Update (5/31/2012): To the extent appropriate, my update to Part 1 applies here. I have not edited anything in this post, though. [End Update]
Note: Here is Part 1 of this series rebutting the recent meta-analysis purporting to demonstrate that infancy is the best time to impose circumcision on healthy males.
The interesting thing about the Brian Morris, Jake Waskett, et al article, “A ‘Snip’ in time: what is the best age to circumcise?”, is how reckless they are with their logic. They toss out information without regard for obvious rebuttals or how unrelated the so-called evidence is to their conclusion. If they think it might stick, they include it. One can only conclude that they started with the outcome of their analysis before gathering the supporting data.
For example, in their conclusion, they write that early circumcision “means an assurance of greatly reduced risk of penile cancer later in life, no smegma, better hygiene, and lower risk of various STIs.” They don’t include anything on why smegma is supposedly bad and thus indicates circumcision is not only good, but should be imposed on healthy infants. I’m sure they can find something, although I doubt it would be compelling. There’s also the logical question of why it’s an indication for non-therapeutic genital cutting on boys but not girls, who also develop smegma.
They continue this effort in their conclusion. In a sub-heading they write:
Some of the arguments against waiting until later to circumcise are:
• The cost (to the individual or the public purse) is much higher, and often unaffordable, for later circumcision.
The cost to the individual who doesn’t need circumcision later in life is zero. That population would be very large for males left intact. Even from the irrelevant “public purse” approach, they would need to calculate the cost of therapeutic circumcision paid for by they public later in life against the cost of non-therapeutic neonatal circumcision (cost per instance X number of instances). They don’t.
Also, the time value of money must be factored into the comparison. A dollar spent today is not the same as a dollar spent twenty, thirty, or more years from today. The number of adult circumcisions needed would have to be even greater to justify their public purse argument. It still wouldn’t be ethical to circumcise healthy infants, of course.
That’s not the worst “argument against waiting” they offer. This is:
• Educational resources for boys to make an informed decision are quite limited.
I had to read this several times to be certain it said what I read. They can’t be this ridiculous. They are.
The immediate, obvious rejection of that nonsense is that boys (and adult males) can use the same educational resources Morris, Waskett, et al suggest parents use to make an “informed” decision. Surely they exist, or else the position that parents can make an informed decision without adequate educational resources is irresponsible. What makes the male himself too stupid to understand the same materials? There’s no defense for their statement or their conclusions.
They offer a few more:
• Boys who later choose circumcision will likely wish it had been circumcised in infancy.
This is the bizarre argument I’ve encountered from Waskett, the mythical “right” to grow up circumcised. But this is the radical position. Boys who would later reject circumcision can’t undo the harm imposed on them. The authors incorrectly dismiss this. It is the center of both the physical and ethical argument against non-therapeutic child circumcision.
• Many older boys and men may not want to face an operation even though they wish to be circumcised.
That ties to a statement earlier in their article:
Even if a man is willing to be circumcised this does not mean he will end up having the procedure done. On the other hand, a lack of willingness to be circumcised should not be interpreted as a preference to be uncircumcised. This is because a large number of obstacles have been documented, such as fear of pain or complications, embarrassment, inconvenience and cost. The obstacles are discussed in the following sections. It is reasonable to suppose that, if these barriers could be addressed through the provision of correct information and financial assistance, the fraction of men willing to be circumcised would increase significantly. Better education of parents before or soon after their baby is born about actual risks should, by helping to ensure a circumcision in infancy, avoid later deliberations and barriers to circumcision in adolescence and adulthood.
That’s very convenient for their preference. Just assume anything that helps your position and disregard anything the suggests something else. Notice the shift in that paragraph. The last sentence of that paragraph has zero relation to the rest of the paragraph. A male’s refusal to be circumcised despite a claimed desire to be circumcised demonstrates that he values avoiding the costs more than receiving the benefits. The only reasonable supposition is that the infant would likewise be unwilling to undergo circumcision if left his choice. The authors’ suggestion is nonsense.
There is at least one more installment to come.
The very title of their paper, “A ‘Snip’ in time: what is the best age to circumcise?â€, attempts to move their readers past a very important question.
By fore WHEN, WHY should anyone be circumcised, period?
The standard of care for therapeutic surgery requires the medical benefits of the surgery to far outweigh the medical risks and harms, or for the surgery to correct a congenital abnormality. Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is unethical and inappropriate to perform surgery for therapeutic reasons where medical research has shown there to be other techniques to be at least as effective and less invasive.
Absent from this paper are non-surgical alternatives to achieving the so-called “benefits” of circumcision. But then, why should they, when they’ve already assumed the reader has moved past the “why” question?
When you analyze this paper, and when you analyze the body of “research” their names appear on, it is quite obvious that their interests are not in disease prevention, but in preserving a surgical procedure for which they display a morbid fascination.
It should interest readers to know these men’s interests and credentials.
Brian Morris is no expert on circumcision, but merely an enthusiastic circumcision fanatic of long standing. He neither holds degrees (nor genuine interests) in surgery, urology, pediatrics, nor epidemiology, and his field of study is only remotely related to medicine. He is in no way an authority on circumcision, much less male genitalia, child care, nor disease prevention. Why he thinks he has any authority to comment in these fields should baffle his readers.
Jake Waskett is not a doctor or medical professional of any kind. Waskett is a computer software engineer in his thirties with a history of circumfetishism (a sexual fixation for the circumcised penis, and/or sexual gratification from the act of circumcision itself). He is on record having a fixation for circumcision since he was 5 years old, and he is an avid gatekeeper for all circumcision-related articles at WikiPedia. Readers may notice that circumcision articles all have a pro-circumcision slant; this the sole person responsible. He will not let anyone who does not share a pro-circumcision bias edit circumcision-related articles at WikiPedia. The name “Jake Waskett” appears on recent papers regarding circumcision because he has won the favor of Morris and other circumcision advocates.
Some readers may conflate my pointing out of conflicts of interest with ad hominem.
The following has been taken from the ad hominem article at Wikipedia:
“Where a source seeks to convince by a claim of authority or by personal observation, identification of conflicts of interest are not ad hominem – it is generally well accepted that an “authority” needs to be objective and impartial, and that an audience can only evaluate information from a source if they know about conflicts of interest that may affect the objectivity of the source. Identification of a conflict of interest is appropriate, and concealment of a conflict of interest is a problem.”
Men cannot be trusted to deliberate soberly and sensibly the pros and cons of having foreskin, because intact men are usually foreskin fetishists. Hence intact men cannot be trusted to do what is best for themselves and society, namely to eliminate the foreskin. Therefore, parents are doing a good thing when they circumcise a baby boy at the start of life, when a boy cannot remember the experience and thus goes through life having no awareness of what it’s like to have foreskin. The extra sensitivity intact men enjoy is assumed to encourage antisocial behaviour.
The foreskin is obviously bad, because of “evidence.” That “evidence” consists of peer-reviewed articles in the medical literature, which are never wrong, right? And the interpretation of a published article is always straightforward, right?