Author: Tony

Why I Skim The Daily Dish

I still have Andrew Sullivan’s blog in my RSS reader, but only as a way to stay informed on what’s happening. Most days I only skim it, not carefully. Where he used to be open to questions, however scattered he may have bounced around on his emotional responses, now he usually exhibits a single with-me-or-against-me attitude. In anticipation of Brown’s victory in yesterday’s special election for the Massachusetts Senate seat previously held by Ted Kennedy, Sullivan wrote (emphasis in original):

The second explanation is the Brooks/Noonan theory that somehow everything feels wrong to the Independent or conservative-leaning voters. They have an instinctual fear of more government and, even though the Senate bill couldn’t be more minimalist within the confines of expanding access and controlling costs, this gnaws at them. I think this is a legitimate feeling (I have it too) – but an illegitimate argument.

Look: the markets conservatives have believed in have failed.

As the more honest conservatives (Greenspan, Posner, Bartlett) have noted, the financial crisis was a clear indicator that we need a more active and vigilant government in regulating the financial sector. And when you look at the results of America’s hybrid and dysfunctional healthcare system, it is more than clear that the status quo is unsustainable. Yes, this system has pioneered amazing breakthroughs and a pharmaceutical revolution that has transformed lives. But the cost and inefficiency of this is simply staggering. Look at the graph above. If you think it’s great, support the GOP. They don’t want to change anything, but a few tweaks.

Which part of America’s hybrid and dysfunctional health care system proves that the market has failed? It’s an interesting claim, but it’s not an argument. It’s a silly analysis of what the market should provide and how much it should cost. There’s nothing objective here. There’s only the expectation that we all agree that the government is the only way to fix the market failure of our hybrid health care system. As he writes later in his post:

At least Obama seems interested in government. The GOP seems interested only in politics and rhetoric that can sustain the bubble of deep denial they live in.

Obama and the rest of the Democrats are interested in government as the solution, which is the wrong approach. It’s easy to suggest that government will be reformed in the process, but that’s a rather nonsensical assurance when the problem is systemic in our interest-driven political system. Wishful thinking will not stop the flow of special handouts and exemptions that result with government involvement.

There’s a complex case to be debated, which hasn’t happened because it’s easier to spew anecdotes as universal fact. It’s easier to write “…Tea Partiers are just opposing the working poor having a chance to buy health insurance,” as Sullivan wrote in November, than it is to confront a group’s objections. In fairness, Sullivan has questioned what Republicans would do instead. But assuming indifference and malice in the face of silence is unhelpful speculation.

This is not to endorse the Republican approach. I find the party to be devoid of any value, which is to say I hold Democrats and Republicans in equal esteem. Nor am I endorsing Senator-elect Brown as a beacon of principled leadership newly arrived in Washington. From the little I’ve read, he’s more of the same, defending torture by the American government, for example. But him not having a coherent or satisfactory answer on the current Senate and House health care bills does not equate with there being no coherent or satisfactory rebuttals to the current bills. As Mark at The League of Ordinary Gentlemen wrote:

It is increasingly frustrating to me that, for many supporters of Obama, any belief that the existing health care reform bills will do more harm than good is automatically written off as being in bad faith or, as it were, “nihilistic.”

I believe I’ve advocated here that any health care reform aimed at reducing costs must start with untangling health care from employment. An individual’s employer is no more responsible for her health than it is for insuring her automobile or home. It’s a holdover from the ridiculous tax rates of the World War II-era, where offering health insurance as an employment benefit was economically wise. Rather than fix the rates, government enshrined the concept in tax law. That was stupid, but it worked when people worked at a single company for life. Today it’s uncommon to have had only a single employer by age 30. If we don’t fix that broken government-provided incentive, we’ll continue to have people lose their health insurance when they lose their jobs.

The current legislation keeps that tie, but punishes indiscriminately for receiving “too much” of a benefit. That’s just doubling down on the madness of the past, thinking that government can fix what government broke by adding more government. It’s the nonsensical thinking of the central planner, the kind who believes that anything that isn’t what it should be in a hybrid market is clear proof that the market has failed, requiring more of the planner’s expertise.

To show that other ideas exist, Megan McArdle offers her suggestion:

Raise the Medicare tax by half a percentage point, and eliminate the tax-deductibiity of health insurance benefits for people making more than $150K a year in household income, $100K for singles. Then make the federal government the insurer of last resort. Any medical expenses more than 15% or 20% of household income, get picked up by Uncle Sam.

I’m not a fan of this because it still messes with the tax code, encouraging employers and employees to tinker with non-cash compensation for borderline salaries. Other people may want that approach, but I’d rather have cash and make my own decisions. Social engineering is not good. For example, a $100k threshold means different realities in D.C. versus Omaha. It’s a lot of money either way, but that punishes people unfairly in areas with a higher cost of living. The tax code would need to be more complicated to rectify this problem, which proves the need to simplify away from government trying to influence “correct” decisions.

That said, I’m willing to consider it as an opening to ridding the tax code of the health insurance exemption.

So, alternative ideas clearly exist. But it’s easier for Sullivan to vent, lumping everyone who disagrees with him into a tidy, immature opposition. In a later post yesterday, he wrote in a post titled “A Libertarian Revolt?” (emphasis in original):

Since so much of the energy behind the Brown candidacy seems to be driven by anti-government sentiment, why is someone like me – who actually criticized Bush for being big government long before these late-comers – so dismayed?

Here’s why. The rage is adolescent. It did not exist when the Republicans were in power and exploded government during years of economic growth. Fox News backed Bush to the hilt through it all, as he added mounds of unfunded entitlements to the next generation’s debt, and then brought Beck in as soon as Obama inherited the mess. Scott Brown, moreover, has no plans to cut the debt or control government: none. He is running in d
efense of every cent in Medicare. He wants to increase the deficit by more tax cuts. He favors an all-powerful executive branch that can suspend habeas corpus and torture people. He has no intention of cutting defense. His position on the uninsured is: get your own states to help. His position on soaring healthcare costs is: stop the first attempt to control them.

We hear Karl Rove lamenting big government! We hear Dick Cheney worrying about deficits! The cynicism here is gob-smacking. And the libertarian right is just happy to go along.

Like I said, I don’t endorse Brown for these reasons. If I lived in Massachusetts, I wouldn’t have voted for him or Coakley in yesterday’s election. So why am I lumped into the nihilist group because I’m a libertarian who thinks the current health care bills would cause harm to the nation? Sullivan is aware enough to understand that Libertarians ≠ Republicans, yet he pretends they’re synonymous without looking at what libertarians offer because both groups oppose the solution he wants. It’s unfair to rant incomprehensibly against something that is clearly untrue. One might say it’s adolescent, which is why The Daily Dish is no longer must reading for me.

Our Security Makes Me Afraid

This:

The man who is believed to have slipped into a secured area of Newark Liberty International Airport and to have caused a six-hour shutdown of a major terminal on Sunday has been arrested, Port Authority officials said on Friday night.
…

Mr. [Haisong] Jiang’s arrest [on a charge of defiant trespass] came a day after a video showing security footage of the incident was released by Mr. Lautenberg. It shows a man in a light-colored jacket standing near where arriving passengers exit a secured part of the airport. When a security guard leaves his post, the man embraces a woman and slips across the rope into the secured part of the terminal. The two then walk away together.

I don’t have much to say on the facts of the case. I haven’t seen the video, so I can’t decide whether or not the Mr. Jiang’s alleged actions were intentional. Instead, I want to comment on this:

The security guard has been on administrative leave since Tuesday, and he faces disciplinary action, according to the Transportation Security Administration. Derrick F. Thomas, a national vice president with union representing the guard, told The A.P. that the guard has “been rated a model employee.”

While in high school, I worked at a drug store. One day, the assistant manager in charge of the store during my shift left for approximately 30 minutes to run personal errands. She left a senior clerk in charge. If my memory is correct, that clerk was a high school student like me. Nothing occurred at the store during her absence. The next time I reported to work, I learned the manager had fired the assistant manager for her action.

If secure restricted areas of an airport demands attention and scrutiny to each individual entering, as we’re told it does, what’s less severe here than what occurred at a drug store twenty years ago that makes administrative leave appropriate rather than immediate dismissal?

My initial conclusion is to accept the obvious distinction. The drug store was a private enterprise. The TSA is a government entity. The former requires accountability. The latter can’t. I’m inclined to be skeptical of this conclusion, since I don’t wish to be an ideologue. Then I read this (via KipEsquire):

A bystander waiting for an arriving passenger noticed the breach and told the guard. TSA officials then discovered that surveillance cameras at the security checkpoint had not recorded the breach and were forced to consult backup security cameras operated by Continental Airlines.

There could be any number of issues why such a lapse might occur, technical or otherwise. None of them are acceptable. This is security theater, not security. And we’re doubling down on our stupidity with every new, predictable incident.

Science Requires Ethics, Part 3

Jake responded to my last entry in our ongoing series. (My first and second entries.) I’ll just jump in. Addressing my view that he is a pro-circumcision advocate, Jake writes:

I find this a rather peculiar statement. I suppose in a sense that any attempt to weigh benefits against risks will have some subjective qualities, and perhaps that can’t be avoided altogether. However, as subjective values are meaningless to another person I would hope that most observers try as objective as is reasonably possible. I certainly try; I can only hope that I succeed.

I am uninterested in convincing or encouraging parents to circumcise their sons, and have been careful to avoid making a recommendation either way. Anyone sufficiently interested (not to mention patient) can verify this by working through the many thousands of my public comments over the years – I use the same name everywhere, so it is not difficult to find them via Google. Indeed, I believe that such advocacy would be contrary to my pro-parental choice position: I genuinely believe that parents should make that decision, not me.

Unlike my perception of many individuals I’ve encountered when discussing circumcision, I believe that Jake advocates parental choice with the intention he states, which is that I think he accepts the decision by parents who do not choose to circumcise their sons. Many parental choice advocates do not believe that decision is valid in their parental choice worldview. In that respect, my saying that Jake “uses his conclusion to encourage parents to circumcise” was incorrect.

Rather, I believe that he is effectively a pro-circumcision advocate because he views his assessment of circumcision as containing some level of objectivity. It can’t, just as my assessment can’t. The difference between our views, I think, is that mine involves the child’s opinion, placing it above that of his parents.

I don’t have an opinion on circumcision, per se. I think it’s an odd choice for a healthy male to make, but that’s the lens of my preferences and experience. Jake has his own opinion, which is clear from his choice to have himself circumcised as an adult. Again, I think that’s odd, but my opinion on that is irrelevant because his choice is valid for him.

On the topic before us, though, the focus of infant circumcision must be infant circumcision, not infant circumcision. I write from the former, while I believe Jake writes from the latter. That difference is why I claim that his conclusion is subjective and incomplete.

Next, Jake considers my take on an appeal to authority:

My first inclination was to agree, but on reflection I think it would depend on the situation. Consider the following hypothetical scenario:

PERSON A: Circumcision is awful because the AAP don’t recommend it.
AAP: [Introduces a recommendation in favour of circumcision]
PERSON A: Oh, the AAP are biased, ignore them.

Here the appeal to authority is utterly invalid. It is quite apparent that it is a sham: the AAP are being presented as an authority merely because the person hopes to gain an advantage by doing so. The person clearly has no integrity, nor any credibility, and can and should be ignored. …

This scenario is close to what I considered. Although I wouldn’t go as far as Jake does in condemning the person’s integrity without more information, it is the response I predict any person to have to the scenario and why I despise appeals to authority.

Even though Jake’s first scenario exemplified my point, his second scenario is instructive:

… Now consider this:

PERSON A: Circumcision is awful because the AAP don’t recommend it.
AAP: [Introduces a recommendation in favour of circumcision]
PERSON A: Okay, the AAP now recommend it, so it’s okay.

In this situation, it seems to me that this is a valid appeal to authority, in that the person is willing to adapt their position once the authority changes theirs.

I disagree, again because the focus of the appeal is infant circumcision, not circumcision. It’s an abdication of judgment in favor of someone else’s conclusion. If Person A is the individual being circumcised, I am indifferent to his acceptance of the authority’s conclusion and judgment. That’s not what’s at stake.

It’s possible to make this too broad. I am not suggesting that expert opinion is worthless or should be ignored. I am saying that, when the focus is on infant circumcision, and specifically the circumcision of healthy infants, citing the authority’s subjective conclusion of a net benefit (or neutrality) is a diversion from the individual child’s lack of need and possible preference for keeping his normal foreskin. The AAP is relatively neutral today, and I contend they’re wrong because they ignore facts (out of philosophical ignorance).

Next, on circumcision versus vaccination:

I see: Tony applies a different standard for surgery and vaccinations. This doesn’t make much sense to me, for several reasons. Firstly, from an admittedly pedantic point of view, is there really that much of a difference? Surgery involves risk. Vaccinations involve risk. Surgery involves cutting the skin. Vaccinations (as delivered by a needle) also involve cutting the skin, albeit in a minor way. So I have to ask, where exactly would you draw the line?

Secondly, does it make sense to create multiple standards? To my mind, no. But I may be biased: I’m trained as an engineer, and when I observe lots of different little rules I see a situation in which there ought to be one, more general rule. Special cases are usually an indication that the general rule needs some more attention. Maybe one shouldn’t apply engineering principles to ethics. I don’t know, but I can’t see any reason why one shouldn’t…

Yes, there is a difference. Surgery removes a healthy, functioning body part. Vaccination does not. I draw the line between them for that primary reason. So, yes, it makes sense to create multiple standards.

In turn, it doesn’t make sense to create multiple standards for boys versus girls for the same parental activity and justifications. Later, in response to my view that anti-FGM laws would not be overturned if female genital cutting was shown to have potential benefits, Jake writes:

In an ideal world, I wish I could say that anti-FGC laws would indeed be overturned if scientific knowledge changed significantly. However, I’m sorry to say that Tony is probably right in that they wouldn’t be. I don’t think that this has anything to do with rights, though: it’s a simple case of collective prejudice. The notion that FGC is horrific is deeply ingrained into modern, Western society, and it takes an awful lot to dislodge that notion. I know this from personal experience: I have to make a conscious effort to think about FGC objectively, and have to fight the knee-jerk reaction. And I consider myself very open-minded.

I accept that circumcision can have potential benefits. I am opposed to prohylactic¹ infant genital cutting because pursuing these potential benefits for an individual who can’t consent is unethical. It is unethical because there are real and potential harms. Jake is wrong in his view because he is valuing science in a manner that leaves it insufficiently tethered to ethics. It’s a view that, because we can achieve something, it is ethically valid to pursue it. I find that approach abhorrent. It gives parents the choice to pursue an option that is not theirs to pursue. Their opinion must be subordinate to the objective facts of their child’s healthy body.

To my point that adults can choose condoms and that parents can’t know if their sons will be irresponsible
, Jake replies:

To both points, I agree. Nevertheless, it seems difficult to deny that if it were performed during infancy, circumcision would help to reduce this risk when the child became an adult.

I’m not denying that it might help reduce this risk, but it requires a specific, low-risk, low-probability situation to be effective. The choice of surgery to chase a miniscule benefit must be left to the individual.

Of course, it’s worth a reminder that the studies in Africa involved adult volunteers. Leaving aside the ethical difference, declaring that circumcision would help males (especially Western males) circumcised as infants is speculation. There are more variables involved, including the foreskin’s adherence to the glans in infants and the prevalence of HIV in the society.

In response to my review of his opinion on “most effective/least invasive”:

Here I believe Tony has misunderstood, or at least has not considered the issue with sufficient care. If there is a medical problem to address, then the physician’s responsibility is to solve that problem while exposing the patient to the least risk. That’s the essence of the “most effective/least invasive” standard. But if there is no medical reason for considering circumcision, then it is meaningless to even consider the “most effective” solution. If circumcision is being considered for non-medical reasons then it is in all probability the only solution to the problem (that being that the child is not circumcised). So it is the wrong standard to apply.

I believe I’ve understood him correctly. He is wrong. If there is no medical reason (i.e. need) for circumcision, it’s unacceptable to permit it on children. Normal genitals are not a “problem,” no matter how opposed the boy’s parents are to his normal genitals. I repeat my earlier criticism: Jake is begging the question he wants to answer. Medical need is the standard for proxy consent to surgery. Without medical need, the process stops. No intervention is valid.

Next:

At this point Tony declined to list ‘”surgeries we recognize as offensive” that are valid when benefits and risks are properly weighed’, stating:

I am not citing any particular science or surgeries because that was not my point.

This is a shame. I had hoped that Tony would at least try. I cannot think of any, and my suspicion is that this is because none exist. And if none exist, then Tony’s earlier objection that “Setting the ability to chase potential benefits as the ethical standard opens the range of allegedly valid parental interventions to include any number of surgeries we recognize as offensive” seems a rather empty objection.

Immediately following my objection, I wrote that “I am attacking a way of thinking,” which is to say that I reject the notion that because we can achieve a potential benefit, it is ethically valid to pursue it. At its core, prophylactic infant circumcision is about chasing potential benefits. I reject that for the multitude of reasons I’ve presented. Speculating that I did not cite any because none exist is a straw man.

Citing “surgeries we recognize as offensive” is a pointless diversion. However, I’ll play along briefly. I nominate removing the breast buds from infant females to reduce their risk of breast cancer. I have no idea if this would work or it’s been studied in any manner. It doesn’t matter, because my point was to reject the thinking that believes a potential benefit may be chased. I suspect this would be offensive to most parents, as it almost always is when I raise it in debate. Non-essential, healthy, functioning breasts are different from non-essential, healthy, functioning foreskins, somehow. My guess is that Jake’s approach to this would be his utilitarianism, which would assess whether removing breast buds has a potential benefit. (Unless he has some objection I haven’t determined.) If it does in his evaluation, it is a valid choice for parents, even if only chosen by those few parents who don’t find it offensive. I reject that because the healthy girl may not want the intervention.

Next:

It is meaningful to compare female genital cutting to male genital cutting because, ethically, they involve the same issue. Unnecessary surgery on a non-consenting individual is wrong.

If you take that last sentence as axiomatic, then you will probably see the two issues as similar (although, presumably, there’s no reason to focus on genital surgery in particular). Those of us who adopt a different ethical principle – something like “harmful surgery on a non-consenting individual is wrong” see no problem with circumcision, and a problem with female genital cutting.

(I realize that I’m about to object to an issue of semantics in his axiom, but I’m certain I’ve gotten the gist of any future clarification correct.)

All surgery is harmful, including circumcision. It’s meant to achieve some benefit greater than the harm. Jake concludes that circumcision is, at worst, neutral. But that is his subjective evaluation. It is as irrelevant as my opinion that it is a net harm. Proxy consent is not valid for prophylactic infant circumcision because circumcising healthy infants is objective harm pursuing subjective benefits. Jake writes:

… Evaluation of potential benefits should not be dismissed as mere opinion. The literature contains a relatively large amount of data, which can be summarised in the form of objectively quantifiable data.

Potential benefits are based on objectively quantifiable data. Determining the value of applying those objectively quantifiable data to the objectively healthy penis of an infant male is subjective, mere opinion. Deriving an opinion is only valid for the male himself as applied to his body.

Finally:

There is an obvious double standard. Girls may not have their healthy genitals cut for any reason. Boys may have their healthy genitals cut for any reason. That’s the valid comparison.

That’s not even correct. Try getting a surgeon to perform a glansectomy on a healthy boy. Or castrate him. Or perform any number of other surgeries on his genitals. He or she will refuse. Most such surgeries are a net harm (except when actually needed, in which case the benefits are considerably greater, thus making them a net benefit), and cannot therefore be ethically performed. Circumcision is unusual precisely because it is a surgery which is neutral or (depending who you ask) a net benefit. And that’s why the reason for a specific circumcision doesn’t really matter.

I think it’s obvious that my declarative statement about genital cutting implied “as it’s commonly practiced in Western society,” which would preclude intentional glansectomy, for example. Moving on.

What Jake omits here is telling. Circumcision is neutral or a net benefit, according to him. He’s ruled out that prophylactic infant circumcision can be a net harm, the glaring mistake in his analysis.

A male who suffers a serious complication from circumcision would unquestionably qualify as experiencing a net harm. That risk is inherent in every circumcision. But leaving that aside, a “normal” circumcision has results. Evaluating those results, even if just on a cosmetic level, is a subjective process. There is no correct, objective way to evaluate a change, which is what circumcision is. All tastes and preferences are subjective to the individual. Even a preference regarding the potential health benefits of circumcision. The possibility of “No, thank you” is why infant circumcision is unethical.

¹ I am no less opposed to ritual infant circumcision. Discussing it in depth here would be a distraction. For a primer on my opinion, see here.

“Doesn’t everyone believe that it is evil to be selfish?”

Spoiler Alert: This entry includes a discussion of plot points from “The Fountainhead” and “Atlas Shrugged.”

In the New York Times Adam Kirsch reviewed Anne Heller’s new Ayn Rand biography, “Ayn Rand and the World She Made.” I have nothing to say regarding Heller’s book specifically because I haven’t read it yet. Here I wish to focus on Kirsch’s grasp on Ayn Rand’s two major novels. There is nothing to definitively suggest he hasn’t read them, although I suspect he hasn’t. There is plenty to prove that he hasn’t understood them if he has read them.

He reveals his ignorance in the first seven words of his review:

A specter is haunting the Republican Party — …

The implications of Atlas Shrugged and The Fountainhead are as relevant against the Republican Party as they are against the Democratic Party. Neither cares about anything beyond handing out favors to its preferred group of insiders in exchange for continued power. The individual is a tool to be manipulated for the party’s needs. Kirsch’s references to Whitaker Chambers and Wendell Willkie should’ve been enough for him to at least explore the validity of his thesis. Instead he cited the rantings of outrage-huckster straw man Glenn Beck, who is not a libertarian.

(Note: The term libertarian is the easiest way to represent liberty here. But Rand was an Objectivist, which is similar but not synonymous. See here, for example.)

Next, Kirsch attempts to summarize Rand (emphasis added):

And while it’s not hard to understand Rand’s revenge-fantasy appeal to those on the right, would-be Galts ought to hear the story Anne C. Heller has to tell in her dramatic and very timely biography, “Ayn Rand and the World She Made.”

“Going Galt” is likely a revenge fantasy to those claiming they will now “Go Galt” as a result of some offense by the Obama administration, but that doesn’t guarantee it reflects the meaning of what they’ve co-opted. First, Rand would’ve been no less an opponent of George W. Bush’s administration than she would’ve been of Obama’s. Or likely any other presidential administration since the publication of Atlas Shrugged because of the ever-growing control of the modern presidency (and legislature) over the choices of individuals.

More importantly, “Going Galt” is about withdrawing from a society that seeks only to act as a leech. Some of the words Rand gave to Galt:

There is a difference between our strike and all those you’ve practiced for centuries: our strike consists, not of making demands, but of granting them. We are evil, according to your morality. We have chosen not to harm you any longer. We are useless, according to your economics. We have chosen not to exploit you any longer. We are dangerous and to be shackled, according to your politics. We have chosen not to endanger you, nor to wear the shackles any longer. We are only an illusion, according to your philosophy. We have chosen not to blind you any longer and have left you free to face reality-the reality you wanted, the world as you see it now, a world without mind.

We have granted you everything you demanded of us, we who had always been the givers, but have only now understood it. We have no demands to present to you, no terms to bargain about, no compromise to reach. You have nothing to offer us. We do not need you.

Galt’s speech is “goodbye,” not “let’s negotiate a compromise.” But it’s only a goodbye to the world of moochers and looters, not from producing or living as he wishes. Galt’s Gulch was a society where men and women produced. This year’s “Going Galt” meme was about going idle. It is a reaction to the ongoing problem identified by Rand, but it is not her solution.

For one thing, it is far more interesting than anything in Rand’s novels. … The characters Rand created, on the other hand — like Galt or Howard Roark, the architect hero of “The Fountainhead” — are abstract principles set to moving and talking.

This is at once the failure and the making of Rand’s fiction. The plotting and characterization in her books may be vulgar and unbelievable, just as one would expect from the middling Holly­wood screenwriter she once was; but her message, while not necessarily more sophisticated, is magnified by the power of its absolute sincerity. …

Rand was a Romantic, which is why her characters “are abstract principles set to moving and talking.” I’ve heard it said (I forget by whom) that Rand was a 19th century writer in the 20th century. That’s an accurate description, but as a criticism from Kirsch, it’s purely subjective. The proper approach to criticism is to judge whether or not the literature works at what the writer attempted rather than whether or not the reviewer approves of the writer’s intent and/or method. Her ideas, which are what Kirsch attacks¹ in his essay, are not false simply because he perceives her characters as abstract principles.

Personally, I enjoyed Rand’s approach to both novels as literature. I found her characters and situations compelling and effective in achieving what she sought to present. However, she could not write sex scenes. The sexual relationships in both The Fountainhead and Atlas Shrugged suggest that she had a bizarre concept of sexual intimacy. Whatever she believed in her life, Roark’s rape of Dominique in The Fountainhead is an inexcusable error in her presentation of Howard Roark as an idealized man. She was not a perfect novelist never to be questioned.

Kirsch reveals his misunderstanding (or ignorance) of Rand’s novels in this paragraph:

Rand’s particular intellectual contribution, the thing that makes her so popular and so American, is the way she managed to mass market elitism — to convince so many people, especially young people, that they could be geniuses without being in any concrete way distinguished. Or, rather, that they could distinguish themselves by the ardor of their commitment to Rand’s teaching. The very form of her novels makes the same point: they are as cartoonish and sexed-up as any best seller, yet they are constantly suggesting that the reader who appreciates them is one of the elect.

In Atlas Shrugged there is a difference between John Galt and James Taggart, but there is also a difference between John Galt and Eddie Willers. Rand presented the idea that talent is real and identifiable, but also that, while everyone isn’t moral, anyone can be. Eddie Willers wasn’t invited to “Go Galt” because he wasn’t a creator, but he wasn’t despised because the heroes of Atlas Shrugged knew him to be moral who recognized the difference between producing and looting. Patronizing to the untalented moral man? Probably. Evidence that Rand believed everyone could be an elite? No.

Kirsch next engages in the type of cartoonish characterization he attributes to Rand’s novels. When discussing Rand’s process for writing and publishing Galt’s speech, he states (emphasis added):

… Rand labored for more than two years on Galt’s radio address near the end of “Atlas Shrugged” — a long paean to capitalism, individualism and selfishness that makes Gordon Gekko’s “Greed is good” sound like the Sermon on the Mount. … [Random House’s Bennett] Cerf offered Rand an alternative: if she gave up 7 cents per copy in royalties,
she could have the extra paper needed to print Galt’s oration. That she agreed is a sign of the great contradiction that haunts her writing and especially her life. Politically, Rand was committed to the idea that capitalism is the best form of social organization invented or conceivable. This was, perhaps, an understandable reaction against her childhood experience of Communism. …

Yet while Rand took to wearing a dollar-sign pin to advertise her love of capitalism, Heller makes clear that the author had no real affection for dollars themselves. Giving up her royalties to preserve her vision is something that no genuine capitalist, and few popular novelists, would have done. It is the act of an intellectual, of someone who believes that ideas matter more than lucre. In fact, as Heller shows, Rand had no more reverence for the actual businessmen she met than most intellectuals do. The problem was that, according to her own theories, the executives were supposed to be as creative and admirable as any artist or thinker. They were part of the fraternity of the gifted, whose strike, in “Atlas Shrugged,” brings the world to its knees.

Wall Street is a fine film, but it’s full of hogwash as an attempted refutation of capitalism. The movie is Oliver Stone’s half-understanding of “greed”, which is similar to the very common misunderstanding of Ayn Rand’s vision of “selfishness.” Advocates of capitalism don’t push it as the best form of social organization in order to create an enclave of Gordon Gekkos. It is the best form of social organization because it is based on voluntary exchange. Decentralized decision-making is better at discovering and meeting individual needs and desires. It is based on the realization that elites can’t possibly know what’s best for everyone or anyone.

A key facet of economics is that all tastes and preferences are subjective. Rand’s willingness to concede 7 cents per copy to keep Galt’s speech unaltered indicates only that she valued the presentation of her unedited work more than 7 cents per copy. It was a voluntary exchange, mutually beneficial to her and Random House. Suggesting that this is a contradiction of her philosophy, that no “genuine capitalist” would ever give up money, is a pejorative little different than suggesting that “no genuine Jew” would choose principle over pennies. Kirsch’s statement is a smear of lesser magnitude because his stereotype is more acceptable politically, but it is still a smear.

Rand presented her view of money in Atlas Shrugged, as spoken by Francisco d’Anconia in his speech on money. An excerpt relevant to Kirsch’s cartoonish mischaracterization of capitalists:

“So you think that money is the root of all evil?” said Francisco d’Anconia. “Have you ever asked what is the root of money? Money is a tool of exchange, which can’t exist unless there are goods produced and men able to produce them. Money is the material shape of the principle that men who wish to deal with one another must deal by trade and give value for value. Money is not the tool of the moochers, who claim your product by tears, or of the looters, who take it from you by force. Money is made possible only by the men who produce. Is this what you consider evil?

The notion that Rand’s only action consistent with her philosophy would be to hoard “lucre” reveals Kirsch’s ignorance of Rand. His disagreement with her does not disqualify him from critiquing her. Not understanding her novels or her philosophy does.

11/1 Update: The more I think about Adam Kirsch’s book review of Ayn Rand’s The Fountainhead and Atlas Shrugged Anne Heller’s Ayn Rand and the World She Made, the more I realize it was worse than I depicted. Rand explained what she thought of Kirsch’s idea of the “genuine capitalist” in The Fountainhead. His name was Gail Wynand, the news tycoon who published ideas he believed to be false in order to collect “lucre” from customers. Nothing was beyond Wynand’s preference for pennies over principle, as evidenced by his publishing Ellsworth Toohey’s words. In the novel’s conclusion, Wynand did not get what he wanted because he did not deserve it. He’d sacrificed himself for something smaller.

¹ Remember, though, that his essay is ostensibly a book review of a Rand biography.

Science Requires Ethics, Revisited

Jake Waskett responded to my critique of his entry about Intact America’s letter. I find it lacking.

… It’s a shame that he mischaracterises me as a “pro-circumcision advocate”, though (I’m pro-parental choice, not pro-circumcision).

I do not accept that I’ve mischaracterized his position as a pro-circumcision advocate. However, I’ll clarify to be as specific as possible. He believes the potential benefits of infant male circumcision outweigh the risks and negatives, a subjective conclusion based on his preferences. Given that he uses his conclusion to encourage parents to circumcise their sons, the difference he states is immaterial.

Next:

… has attempted a deconstruction of the letter, labeling it “propaganda”.

“Labelling” seems a curious choice of word, implying that the choice of term is dubious. Propaganda is defined as “The systematic propagation of a doctrine or cause or of information reflecting the views and interests of those advocating such a doctrine or cause.” Thus, it seems a perfectly appropriate choice of term for an advertisement created by an anti-circumcision organisation for the explicit purpose of promoting their cause to the AAP.

This is a matter of semantics versus intention. Definitionally, propaganda is an acceptable choice. It is also impossible to ignore the cultural implication of the use of the word. We do not think marketing when we hear it. Rather, we hear lies. That was the intent I perceived, which informed my response.

Still, it’s a minor point in the realm of this topic. Obsessing on it would be a diversion, so I retract the point.

Next, when I wrote that I agreed with the opening paragraph of Intact America’s letter, I stated that I’m not a fan of appeals to authority. Specifically:

As should be evident with the apparent intention of the CDC to recommend infant circumcision, it only takes one ill-conceived recommendation to distract from the core issue.

Jake writes that this is “utterly incomprehensible.” I’m not sure how, so I’m not sure how to clarify. If an authority cited directly (e.g. AAP) or indirectly (e.g. CDC) changes its position in a way that then conflicts with the original appeal, the appeal to authority may weaken the case for the target audience. It’s an ineffective strategy.

Despite my misgivings, Intact America structures the argument correctly because it identifies that core: ethics demand not imposing medically unnecessary surgery on normal, healthy children, regardless of gender or potential benefits.

Tony is, of course, free to subscribe to whatever system of ethics he so chooses. However, to my mind he is setting an extraordinary requirement: that an intervention should not merely be medically beneficial, but must actually be necessary. If applied consistently, such a standard would mean, for example, that vaccinations are unacceptable, since they are rarely necessary.

His assessment is close, but too neat for this complicated comparison. That is the requirement I set for proxy consent to surgery. The scenario for vaccinations differs. As I wrote before, the difference rests on how the problems the interventions are meant to prevent occur. Becoming infected with measles requires no effort other than participation in society, while acquiring HIV from an HIV+ female through vaginal intercourse requires a very specific action, an action not undertaken by infants. Later in his reply, he writes about this:

This is a nonsensical argument: it is absurd to analyse the issue as though children never grow up. Peter Pan is fiction. Children grow up to become adults, and yes, that includes having sex.

Of course, to which I reply as a start: condoms. Condoms are among the many possibilities short of circumcision as an infant available to adult males, including circumcision as an adult, to reduce the risk of HIV transmission.

Ultimately the comparison to vaccines must rest on diseases like HIV rather than the other potential benefits used to justify circumcision. They roughly share some of the same characteristics. The comparison fails because, as I wrote, the way in which the diseases spread differ. For most vaccines, it is the most effective and least invasive way to stop the spread of the targeted disease. With comparable diseases, circumcision is neither the most effective or the least invasive method available.

The risk of female-to-male HIV transmission through vaginal intercourse is a significant problem in Africa. In America HIV transmission risk through sex overwhelmingly involves male-to-male transmission, from which the (voluntary) circumcision of (adult) males has shown no statistically significant reduction.

Tony’s words are somewhat misleading here. There haven’t been any controlled trials of voluntary circumcision in MSM yet. The American studies to date have mostly compared previously (and probably neonatally) circumcised men with uncircumcised men. Some studies have shown a statistically significant reduction, but others have not.

Fair enough on precision. However, an implicit point in my argument here stands unaltered. Assuming voluntary adult circumcision is shown to reduce the risk of all forms of HIV transmission through sex, parents can’t know that their sons will be irresponsible and “need” this intervention. It’s a speculation that does not need to be made for a child. He can choose it later.

Responding to my declaration that surgical risks be weighed against objective (lack of) need rather than potential benefits, Jake replies:

As Tony correctly observes, the situation we’re discussing is not one in which there is an immediately pressing need for therapeutic intervention, hence the “most effective and least invasive” criteria for choosing that intervention do not apply. Instead, the situation involves a healthy child, much as with vaccinations. And as with vaccinations, we weigh the risks (adverse reaction) against the future benefits (reduction of risk of disease). Tony is of course free to apply his own ethical standard, but he should not be surprised that others choose not to follow him.

There is no need, so “most effective/least invasive” doesn’t apply? Jake is begging the question he wants to answer rather than addressing objective facts. He’s saying that the standard for surgical intervention on a child should be stricter when the child is sick than when he is healthy. Parents can be more speculative and exploratory with surgery for their healthy (male) children? That’s ridiculous. Without objective need for an intervention, proxy consent for surgery can’t be valid. With objective need, it can be valid because the child needs some form of decision made and he is incompetent to make that decision.

Setting the ability to chase potential benefits as the ethical standard opens the range of allegedly valid parental interventions to include any number of surgeries we recognize as offensive. The science becomes ungrounded by any concern for the individual child as an individual.

Unfortunately, Tony hasn’t identified any of these “surgeries we recognize as offensive” that are valid when benefits and risks are properly weighed. I would be interested to learn of any that he – or anyone else – can think of.

I am not citing any particular science or surgeries because that was not my point. I am attacking a way of thinking, particularly about the ethics of circumcising healthy children, but it applies more generally. Jake is a utilitarian. I am not, precisely beca
use of the way it permits his mixing of subjective criteria into a universal recommendation. I recognize that each person is an individual with different preferences and desires. Prophylactic (and ritual) circumcision violates that child’s rights.

But to his retort, if a study were to find potential health benefits for genital cutting in a study of adult female volunteers, would that be acceptable to apply to healthy female minors? I’ve had this discussion with Jake previously, so I know he’d have no problem with it if parents subjectively valued the benefits more than the risks. He is wrong. Society would be (correctly) outraged at the suggestion of violating the child’s rights in favor of her parents’ “rights”. Our anti-FGM laws would not be overturned. Those results would never be applied, regardless of the science.

Add to this the fact that parents treat the same maladies circumcision is supposed to prevent with less invasive, non-surgical methods when they affect their daughters, and Jake’s argument misses the ethical case against infant circumcision because he’s making the case for circumcision devoid of context and ethics. That’s a case that works only if it’s a voluntary decision by the adult male himself.

This paragraph makes no sense.

That paragraph is clear. We apply different standards to boys and girls. A female minor’s risk of UTI is higher than that of a male minor’s, yet we do not vigorously seek proof that genital cutting is the answer, nor, as I said above, would we apply it to infant girl if we could find such results. Now replace UTI with cancer. Ethically, we’d have the same approach to girls. Their genitals would be off-limits.

[Quotation of my words omitted]

If Tony had been paying attention, he would have noticed that I actually identified the three reasons why IA claimed that circumcision was unethical, and addressed each in turn.

As I’ve explained, Jake’s version of ethics is flawed because he values only his own opinion as a viable conclusion on the subjective topic. Proxy consent requires objectivity first. A passive-aggressive insult directed at my reading comprehension does not prove that I was wrong.

As a reminder, here is what IA claim: “Doctors have a responsibility to tell parents the truth: circumcision does not prevent disease. Most European nations, with circumcision rates near zero, have lower HIV/AIDS rates than the United States.”

As I read that, the second sentence seems to be presented as evidence for the first. If that is so, IA appear to be saying that the most definitive evidence can be found in between-country comparisons.

I read it a differently, based on the context of how the letter is organized. I will not defend the statement Jake objects to because I believe Intact America’s statement is poorly written. I read it as saying a) studies have found that (voluntary, adult) circumcision has been shown to reduce the risk of (female-to-male) HIV transmission and b) other similar countries that do not circumcise have lower HIV rates, therefore c) infant circumcision is not the answer. I made that point in my response. Doing so in the way that he did, it’s clear we’re using different interpretations. I do not think Jake is wrong to call out Intact America’s wording.

The risk factors among America’s population are similar to those of European nations, not African nations. Our risk is male-to-male transmission and shared needles during IV drug use.

If Tony is confident in his assertions, perhaps he will volunteer to have heterosexual intercourse with an HIV+ woman. Probably not, I suspect, because of course that’s a risk anywhere. The main difference, of course, is that the probability of exposure changes dramatically. Put bluntly, if you sleep with a person then your risk of acquiring HIV depends on the probability that they are HIV+.

Jake establishes a straw man here. I made a statement of fact about HIV transmission in the United States. His rebuttal is that I should be willing to have sex with an HIV+ woman because I state that voluntary, adult circumcision applied to infant males is not what we need. Presumably he means without a condom. Where have I said that unsafe sex – of any kind, with or without a foreskin – is wise? Jake’s scenario is a stupid diversion.

The complications of circumcision affect individuals. Those individual have rights. We recognize this for female minors, legislating against parental proxy consent for medically unnecessary genital surgery on daughters for any reason. The ethical argument against infant male circumcision involves the equal rights concept that the same protection should be applied to males. Waskett hasn’t yet made a coherent case for denying these rights to male minors.

It is not meaningful to compare female genital cutting to circumcision. Female genital cutting is a net harm, with no known medical benefits, immediate risks, and a considerable chance of permanent harm. Society passes laws to protect the vulnerable from harm, and so it makes sense to protect children from female genital cutting. But – applying the same principle – it doesn’t make sense to legislate against circumcision, because there is no net harm. Most reasonable people, weighing the risks and benefits, come to the conclusion that it is neutral or beneficial.

It is meaningful to compare female genital cutting to male genital cutting because, ethically, they involve the same issue. Unnecessary surgery on a non-consenting individual is wrong. America’s anti-FGM law makes no exemption for potential benefits or parental opinion. The former is, as Jake points out, not shown by studies. The latter is all that informs infant male circumcision, since an evaluation of potential benefits is opinion absent any objective indication for the child’s healthy genitals. There is an obvious double standard. Girls may not have their healthy genitals cut for any reason. Boys may have their healthy genitals cut for any reason. That’s the valid comparison.

To Jake’s claim of “no net harm” from male circumcision, I’ll repeat that it is a subjective evaluation. It is his opinion. I weigh the objective harms – scar, lost nerves, excised frenulum, asymmetrical suturing, altered functionality – from my “normal” circumcision differently than he weighs them from his (self-chosen) circumcision, but he is not me. As he was correct in deciding on circumcision for himself, I am correct in evaluating it differently for my body. Not Jake, not my parents, not “most reasonable people”, not whoever else he wishes to cite who approves of circumcision. That gets lost in his utilitarian disregard for ethics on a topic without a valid objective conclusion for his position.

Just Wait Until Government Gets Involved

I’ve mentioned a few times in my Twitter feed that I started playing hockey this fall for the first time. I’ve played a handful of games already, sustaining some form of injury in more than half of them. It hasn’t deterred me because I’ve discovered a love for the game. Unfortunately, though, my latest injury may be something more than a nagging reflection of my out-of-shape 36-year-old body. I fell in my most recent game, landing awkwardly on my wrist and hand. It’s now stiff, swollen and a strange shade of orange. After a few days, I finally acknowledged that machismo isn’t the best way to deal with it. So, today I went to the doctor.

I had to answer biographical questions with no bearing on getting an x-ray. I had to provide a photo id to be scanned, allegedly to prevent insurance fraud, as required by federal law. My doctor had to give me a prescription for extra-strength Advil, which I declined, if I wanted to take one pill instead of several. I’m sure there were other laws being followed that did not add to my medical care. What will it be like when the government gets involved?

When I get the bill for my doctor’s consultation and the x-ray services, I will be responsible for 100% of it in my high deductible health insurance plan because I haven’t met my deductible. I find that acceptable because I intentionally signed up for my plan. The deductible matches the cumulative annual premium for my previous policy. What will happen to my preferred plan since it is unlikely to include what Congress decides I need because it doesn’t provide a full range of services included for “free”?

The key, though, is my ability to get the care I needed. I scheduled my appointment yesterday afternoon, saw my doctor this morning, and got x-rays taken on a walk-up outpatient basis immediately after that. I’ll know tomorrow whether I’ve fractured anything. I have no doubt that I’ll be able to quickly receive any additional treatment I may need. Our current medical system costs money, but that timeline is not free. Congress is too far removed from individuals to determine that the trade-off between those two is incorrectly balanced. I doubt it cares. The potential outcome concerns me.

Hanna Rosin Is Still Wrong On Circumcision, Revisited

Hanna Rosin returns with another apologia showing her determination to remain blind to the ethics against infant circumcision.

… But now that I have done my homework, I’m sure I would do it again—even if I were not Jewish, didn’t believe in ritual, and judged only by cold, secular science.

First, interviewing and/or reading the websites of Edgar Schoen and Brian Morris is not doing one’s homework. They are pro-circumcision advocates who promote bizarre theories. Two of them appear nearly verbatim in Rosin’s essay.

On the larger point, she’s mistaken. Cold, secular science demonstrates that an infant male’s foreskin is healthy. Intervention is not indicated. The cold, secular science she refers to replaces ethics with utilitarian conclusions devoid of any concern for the child’s opinion. This is inexcusable where proxy consent is involved for a medically unnecessary surgical intervention.

There’s a lot of nonsense in this next paragraph, so I’ll unpack it slowly:

Every year, it seems, a new study confirms that the foreskin is pretty much like the appendix or the wisdom tooth—it is an evolutionary footnote that serves no purpose other than to incubate infections. …

No. Every year, it seems, a new study confirms that there is some other potential benefit to be chased for a minor risk. Very few studies have been done on whether or not the foreskin is an “evolutionary footnote that serves no purpose other than to incubate infections.” This is her bias creeping in. She doesn’t value the male foreskin, so it must have no value. This despite the clear evidence that the foreskin contains nerve endings, among the many facts that disprove her opinion. It’s an illogical avoidance of the issue involved. Only the individual can draw a subjective conclusion for himself such as the one Rosin presents.

… There’s no single overwhelming health reason to remove it, but there are a lot of smaller health reasons that add up. …

Again, this is her subjective evaluation because the boy’s health is the only objective fact involved.

… It’s not critical that any individual boy get circumcised. …

She ignores the idea of the child as an autonomous person with basic individual rights. The excuse will be the collective, which I’ll dismantle momentarily.

… For the growing number of people who feel hysterical at the thought, just don’t do it. …

This is the usual trope: If you don’t like circumcision, don’t circumcise your son(s). That dismisses the individual in favor of the notion that his parents’ have ownership interests in this part of their child’s son’s body. For the male who doesn’t want to be circumcised, his opinion is correct for his body. If he was healthy at the time of his circumcision, proxy consent was invalid. He can’t undo his parents’ decision (for their own subjective reasons).

… But don’t ruin it for the rest of us. …

Rosin is digging deeper into her self-absorbed approach to this topic, further proving the ownership mentality necessary for her stance to appear viable.

… It’s perfectly clear that on a grand public-health level, the more boys who get circumcised, the better it is for everyone.

It’s perfectly clear that on a grand public-health level, the more males who get circumcised, the better it is for everyone if our HIV epidemic ever begins to resemble the African epidemic relevant to the randomized controlled trials involving adult male volunteers that showed a reduction in the risk of female-to-male vaginal transmission. But the usual caveats apply. America’s HIV situation differs from Africa’s. STD transmission requires sexual activity, which excludes male minors from the target group. All other potential health benefits from infant male circumcision involve only risks to the individual and are not relevant to the collective public health angle Rosin peddles here.

Twenty years ago, this would have been a boring, obvious thing to say, like feed your baby rice cereal before bananas, or don’t smoke while pregnant. These days, in certain newly enlightened circles on the East and West Coasts, it puts you in league with Josef Mengele. Late this summer, when the New York Times reported that the U.S. Centers for Disease Control might consider promoting routine circumcision as a tool in the fight against AIDS, the vicious comments that ensued included references to mass genocide.

People who suggest mass genocide are idiots, but the ethical point stands. Without ethics, the cold, secular science Rosin presents would permit any number of offensive interventions. What could we study about cutting the genitals of adult female volunteers that we could then apply to healthy female minors at the request of their parents? How is that offensive suggestion suddenly rational when changing the gender from female to male?

There’s no use arguing with the anti-circ activists, who only got through the headline of this story before hunting down my e-mail and offering to pay for me to be genitally mutilated. …

This is ad hominem. I haven’t hunted down her e-mail. I’m not suggesting that she be genitally mutilated. Instead, I’m offering a logical, fact-based rebuttal to her personal opinions about what she wants the facts to be.

… But for those in the nervous middle, here is my best case for why you should do it. Biologists think the foreskin plays a critical role in the womb, protecting the penis as it is growing during the third month of gestation. Outside the womb, the best guess is that it once kept the penis safe from, say, low-hanging thorny branches. Nowadays, we have pants for that.

I’ve seen it before from Brian Morris¹, but I thought Rosin would be a bit less ridiculous. Instead, she repeats it as logic, as her best case, rather than dismissing it for the obvious nonsense it is. If the evolutionary purpose of the foreskin was to protect the penis from, say, low-hanging thorny branches, it’s purpose is not suddenly irrelevant because we wear pants. The foreskin’s purpose is to protect the penis, full stop. What it protects the penis from is a matter of circumstance particular to each male’s life, not the level of civilization of his time.

After rehashing some of the last 140 years of circumcision history, this:

… Circumcision, it turns out, could reduce the risk of HIV transmission by at least 60 percent, which, in Africa, adds up to 3 million lives saved over the next twenty years. …

Condoms, it turns out, could reduce the risk of HIV transmission by nearly 100%.

To the ethics, she omits that the studies involved adult volunteers. She hasn’t made the ethical case for why circumcision should be forced on non-sexually active infants.

These studies are not entirely relevant to the U.S. They apply only to female-to-male transmission, which is relatively rare here. But the results are so dramatic that people who work in AIDS prevention can’t ignore them. Daniel Halperin, an AIDS expert at the Harvard School of Public Health, has compared various countries, and the patterns are obvious. In a study of 28 nations, he found that low circumcision rates (fewer than 20 percent) match up with high HIV rates, and vice versa. Similar patterns are turning up in the U.S. as well. A team of researchers from the CDC and Johns Hopkins analyzed records of over 26,000 heterosexual African-American men who showed up at a Baltimore clinic for HIV testing and denied any drug use or homosexual contact. Among those with known HIV exposure, the ones who did turn ou
t to be HIV-positive were twice as likely to be uncircumcised. There’s no causal relationship here; foreskin does not cause HIV transmission. But researchers guess that foreskins are more susceptible to sores, and also have a high concentration of certain immune cells that are the main portals for HIV infection.

But the results are so dramatic that we must apparently discard our rational minds and circumcise infants to prevent a disease from spreading in the U.S. in a way that it doesn’t generally spread now. We must do this because researchers are guessing, and look, we have self-reported anecdotal data to rely on. She’s proven nothing by citing this.

Regarding the study of 28 nations, which 28 nations did Halperin choose? I can pick a group of countries that will show the opposite. The real problem is behavior, not anatomy. Rosin admits as much, indirectly, when she states that the foreskin does not cause HIV transmission. Remember, correlation does not equal causation.

Then there are a host of other diseases that range from rare and deadly to ruin your life to annoying. Australian physicians give a decent summary: “STIs such as carcinogenic types of human papillomavirus (HPV), genital herpes, HIV, syphilis and chancroid, thrush, cancer of the penis, and most likely cancer of the prostate, phimosis, paraphimosis, inflammatory skin conditions such as balanoposthitis, inferior hygiene, sexual problems, especially with age and diabetes, and, in the female partners, HPV, cervical cancer, HSV-2, and chlamydia, which is an important cause of infertility.” The percentages vary in each case, but it’s clear that the foreskin is a public-health menace.

This is the “something may go wrong” theory mixed with the “we can do this, so it must be ethical” non-standard employed in Rosin’s cold, secular science. It’s devoid of any context for how common those risks are, differences between minors and adults, risk factors and possible prevention and treatment options. The whole thing is a diversion, completed with the shameless fear-mongering of “the foreskin is a public-health menace.”

This mundane march of health statistics has a hard time competing with the opposite side, which is fighting for something they see as fundamental: a right not to be messed with, a freedom from control, and a general sense of wholeness. For many circumcision opponents, preventive surgery is a bizarre, dystopian disruption. …

Yes, because the opposite side is grounded in reason and objective facts. I’ve made the case extensively why this is true. Rosin has yet to show why this is false (in any of her attempts).

… I can only say that in public health, preventive surgery is pretty common—appendix and wisdom teeth, for example. …

Remember, she’s established her case for preventive medicine on the idea that the foreskin has no purpose, which is false. There’s also recent evidence suggesting the “unnecessary” appendix has a function, proving that cold, secular science is always learning more. And she’s demanded that we accept infant circumcision as a matter of public health, yet has provided no legitimate public health risks requiring infant circumcision. Phimosis, for example, is not a public health risk in any way. (It doesn’t automatically require circumcision, either.)

Sexual pleasure comes up a lot. Opponents of circumcision often mention studies of “penile sensitivity regions,” showing the foreskin to be the most sensitive. But erotic experience is a rich and complicated affair, and surely can’t be summed up by nerve endings or friction or “sensitivity regions.” More-nuanced studies have shown that men who were circumcised as adults report a decrease in sexual satisfaction when they were forced into it, because of an illness, and an increase when they did it of their own will. In a study of Kenyan men who volunteered for circumcision, 64 percent reported their penis to be “much more sensitive” and their ease of reaching orgasm much greater two years after the operation. In a similar study, Ugandan women reported a 40 percent increase in sexual satisfaction after their partners were circumcised. Go figure. Surely this is more psychology than science.

This paragraph supports my contention that the value of circumcision is subjective to the individual, meaning the decision should be left to the individual who will live with the results, not his parents who invoke their own subjective preferences.

People who oppose circumcision are animated by a kind of rage and longing that seems larger than the thing itself. Websites are filled with testimonies from men who believe their lives were ruined by the operation they had as an infant. I can only conclude that it wasn’t the cutting alone that did the ruining. An East Bay doctor who came out for circumcision recently wrote about having visions of tiny foreskins rising up in revenge at him, clogging the freeways. I see what he means. The foreskin is the new fetus—the object that has been imbued with magical powers to halt a merciless, violent world—a world that is particularly callous to children. The notion resonates in a moment when parents are especially overprotective, and fantasy death panels loom. It’s all very visual and compelling—like the sight of your own newborn son with the scalpel looming over him. But it isn’t the whole truth.

She’s speculating about motive in a way that borders on a return to ad hominem. It all circles back to her self-absorbed, “don’t ruin it for us” mentality. She likes circumcision so I am mistaken in being angry about surgery performed on my healthy infant body. Society would’ve rejected that parental choice on the ethical stance I’ve established, if only I’d been born a girl. By now it’s clear that Hanna Rosin has no intention of doing anything more than working backwards from her conclusion, avoiding the facts that challenge her opinion. That’s something, but it’s not the case against the case against circumcision the title of her essay promises.

¹ I’m not interested in providing Morris a direct link for search engine purposes. Read his speculation here: http://www.circinfo.net/why_are_human_males_born_with_a_foreskin.html

Science Requires Ethics

Intact America ran an open letter, as an advertisement, in yesterday’s Washington Post urging the American Academy of Pediatrics not to recommend that American parents circumcise their infant sons as a strategy against HIV. [Full disclosure: I attended an event hosted by the organization and interact with some of its representatives because I support its cause.] It’s a logical request, based on the necessary combination of science and ethics. A pro-circumcision advocate, Jake Waskett¹, has attempted a deconstruction of the letter, labeling it “propaganda”. His support for that charge is preposterous, as any approach advocating the circumcision of healthy infant males must inevitably be, but his critique fails because he ignores the central issue involved. After a brief introduction, complete with an absurd assumption about Intact America’s motives, Waskett quotes the opening paragraph:

American parents trust their pediatricians and rely on them for the best advice in caring for their children. As a matter of ethics, that advice cannot include neonatal male circumcision – a medically unnecessary, potentially risky surgery that no major medical authority in the world recommends.

I agree with this, although I’m not a fan of appeals to authority. As should be evident with the apparent intention of the CDC to recommend infant circumcision, it only takes one ill-conceived recommendation to distract from the core issue. Despite my misgivings, Intact America structures the argument correctly because it identifies that core: ethics demand not imposing medically unnecessary surgery on normal, healthy children, regardless of gender or potential benefits.

Waskett assesses this with an odd bit of snark about people inventing fire before issuing a parenthetical aside suggesting that the national medical bodies of African nations now implementing mass circumcision programs implies approval. Perhaps this is the case, which circles back to my reservation about an appeal to authority. But assuming it is not a point of fact. Still, if he’s granted the point, what does this prove about Intact America’s ethical argument? The risk of female-to-male HIV transmission through vaginal intercourse is a significant problem in Africa. In America HIV transmission risk through sex overwhelmingly involves male-to-male transmission, from which the (voluntary) circumcision of (adult) males has shown no statistically significant reduction. Even if this wasn’t the case, the ethical issue of applying scientific research to healthy children through surgery centers on infant circumcision, not infant circumcision. That’s the point Waskett ignores. His defense:

So what do we have left? A “potentially risky surgery”. Well, yes, it is. There are risks, of course, albeit small. But these need to be weighed against the benefits: a reduction in the risk of certain conditions.

Finally, “medically unnecessary”. Again, yes, it is. But that’s not an argument against it: something can be beneficial, even advisable, without being necessary. Take vaccinations, for example: they’re not strictly necessary, but they’re certainly advisable.

Their claim that circumcision is unethical seems to be on shaky ground.

No, these risks need to be weighed against the need, or rather, the lack of need. The ethics of proxy consent require parents to choose a balance between the most effective and least invasive solution to remedy their child’s malady. But there is no malady when the boy is healthy. Setting the ability to chase potential benefits as the ethical standard opens the range of allegedly valid parental interventions to include any number of surgeries we recognize as offensive. The science becomes ungrounded by any concern for the individual child as an individual.

Invoking the topic of vaccinations does not change this evaluation. There are similarities between circumcision and vaccination, based on potential benefits. However, the difference rests on how the problems the interventions are meant to prevent occur. For example, becoming infected with measles requires no effort other than participation in society, while acquiring HIV from an HIV+ female through vaginal intercourse requires a very specific action, an action not undertaken by infants. Comparing the two solutions as comparable for parental consent fails.

Add to this the fact that parents treat the same maladies circumcision is supposed to prevent with less invasive, non-surgical methods when they affect their daughters, and Waskett’s argument misses the ethical case against infant circumcision because he’s making the case for circumcision devoid of context and ethics. That’s a case that works only if it’s a voluntary decision by the adult male himself.

Next, Intact America requests that the AAP defend the ethics against infant circumcision rather than considering a revision in favor of the surgery since science necessarily involves ethics when applied to a person’s body, particularly via proxy consent. Waskett calls this request “bizarre,” despite having failed thus far to address the ethical argument made by Intact America.

Continuing:

[sic] still, more than one million American babies undergo the surgery every year driving one billion dollars in health-care spending.

And, no doubt, saving comparable figures in disease prevention.

Waskett’s claim is based on speculation. Perhaps his analysis is correct, but he does not provide proof for his assumption here. We have statistics from other western nations demonstrating the incidence rates for the diseases to which he refers. Since we can analyze circumcision on these terms, “no doubt” is insufficient.

Regardless of the cost, the issue is still the ethics of circumcising healthy infant males. The individual matters, not America’s males as a collective.

Continuing:

Most European nations, with circumcision rates near zero, have lower HIV/AIDS rates than the United States.

Are Intact America really so naive about epidemiology that they think that between-country comparisons constitute a decisive answer to such a question? Evidence-based medicine requires use of the best available evidence (usually randomised controlled trials), not the least (ecological analyses such as this are considered one of the weakest methodologies, and for good reason).

First, the “best available evidence” is that the infant male is healthy. No surgery is indicated or, therefore, justified. But that’s nit-picking facts when it’s as correct to stick with ethics.

Waskett seems to think that Intact America ignores the randomized controlled trials showing risk reduction in female-to-male HIV transmission from voluntary adult circumcision. The letter noted this fact in an earlier paragraph. Still, as I read the letter, Intact America is not making an argument about epidemiology. Rather, it is making an argument about populations and risk factors. The risk factors among America’s population are similar to those of European nations, not African nations. Our risk is male-to-male transmission and shared needles during IV drug use. Circumcision protects against neither. Is that complete proof that infant circumcision in America, unlike the randomized trials involving adult volunteers in Africa, is irrelevant to the United States? No, and I don’t think Intact America is suggesting otherwise. It is simply working from the central fact, which is that it is unethical to circumcise healthy infant males – who are not sexually active – to prevent a disease for which most of them will face minimal lifetime risk and for which less invasive, more effective prevention methods exist. Europe is an appropriate anecdo
tal case study that (infant) circumcision is not necessary to achieve the results health officials desire.

Continuing:

Furthermore, circumcision has significant risks, including infection, bleeding, impairment of sexual function, and even death. Earlier this year, an Atlanta family was awarded $2.3 million because a physician accidentally amputated much of their infant son’s penis during a “routine” hospital circumcision. A Canadian baby bled to death in 2004, after being circumcised in a British Columbia hospital. In 2008, a baby from South Dakota bled to death, and his parents have filed suit against the hospital where he was circumcised, as well as the doctor who performed the surgery.

Yes, accidents happen, and of course they’re tragic. But let’s be sensible. If we’re going to consider the risks associated with circumcision, we also have to consider the risks associated with non-circumcision. Babies die of urinary tract infections – and circumcision reduces the risk. Adults die of penile cancer (again, the risk is reduced) and of HIV (and again).

The complications of circumcision affect individuals. Those individual have rights. We recognize this for female minors, legislating against parental proxy consent for medically unnecessary genital surgery on daughters for any reason. The ethical argument against infant male circumcision involves the equal rights concept that the same protection should be applied to males. Waskett hasn’t yet made a coherent case for denying these rights to male minors.

But on his demand that we include the “risks associated with non-circumcision,” to an extent these must be lumped into the risks associated with living. That’s sufficient since it’s how we treat female minors, but it’s worth noting that Waskett’s argument is flawed because he ignores the context of those ailments, thereby avoiding the ethical issue of proxy consent. He ignores that alternate solutions exist for those risks associated with normal genitalia. Most infections are not life threatening and can be treated with interventions less severe than surgery. The other risks, such as HIV and penile cancer, involve causes (i.e. behavior) not directly related to the foreskin. This is the approach we take with female minors. It is the approach an ethical society would take with male minors.

¹ This is an assumption. I have interacted with Jake Waskett on previous occasions. The language, tone, and approach to the topic match what is found here. As added support, an excerpt in the entry quotes “…in favour of the surgery…” from the Intact America letter, which is a British spelling not found in the original letter. At least one other British spelling appears in the entry. Waskett is British. I leave open the possibility that I am mistaken and will correct if it becomes clear that I am.