Category: Circumcision

Update: New York City Department of Health on Circumcision

Found via RealityBias’ diary at Daily Kos, this follow-up on last week’s news from Thomas Frieden and the New York Department of Health.

Recent media reports misrepresent the Health Department’s response to recent studies showing that circumcision significantly reduces HIV transmission in some contexts. We do not yet know what impact circumcision could have on HIV transmission in New York City, and we have not suggested or planned any initiative or campaign. Quite to the contrary, I indicated in an interview with the New York Times (the source of the misrepresentation) that I very much doubted that even 1% of men at high risk in NYC would undergo the procedure.

Commissioner Frieden claims he was misrepresented. Maybe, and if so, I retract my statements implying as much. But that’s a conditional retraction, for I think he’s trying to save face while forging ahead with his push for circumcision. Saying that he doubts “even 1% of men at high risk in NYC would undergo” circumcision is different than saying “we are not pushing circumcision. Regardless of how he gets to office, Commissioner Frieden is acting like a politician. I don’t trust him.

Continue reading “Update: New York City Department of Health on Circumcision”

Individual bodily integrity trumps collectivist rhetoric.

For your consideration:

37- year old Mukasa is not circumcised but is considering it seriously. “I have heard that if you get circumcised, you cannot catch HIV/ Aids. I don’t have to use a condom or worry about all those other ways of keeping safe. I finally get a method that suits me…” he says. Mukasa is obviously oblivious of the almost negligible but very important fact surrounding the hyped circumcision as an option to HIV/Aids prevention.

I don’t want to give the impression that I think this is a common perception anywhere. I don’t think it is. But it highlights a key point in all the recent discussions of circumcision and HIV. When the United Nations or the World Health Organization or the New York Department of Health and Mental Hygiene touts these studies, it can only control the message it puts out. It can never control how that message spreads and the misunderstandings people will create.

These studies have only said this: voluntary adult circumcision reduces female-to-male HIV transmission by 50-60%.

It said nothing about male-to-female transmission. It said nothing about male-to-male¹ transmission. It said nothing about infant² circumcision. Researchers don’t even know for certain how circumcision appears to reduce HIV transmission. Given the gravity of HIV and circumcision, any recommendation has serious implications. That includes the understanding that people may make a leap not supported by evidence or marketing. I’ve seen enough examples to know that it will occur.

When we focus exclusively on the collective public health “benefit”, we ignore how this affects individuals. The male who gets HIV from dirty surgical instruments in Africa and the boy who loses his penis in the United States aren’t just unfortunate sacrifices for the public good.

¹ In the case of the New York Department of Health, Commissioner Frieden touted a conclusion not even studied in Africa, much less proven.

² Infant circumcision differs greatly from adult circumcision.

You belong to the community, not yourself.

From Uganda:

I wish to respond to Joseph Lule’s article in The New Vision of February 19 titled, “Female circumcision hurts women’s dignity.” To many Africans, particularly Ugandans, our cultural practices have become outdated and dangerous. This is because we look at things through the lenses of foreigners who do not have cultures of significance. For example, the UN officials who claim that female circumcision is violence against women do not belong to communities which have that practice. And women who have undergone circumcision are not complaining.
…

Lule raised the issue of privacy and dignity. However, it is not true that circumcised women are exposed for public viewing.

People have the right or freedom to choose what to do with their bodies. There would be a problem if exercising that freedom would pose a danger to the health and well being of the people. In such case we would talk about ‘how’ and not ‘whether’ to undergo circumcision.

Notice where that parallels the American discussion of male infant circumcision, particularly the last paragraph. If those who’ve been circumcised aren’t complaining, we’ve done nothing wrong. As long as we address how, we can sweep rights aside.

No.

Mind-Numbing Quote of the Day

I don’t understand how some people think, nor do I care to, I think.

I did not give my sons a choice about the matter, but I feel all right about it because the boys have both had it done, and it doesn’t seem to have harmed either of them.

Notice how poor these two justifications are for denying a child his right to his whole body. There is no discussion of medical need – not benefits¹, but immediate need, the standard for every other surgery on children. It’s been done to both, so it’s okay. They don’t “seem” harmed, so it’s okay. Nonsense.

For a better essay, read the counter-point.

¹ The rationale offered in the rest of the essay and the first three comments is equally weak. I’m sure more madness will result in the comments yet-to-come.

Mayor Bloomberg offers a hint of promise.

New York City Mayor Michael Bloomberg offered a refreshing surprise.

Mayor Michael R. Bloomberg raised questions yesterday about an approach under consideration at the Health Department to promote circumcision as a way to reduce the risk of contracting AIDS.
…

“I have not had a chance to talk to Tom Frieden and Alan Aviles about this,” Mr. Bloomberg said, referring to Health Commissioner Thomas R. Frieden and Alan D. Aviles, chairman of the Health and Hospitals Corporation.

Saying that the rate of H.I.V. infection and AIDS in the city was alarmingly high despite education campaigns, he added, “We have to do something about it and we should be looking at everything, and when reputable health organizations talk about ways to do it you certainly are going to give it some serious consideration.”

Still, the mayor said, “whether it’s something that the government should be involved in, or just giving advice and making sure that people get educated, education in the end is the real tool to stop the spread of AIDS in our society.”

I have little doubt that this will turn out with a recommendation intellectually short of where it should end up, but even a pause counts as progress when dealing with a public reaction to circumcision. More such reflection, please.

In a related link, I often wonder whether my anti-circumcision posts related to religion are perceived as anti-Semitic. I know that my view is strictly related to the practice of medically unnecessary circumcision imposed on infants rather than some hidden animosity to religious practices, so I’m not worried about it too much. I state my opinion. I don’t control how it’s interpreted. And occasionally, I encounter some statement that reassures me about my own approach. For example:

Mayor Bloomberg should recuse himself from this decision because he is Jewish. How can anyone who is a part of a 5000 year tradition which advocates male genital mutilation be expected to make an objective decision here?

I’ve heard this kind of foolish stereotype before, and it’s always wrong. It does nothing more than disparage everyone involved in fighting for the rights of infant boys. I assume elected officials (and doctors and …) will carry out their duties with more principle than blindly pursuing their own (assumed) personal agendas. I’m smart enough to know this is not always the case, but I will stick with “innocent until proven guilty”. I’m trying to convince people to apply it to the foreskin’s “dangerous” presence. I’m not about to abandon it elsewhere.

Yes, I think about this more than most people.

This story is from last week, but I ignored missed it while I was away. I think it’s interesting and insightful, while not needing much commentary.

The Marines are banning any new, extra-large tattoos below the elbow or the knee, saying such body art is harmful to the Corps’ spit-and-polish image.
…

“Some Marines have taken the liberty of tattooing themselves to a point that is contrary to our professional demeanor and the high standards America has come to expect from us,” he said. “I believe tattoos of an excessive nature do not represent our traditional values.”

Any time traditional values pops up, I’m likely to shake my head and dismiss the logic. However, when dealing with the military, there is some leeway since members of our military offer up some of their freedoms when they join. Such a policy could have implications in recruiting and retaining soldiers (and sailors and …), but that’s a different debate than whether that policy is reasonable. I’m not inclined to get worked up over the issue.

However, this quote fascinates me:

“This is something I love to do,” said Cpl. David Nadrchal, 20, of Pomona, who made an appointment to get an Iraqi flag and his deployment dates etched onto his lower leg. “The fact I can’t put something on my body that I want — it’s a big thing to tell me I can’t do that.”

Change a few words (while the overall meaning remains) and you arrive at a perfect summation of the argument against routine infant circumcision. It’s a big thing to tell me I can’t… To forbid a tattoo or keeping a foreskin, there must be an excellent justification. Perhaps there is a reason with tattoos, although I find that difficult to believe given the mission of the Marines. There is no reason with routine infant circumcision. The burden of proof rests with he who wishes to remove the body part from the male, not with the male to later protest that irreversible action.

Good Intentions and Taxpayer Money

As long as government is doing something, that action is “good”. Or not:

New York City’s Department of Health and Mental Hygiene is planning a campaign to encourage men at high risk of AIDS to get circumcised in light of the World Health Organization’s endorsement of the procedure as an effective way to prevent the disease.

The taxpayers of New York should not pay for cosmetic surgery. Yes, it has some supposed health benefits regarding HIV, but condoms are more effective. In that context, the surgery is unnecessary because any benefits it might achieve can be achieved without surgery and the corresponding risks. (Malpractice insurance, anyone?) If the government pays for anything, condoms are the way to go.

However, this is government, so when it takes action, it must find extra-special creative ways to be stupid.

In the United States, “New York City remains the epicenter of the AIDS epidemic,” Dr. Thomas R. Frieden, the city’s health commissioner, said in an interview. Referring to H.I.V., he said, “In some subpopulations, you have 10 to 20 percent prevalence rates, just as they do in parts of Africa.”

His department has started asking some community groups and gay rights organizations to discuss circumcision with their members, and has asked the Health and Hospitals Corporation, which runs city hospitals and clinics, to perform the procedure at no charge for men without health insurance.

If you have no insurance, you still get to have sex with fewer consequences! Aren’t New York’s taxpayers city officials generous? But ignore that. The three released studies (which all ended early, remember, despite HIV’s 3-6 month latency period before detection) have not shown any link between circumcision and reduced HIV-infection among men having sex with other men. The research simply isn’t there. To theorize any such link is irresponsible and potentially dangerous.

Continue reading “Good Intentions and Taxpayer Money”

Regular Blogging Will Return Soon

I’ve been on a mini-vacation since last week. Among other activities, I spent a few days exercising my First Amendment rights.

With many dedicated activists, I talked to people about ending routine circumcision in America. I faced most of the opinions I’ve discussed here in some context over the 18 months, from many different perspectives. I could get disheartened¹ if I focused only on the negative reactions, the ones that began “Are you a Christian?”, “But it’s the parents’ choice…”, or “Don’t you have anything better to do?”. I can respond when faced with such questions, although the questioner’s receptiveness to an answer based in logic is rare. The debate certainly helped strengthen my skills at persuasion.

More important, though, were the conversations I had with people who were happy to learn. Many people couldn’t believe we’d be out there discussing this until they learned our perspective. For example, I talked with a group of 13-year-old schoolgirls who were horrified at the prospect of male circumcision once we explained it. One of those girls debated me, probing to find weaknesses in my argument. One could argue that she’s only 13, but she (and her friends) asked intelligent questions. She eventually conceded that a) I knew my facts and b) that what’s she’s been taught is silly. I came away convinced that at least one of those girls will question circumcision enough to not make her future son’s decision.

Overall, it’s a productive way to spend a few days.

Random links discussing the protest here,
here, here, here, here, and here.

¹ One woman shooed her kids away while saying “It’s a 2-second snip, and it’s your mother’s choice. Whatever your culture does, that’s what happens to you.” She didn’t come over so I could ask her opinion about female genital mutilation in countries where it’s practiced as part of the culture.

Slow Solutions From Fast Food

So that I show my contradictions on this morning’s post, consider this decision by Burger King:

In what animal welfare advocates are describing as a “historic advance,” Burger King, the world’s second-largest hamburger chain, said yesterday that it would begin buying eggs and pork from suppliers that did not confine their animals in cages and crates.

The company said that it would also favor suppliers of chickens that use gas, or “controlled-atmospheric stunning,” rather than electric shocks to knock birds unconscious before slaughter. It is considered a more humane method, though only a handful of slaughterhouses use it.

The goal for the next few months, Burger King said is for 2 percent of its eggs to be “cage free,” and for 10 percent of its pork to come from farms that allow sows to move around inside pens, rather than being confined to crates. The company said those percentages would rise as more farmers shift to these methods and more competitively priced supplies become available.

This is invariably good. Less animal suffering while they’re alive is the correct action. Welfarist animal policy can promote a valid marginal gain.

But the animals will still die. Does it matter significantly to the chicken that it’s gassed¹ before it dies? Of course it suffers less, but it still dies. And how significant will the change be if we’re talking 2 percent of Burger King’s eggs and 10 percent of its pork? That still leaves 98 percent and 90 percent of animals, respectively, facing the same amount of suffering. Will this be a one-time improvement, or will there be a continual push to reduce the amount of suffering? The answer isn’t clear.

I found the link to this story at the Daily Dish, where Andrew Sullivan wrote this about the decision:

I’m a McDonalds fan, but I’m switching. The more of us do it, the more likely it is that the rest of the food industry will follow Burger King’s lead.

In the past, Mr. Sullivan wrote about the moral implications of using animals for food. He was honest about the qualm he has with how animals are treated, specifically pigs because of their intelligence. Yet he’s also stated that “it should be possible to remain carnivorous and more humane than we currently are.” Now we see the effect of the welfarist approach. How likely is Mr. Sullivan to align² his views and habits further now that he has a way to ease his moral qualm? I’m not suggesting that guilt is appropriate, but there are consequences to providing such moral escape clauses.

I appreciate what the welfarist approach can do. I’m just not overly thrilled at such half-measures. For example, with routine infant circumcision, anything that reduces suffering should be implemented. But I will not cheer increased use of analgesic creams and dorsal blocks, which should be standard even though they are insufficient. The case against routine infant circumcision is not that the child suffers during the surgery and the healing time after. It is important in the debate, but it is not primary. What the child is being denied for the rest of his life, without his consent, is the problem. No amount of compassion diminishes this. The drawbacks of the welfarist argument allows parents to feel better about “their” decision, and consequently think less about the lifelong consequences. Kids will suffer who may not have faced the knife if their parents had been forced to confront the full ramifications of their actions.

Positive changes are useful and should not be abandoned solely because the results won’t live up the hope. They’re just not enough and should be seen as incomplete.

¹ If you eat that chicken, wouldn’t you then eat some of that gas? Consider this article titled Beef diet ‘damages sons’ sperm’ discussing the impact of pregnant women eating beef raised with “growth promoting chemicals”. (Link via Julian Sanchez.)

² I’m not trying to pick on Mr. Sullivan on this. This rationale is not exclusive to him, nor am I perfect in this in the ways it applies to my life.

In Case the Message Hasn’t Gone Out Already

Let’s see if we can decipher the convenient omissions as the Associated Press builds this story. First, the title:

Circumcision urged to fight HIV

Nothing new there to deviate from previous reporting. Stupid, but consistent as it flows into the lede:

U.N. health agencies recommended Wednesday that heterosexual men undergo circumcision because of “compelling” evidence that it can reduce their chances of contracting HIV by up to 60 percent.

At least they’re saying men, but they might be forgetting a few key qualifications. But who needs to read further. We now know what to do. Even if the marketing is flawed.

The public health impact is likely to be most rapid where there is a high rate of HIV infection among men having sex with women.
…

More study also is required to find out whether male circumcision will reduce HIV infection in homosexual intercourse, it said, but it said promoting circumcision of HIV-positive men was not recommended.

The studies reviewed male circumcision’s alleged protective impact on the transmission of HIV from infected women to HIV-free men. Nothing more. To promote otherwise is unethical. But why should ethics matter when this is buried in the middle of the article where it can be easily avoided by those who skim the beginning looking for a justification to perpetuate what they already want to do.

“It was therefore recommended that countries with high prevalence, generalized heterosexual HIV epidemics that currently have low rates of male circumcision consider urgently scaling up access to male circumcision services,” the agencies said.

I’m trying to think of a country that does not fit that description, but for the life of me I’m drawing a blank. Could it possibly be the United States? Oh, wait… it is? What an oversight. Accidental, I’m sure.

Within those countries that fit the criteria, where other methods of known prevention would work, what’s the suggestion for implementing this not-really-a-solution-solution?

Priority should be given to providing circumcision to age groups at highest risk of acquiring HIV because it will have the most immediate impact on the disease. But, it said, circumcising younger males also will have a public health impact over the longer term.

Younger males is a new euphemism for infants. That’s not what the U.N. is saying, but it’s what it means. It knows that if it gets children circumcised, those males are much more likely to impose the surgery on their own children, regardless of its ethical flaws (and efficacy). Who needs ethics when you have good intentions?