Month: March 2007

This is the last one for the day, I promise.

Earlier today I asked whether or not new findings on HIV prevention might generate an “Oops?” from circumcision advocates. I’ll ask again:

Men with HIV who get circumcised hoping they will be less likely to transmit the AIDS virus may have a greater-than-normal risk of infecting their partners if they resume sexual activity too soon after the operation.

That observation — drawn from preliminary analysis of a study in Uganda — threatens to complicate efforts to tout circumcision as a new weapon against HIV in Africa.

The men in question already had HIV when circumcised. There should be no surprise that they can infect their female partners. Perhaps it’s surprising that the risk is greater than normal, but the bottom line is that the eventuality of infection is a given. Circumcision will only delay the inevitable. This coincides with the truth that responsible, safe sex practices are the only prevention, whether the individuals involved are intact or circumcised, HIV-positive or HIV-negative.

Instead, we’re left with this sentiment¹:

Specifically, it suggests that public health campaigns promoting circumcision must also include messages, directed principally at women, warning of the extreme hazard of intercourse with HIV-positive men who have just had the procedure.

There were obvious reasons not to rush head-first, unthinking into promoting circumcision before these findings. Researchers, politicians, and parents didn’t want to hear this before. Will they now, even though these efforts should’ve been seen as complicated from the beginning, with adequate restraint applied?

¹ Full Disclosure: I exchanged e-mails with the reporter for this story, David Brown, after he wrote a story on circumcision and HIV prevention in August. We had a brief exchange, but my questions were inadequately addressed. Our disagreement partially focused on this statement about the educational approach needed. From that article:

It would also require drawing a clear distinction between that procedure and the misleadingly named “female circumcision,” a form of ritual mutilation with no medical benefit.

The FGM issue is more complex than the simple view that women are mutilated to damage their sexuality while men are mutilated to provide them with medical benefits. That begs addressing the specific issue of male circumcision with a skeptical eye. Instead, he seemed to approach the complex ethical and scientific aspects of male circumcision with the same faulty assumptions accepted by society in general, even when the facts we discussed contradicted his statements. This is not surprising, but it’s also not advisable for a reporter, in my opinion.

Unlike the scientists, politicians, and parents who couldn’t wait to proclaim victory when a few studies showed a correlation between the male foreskin and HIV infection, I will not make bold pronouncements about these findings.

Researchers have discovered that cells in the mucosal lining of human genitalia produce a protein that “eats up” invading HIV — possibly keeping the spread of the AIDS more contained than it might otherwise be.

Even more important, enhancing the activity of this protein, called Langerin, could be a potent new way to curtail the transmission of the virus that causes AIDS, the Dutch scientists added.

Langerin is produced by Langerhans cells, which form a web-like network in skin and mucosa. This network is one of the first structures HIV confronts as it attempts to infect its host.

However, “we observed that Langerin is able to scavenge viruses from the surrounding environment, thereby preventing infection,” said lead researcher Teunis Geijtenbeek, an immunologist researcher at Vrije University Medical Center in Amsterdam.

You’ll recall, of course, that the primary “benefit” of male circumcision as a defense against HIV is that it removes many Langerhans cells. Read through most of the articles in the last year or so on this topic and you’ll see “scientists believe”. Not “scientists know,” but “scientists believe”. Oops?

The question mark on the end of my last sentence is intentional. I have no idea how substantial this research is, or whether it can be replicated. I’m willing to read this last qualification in the story and understand that life is often more complicated than controlled findings.

[Dr. Jeffrey Laurence, director of the Laboratory for AIDS Virus Research at the Weill Cornell Medical College] did offer one note of caution, however.

“In the test tube, this is a very important finding,” he said. “But there are many things in the test tube that don’t occur when you get into an animal or a human. Having said that, though, this is a very intriguing finding.”

Instead of the glee that my viewpoint is now supported, I’ll approach this with caution, the same way circumcision supporters should approach the recent findings on HIV. I suspect the difference is that I know I don’t need science to validate my stance. I’m correct before we get to the science. Circumcision advocates rush to every justification. Why?

But looking at the science, we’re finding information in the short-term. It’s reassuring to project that information long-term, but we must remain open to the possibility that we’re wrong. That is true of any new discovery, but it should be required when the decision is to alter a human body. We should add another, higher standard because that body does not belong to us.

If researchers verify these new findings through real-world tests, will anyone apologize for rushing to circumcise as many males as possible? The answer is an obvious “no”. Those now advocating circumcision will still fall back on the tried-and-true defenses. We’ll okay some version of “alright, it’s not important, but still…“. I can accept that if someone makes decisions about his own body and life. I can’t accept that when someone makes it about someone else’s body and life. But still… isn’t enough.

Last week, Townhall published this essay by Michael Medved regarding circumcision and recent findings about its presumed HIV prevention. Lest you think it’s meant to be a balanced look at circumcision, in the sense that any argument that attempts to validate an insane idea against the critical opposition of logic, it’s not. But you’re probably aware of Michael Medved in general, so this comes as no surprise. If you don’t know in advance, the first paragraph signals his intentions. (Yes, that’s what an opening remark is supposed to do, but it doesn’t help if it’s a flawed assumption.)

For more than ten years, medical science has provided mounting evidence that circumcision brings substantial health benefits. Last week, the release of data from the National Institutes of Health (NIH) made worldwide headlines and gave new impetus for an ancient practice.

When an article begins by explaining that some new justification exists for an ancient practice, you know the writer is uninterested in questioning. In that case, the potential medical benefits are enough, the potential medical drawbacks don’t exist, and it’s preposterous to consider that the child might have a right not to be surgically altered on the whim of his parents. Mr. Medved doesn’t “disappoint,” in that regard. As support, he quotes only this:

“Look,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which financed the trials. “This is a one-time, permanent intervention that’s safe when done under the appropriate medical conditions. If we had an AIDS vaccine that was performing as well as this, it would be the talk of the town.”

Ethical questions do not exist. He is not alone in this erroneous view, but this best exemplifies it. The mere presence of the word permanent should raise every red flag imaginable, whether ethical, legal, or parental. Instead, it’s seen as the greatest benefit. It’s blind.

In the middle of his essay and in his conclusion, Mr. Medved offers a religious defense which warrants a response. It’s not where I want to go with my analysis today, so I’ll point anyone interested here. Apply what I said then to this piece and you’ll have close to what I’d say now. There’s a little more that needs to be said on Mr. Medved’s conclusion, but that’s for another day. For now, you can figure out the gist from my analysis of his opening paragraph.

Instead, I want to highlight this bit of misdirection:

Meanwhile, there are various factors about this horrible plague of AIDS that deserve special attention from all those who take Scripture seriously.

For many years, we’ve known that the best way to contract AIDS is to engage in a practice (male homosexual “intercourse”) strictly prohibited by the Bible.

Now we learn that one of the best ways to protect against the disease is to follow a procedure solemnly commanded in the Bible (circumcision).

I have no idea if his misdirection is intentional or not. I’ve seen it in too many places recently to automatically assume that it’s malicious. It’s likely the same mental blindness that blocks out any negative while seeking to confirm existing beliefs. Regardless, the studies we’ve seen so far only addressed heterosexual HIV transmission from female to male. It’s his prerogative to believe that the Bible has issues with such “intercourse”. But it’s indefensible to apply unproven results to excuse genital surgery on children, especially when the majority of those children will never engage in the unconnected behavior he finds so repulsive and sinful. This does not reveal the wisdom of the Bible. It reveals the fallacy of self-selected facts.

P.S. Note how he states that engaging in an action is the best way to contract AIDS HIV, without the proper qualification that irresponsibly engaging in that action is the cause. Excluding that key, irresponsibility, allows him to ignore the best protection, responsibility. Instead, unnecessary surgery on children is the answer. That’s quite convenient. In the realm of his essay, HIV prevention is an excuse, not a benefit.

From yesterday, this article discusses the factors that play into the parental decision to circumcise or leave their sons intact. It’s mostly accurate, although it tries a bit too hard to be balanced and unbiased in countering clear logic. I understand that the logic is not accepted by society, but that doesn’t change its objective truth.

That’s not what interests me. This does:

The opinions of friends and Berkeley, Calif., neighbors Judith Barish and Denise Leto epitomize the controversy.
…

Barish, a stay-at-home mother of an 8-year-old daughter and two boys ages 3 and 6, decided on circumcision. Although she says the medical reasons at the time were not altogether compelling, the decision was made for other reasons. “Our children are half Jewish. We debated the issue and really looked into it,” she says. “The medical benefits versus the risk seemed like a wash. But ultimately we decided to circumcise as one small concession to religion and culture.”

“Whether a boy is circumcised or not doesn’t matter so much,” she says. “He can be healthy, happy and love his penis either way.”

It’s more appropriate to let the male decide whether or not they approve of that concession, since they’re the ones losing part of their body. Also, they should decide whether or not the concession is “small”. Parents may teach their children their religion, but they do not have the right to practice their religion on the bodies of their children.

To Mrs. Barish’s last point, I’m sure her sons will be fine with being circumcised. Most males are conditioned that way in our society. But to a boy who doesn’t like it, a proclamation from his parents that he can love his penis either way is the wrong analysis. If the boy doesn’t love the permanent change his parents imposed, he’s out of luck. There is no other way for him. What Mrs. Barish is really saying is that a boy should “be healthy, happy, and love his penis” the way his parents choose. That is a flawed basis for decisions regarding medically-unnecessary surgery.