized movement? The answer is obviously the latter, but paper0airplane consistently writes as if it’s the former. That is what I wish to reject here.
In July paper0airplane posted this:
… My opinion also hasn’t changed. I do not circumcise, I don’t think circumcision is necessary. I also do not approve of the tactics used by intactivists, and were they to change those tactics, I would support them wholeheartedly. Much like the rabid pro-life crowd, intactivists generally resort to appeals to emotion, twisting of facts, offering up studies (that they haven’t even read) claiming they say one thing, when in fact they do not (relying, instead, on the fact that many will not actually read the study, simply providing one counts as support of their argument), sometimes outright lying. That includes setting up studies in such a way as to pre-determine the outcome. These are things that I disagree with, and will continue to disagree with. Since most intactivists, instead of actually reading my site objectively, believe that I am actually pro-circumcision and that my site advocates for circumcision, I’m attacked quite often. …
People who can be classified as intactivists cannot be neatly stuffed into a box labeled “Endorses These Tactics”. I am an intactivist, although what I wrote in 2006 still holds. The term intactivist is cute and descriptive, but because it’s cute, I do not like it. It does little more than give reporters an excuse to fill in stories with details at which typical readers will roll their eyes. That’s not helpful. The term has gained wider acceptance, but it’s still treated in much the same way in many places. And paper0airplane uses it as a convenient stereotype.
So, from that July post, in order:
- Generally suggests stereotyping. That should be a signal that the critique is shaky. Not necessarily flawed, but evidence is required and should be drawn from and applied to the person(s) using the criticized tactic.
- Appeals to emotion as a tactic is the least effective approach. Those who use it exclusively need to expand their repertoire. But its use, even exclusively by some, says nothing about intactivism as a whole.
- I do not twist facts. Grinding this axe with a blunt dismissal of all rather than against the few who deserve it impedes my efforts. If paper0airplane insists on grouping everyone together, prove that I’m the hack caricature with examples. Otherwise, I’m left to assume that paper0airplane is a lazy thinker and writer. (The body of work that assumes any intactivist is all intactivists is evidence of this.)
- I do not defend studies I know to be flawed. I’ve long held that the “estimated number of deaths” study is flawed¹. Conversely, I’ve also demonstrated that the “circumcision makes no difference to sexual sensitivity/satisfaction” studies are flawed. Should this count as an argument against all proponents of child circumcision or just those who fallaciously treat this issue as settled science based on these flawed studies? There are proponents who are very much lying propagandists. There are also proponents who are sincere and honest but insufficiently informed. I prefer to deal with who is in front of me rather than the worst of everyone I’ve ever encountered.
- I’ve read enough to know that paper0airplane is opposed to routine infant circumcision. I also know that paper0airplane defends ritual circumcision. I disagree with this because the arguments against non-therapeutic circumcision, both ethical and scientific, apply to males born to religious parents. I do not wish to imply that change will be easy, only that change is necessary, as various reforms throughout history have been necessary. We are not at the pinnacle of balancing religion and rights. (More on this in another post.)
Going back to paper0airplane’s first post, this:
There are many many very reasonable people that label themselves intactivist. They’re nice people are are just as interested in the truth as you or I. Unfortunately, the loudmouths at the front are doing all the damage. They color public perception of what intactivism is. I think we can greatly reduce the number of circumcisions without being total A-Holes or alienating all our circumcising friends and family. Without being bullies. Because that’s what intactivists are represented by. Bullys. To the reasonable people that label themselves intactivist, I beg you! Find another way to label yourself! People will be more likely to listen if you don’t have to carry the intactivist baggage around.
This paragraph demonstrates my point. There are intactivists who use problematic and/or unethical tactics. Again, this is inevitable in any decentralized movement, just as one can easily find examples of the same among circumcision proponents. It’s possible to challenge, refute, and/or discredit “the loudmouths” without dismissing everyone by stereotyping on the behavior of a subset. I wish paper0airplane would make that effort instead of indiscriminately smearing good and bad activists as the same.
¹ While this study is not something I trust or cite, the number of deaths from non-therapeutic child circumcision is objectively non-zero. That is a fact. How many deaths from non-therapeutic genital cutting on a non-consenting minor do we need before we can demonstrate the ethical case against prophylactic child circumcision? The mere risk of one is enough, but one death is certainly too many. I suspect paper0airplane agrees, although that makes the accompanying defense of religious circumcision of children indefensible. Ritual circumcision of minors is no less an affront to human rights than cultural circumcision.
Posted: September 29th, 2012 | Author: Tony | Filed under: "Voluntary", Logic, Media Marketing, Science | No Comments »
I want to revisit the AAP’s technical report accompanying its revised circumcision policy statement. In the Ethical Issues section, on page 760, this:
… Parents who are considering deferring circumcision should be explicitly informed that circumcision performed later in life has increased risks and costs. Furthermore, deferral of the procedure also requires longer healing time than if performed during the newborn period and requires sexual abstinence during healing. …
This is so often repeated that it’s simply become the accepted truth about voluntary adult circumcision. It should be questioned¹. Does circumcision require a longer healing time in adults than if it’s forced on infants? Evidence suggests this is overblown, at best.
From a 1999 paper by Daniel T. Halperin, PhD and Dr. Robert C. Bailey, “Male circumcision and HIV infection: 10 years and counting”:
By avoiding this issue althogether (sic, medical professionals and public-health authorities may inadvertently be harming the very individuals whom they are trying to help. As increasing numbers of men and boys turn to circumcision as perceived protection from AIDS, many will be exposed to harm by untrained practitioners who use unsafe methods. Yet, contrary to some popular misconceptions, safe and inexpensive male circumcision is routinely performed in developing countries in clinical settings. The procedure is normally performed on an outpatient basis with local anaesthesia, and most men return to light work activities the next day.
From the Brian Morris et al. paper I didn’t like, in the “Absence from work or school” section on Page 10 (pdf):
Unlike the convenience of circumcising a baby that (sic) sleeps most of the time and is a dependent in society, circumcision during productive work or school years will typically require taking time off, although the amount of time off required is typically small. In one study of men circumcised with the Shang Ring device, men took an average of 1.1 days off work; 80% were back at work by day 2, with only 20% requiring more than 2 days, and little disruption to activities or discomfort was reported for the week the ring was in place . Eighteen percent of men in the study reported disruption to their work while the device was present, and 30% had not resumed routine leisure activities by 7 days. In the large Kenyan RCT, only 4% of men required 3 days or more before they could return to normal activities . In a study of childhood MC, median times of 5 days to return to normal activity and 7 to return to school have been reported . This may have been because children are usually more active than adults, thus increasing the chances of injury and so prolonging the healing period.
It’s also interesting that the AAP’s claim is unsourced in the technical report. On what evidence do they claim that adult (i.e. deferred) circumcision requires a longer healing time than infant circumcision? It doesn’t seem to be an accurate statement.
¹ The claim that it costs more should also be questioned. If nothing else, the time value of money must be factored in. The several hundred dollars saved now (that will accumulate) must be compared to the present value of the future cost. The unlikelihood of needing circumcision must also be included. If adult circumcision costs 10x more but is only performed in 8% of males, the net effect is that it’s cheaper. No results from such an analysis would change the sufficient ethical argument against non-therapeutic infant circumcision.