Category: Propaganda

The Facts, Although Interesting, Are Irrelevant

When I wrote about the American Academy of Pediatrics’ revised policy statement on ritual genital cutting of female minors, I sensed some misunderstanding of what the policy says. Then the story hit the New York Times, among many outlets covering it, confirming what I suspected.

In a controversial change to a longstanding policy concerning the practice of female circumcision in some African and Asian cultures, the American Academy of Pediatrics is suggesting that American doctors be given permission to perform a ceremonial pinprick or “nick” on girls from these cultures if it would keep their families from sending them overseas for the full circumcision.

Saying that the AAP now supports female genital cutting grabs attention, but it’s not an accurate summary of the policy statement. The AAP’s conclusion:

The American Academy of Pediatrics:

  1. Opposes all forms of FGC that pose risks of physical or psychological harm.
  2. Encourages its members to become informed about FGC and its complications and to be able to recognize physical signs of FGC.
  3. Recommends that its members actively seek to dissuade families from carrying out harmful forms of FGC.
  4. Recommends that its members provide patients and their parents with compassionate education about the physical harms and psychological risks of FGC while remaining sensitive to the cultural and religious reasons that motivate parents to seek this procedure for their daughters.

I stand by my original interpretation that the AAP left itself room to appeal to both sides of the argument. It brought up a ritual ‘nick’ for ceremonial blood, but avoided anything more declarative than hinting that it should be discussed. But it did not endorse female genital mutilation, unless one defines genital mutilation as any blade-to-genitals. (If that’s your definition, I agree from my rights-based perspective, but the same applies to male genital cutting.) If the goal is to reduce and eliminate harm to children, it’s stupid to suggest that we factor anything other than harm from non-therapeutic genital cutting and sexist to suggest the victim’s gender matters, somehow.

So, to be clear, I don’t have much respect for the AAP, for multiple reasons. It’s revised statement is cowardly. And I’m angry that the story has careened in a manner that requires me to defend an organization unable to reject non-therapeutic male circumcision, a practice it admits¹ is harmful. But here, with this statement, the AAP did not recommend that doctors perform female genital mutilation, nor did it initiate discussion of anything other than the least harmful forms of Type IV as a substitute for Types I, II, and III in a context where some form of genital cutting is likely.

To its credit the New York Times called the AAP:

A member of the academy’s bioethics committee, Dr. Lainie Friedman Ross, associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago, said the panel’s intent was to issue a “statement on safety in a culturally sensitive context.”

Dr. Friedman Ross said that the committee members “oppose all types of female genital cutting that impose risks or physical or psychological harm,” and consider the ritual nick “a last resort,” but that the nick is “supposed to be as benign as getting a girl’s ears pierced. It’s taking a pin and creating a drop of blood.”

I don’t accept that ear piercing is benign, but for the purposes here, Dr. Friedman Ross shows that the AAP did not say what many now hysterically claim it said. The now-accepted misunderstanding of its revision is unfortunate because there’s a relevant, necessary path for the discussion to take now that it’s opened:

Dr. Friedman Ross said, “If you medicalize it and say it’s permissible, is there a possibility that some people will misunderstand it and go beyond a nick? Yes.”

But she said the risk that people denied the ceremonial procedure, usually on the clitoris, would opt for the more harmful one was much more dangerous.

I’d like to see research to back that claim, but for some (probably significant) percentage, I have no doubt she’s correct. Unfortunately, the hysteria now present in the debate involves people who either have not read the revised policy statement or have poor reading comprehension skills, so we can’t approach that topic. (Remember, too, that I wrote that I favor of zero tolerance on this if you wish to accuse me of anything for pursuing the discussion.)

Instead, we’re left with people preening about an existing, incomplete (or inaccurate) narrative. The sentiment seems to be a determination to show that one cares about the issue in the correct way rather than figuring out how to minimize harm to children. I’m not saying that people who exhibit the former are uninterested in the latter, but they’re inadvertently working against the legitimate goal.

Post Script: I’d planned to include examples from other sources. Since they generally raise issues that are tangential to my objective in this post, I will address them separately.

¹ The AAP exhibits its cowardice by admitting this indirectly. It engaged in obvious moral relativism as it acknowledged that male circumcision is more harmful than what it proposed we discuss and that causing harm violates the physician’s “principle of nonmaleficence.” But the proper conclusion that non-therapeutic male circumcision is harmful and should therefore be prohibited on male minors is unavoidable from the bioethics committee’s statement on female genital cutting.

Expect the Unexpected: Revisited

Our political obsession with identifying Others is potentially as dangerous as it is offensive. Safety is a legitimate role for the government, to the extent it can reasonably be achieved. But we need to uncover the psychopaths (or related variants) who would be murderers, regardless of skin color. Racial profiling is the appearance of safety for political cover. With this week’s news about Colleen Renee LaRose, the Philadelphia woman (Image) suspected of recruiting for terrorist organizations, I want to repost an entry I wrote almost five years ago.

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With a new terrorist threat to the New York subway system gripping the nation, the blogosphere is abuzz. I obviously share everyone’s concern and want our police and security forces to thwart any (potentially) forthcoming attacks. In an effort to accomplish this, the debate seems to descend to an argument simple profiling. When the constitutionality of profiling inevitably arises, the proponent either responds with some variation of “Constitution be damned” or “random” searches. New York implemented a random search policy for backpacks, which was incomplete, at best. (ed. note: Dead links omitted.) Yet, the proponents of profiling continue to advocate ineffective policies. Consider this from La Shawn Barber, who writes extensively and credibly about the threat of terrorism:

Will Islamofascists bomb the NYC subway? Is it all just a rumor? Your guess is as good as the government s. Flip a coin. Draw a straw. Throw it against a wall and see if it sticks.

Are they still searching little old ladies and skipping young men of Middle Eastern descent because it would be racist to search them? Probably.

It would be racist but I’m not against if for that reason. Immediate threats to safety must shake the debate from simple intellectual discourse. But within that intellectual discourse, reason can provide insight into how such a policy could fail, and fail miserably.

I don’t normally agree with Michelle Malkin on much, as evidenced by the posts here where I’ve referenced her blog. But with her reporting on last weekend’s suicide bomber in Oklahoma, she’s doing excellent work highlighting deeper facts in the case. There are indications that the bomber, Joel Henry Hinrichs III, was a Muslim. He attended a local mosque in Norman, OK. His Pakistani roommate hasn’t been heard from since the bombing. Mr. Hinrichs’ bomb included TATP, an explosive compound not commonly used in America, but popular with terrorists. He tried to purchase a large amount of ammonium nitrate. On Saturday, he apparently tried to enter the stadium during the Oklahoma football game before settling on the bench where he blew himself up (intentionally or unintentionally). Etc. I don’t know what story these and other facts will eventually tell, but it seems clear that there is more to the story than just some depressed guy commiting suicide. While I’m not ready to declare this an Islamofascist suicide bombing on American soil, the details of this case should be pursued.

This case also highlights the ineffectiveness of racial profiling in our attempt to prevent further terrorism. Click this picture of Mr. Hinrichs. (Image Source) Ignore the beard; a roommate of mine in college had a beard like that and he was no terrorist, unless you count accidentally killing fish when his hydroponic fish tank failed. So let me ask the obvious question. Say Mr. Hinrichs had tried to bomb the New York subway. Would racial profiling for “young men of Middle Eastern descent” have caught him? Is it reasonable to assume that if we rely on racial profiling, terrorists will switch tactics to include racial (and gender) profiles we’re not looking for?

Grace, go to bed. You obviously have had a very busy day of crazy.¹

Here’s actress Debra Messing testifying before the House Foreign Affairs Subcommittee on Africa and Global Health in her role as an ambassador for PSI, asking for more federal tax dollars to support “voluntary, adult” male circumcision in Africa (emphasis added):

… I would like to tell you today about two prevention tools that could make a difference if there is continued investment: male circumcision and HIV testing and counseling.

First, voluntary adult male circumcision. There is now strong evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by about 60 percent, yet only about one in ten Zimbabwean adult men are circumcised. PSI and its partners run circumcision clinics in Zimbabwe and other countries, with support from PEPFAR and other donors.

I was invited to observe the procedure, which is free to the client, completely voluntary and according to the young man I spoke with who underwent the procedure, painless. The cost of the procedure at that clinic—including follow-up care and counseling—is about $40 U.S. dollars.

UNAIDS and the World Health Organization have issued guidance stating that male circumcision should be recognized as an important intervention to reduce the risk of heterosexually acquired HIV infection in men.

Even with no demand creation, the clinic I visited serves upwards of 35 clients per day. It is estimated that if male circumcision is scaled up to reach 80 percent of adult and newborn males in Zimbabwe by 2015, it could avert almost 750,000 adult HIV infections—that equals 40 percent of all new HIV infections that would have occurred otherwise without the intervention—and it could yield total net savings of $3.8 billion U.S. dollars between 2009 and 2025. Male circumcision programs get robust support from the U.S. government in Zimbabwe and other countries, but greater resources would yield greater results.

Always remember that when public health officials – or actresses – talk about voluntary, adult male circumcision, they never mean voluntary or adult.

¹ Title quote reference here.

Spying on Students in Pennsylvania

For a brief summary:

The FBI is investigating a Pennsylvania school district accused of secretly activating webcams inside students’ homes, a law enforcement official with knowledge of the case told The Associated Press on Friday.

The school district has acknowledged that each student’s school-issued computer has software that allows the district to access it remotely, including the ability to capture images. My guess is that, in the case of the student who’s parents have sued, the alleged image was likely something the student downloaded and the school saw on his hard drive. If I’m right, it’s still creepy, but (momentarily) relegates to possibility the theories that the school captured images of naked students.

Since the privacy implications must still be considered, the article includes commentary from privacy experts. The experts aren’t quoted as saying anything surprising. The reporter offers a different perspective in her transition:

The Pennsylvania case shows how even well-intentioned plans can go awry if officials fail to understand the technology and its potential consequences, privacy experts said. Compromising images from inside a student’s bedroom could fall into the hands of rogue school staff or otherwise be spread across the Internet, they said.

Which school officials would not be ‘rogue’ if such pictures fell in their hands? I take the implication that somehow there are school staff members who should be legitimately authorized to see such pictures, that some spying is appropriate. I’m sure that’s lazy writing rather than a disturbing lack of skepticism of authority. But someone obviously authorized the installation of this software and didn’t notify the students or their parents that it was included. I always assume stupidity first, if it’s possible, but it would be unwise to rule out an conscious disregard for civil liberties.

(They’re children, after all. They have no rights at school or away from school if school officials deem those rights an impediment to order.)

“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.

Insults Instead of Inquiry

Robert Stacy McCain blogged about Hanna Rosin’s first circumcision post at the Daily Dish:

She dares defend circumcision while guest blogging at the site of the world’s foremost foreskin fetishist, Andrew Sullivan.

“Male genital mutilation!” scream the connoisseurs of uncut, preservationists of the precious prepuce.

Get over it, people. Only porn freaks and gay men — having ample opportunity to comparison shop, as it were — obsess so fanatically over the difference. …

Is this typical of McCain’s writing? Rather than deal with the issue up for discussion, he smears Andrew Sullivan, which would be bad enough if Mr. Sullivan had any direct involvement in Mr. Rosin’s entry. That Mr. Sullivan is not involved in the post and yet is the direct target of the smear shows an appalling lack of class. But he was only having “some mocking fun”, as he writes in a follow-up post, because he “knew” Andrew Sullivan to be a foreskin fetishist. More on this in a moment.

… As I was taught in commercial design classes 30 years ago, form follows function, and familiarity with the fact of foreskinless functionality (i.e., I’ve fathered six kids) indicate my circumcised state is entirely adequate to the rigors of the task.

This proves what? I’m not aware of anyone making the claim that circumcised men can’t have sex or that humanity will die out because circumcision causes sterility. This is a pointless diversion. “My penis works after circumcision” proves nothing about the merits of infant/child circumcision because it’s a “comparison” of one data point specific to one individual.

The advantages in terms of hygiene are well-known, and tend to be especially appreciated by mothers who have a difficult enough time getting boys to bath, much less to wash their winkies with health-conscious care. …

The advantages in terms of hygiene are achieved easier with basic hygiene methods (i.e. soap and water), which are still required after circumcision. McCain’s error likely centers on his apparent ignorance of human anatomy. The foreskin adheres to the penis at birth and will not separate for many years. This protects the penis. The normal separation process may last late into puberty, long after mothers have ceased washing their sons’ genitals. Not only is there no need to go digging for dirt, it is potentially harmful to do so. Not that that stops parents from permitting doctors to forcefully break the natural adhesion in order to circumcise.

As for the throwaway point about circumcision easing the job of mothers, any parent who circumcises their healthy child to make their job easier is a bad parent. Child care is difficult? Don’t have kids. Choose to have kids and you discard your right to place your laziness first.

Back to his claim about fetishists:

… And it is certainly my impression — based on comments whenever the subject is raised — that women generally prefer what we might call the kosher pickle.

If there are fetishists, which side are they on? Is it those who advocate for each male to keep his normal genitals and choose for himself for his reasons or those who believe that parents may impose unnecessary surgery on their son’s genitals because they believe his future partner(s) will find his circumcised penis more sexually appealing? A woman can believe a man with a surgical scar on his penis is sexually preferable, yet it is those who state that the foreskin is a normal part of the penis, and each male should decide for himself, who are the fetishists? With this smear, McCain shows nothing more than an apparent character flaw deployed to mask his lack of curiosity.

He continues in his follow-up post (linked above):

Being quite happily married for 20 years, after having previously spent more than a decade as an equally happy and reasonably popular bachelor, I protest any suggestion that I really give a damn about anyone else’s penis but my own. While quite satisfied with my own equipment, I think it unseemly that I should boast of its merits, or to cast aspersions on the equipment of others.

What obtrudes here — and it obtrudes from only one direction in the present discourse — is the Foreskin Lobby’s repeated assertion that the circumcised penis is “mutilated” or in some other way inferior to the unmodified phallus.

I’m happy that he’s happy with his circumcised penis. I do not intend to waste my time trying to convince any circumcised male that he needs to be unhappy and wish that he hadn’t been circumcised. I’d gain nothing from such an endeavor, and it’s unnecessary to my logical and ethical case against circumcision. What each male decides for himself is what’s valid. No one is suggesting he has to give a damn about anyone else’s penis. But he needs to give a damn about the males who will give a damn about their own penises being altered by their parents without medical need.

McCain’s position, like most Americans, is that parents can decide and whatever they decide is fine, for whatever reason. It’s not. The child is healthy. He doesn’t need surgery. The legitimacy of proxy consent ends there. This should be blindingly obvious, especially when considering the inane, offensive reasons many parents give. As McCain highlights without awareness with his reference to women’s stated preference, parents circumcise based on nonsense. They don’t know what their son’s future partner(s) will prefer or whether he would want to have sex with someone who would reject him for having normal male genitalia. There is no possible defense for non-therapeutic infant male circumcision. That is the issue, not that Robert Stacy McCain likes being circumcised or that I hate it.

So, are those who derogate the foreskinless phallus as “mutilated” expressing some sort of religious bigotry? I hesitate to suggest such a thing, but sincerely wish that these barbaric aficionados of heathen penises would cease inciting unseemly debates over a subject so offensive to so many.

I am not surprised that someone who would trot out the fetish smear – in mocking fun, of course – would also attempt the more offensive smear that having a problem with infant circumcision is just a charade for anti-Semitism. There is no problem with circumcision as a religious rite, only with circumcision of children as a religious right. An adult may choose circumcision for himself for religious reasons or any other reason he deems worthy. And, yes, I’m aware of what the Old Testament says about circumcision. I also know what it says about slavery and adulterous women and so on. Civil society does not permit those, either, because we grasp that individuals have rights. What someone would choose for himself may not be what someone else would choose for him. The only valid option is to default to the individual’s choice. Hence, no circumcision of healthy children.

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Because it’s there… He concludes his original entry with this:

Those who prefer the sword-and-scabbard setup are perfectly entitled to their preference, …

I’m not entitled to my preference, am I, because society allowed my parents to surgically entitle their preference on me? This is the point McCain seems determined to miss.

… without casting aspersions upon those of us who’ve forsaken the sheath and keep the blade ready. “Mutilation,” indeed!

Without casting aspersions… Fascinating. Those who resort to name-calling are always the most thin-skinned, aren’t they?

Single-Payer and Circumcision in America

In my second response to Hanna Rosin’s posts on circumcision at The Daily Dish, I closed with this:

As a circumcised male, why do I care whether circumcision is mandated by the government or merely by my parents? The result – forced circumcision – is the same for me. Basically, Rosin engages in the “if you don’t like circumcision, don’t circumcise your son” defense. This is wrong. The case against circumcision centers on the boy as a (healthy) human being, not the boy as a son of parents making a choice.

This is the core of the ethical refutation of prophylactic infant male circumcision. Proxy consent cannot be justified on any grounds because the surgery is unnecessary, permanent, and carries an inherent risk of damage beyond what is deemed acceptable. On the last point, remember that no one considers the boy’s potential future disagreement with society’s definition of acceptable.

Ms. Rosin’s passage that prompted my comment involved the question of government-mandated circumcision. The CDC is not recommending that, of course. My point stands because, to the circumcised child, an influenced decision is no better than a required non-decision if he does not wish to be circumcised. But it does raise an interesting point for the current debate over health insurance reform that I’ve attempted to make in the past. From Ed Morrissey:

I’m neutral on the issue of circumcision, which has become a controversial practice, but find this idea of interventions very, very odd. In the first place, circumcision does not provide an immunity to STDs, not AIDS or anything else. Studies indicate that circumcised males may have less danger of acquiring an infection, but as the NYT points out, that’s from heterosexual relations — a very minor channel of AIDS communication in the US. Men have much better choices than circumcision for avoiding HIV infection, including the use of condoms (still not a perfect defense, but better than circumcision), refraining from intravenous drug use with shared needles, avoiding high-risk sexual practices altogether, and so on.

Why should the CDC push circumcision at all? The government has no business being in the middle of that decision. Under ObamaCare, however, when the government starts paying more and more of the health-care tab, they will point to ambiguous cost savings down the road — in this and other cases, decades down the road — to pressure Americans into surrendering their choices now. [ed. note: surrendering the choices of their children]

Apart from unnecessarily cluttering the single-payer issue with the “ObamaCare” phrase, this is exactly right, I think. How often do we need to see the public health community ramble on about the cost-benefit analysis “proving” that the net effect of prophylactic infant male circumcision is positive? How many lies pretending that non-essential and non-functional are synonyms will be necessary before we accept that not everyone shares the same view about what individuals should do and have, when those same people so often prove that they mistake their opinion for fact? Those people are at least as likely to make it to positions of power as anyone who considers the child’s lack of need and possible future objections.

It’s useful to highlight that most countries with an explicitly single-payer health care system have infant male circumcision rates that don’t approach 10%. Of course. But we can’t dismiss that the rates are greater than 0%. We must consider why.

I think the question of why narrows to culture. American culture places a high, irrational value on circumcision and its alleged wonders. Whether it’s the perceived health benefits for diseases that are already unlikely in a normal human state or a fear that schoolmates and sexual partners will laugh at him if he’s normal rather than common, we don’t evaluate circumcision factually. Ms. Rosin demonstrated this when she wrote that calling circumcision surgery is “a bit of an exaggeration.” No, it’s not, but our society possesses a strong anti-curiosity attitude on the topic. As Mr. Morrissey noted, the New York Times article provides all the necessary data to show that the CDC’s thinking is irrational. Yet, it’s picked up by people like Ms. Rosin who uncritically regurgitate only the parts they like and declare the resulting subset of findings uncontroversial. This is the low level of discourse in America surrounding circumcision and children.

If America had implemented a single-payer system at the same time England created its system, we could make a one-to-one comparison and the incidence of circumcision today would likely be close. But we didn’t. Instead, we have 60 additional years of circumcision to defend and justify. We have irrational beliefs to refute, should those holding those beliefs be willing to question them. We have a society that “knows” the foreskin is “just a flap of useless skin” and isn’t interested in hearing anything to the contrary, no matter how logical or based in scientific proof. A majority of our society still believes that the individual child is in the care of his parents for his medical decisions without a thought that this non-therapeutic surgical intervention is (social) experimentation, not medical care. The national discussion becomes about what people want to believe, not what is true. Cost is not a primary concern.

**********

Patrick Appel posted the Ed Morrissey link at The Daily Dish, where I found it. Mr. Appel writes:

The CDC is thinking of promoting circumcision, not requiring it. Whether or not you agree with the procedure, this controversy has nothing to do with health care reform. If single-payer leads to more circumcision, then how come America has among the highest rates of circumcised men in the world, much higher than most if not all countries with socialized medicine?

Mr. Appel makes the same mistake. The argument isn’t that single-payer leads to more circumcision. The argument is that American single-payer will not lead to a decrease in male circumcision. Either the system will pay or parents will pay. My view is the former because public health officials invariably think about the public rather than the individuals in the collective and politicians do not have the moral framework to say “no” to the inevitable backlash that would occur. Without legal reform recognizing the same rights for boys that we’ve already codified for girls, circumcision will continue in America, regardless of who pays.

Hanna Rosin Is Still Mistaken On Circumcision

Hanna Rosin summarizes the responses to her circumcision post from yesterday “into three basic categories”:

1. How can we do this to a child without his consent? There are so many things we do to children without their consent – change their school, banish their friends, give them drugs, abandon and neglect them. Removing a foreskin should not even fall in the top 20 ways to ruin your child’s life.

Right, ethics. She again fails to address this valid concern. Stating that “X is worse than Y” grants no legitimacy to Y.

2. “Foreskins are, well, fun,” writes one gay reader. My authority here is obviously limited. That said, all that research of specific areas of male sensitivity (Andrew cites some here) has always struck me as dubious. Erotic pleasure is a rich and complicated thing. Specific percentages of sensitivity can’t possibly sum up the experience.

Those last two sentences are true. Yet, she’s said nothing in defense of infant circumcision with either statement. Even if she’d explained why the research of specific areas of male sensitivity strikes her as dubious, what would that prove about infant circumcision? An extension of the ethical argument she’s failed to confront involves each individual deciding what constitutes preferred pleasure and sensitivity from and for his normal body. Erotic pleasure is a rich and complicated thing unique to the individual. Specific percentages of sensitivity evaluated by another can’t possibly sum up the experience for the individual.

3.Preventative surgery is a “bizarre notion.” This is somewhat more convincing. But for one thing, “surgery” is a bit of an exaggeration. We certainly cause infants minor pain for the greater public good many times, in the form of vaccines. It depends, I suppose, whether you consider HIV and STD’s a widespread public health crisis, or something affecting only a very few. I could get into the specifics of the research here, but I won’t.

Why is surgery in quotes? It is not an exaggeration to call circumcision surgery. Even her source from yesterday’s article, WebMD, defines circumcision as “the surgical removal of the foreskin, the tissue covering the head of the penis.” If there is a risk of death, no matter how small, circumcision is surgery. Her statement suggests a lack of curiosity on the subject for anything beyond what she wants to believe.

The vaccine argument is interesting and related. However, circumcision is the (surgical) removal of healthy, functioning tissue. The associated pain is a separate, secondary aspect for consideration. Our ability to control pain and its temporary presence are not defenses for performing the offending surgical procedure. Controlling pain does not render the intervention humane.

Nor are a boy’s genitals subject to the alleged needs of the public good. STDs require specific, individual actions. Those are actions that infants will not be undertaking for many years. When they begin engaging in those actions, they must use condoms, regardless of whether or not they still have their foreskin. Conveniently, a condom’s effectiveness is considerably higher than that of circumcision.

On the specifics of the research, it would be useful for her to state them. I’ll probably agree with her. It’s not necessary, though, because the discussion must circle back to ethics because she’s advocating circumcision on healthy infants, not adult volunteers. What we can do is not synonymous with what we should do.

**********

I didn’t include this in my objection yesterday because it disappears as an issue once we get the question of infant circumcision correct, but it’s an interesting point to pursue because a willingness to comprehend circumcision from perspective of the child’s rights is essential to ultimately grasping why circumcision is wrong. From her entry today:

…, my post defending circumcision taps into the current fears about “big government trying to mandate certain types of medical procedures,” as one reader wrote in.

As a circumcised male, why do I care whether circumcision is mandated by the government or merely by my parents? The result – forced circumcision – is the same for me. Basically, Rosin engages in the “if you don’t like circumcision, don’t circumcise your son” defense. This is wrong. The case against circumcision centers on the boy as a (healthy) human being, not the boy as a son of parents making a choice.

I Do Matthew Yglesias’ Homework

Last week, in a post lamenting the not-odd fact that the words and actions of politicians do not match, Matthew Yglesias wrote this:

My personal feeling, the longer I spend in DC and working in the political domain, is that I get better and better at understanding other people’s ideologies. I also feel that people writing about politics often caricature opponents’ views as part of a rhetorical strategy. But I’ve been back-and-forth on the main issues long enough that I’m pretty sure I could switch this blog’s point of view and do a credible job of offering critiques-from-the-right of the progressive liberal health reform movement and the progressive liberal approach to domestic policy generally. One happy consequence of this is that I find the stubborn persistence of principled disagreement less mystifying than I once did, and have a greater appreciation for what I now think of as a certain irreducibly Kierkegaardian element to ideological commitment that, in turn, helps explain why so many “normal” people have such fuzzy political views.

The words I placed in bold are important to remember while reading an entry Mr. Yglesias posted¹ yesterday (archived version:

There’s lots of great stuff in this Ed Pilkington story about the dark side of free market health care (via Tomasky) but my favorite bit was this part:

Eventually his lack of motor control interfered with his work to the degree that he was forced to give up his practice. He fell instantly into a catch 22 that he had earlier seen entrap many of his own patients: no work, no health insurance, no treatment.

He remained uninsured and largely untreated for his progressively severe condition for the following 11 years. Blood tests that could have diagnosed him correctly were not done because he couldn’t afford the $200. Having lost his practice, he lost his mansion on the hill and now lives in a one-bedroom apartment in the suburbs. His Porsches have made way for bangers. Many times this erstwhile pillar of the medical establishment had to go without food in order to pay for basic medicines.

This is the kind of thing that makes it so hard for me to take seriously the idea that we can’t have the government give people health care because it might subject them to “rationing.” Depending on the details, it may or may not be correct to believe that any particular government program is being too stingy. But how does giving people nothing at all resolve that problem?

There are two issues here, closely related to Mr. Yglesias’ entry from last week linked above. The initial problem is glaring but only if you follow the link to the Ed Pilkington story. You wouldn’t know this from his excerpt, but the paragraph continues (emphasis mine):

He remained uninsured and largely untreated for his progressively severe condition for the following 11 years. Blood tests that could have diagnosed him correctly were not done because he couldn’t afford the $200. Having lost his practice, he lost his mansion on the hill and now lives in a one-bedroom apartment in the suburbs. His Porsches have made way for bangers. Many times this erstwhile pillar of the medical establishment had to go without food in order to pay for basic medicines. In 2000 Manley finally found the help he needed, at a clinic in Kansas City that acts as a rare safety net for uninsured people. He was swiftly diagnosed with Huntington’s disease, a degenerative genetic illness, and now receives regular medical attention through the clinic.

Mr. Yglesias’ excerpt is an incomplete representation of the complex facts, presumably to make the point – a caricature, if you will – that the free market has failed. But has it really failed?

Mr. Manley probably should’ve saved his money for potential later-life crises rather than buying a new Porsche every year, as the article states he did when his practice was strong. That is a relevant point, but it’s little more than a distraction to the real issue underlying Mr. Yglesias’ belief that everyone has an obligation to pay for everyone’s care, especially where the free market (allegedly) fails. Regardless, we have the system we have, not the one either side wishes. It shouldn’t have taken so long for Mr. Manley to receive the care he needed. Stating this needn’t be considered a concession or profound.

What Mr. Pilkington, and subsequently Mr. Yglesias, failed to explore is the care that Mr. Manley eventually received.

[Dr. Sharon] Lee’s clinic, Family Health Care, is a refuge of last resort. It picks up the pieces of lives left shattered by a health system that has failed them, and tries to glue them back together. It exists largely outside the parameters of formal health provision, raising funds through donations and paying all its 50 staff – Lee included – a flat rate of just $12 an hour.

Unlike Mr. Yglesias, I researched Family Health Care. It took approximately 10 minutes. Mr. Manley is getting care thanks to the “dark side of the free market.” Consider the clinic’s financial profile for 2005-2007:

The clinic receives 0% of its funding from government, meaning that the remaining 100% of its budget comes from the bank accounts of individuals, corporations, and non-profit organizations. Where is the free market failure to provide health care to those in need?

The structure of the American health care and insurance system is idiotic and needs reform. We should talk about that. The article even includes anecdotal stories to suggest problems that need to be addressed within the views of each side’s extremes. But presumably that wouldn’t have made the point for Mr. Pilkington or Mr. Yglesias that government needs to step in to protect the poor from the free market’s alleged failures, which are, we are told, ignored by the mean-spirited right-wing capitalist liars opposed to President Obama’s proposal. A neat, tidy box, indeed. That reaches closer to ideological commitment – propaganda, if you will – than journalism.

Update: I’ve struck the reference to propaganda. This isn’t that. Rather, Mr. Yglesias’ ideological commitment is more likely laziness embracing the appearance of victory.

¹ Normally I refuse to reprint an entire entry because links are survival. In this case, I can think of no other way to make my points.

Because… HIV!

It’s easy to talk about “public health” as if we’re all in one giant collective, with the same needs and desires. But that’s not true. We are each an individual, with specific, unique considerations. It is foolish to pretend that one approach is sufficient for everyone. It is offensive to behave as though the recipient of that one approach is irrelevant to whether or not it should be applied. Consider:

Public health officials [at the Centers for Disease Control and Prevention] are considering promoting routine circumcision for all baby boys born in the United States to reduce the spread of H.I.V., the virus that causes AIDS.

The article is little more than the latest 6th Grade Current Events drivel churned out from the New York Times’ “Promote Infant Male Circumcision” template. Guess where the author/editor placed this paragraph in the story:

Circumcision is believed to protect men from infection with H.I.V. because …

The paragraph demonstrating that scientists do not yet understand how circumcision is supposed to reduce the risk of female-to-male HIV transmission should probably appear early, before the committed sentiments from those wishing to transfer the findings on adult volunteers in Africa to infant non-volunteers in America. Yet, it’s the last paragraph in the article. 916 words precede the significant fact that advocates do not yet know the relevant fact to support what they now wish to force on children.

Unsurprisingly, the word ethics appears nowhere in the article. The mere suggestion of potential benefits, despite the irrefutable fact that they are not needed and the high probability that they would not be desired, is enough to take pro-infant circumcision advocates seriously when the logic of basic human rights and medical ethics demands that we dismiss them from polite company. Instead, this passes for “serious”:

But Dr. Peter Kilmarx, chief of epidemiology for the division of H.I.V./AIDS prevention at the C.D.C., said that any step that could thwart the spread of H.I.V. must be given serious consideration.

“We have a significant H.I.V. epidemic in this country, and we really need to look carefully at any potential intervention that could be another tool in the toolbox we use to address the epidemic,” Dr. Kilmarx said. “What we’ve heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks.”

Does “any potential intervention” have any ethical limitation? Removing the boy’s penis would surely solve the transmission problem. Is that acceptable?

I am, of course, being intentionally ludicrous. Removing a boy’s penis is not what Dr. Kilmarx is suggesting. Yet, he is promoting a mentality that how he fears HIV and values prevention is the only acceptable approach. Therefore, any intervention he deems appropriate must be appropriate. Because… HIV!

It will not work, for several key reasons, all easily identifiable and critical to the process:

He and other experts acknowledged that although the clinical trials of circumcision in Africa had dramatic results, the effects of circumcision in the United States were likely to be more muted because the disease is less prevalent here, because it spreads through different routes and because the health systems are so disparate as to be incomparable.
…

There is little to no evidence that circumcision protects men who have sex with men from infection.

Another reason circumcision would have less of an impact in the United States is that some 79 percent of adult American men are already circumcised, public health officials say.

Add to that the reality that any infant male circumcised today to prevent reduce his (already low) risk of HIV will not be sexually active until approximately 2024 or beyond. When he is sexually active, he’ll still need to wear a condom. Circumcision will have added nothing to his life as an HIV prevention. It’s success, however limited it would be, depends upon the male behaving irresponsibly. An assumption that a boy will be irresponsible is not a valid justification for the surgical removal of a healthy, functioning body part.

Yet, that basic human right – the same right accepted and codified for female minors – is denied to male minors for nonsensical reasons:

The academy is revising its guidelines, however, and is likely to do away with the neutral tone in favor of a more encouraging policy stating that circumcision has health benefits even beyond H.I.V. prevention, like reducing urinary tract infections for baby boys, said Dr. Michael Brady, a consultant to the American Academy of Pediatrics.

He said the academy would probably stop short of recommending routine surgery, however. “We do have evidence to suggest there are health benefits, and families should be given an opportunity to know what they are,” he said. But, he said, the value of circumcision for H.I.V. protection in the United States is difficult to assess, adding, “Our biggest struggle is trying to figure out how to understand the true value for Americans.”

This is the coward’s path¹. They won’t recommend it, but they’ll tell parents it’s really wonderful and prevents all these scary things. They’ll dismiss the risks and ethics involved, and they’ll ignore the statistics in context. For UTIs, the statistics show that all males, circumcised and intact combined, face approximately a 1% risk of UTI in the first year of life. The majority of those UTIs are easily treated without circumcision. Those that are not are generally caused by anatomical abnormalities, not the presence of the normal foreskin. [ed. note: Links when I can find them. It’s late.]

But none of that matters to those who believe that parents should decide what is best for their family regarding their son’s foreskin. We don’t extend this appalling idea that the family owns the foreskins of its sons to the genitals of its daughters. No, a female minor’s genitals belong to her, regardless of the parents’ opinions. That’s critical in displaying the hypocrisy and cultural blinders because the advocates are only discussing opinion. They’ve established a perceived value to non-therapeutic male circumcision. They’ve endorsed that with the power of their titles to those parents who want to believe the same illogical conclusion. Because they value it, they can’t conceive that the healthy child who will be surgically altered could possibly mind. He wants it, don’t you know, because dad likes it and mom likes it and what if his classmates laugh at him or girls won’t have sex with him? He needs to have less to be enough. And because… HIV! That he could conclude that non-therapeutic circumcision performed on him as an infant is mutilation is inconceivable. The person who believes that is allegedly the fringe lunatic who rejects the public health. Because… HIV!

To the CDC: My non-therapeutic circumcision as an infant was mutilation. My parents had no legitimate authority to request it. The doctor had no legitimate authority to perform it. I do not value circumcision for me. I never will, no matter how much your unethical experts tell me I should. I have never and will never need any HIV risk reduction because I do not engage in unsafe sex. Should I encounter any of the other medical maladies discussed in relation to circumcision, I will prefer the least-invasive effective treatment available. I believe in evidence-based medicine, particularly the simple-to-understand truth that healthy genitals are evidence that no surgical intervention is ethical on a child. Not even on the genitals of American boys.

¹ It is also why appeals to the authority of an organization like the AAP are unwise. They may present a (barely) acceptable tone today, but tomorrow is always a new day to be irration
al.