Category: Circumcision

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

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

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

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

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

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

Instead, I want to highlight this bit of misdirection:

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

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

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

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

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

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

That’s not what interests me. This does:

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

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

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

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

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

From the Washington Post article I mentioned in yesterday’s entry, this:

The young and hip at ground zero of the AIDS epidemic meet, drink and pair off under the knowing gaze of bartender Brian Khumalo. Sometimes they first buy a three-pack of condoms from the box he keeps by the liquor, sometimes not.

Night after night they return for the carefree, beery vibe, with the same partners or new ones, creating a web of sexual interaction. A growing number of studies single out such behavior — in which men and women maintain two or more ongoing relationships — as the most powerful force propelling a killer disease through a vulnerable continent.

This new understanding of how the AIDS virus attacks individuals and their societies helps explain why the disease has devastated southern Africa while sparing other places. It also suggests how the region’s AIDS programs, which have struggled to prevent new infections even as treatment for the disease has become more widely available, might save far more lives: by discouraging sexual networks.

I want to pound my head on my keyboard. Education and behavioral changes are the answer? Who would’ve thunk it? Until societies address these real issues, promoting circumcision will not achieve the significant success now touted. That exacerbates the violation being committed against children. Once societies address these issues, any alleged benefits of circumcision will not be sufficient to excuse the violation.

Still, it’s easier to run with what is accepted than what is valid:

A second key factor helping the virus spread through southern Africa is low rates of circumcision. Before European colonialists arrived, most tribes in the region removed the foreskins of teenage boys during manhood rituals. Those rites, which were discouraged by missionaries and other Westerners who regarded them as primitive, have gradually declined as the region rapidly modernized.

Essentially, it’s our fault. We stopped them from being smart. Please. Before we get to that, we should analyze how “key” this second factor really is.

Dozens of studies, including three experimental trials conducted in Africa in recent years, show that circumcised men are much less likely to contract HIV because the most easily infected cells have been removed.

Those men are less likely to contract HIV within the short time frame covered by the studies before the researchers decided that circumcision is wonderful and should be offered to all men. No long-term research has been done, other than the very big, albeit unscientific, circumcision experiment carried out by American parents. Why focus on that and the easy comparison to Europe’s infection rate among mostly intact males when we can instead blame the African HIV epidemic on those Europeans? Ugh.

These factors, researchers say, explain how North Africa, where Muslim societies require circumcision and strongly discourage sex outside monogamous and polygamous marriages, has largely avoided AIDS. They also explain why the epidemic is far more severe south of the Sahara, where webs of multiple sex partners are more common, researchers say.

West Africa has been partially protected by its high rates of circumcision, but in southern and eastern Africa — which have both low rates of circumcision and high rates of multiple sex partners — the AIDS epidemic became the most deadly in the world.

The same logic that suggests circumcision as a viable HIV prevention strategy would also suggest that all societies should convert to Islam. It only depends on how far you want to go beyond the actual cause. This simply reveals the difference between people who believe circumcision prevents HIV infection and people who know that circumcision may only delay HIV infection, should the circumcised male engage in irresponsible behavior. That’s the true scenario where we can assess “other things being equal”.

People are determined to believe that circumcision is the ideal prevention for HIV. The problem with this flawed idea rests in one simple truth: too many overlook any other factor that might impact risk far more than keeping intact genitals. It’s far easier to rush to this surgery because it’s accepted. It helps that the victim can’t fight back, though civilized people won’t acknowledge it in quite those terms. Usually some notion of “best interests” will follow the decision.

Unfortunately, there are other factors involved in life. It’s foolish to believe that such extreme choices can exist in a vacuum devoid of any drawbacks. Yet, people do. For example, Andrew Sullivan conceded a stance that he was not justified in conceding. Long-time readers will remember that I hammered this at the time. In my response I quoted a study that included the phrase “other things being equal” to describe how circumcision will protect. I said it then, and here it is again: all other things are not equal.

This bears significance now because Mr. Sullivan links to this story from the Washington Post, via Steve Sailer, about promiscuity in Africa. I’ll get to that story in another entry, but Mr. Sailer comments on the article with this:

Another contributor to the high rates of AIDS in Southern/Eastern Africa besides multiple concurrent partners and lack of circumcision is the bizarre fetish for “dry sex,” which I would guess doesn’t exist among West Africans because (thankfully) you never hear about it among their African-American cousins.

To which Mr. Sullivan responds:

Dry sex?

This is inexcusable. For someone who is now willing to endorse allowing parents to circumcise their sons to prevent (an unlikely) HIV infection if they “believe that diminishing their child’s future sexual pleasure is worth the benefit of extra protection from HIV,” there is an obvious burden not to be blind-sided by a known risk factor in the spread of HIV in Africa. Depending on the prevalence of “dry sex,” it’s reasonable to suspect that this has a far greater impact on the transmission rate than intact genitals. Intact or circumcised, dry sex will lead to abrasions and tears, and as a result, blood. If that blood is tainted with HIV, no lack of foreskin is going to save the male. He is betting on luck alone.

The sensible stance recognizes that parents can never know how their children will behave. But “dry sex” is not generally considered a cause of significant HIV infection in the United States, or the rest of the industrialized world. The risk of HIV infection in America is, in fact, quite low for heterosexual males having unprotected sex with HIV-positive women. This destroys any myth that parents have a right to make a permanent surgical decision for their child that clearly diminishes his sexual sensitivity.

Fear is not enough. Logic and liberty demand that we must look past fear. If adult males wish to have themselves circumcised to prevent HIV, we should not stop them. But advocating or permitting infant circumcision as a means to prevent future HIV infection is merely bowing before fear without concern for understanding.

What kind of connection can I make from Calvin and Hobbes?

That’s the setup. Here’s the payoff:

Girls need protection from the actions of adults. Boys don’t need that protection because they’re tougher and can handle anything. Even a scalpel to the genitals, right?

Yes, I understand the humor, but I don’t find the extreme version of this thinking funny or compelling. Believing that the recipient’s gender determines the acceptability of a specific action is indefensible sexism. Equality considers human beings, not different standards based on whether the person has a penis or a vagina. This is as true with circumcision as it is with equal pay.

John Gray, of Men are from Mars, Women are from Venus fame, on circumcision:

Dear John: I would like to know how you feel about circumcision. Do you think we should allow this society to continue to mutilate our babies? How does that affect them later in life? – Cutting Remarks, in Seattle, Wash.

Dear Cutting: Current research shows there is no valid health reason for circumcision. I am unaware, however, of any research on circumcision that demonstrates traumatic effects.

He’s correct, of course, that there is no valid health reason for (pre-emptive) circumcision (on a non-consenting individual). He doesn’t imply this, so I’m merely extending beyond his words, but the lack of research on traumatic effects does not mean they don’t exist. This seems obvious to me, but I’ve engaged in enough conversations in which someone has said something like “if it caused harm, they would’ve studied it by now.” Not if you’re convinced through years of hearing nothing but glowing reviews, with negative consequences dismissed as fringe inaccuracies.

For example:

Circumcision may provide even more protection against AIDS than was realized when two clinical trials in Africa were stopped two months ago because the results were so clear, according to studies being published today.

Read the rest of the article and you’ll find nothing about potential negative consequences of this announcement. There isn’t even a mention that the study did not involve men circumcised as infants. It’s amazing that the story even mentions the original announcement in December of the trial’s tentative results. The first version¹ published on Friday did not include it, instead leaving the impression that this was more good news about the supposed wonders of circumcision. That’s different than a fuller evaluation of the actual results. That puts the decision to breathlessly announce the trial findings irresponsible. Anyone want to suggest that further evaluation revealing a lower “protection” than previously thought wouldn’t be buried on page A-27?

When reading or hearing these stories, remember two key points. Infants are not having sex. Circumcision only provides potential protection from HIV if the male is having unprotected sex with an HIV-positive woman. No sane person would argue that infants should start having sex or that circumcised men do not need to worry about their sexual practices. This news, however interesting, is irrelevant to the reality of what we should and will teach our children. There is a debate to be had about Africa, where HIV is a true epidemic, but that is exclusive to that situation. From what I’ve read, I still contend that education and economic development are more important. However, if some think circumcision is useful, I can accept that, as long as it’s offered exclusively to adult men who consent. Anything else is unethical.

¹ Unfortunately, I did not save a copy of that article. The New York Times has since updated the article to include a reference to December’s news.

From Uganda, this news:

The Ministry of Health has started talking to stakeholders as one of the procedures for drafting a policy on circumcision.

There is nothing explicitly in the article that indicates whether or not the proposed policy will apply to infants. As such, I am only speculating that it does when I ask the obvious: will the Ministry of Health consider infants as stakeholders? Where the Ministry’s policy involves infants, those boys are the key stakeholders. Without their input, or a “reasonable person” proxy standard for them, any policy that permits circumcision would treat them as little more than property. That would be wrong.

If the policy discussion is strictly to figure out how to economically offer circumcision to adult men in a clean, safe environment with qualified surgeons, then the Ministry should be commended.

Contrary to the newly popular argument that circumcision is an appropriate prevention technique against HIV, consider this trial:

Jacinta Julia Adams Fernandez, a mother of three, is one of 175 Dominican prostitutes lending their bodies to a trial of what New Jersey-based Merck & Co. hopes will prove to be a vaccine against the virus that causes AIDS.
…

The prostitutes, who will spend much of the next four years traveling to Santo Domingo for injections and checkups, were recruited from brothels across the country. They are among some 3,000 people in eight countries testing the experimental vaccine — a combination of deactivated cold viruses and synthetically produced HIV genes meant to train the body to destroy infected cells.

The article states that the vaccine is in the second of three phases. Each phase is several years long. What should we tell the male circumcised today as an infant, solely to further limit whatever (small) risk of HIV infection he may eventually face, if this vaccine turns out to be effective? We’ve found a better method of prevention, so sorry you had to give up a functioning, healthy body part? Oops? Will those pitiful regrets suffice?

Infant circumcision as a means to prevent HIV is flawed from the start because it’s a clear violation of the child’s rights. But it’s also flawed because there may be a better solution (aside from not engaging in unprotected sex with HIV-positive partners) by the time he’s old enough to begin having sex. Science is not complacent. It does not stand still with “good enough” solutions. That truth should constrain unnecessary actions today. As I’ve said many times and will repeat again, if an adult male wishes to have himself circumcised as an added prevention against HIV, he should have that choice. I don’t have to agree with it or like it. What to do with his body should be his choice.

The same applies to infants. When he becomes sexually active, he should have the choice with all scientific information available at that time. There is a significant difference between an adult circumcising himself now, knowing that a successful vaccine is still, at best, years away, and parents circumcising their son today without knowing what his risk will be, based on his personal behavior and the scientific advancements in the approximately decade-and-a-half until he becomes sexually active. Ignoring the distinction is unethical.

Via Boing Boing.

How many more stories like this must we read? I’m certainly frustrated seeing them because they wouldn’t occur in a sane world. This time, from the U.K.:

Detectives are investigating the death of a seven-day-old baby after he was circumcised.

Stunned relatives at the Jewish ceremony saw the toddler experience breathing difficulties.

He was taken to hospital but died eight days later. A post mortem found the infant died from cardiac arrest and oxygen starvation.

Forget the religious aspect of this particular story; it has no bearing. The risk is the same, regardless of the reason the surgery is performed, so the implication is broad enough to cover every male infant circumcision.

Is there some threshold for the number of baby boys who must die before we become outraged at this unnecessary procedure? We’re not there yet?

__________________________________

In explaining the background of circumcision for this story, The Mirror provides a precise example of the kind of “balanced” coverage too many take with circumcision. No one wants to offend because male circumcision is seen as normal. Parents who do it are somehow justified in putting their child through the risks of surgery for non-medical reasons. I reject that, as everyone should.

In a connection clearly missed by the The Mirror in its effort to be unbiased, it presented this:

Circumcision of boys is an operation in which the foreskin is removed from the penis. With small babies, local anaesthetic is often sufficient and avoids the risks of a general anaesthetic.

Local anesthetic is “often” sufficient, except it’s not. It takes no leap to realize that cardiac arrest and oxygen starvation might result from surgery on an inadequately anesthetized patient. This would be offensive in nearly every circumstance, but is particularly so when the surgery is unnecessary.

Contrary to a common misconception, babies feel pain. Lest anyone doubt this, listen to the end of this podcast. In the segment titled The Horror of Circumcision, you’ll hear nothing but the baby’s screams as his foreskin is removed¹. If you doubt what I say about circumcision, listen. You won’t come away disagreeing with me.

Also in the article:

Some people believe the skin is redundant and gets in the way of hygiene.

Those people are ignorant.

This back-and-forth nonsense of presenting all sides is maddening. All sides do not warrant equal presentation. Circumcision is wrong. Parents do not have the right to impose such a decision on a child for any reason other than immediate medical need. If newspapers can’t admit this, they should stay quiet and let the facts speak rather than furthering illegitimate excuses.

Update (02/25/07): Based on comments to this entry, I’ve altered this post to better reflect what I meant. I’ve replaced “those people are stupid” with “those people are ignorant“. I know that word can also be seen as a pejorative, but I intend for the word to be taken in the specific context of its definition, “lacking knowledge or comprehension of the thing specified”. In the future I will aim to be more precise.

¹ The use of effective anesthetic should be mandatory as long as we’re going to perpetuate the mistaken view that infant circumcision is acceptable. That is an argument for minimum decency. The use of effective anesthetic does not miraculously erase the basic, serious unacceptability of routine infant circumcision.