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Clarifying Circumcision Facts, Part 1

I've been in an on-and-off circumcision debate on Twitter recently with an individual named NotStyro. (My Twitter link.) I find the debate useful because I find his responses inadequate. However, 140 characters isn't enough to debunk the flaws in the link he typically provides. I have a different qualm, but first, a representative tweet from NotStyro on the subject.

just to inform, not debate... [link redacted] ...let me know if you would like more information

I find this understandable within the limitations of Twitter, but unsatisfactory overall because the site he links makes this offer:

Why should you consider circumcision ?

With the anti-circumcision propaganda on the net, consider the following facts:

If parents will make a choice (that isn't ethically theirs), I want more than a list of seven facts of questionable legitimacy. To the extent these facts are facts, they still do not support what NotStyro recently promised a father questioning his son's pending circumcision to go forward with the surgery:

... he'll appreciate your decision later in life.

As he's been in our debate, NotStyro is indifferent to the reality that men, including me, do not appreciate that decision by our parents. This is our fundamental disagreement. I demand only that each individual retain the choice to decide about his body. NotStyro argues differently. But we can't get to it until we agree on facts.

There's too much information in his link for one post, so I'm going to break this up into its logical parts. The list NotStyro links to has seven items. Each item will get an entry. Once I've posted an entry, feel free to debate (i.e. defend) a position. No e-mail or web address is necessary to comment. I'm establishing only one rule beyond normal etiquette: inappropriate links will be deleted. Most links will stay if they're defended. (No canned answers, please; address the items from the list.) But I will not allow a direct link to the list of seven items under any circumstance. The site is a pro-circumcision fetish site, complete with circumcision fiction. I will not promote it. If you must visit it (NSFW), follow the link through NotStyro's tweet above. Anyone may participate, of course. To NotStyro directly, I'm asking for more information.

On to item #1:

1. The foreskin increases the risk of male and female infections.

  • 'Current new-born circumcision may be considered a preventative health measure analogous to immunisation in that side effects and complications are immediate and usually minor, but benefits accrue for a lifetime’

"May be considered" is a claim, not a fact. Nor is infant male circumcision analogous to immunization. The threats are distinct. Unvaccinated, I could catch measles by simply going out in public. I am not going to become HIV-positive without specific sexual behavior I can control, regardless of whether or not I have my foreskin.

There is a further complication to the comparison. The recent, actively-touted studies looked only at female-to-male HIV transmission. This is the least common transmission among those involving men. For example:

Female-to-male HIV infection was not observed in long term stable monogamous relationships. These results emphasize the relative uni-directionality of heterosexual transmission in non-promiscuous couples.

That suggests what we already know. HIV is transmitted through promiscuous, unprotected sex. Pretending that circumcision is a significant benefit when neither of those conditions exists is wishful thinking. Circumcised or not, if an individual behaves recklessly, there are consequences. That is the lesson. Parents will be more successful at keeping their sons (and daughters) safe from HIV if they teach them about responsible sexual behavior. No medical expert proposes that circumcised men may now ignore condoms. Circumcision is superfluous and unnecessary. This is particularly true in the United States, where HIV infections result primarily from IV drug use and male-to-male transmission. Circumcision is irrelevant to the former and ineffective to the latter.

The rest of the claim is questionable, as well. Minor complication is subjective, as determined by the victim. You may think a skin tag is "minor"; I would not. I prefer to think of complications as treatable and not treatable. In this case, yes, most complications are treatable. That raises the obvious ethical question of imposing surgical risk on a non-consenting, healthy individual, which I will save for another post in this series.

But what about those complications that are not treatable? These can be lesser problems such as tight, painful erections. If we move up the spectrum, we can discuss males who lose portions or all of their glans. Are we still in the territory of "minor"? What if we go to the extreme, death. It happens. I won't pretend it happens often, but how many times may it happen before we suggest that maybe healthy boys dying from by-definition unnecessary surgery is unacceptable? The lack of medical need demands the answer be 0. It isn't, which demonstrates that we do not rely on facts when circumcising healthy infant males.

Continuing from the list:

  • Circumcision reduces the risk of vaginal infections.

Probably, based on some of the studies I reviewed. If, of course, the results were properly controlled and the results are transferrable to industrialized nations. Maybe, maybe not, but I'll concede the point for argument's sake. This is a factual claim. So what?

The underlying issue here is the ethical flaw. It is unethical to alter a non-consenting individual's body to reduce the risk that his future partners - if he is heterosexual - will suffer vaginal infections. That is a decision for him to make. He may include his female partners in the decision-making process. But that is within only his discretion. All else is a speculative guess. A speculative guess involving another's healthy body is indefensible, even if his parents make the speculative guess.

To put it in perspective, a male can't cause vaginal infections if we prohibit him from having sex with women. He can't cause vaginal infections if we remove his entire penis. These are extreme, ridiculous hypotheticals. But they demonstrate that just because we can do something does not mean we should. There is more involved in permitting parental proxy decisions than just the fact that Action X generates Result Y.

Whether or not this generates a debate, and how long that debate transpires, will determine when part 2 appears. I will continue the series, regardless.

Comments

I'll open the comments with an acknowledgment that this post touches a lot of issues. I tried to refrain from that, but Item #1 is very open-ended. Future posts will be more restricted because the list makes specific rather than general claims.

it's good you're challenging people on circumcision. there are always going to be individuals who defend it, just as there are many who defend the equivalent assault on female children.

you say everything that needs saying here:

"The underlying issue here is the ethical flaw. It is unethical to alter a non-consenting individual's body"

everything else amounts to busy work. it's like analyzing the term 'uncircumcised'. i mean, what? isn't that like the term 'unlobotomised'?

All of the studies purporting benefits for circumcision can ONLY SUGGEST they exists simply because none of them are scientifically credible.
For a hypothesis to be valid, it must be based on UNFLAWED data & must make accurate prediction.

None of the studies meet these criteria.

It depends if you are talking about routine infant circumcision, or an adult deciding for himself to get a circumcision.

There needn't be a debate about routine infant circumcision. Even if all the arguments by the pro-circ brigade were true, it would still be wrong to cut off an important functioning part of a baby's body without his consent.
Leaving the ethical problem aside, the question one should ask is - "is there a NET benefit?"
You cannot just look at the supposed advantages and base your decision on that alone. You have to look at the downsides to circumcision - for example the risks of complications and the loss of sexual function and sensitivity of the penis.

Is there a net benefit? No of course not. 75-80% of the world is intact. Non religious circumcision was only introduced in the late 1800's to stop masturbation. They thought that masturbation was bad for you and caused illnesses. It was only taken up in English-speaking countries. The USA is the only 1st world country still doing it. The AAP and all other medical associations find no net benefit to infant circumcision:
http://www.circumstitions.com/AAP-ana.html

Ed. note: Deleted my note because it didn't make sense. James_T provided enough. I missed a point on my first read through. My apologies. - Tony

Specifically in regard to medical studies. These links should be helpful informing NotStyro:

http://cirp.org/library/disease/

cirp has got 1000's of articles:
http://www.cirp.org/library/

Then there is circumstions.com:
http://www.circumstitions.com/

Also have alook here:
http://www.advocatesforyouth.org/publications/factsheet/fsest.htm

Countries that do not circumcise (all of Europe) have lower rates of various diseases. So circumcision can't be that great.

It's no more ethically ok to circumcise a male than to circumcise a female. Some forms of female genital mutilation i.e. clitoral hood removal, are analogous to the the removal of the foreskin in male genital mutilation.
Female genital mutilation used to be done in the U.S. as well; the discourage masturbation. That we don't still do it to girls has been up to the whims of history. Continuing to do it to males is clearly a human rights violation because the male is not consenting to the surgery.
Mgmbill.org seeks to give equal bodily rights to males. Anti-FGM legislation was passed in 1996.

Ed. note: I'm going to publish this because it offers useful statements, but it's a canned answer. I want comments addressing the specific points in my entry. We're correct in the debate, but society is blind to that too much. We have to play on their terms for now, defeating their claims. Let's try to do that. - Tony

You might also want to check out the following:

Canadian Paediatric Society
"Recommendation: Circumcision of newborns should not be routinely performed."

http://www.caringforkids.cps.ca/pregnancy&babies/circumcision.htm
"Circumcision is a 'non-therapeutic' procedure, which means it is not medically necessary."
"After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.

RACP Policy Statement on Circumcision
"After extensive review of the literature the Royal Australasian College of Physicians reaffirms that there is no medical indication for routine neonatal circumcision."
(those last nine words are in bold on their website, and almost all the men responsible for this statement will be circumcised themselves, as the male circumcision rate in Australia in 1950 was about 90%. "Routine" circumcision is now *banned* in public hospitals in Australia in all states except one.)

British Medical Association: The law and ethics of male circumcision - guidance for doctors
"to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate."

National Health Service (UK)
"Many people have strong views about whether circumcision should be carried out or not. It is not routinely performed in the UK because there is no clear clinical evidence to suggest it has any medical benefit."

The College of Physicians & Surgeons of British Columbia
"Circumcision is painful, and puts the patient at risk for complications ranging from minor, as in mild local infections, to more serious such as injury to the penis, meatal stenosis, urinary retention, urinary tract infection and, rarely, even haemorrhage leading to death. The benefits of infant male circumcision that have been promoted over time include the prevention of urinary tract infections and sexually transmitted diseases, and the reduction in risk of penile and cervical cancer. Current consensus of medical opinion, including that of the Canadian and American Paediatric Societies and the American Urological Society, is that there is insufficient evidence that these benefits outweigh the potential risks. That is, routine infant male circumcision, i.e. routine removal of normal tissue in a healthy infant, is not recommended."

See also:
Canadian Children's Rights Council
"It is the position of the Canadian Children's Rights Council that "circumcision" of male or female children is genital mutilation of children.


Drops in male circumcision:
USA: from 90% to 57%
Canada: from 47% to 14%
UK: from 35% to about 5% (less than 1% among non-Muslims)
Australia: 90% to 12.6% ("routine" circumcision has recently been *banned* in public hospitals in all states except one, so the rate will now be a lot lower)
New Zealand: 95% to below 3% (mostly Samoans and Tongans)
South America and Europe: never above 5%

It's worth remembering that we wouldn't even be having this discussion if it weren't for the fact that 19th century doctors thought that :
a) masturbation caused various physical and mental problems (including epilepsy, convulsions, paralysis, tuberculosis etc), and
b) circumcision stopped masturbation.

Both of those sound ridiculous today I know, but if you don't believe me, then check out this link:
A Short History of Circumcision in North America In the Physicians' Own Words

Over a hundred years later, circumcised men keep looking for new ways to defend the practice.

The record payout for a botched circumcision is $22.8 million. It was said at the time that the victim "will never be able to function sexually as a normal male and will require extensive reconstructive surgery and psychological counseling as well as lifelong urological care and treatment by infectious disease specialists."

Thanks everyone. Good points overall.

I'd like to address one point from James. Everything I write is about child circumcision. I don't care what adult men do. I hope they make an informed decision, and obviously I don't think they should get circumcised, but it's not my place to interfere or judge them. I only care about leaving children the choice to make their own decision.

We shouldn't need to debate it. Unfortunately, we do because our legal system hasn't caught up yet.

I don't know if this was posted yet, you wanted a supporting link for disease rates in Europe. I think this might do.

Oh, I see it was already posted. I should read before I post. ;)

Okay, Tony, so you suddenly want a discussion that you declared that will result in “neither of us will change our minds.” I have to wonder, what caused the change of mind? Was it my supplying links for information to those that either requested information or might have a demonstrated need for the information provided in the links? Or maybe it is that the information provided challenges your view of your own 'manhood' (and begging the question of how you came to hate that particular organ)?

You seem to be harboring a delusion that infants hold rights to that which they cannot enjoy or utilize. Unfortunately, you are joined with a great many people that disapprove of male circumcision in this similar malady. Even more unfortunate (for me, at least, I guess) is that the only manner to address this issue is by discussion with each afflicted individual.

So here it begins...

It is an almost worldwide opinion that parents and guardians are fully entitled to authorize and allow for medical treatments to be taken onto their child when immediate medical necessity is warranted. It is likewise accepted and expected that parents and guardians are fully entitled to authorize medical treatments that protect and foster a child's long-term best interests.

Infant male circumcision clearly fits into the latter of these parental entitlements. A parent or guardian that authorizes circumcision for their child is doing so under the belief that circumcision is in the long-term best interest for their child. It is also likewise that a parent or guardian that does not authorize a circumcision is also making the decision in that same frame of mind – in the long-term best interest for their child.

So, which set of parents or guardians is correct? Both, neither, or some amalgamation? While not wanting to belabor the point, but too well knowing the audience, I'll continue. Simply, both sets of parents and/or guardians are correct. Both are making the correct decision as to what is to be done, or not done, in the best interests of their child.

"It is likewise accepted and expected that parents and guardians are fully entitled to authorize medical treatments that protect and foster a child's long-term best interests."

So. according to you, all it takes is a BELIEF in something to justify it? What ever happened to facts, evidence, and proof of them before one requests it? So, using your assertion, HOW does circumcision fulfill your attempts at a justification?

Without these it is not possible to make a CORRECT decision, and playing word and re-definition games alters nothing.

In short, you have not provided anything of substance--try again.

PROVE it IS in the child's best interest--start by disproving the harm done by circumcision!

Normally I don't answer trolls, but since Tony let you through...

"A parent or guardian that authorizes circumcision for their child is doing so under the belief that circumcision is in the long-term best interest for their child."

...replace with...

"A parent or guardian that authorizes circumcision for their child is doing so under the belief, and/or after researching the facts, that circumcision is in the long-term best interest for their child."

"It is likewise accepted and expected that parents and guardians are fully entitled to authorize medical treatments that protect and foster a child's long-term best interests."

So. according to you, all it takes is a BELIEF in something to justify it? What ever happened to facts, evidence, and proof of them being necessary before one requests it? So, using your assertion, HOW does circumcision fulfill your attempts at a justification without them?

Without these it is not possible to make a CORRECT decision, and playing word and re-definition games alters nothing.

In short, you have not provided anything of substance--try again.

PROVE it IS in the child's best interestperhaps start by disproving the harm done by circumcision!

"Normally I don't answer trolls, but since Tony let you through...

...replace with...

"A parent or guardian that authorizes circumcision for their child is doing so under the belief, and/or after researching the facts, that circumcision is in the long-term best interest for their child."

LOL, try actually answering my point-, unsupported repetition and/or more word games hardly qualifies as answering them. Is this the best you have to offer?

So, after this research, what are the scientifically credible proofs (facts)of any benefits for circumcision?

NotStyro,

I'm about to post my response to you. However, I want to make this point separately. I don't think the anonymous comment was trollish. It appears to be resolved, anyway. I'm leaving the comments as they are to avoid any disruption of the flow.

First, one point of etiquette. Attempted insults will be tolerated because I find them amusing. But if you're trying to bait me into hysteria with taunts that I'm "afflicted" by what my parents did to my "manhood", you're wasting your time. My principled stance works with or without my personal preference. Nor do I think an adult male preferring circumcision for himself is insult-worthy. I'm not sure how the opposite - a male circumcised without his consent preferring that he'd been left intact - is supposed to be insult-worthy, either, unless I look at it as a reflection on the insulter rather than the insulted. I won't draw that conclusion based on one insult. Multiple insults, I probably will.

Second, you're not defending the facts in the list you provided. You're getting more directly at the heart of the issue, so I can live with that. And I know this discussion won't result in either of us changing our minds. Still, it's only fruitless if I'm trying to change your mind. You believe circumcision is appropriate for all, despite the clear evidence that the foreskin does not lead directly to increased problems within the population. I believe each healthy person should choose for himself, whatever he may choose, for whatever reason. And statistics on adult males seeking circumcision support my claim that intact males rarely seek or need circumcision. I seek to demonstrate that you are ignoring principles and counter-arguments to facts. I've considered the full range, and I'm willing to defend my position that what you ignore rejects any defense of routine infant circumcision.

You claim that infants don't hold certain rights because they're unable to enjoy or utilize. Do you support the anti-FGM law that protects those "unheld" rights of girls? It prevents their parents from doing exactly what you're advocating for parents to do to their sons, impose surgery for cultural reasons. What other individual rights do infants not hold? What is the limit for parental intervention? How does gender play into those limits? What rules, if any, are appropriate? How do those rules match the Constitution's guarantee of equal protection?

Let me ask you a question: When the validity of slavery was an almost worldwide opinion, did that make slavery valid? I say "no" because slavery violates a core principle of individual human rights inherent in every person's birth, regardless of what most people believe at the time. I don't doubt that you would also say "no" to that question, but your defense of genital cutting on healthy infants is an unprincipled embrace of majoritarianism. You simply can't have both. What is permitted for parents is not synonymous with what should be permitted for parents.

You also deflect the problem in your position by conflating parental proxy for medically unnecessary decisions with medically necessary decisions. No one questions the latter. Even though the decision on what to do can be very subjective, the decision that something needs to be done is based on objective criteria. The former, however, clearly permits subjective decisions based on subjective criteria. "Long-term best interest" is so open-ended that it means anything a parent wants it to mean. I've encountered a very wide array of excuses for infant circumcision, but many parents primarily base their decision on some combination of these three "best interests":

  • Like father, like son
  • Mom and/or dad thinks foreskin's are icky and ugly
  • Mom and Dad can't be bothered to learn how to clean the foreskin

It's clear that many individuals reject what their parents value. Protecting the right to choose differently for one's self is the point of enforcing individual rights, from birth, on principled grounds. For example, my father died when I was three. I never saw him naked, that I remember. Nor would I care about his penis if he was still alive now that I'm 35. He had very curly hair, too, but I cut my hair before it gets long enough to start curling because I hate it when my hair curls. Are you willing to argue that I'm wrong about my personal opinions about my life, that my dad's reality and choices were all that's appropriate for me throughout my life? Your defense of infant circumcision for reasons other than immediate, direct need requires that view.

I imagine you'll still rely on the open-ended "best interests" defense. But I started this series to discuss the facts that parents allegedly use to determine best interests. Either you'll prove that those facts are enough to justify infant circumcision, or I'll prove that the counter-arguments prove those facts are not enough. Maybe we can engage in that debate first?

NotStyro,

I've changed the link in your name on your most recent comment to your Twitter account.

Although I find the link you used lacking in both validity and tone, I'll post it, just as I've allowed the other links in this thread. Your link is here:

DEBUNKING THE MYTHS AND LIES MADE BY THE ANTI-CIRCUMCISION CULT

However, it violates several points I think are implicit. First, "cult" is hyperbole, a smear designed to dismiss rather than refute.

Second, unless you can convince me that you are directly involved in creating and maintaining that list, it's not appropriate as your hyperlink. I do not want anyone to get an unintentional mistaken impression that you're affiliated with it.

Third, I let links through earlier that weren't sufficiently defended or relevant to what I'd discussed. I'm not opposed to that, although I don't think it helps teh commenter's case. But you provided it without defending it or even pointing out that you were including it. Something that proposes to debunk 18 myths can't be slipped into the debate.

That said, for the reasons you've dismissed your original link that I started this series with, it's probably better that we use another list to resume this series. I'm open to whatever list you provide. Do you want to use this one?

I will warn you that this new list cites the fetish site CIRCLIST as a reference in its attempted debunking. Expect me to highlight that.

I think everything has been said so far. I guess NotStyro's post begs the question how far can one take the banner of parental authority? As has been said, nobody would say that a parent could authorize a medically necessary treatment but it is ethically questionable when you're talking about something that has no practicle medical value and at the same time is invasive.

"As has been said, nobody would say that a parent could authorize a medically necessary treatment but it is ethically questionable when you're talking about something that has no practicle medical value and at the same time is invasive."

Let's not forget harmful and risky.

Tony, I rather like to create a rotation of links in the requested url field, but if you want something valid and personal I guess I'll just leave the field empty. Now for a little about the points you made regarding the link.

First point, while 'cult' may sound like hyperbole or a smear, in this case it may actually be accurate. A dictionary definition of 'cult' supplies the following definition “an instance of great veneration of a person, ideal, or thing, esp. as manifested by a body of admirers: the physical fitness cult.” Considering that a good deal of people that call themselves 'intactivists' and 'anti-circumcision activists' will debate and discuss against male circumcision in great detail and at great length, plan and participate in marches, write and protest to medical & political bodies that may have some weight regarding policies about infant & child health, etc., it is clearly reasonable to consider that they are a cult.

Third point, the link provided was not defended nor brought into discussion because there was not any reason to bring it into the discussion. Also, it would only be noticed if someone were to follow the link under my nickname. It was supplied as an optional or throw-away link.

Getting back to topic, how are the following lists/links...?

http://www.circinfo.net/health-benefits-and-reviews.html
“Male Circumcision Guide for Doctors, Parents, Adults & Teens”

http://www.medicirc.org/meditopics/medicirc_topics.html
“Circumcision: a lifetime of medical benefits”

http://www.malecircumcision.org/index.html
Clearinghouse on Male Circumcision for HIV Prevention”

This last link is particularly interesting since it comes from the World Health Organization (WHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the AIDS Vaccine Advocacy Coalition (AVAC), and Family Health International (FHI). I'm fairly sure that information at, or referenced at, this site should not raise a 'pro-circumcision' and/or 'fetish' banner.

NotStyro,

I think we're playing a little too semantic with "cult", for under your definition, you're in a cult as much as I am. Forget whether or not it's true, as neither of us would label ourselves as cultish. I don't think the word helps the debate because in the link it is meant as a denigrating smear rather than a factual claim. I'm not here to insult. I'm hoping you're not, either.

As for the link, if you read my response as implying any sort of malice on your part for leaving the link attached to your name, I meant none. I assumed your intent was innocent. I should've been a bit clearer. My only point is that I want the circumcision debate to be as open as possible.

Of the three sites you link, I definitely prefer the last. As you can guess, I consider Schoen and Morris propagandists.

I looked through the third link briefly this morning, and it seems to be so far mostly a filter of other news. That's fine, and I think you're correct that it doesn't raise the pro-circumcision or fetish banner. I don't expect it to show the latter, but it will become slanted to pro-circumcision quickly by the nature of its mission. It'll have the ethical blindspot regarding infant vs. adult circumcision that most people have. The news/press releases surrounding its launch give the game away if you've followed the debate at all.

However, I'm looking for the full range of facts rather than just HIV. I don't know that the third link gets us very far. I don't really care which site we use, so I'll nominate Schoen's site, just because he seems to be more specific than Morris. Make sense?

Tony, while I am unsure about your involvements with any cults, as it may cause issues with your principled objectivity, but I am quite sure that I am not part of any cults, at least as far as the topic of discussion. I am my own person and not involved in any group or organization. My main concern is that parents, guardians & others have access to information that will assist them in making a choice for their child, themselves or others.

I don't believe I am heavy-handed in the links or recommendations as I have never threatened parents with calls to DFS over whether they have, or have not, circumcised their son(s). I have not, that I remember, referred to a parent/guardian as a 'mutilator' for circumcising, or that they are a party to 'child negligence' if they fail to circumcise.

I anticipated that you might have issues with Dr. Morris and Dr. Schoen. Not surprisingly, I have no problem with either as both have backgrounds in medicine & medical research and have been published in peer reviewed journals. Calling either of these fine doctors 'propagandists' will likely result in each us in turn referring to each researcher in a paper as a 'quack', 'propagandist', 'paid', 'sponsored' or other words and phrases that undermine their credibility.

I don't engage in those behaviors, either. I've seen them - on both sides, as I hope you'd acknowledge, as well. That speaks to the person or group engaging in that behavior, not the underlying principles and facts within the topic.

I call Schoen and Morris propagandists because they use their credentials to push subjective reasons to circumcise. Having an MD or PhD does not validate the claim - as a justification for infant circumcision - that women prefer circumcised men. Schoen and Morris both go there, among other statements.

Still, I'm primarily pointing out my opinion of them as propagandists so that I'm upfront. I don't think research into benefits is propaganda or quackery just for looking at facts. Finding that voluntary, adult circumcision reduces the risk of HIV is science. I may question the results, but that's different from questioning motive. When those results are used to justify infant circumcision under the assumption that the findings on voluntary, adult circumcision are transferable, that's what I challenge. Such a claim ignores ethics.

For example, from December 2006:

"These (African) countries should now prepare how to introduce circumcision on a large scale," UNAIDS chief Dr. Peter Piot told Reuters. "The science is clear."

Baby boys should be targeted first but then attention should switch to adolescent boys and adult men, said Piot, who is in New Delhi to meet Indian officials on how they plan to tackle the world's largest HIV/AIDS caseload.

During what is stated as an HIV epidemic, he wants to start with infants and work his way eventually to sexually-active males. He knows that circumcising infants is the way to change the culture. That's a bias based on preference, not science. Thus, it's propaganda.

The idea of "paid" comes up with the Sorrells (I believe) fine touch study. I make points based on the idea of that study, but I do not quote the study's finding. Primarily that's because I don't need to, but also because it's bad marketing on my part to cite it. Rightly or wrongly, others will rip it for being "paid". So I don't bother.

With regard to Schoen, Morris, or anyone else, I'll debate the facts as they provide them. If I veer too far into opinion, call me out on it.

My last post was indeed a canned answer, but I thought it was relevant and authoritative, seeing as how the CPA, BMA, and RACP were quoted.

If someone's trying to claim "The foreskin increases the risk of male and female infections", then they're going to have a hard time explaining those position statements.

They might find it hard explaining this too
http://www.jpeds.com/article/S0022-3476(07)00707-X/abstract

The longest such study anywhere, and the circumcised men had a slightly *higher* risk of STI's...

Tony, ok, so you are acknowledging the science behind studies that demonstrate that circumcision reduces HIV transmission during sexual intercourse? That micro-abrasions in the foreskin may allow an access point for systemic infections? With, of course, the disclaimer that a condom or other physical barrier for transmission should be the primary method of disease & birth control.

If those questions above are true then what is the problem? That the finding on studies of adults are not transferable to infants, children & adolescents? I don't want to assume an answer here, but how would the question of 'at what age' the circumcision happened matter more than that it took place before unprotected sexual intercourse with a possibly STD/HIV positive partner?

Regarding circumcision of infants and working to adults, I don't really see the problem. Considering that they are working with a finite amount of money, resources and in developing nations, the best option may be to supply adults and adolescents with condoms and disease prevention training while they train surgery & clinic staffs and wait for the costs & risks to drop. While at the same time give circumcisions to infants & children as the procedure is less costly, there is much less risk and even if they fail to receive disease prevention training, they are somewhat covered when, in 10 or more years, they become sexually active.

The problem is that good medicine requires good ethics and in this case, infant or child circumcision does not represent good ethics. Since circumcision is an invasive procedure and it doesn't remove the need for other more effective, safer, and less invasive methods of protection it can only be responsibly offered to adults. As far as resources are concerned, when you have a finite supply of resources in such a case, you should be focusing on the at risk population first. This would mean adult men not infants. The only reason to focus on infants is to insure their informed consent is not required. It's easier to scare parents into providing consent than an individual because ultimately a minor operation is one done on someone else.

Ed. note: Duplicate. Deleted.

"I anticipated that you might have issues with Dr. Morris and Dr. Schoen. Not surprisingly, I have no problem with either as both have backgrounds in medicine & medical research and have been published in peer reviewed journals. Calling either of these fine doctors 'propagandists' will likely result in each us in turn referring to each researcher in a paper as a 'quack', 'propagandist', 'paid', 'sponsored' or other words and phrases that undermine their credibility."

I have no problem with calling them propagandists--as Schoen has lied in his papers about circumcision and penile cancer (proof upon request), and Morris has altered material he posts on his site (proof upon request.

"Tony, ok, so you are acknowledging the science behind studies that demonstrate that circumcision reduces HIV transmission during sexual intercourse? That micro-abrasions in the foreskin may allow an access point for systemic infections?"

Regardless of what Tony accedes to or not, I will not acknowledge any speculation in your comment.

The studies are not science--they are poorly- done statistical studies.

Empirical evidence disputes the whole circumcision/HIV hypothesis.

Microtears in the foreskin? this is nothing but specious and facile speculation.

Joe, male infant circumcision is a minimally invasive procedure, just usually requiring two injections of local anesthetics for the dorsal penile nerve blocks.

The reasoning behind the focus on circumcising male infants first is due to training, costs and risks involved. Neonatal circumcision a fairly easy procedure to train & learn and afterward has a very low rate of complications (0.2% - 0.6% in USA & Israel). These complications are usually minor bleeding or local infection and are cleared-up fairly quickly due to a neonates physiology.

Adult male circumcision complication rates have been as high as 3.8% with adverse events such as pain, excessive bleeding, infection, swelling or hematoma, appearance issues, insufficient skin removal, delayed healing, and anesthesia events. Training & costs are greater due to special sutures being required to deal with nocturnal & spontaneous erections. There are also behavioral issues to address such as men wanting to resume sexual intercourse/activities before healing has completed.

Regarding the ethics of male infant circumcision, you may want to read the following document published by UNAIDS:
http://www.malecircumcision.org/programs/documents/human_rights_ethical_legal_guidance_03_08.pdf

Page 16 offers these statements:
Male circumcision performed on infants involves the least physical risk. In counseling parents who
are offered, or who request, male circumcision, health providers have a responsibility to explain all of
the pros and cons, including that male circumcision is an irreversible procedure, and that it provides
a child with no benefits in relation to HIV until the child becomes sexually active. However, there
are possible immediate benefits, such as reduced likelihood of urinary tract infections in infancy
Parents considering infant male circumcision may wish to leave the decision to their child, waiting until he has the capacity to consider the risks and benefits on his own. However, some parents, in the context of the best interests of the child, may wish to have their male child circumcised as an infant after considering evidence that there are fewer medical complications associated with the procedure when performed at an early age.

In the case of infants, informed consent must be obtained from parents, the child’s legal
guardians or, in the absence of both, the primary caregiver.20 All decisions must be based
on the best interests of the child. Parents should be provided with clear and understandable
information on the benefits and risks of male circumcision in infancy compared
with older ages, including when the child is mature enough to decide for himself.

It appears that informed parental/guardian/caregiver consent must be sought after providing sufficient pro/con information in a clear & easily understood manner.

Robert, please do some research – foreskin susceptibility to HIV has already been studied. Please see the following:

Patterson BK et al. Susceptibility to human immunodeficiency virus-1 infection of human foreskin and cervical tissue grown in explant culture. Am J Pathol, 2002, 161(3):867–873.

http://ajp.amjpathol.org/cgi/search?volume=161&firstpage=867&sendit=Search&DOI=&author1=&author2=&titleabstract=&fulltext=&fmonth=Apr&fyear=1964&tmonth=Mar&tyear=2009&hits=10&journalcode=amjpathol&fdatedef=1+April+1964&tdatedef=1+March+2009

Abstract:

Numerous studies have indicated a protective effect of male circumcision against acquisition of human immunodeficiency virus (HIV)-1. We investigated mechanisms responsible for the possible increased HIV-1 susceptibility of human foreskin. Foreskins from eight pediatric and six adult patients with (n = 3) and without (n = 11) histories of sexually transmitted disease were evaluated. Six cervical biopsies from HIV-1-seronegative women were included as controls. CD4+ T cells, macrophages, and Langerhans’ cells (LCs) were quantified using image analysis. Cells expressing HIV-1 co-receptors CCR5 and CXCR4 were quantified using immunofluorescence and image analysis. Foreskin biopsies were infected ex vivo in organotypic culture with HIV-1. HIV-1 DNA copies in foreskin and cervical mucosal tissue were compared and the infected cell phenotype was determined. Foreskin mucosa contained higher mean proportions of CD4+ T cells (22.4%), macrophages (2.4%), and LCs (11.5%) in adults than in children (4.9%, 0.3%, and 6.2%, respectively) or in cervical mucosa (6.2%, 1.4%, and 1.5%, respectively). The highest proportions of CD4+ T cells and LCs occurred in patients with a history of infection. Foreskin immune cells expressed predominantly the CCR5 HIV-1 co-receptor. Adult foreskin mucosa had greater susceptibility to infection with HIV than cervical mucosa or the external surface of foreskin tissue. Circumcision likely reduces risk of HIV-1 acquisition in men by decreasing HIV-1 target cells.

NotStyro,

There's a lot to digest here. I know most of what I want to say, and I will address your points. However, I'm not ready to respond yet. I need more information before I can adequately address your statements. Earlier I asked a few questions. Answers to those questions are necessary because we're playing with assumptions that should be identified.

What is the limit for parental intervention? How does the gender of the child play into those limits? What rules, if any, are appropriate?

NotStyro Said:


Joe, male infant circumcision is a minimally invasive procedure, just usually requiring two injections of local anesthetics for the dorsal penile nerve blocks.

No, it is an invasive procedure. Having seen it done live and in color I can assure you it doesn't tickle no matter what you do. But, in many ways, whether or not something is invasive misses the point. Even if it was painless, it still wouldn't be ethical simply because it isn't medically therapeutics.

NotStyro Said:


The reasoning behind the focus on circumcising male infants first is due to training, costs and risks involved. Neonatal circumcision a fairly easy procedure to train & learn and afterward has a very low rate of complications (0.2% - 0.6% in USA & Israel). These complications are usually minor bleeding or local infection and are cleared-up fairly quickly due to a neonates physiology.


Adult male circumcision complication rates have been as high as 3.8% with adverse events such as pain, excessive bleeding, infection, swelling or hematoma, appearance issues, insufficient skin removal, delayed healing, and anesthesia events. Training & costs are greater due to special sutures being required to deal with nocturnal & spontaneous erections. There are also behavioral issues to address such as men wanting to resume sexual intercourse/activities before healing has completed.

Those are excuses. The only reason the complication rate is higher for adult circumcision is because you have an actual person who is capable of complaining about problems. If a circumcision removes too much skin, is very painful post op, or results in more damage than was expected, an infant can't tell the parent about it. And many other complications (other than those that are blatantly obvious post op) may be written off by the child later in life as that's just the way it is. This is starting to change now that people have better access to information.

Also, the low complication rate you post doesn't include long term complications such as stenosis among other things which require further surgical intervention often by a specialist such as a pediatric urologist which (and this is just a guess) will be in very short supply in Africa. This is part of the reason why those aren't generally recorded.

And focusing on infants does break the rules of treatment when you have finite resources. Treatments, especially with minimal resources, always goes to those at risk first. That's why Gardisal, for example, is only recommended for those 9 - 26. And why other vaccines are given at the times they are given.

Infants aren't in the at risk population for HIV. By focusing on adults only you:

1. Eliminate the ethical problem (for the most part).

2. Focus resources where they are needed.

3. You are given the opportunity to have access to the adult man to ensure that he knows that circumcision won't protect him, it might only slightly lower the risk and that, whether circumcised or not, condoms are still required. You will also be able to explain that it will have no impact on his partner.
(This is actually a big problem now, many believe circumcision makes the immune to HIV but nobody is paying attention to that.)

The only reason nobody raises an ethical flag for infant circumcision is because it has a type of ethical immunity due to its connection with religion. That's it.

You should address some of Tony's questions I'd be interested too.

Nice article there about HIV viruses being present in foreskin, but somehow the second function of Langerhan cells is being ignored--passing the virus onto the macrophages for digestion.. the foreskin receptors do NOT transmit the viruses..

http://www.cirp.org/library/disease/HIV/dezzutti/
Communicable Disease Center, June 1998

Bailey and boys conveniently ignore this second function.

They also ignore the function of langerhin..

http://news.yahoo.com/s/hsn/20070305/hl_hsn/scientistsdiscovernaturalbarriertohiv

Half-baked theories usually employ half-baked information.

"The reasoning behind the focus on circumcising male infants first is due to training, costs and risks involved. Neonatal circumcision a fairly easy procedure to train & learn and afterward has a very low rate of complications (0.2% - 0.6% in USA & Israel). These complications are usually minor bleeding or local infection and are cleared-up fairly quickly due to a neonates physiology."

What is the source of the OPINIONS stated here?

AND where in the world did you get these complication stats--what study(ies) where they based on..

HERE are the more realistic stats from actual studies:

1. iatrogenic Phimosis 2.9%

2. Adhesions 71%

3. Meatal ulcers 31%

3. Meatal stenosis 8%

4. infection up to 10%

5. Bleeding

1. JOURNAL OF UROLOGY, Volume 169, Number 6: Pages 2332-2334,
June 2003.

Outpatient Management of Phimosis Following Newborn Circumcision.
H. Jason Blalock, Vijaya Vemulakonda, Michael L. Ritchey, Michaelene Ribbeck

2. JOURNAL OF UROLOGY; Volume 164 Number 2: Pages 495-496, August 2000.

Penile adhesions after neonatal circumcision.
Ponsky LE, Ross JH, Knipper N, Kay R

3. CANADIAN MEDICAL ASSOCIATION JOURNAL, Volume 95: Pages 576-581,
September 10, 1966.
The Problem of Routine Circumcision

http://www.emedicine.com/ped/topic2356.htm

4. BRITISH JOURNAL OF SURGERY, Volume 80, 1231-1236, October 1993.
Williams % Kapila
HAWA PATEL, M.B., Ch.B. (Cape Town), D.C.H., M.R.C.P.(E),*
Kingston, Ont.

5. BRITISH JOURNAL OF SURGERY, Volume 80, 1231-1236, October 1993.
Williams % Kapila
HAWA PATEL, M.B., Ch.B. (Cape Town), D.C.H., M.R.C.P.(E),*
Kingston, Ont.

"Adult male circumcision complication rates have been as high as 3.8% with adverse events such as pain, excessive bleeding, infection, swelling or hematoma, appearance issues, insufficient skin removal, delayed healing, and anesthesia events. Training & costs are greater due to special sutures being required to deal with nocturnal & spontaneous erections. There are also behavioral issues to address such as men wanting to resume sexual intercourse/activities before healing has completed. "

And what study is the source of these rates--and the source for the rest of the OPINION?

BTW, there are DOCUMENTED deaths from neonatal circumcision, yet none for adult circumcision--this speaks volumes!

Notstyro, you talk about circumcision for HIV prevention in Africa but then use the complication rate for 1st world countries.

"And what study is the source of these rates--and the source for the rest of the OPINION?"

Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male Circumcision for reduction of HIV infection risk: The ANRS 1265 Trial. PLoS Med 2005; 2 (10 pages): e298.

Regarding deaths for neonatal circumcision:

"Data in the records show that between 1954 and 1989, during which time 50,000,000 circumcisions were performed in the USA there were only 3 deaths, but during this period there were 11,000 from penile cancer, a disease essentially confined to the uncircumcised"

Wiswell TE. Circumcision circumspection. N Engl J Med 1997; 36: 1244-5.

Statistics for complication rates for neonatal circumcision in Africa are still incomplete at this time. More trials with properly trained staff are required to give an overall & accurate report.

citation: various documents found on malecircumcision.org

Due to work & personal time constraints, I may not be able to respond in a timely manner.

If male circumcision is so great, why are the (mostly circumcised) doctors in Canada, the UK, Australia and New Zealand against neonatal circumcision?

If male circumcision is effective against HIV, how do you explain the seven African countries where men are *more* likely to be HIV+ if they've been circumcised:

Cameroon (4.1% v 1.1%)
Ghana (1.6% v 1.4%)
Lesotho (22.8% v 15.2%)
Malawi (13.2% v 9.5%)
Rwanda (3.5% v 2.1%)
Tanzania (not comparable)
Swaziland (21.8% v 19.5%)

There is also evidence that female circumcision protects against HIV (Stallings 2005), but we wouldn't start promoting that as a strategy against AIDS.

"If male circumcision is so great, why are the (mostly circumcised) doctors in Canada, the UK, Australia and New Zealand against neonatal circumcision?"

Hmm. Where did you get the data to confirm that doctors in Canada, UK, Australia & New Zealand are 'mostly circumcised'? Also, I would tend to think that the doctors from those countries may not be 'mostly circumcised' if they actually hold an anti-circumcision opinion. Millions of circumcised men in the US, Israel, Korea and worldwide have no problem with being circumcised and requesting their son(s) to be circumcised as well.

"If male circumcision is effective against HIV, how do you explain the seven African countries where men are *more* likely to be HIV+ if they've been circumcised:"

The men in those countries that have been circumcised may not have received proper disease prevention techniques and there is some concern regarding risk compensation (Cassell MM et al. Risk compensation: the Achilles’heel of innovations in HIV prevention? BMJ, 2006, 332(7541):605–607. see also page 26 of document titled “Male Circumcision: global trends and determinants” on malecircumcision.org)

Tony, I seem to recall that you may have some questions. If you have, please repost the questions.

"PLoS Med 2005; 2 (10 pages): e298"

Oh, so we have real rates from articles in REAL medical journals, and we are supposed to throw them away because Baily and boys post some in a pay-for-publish article? I think not.

"Data in the records show that between 1954 and 1989, during which time 50,000,000 circumcisions were performed in the USA there were only 3 deaths, but during this period there were 11,000 from penile cancer, a disease essentially confined to the uncircumcised"

Wiswell TE. Circumcision circumspection. N Engl J Med 1997; 36: 1244-5."

Wiswell? And only an OPINION?
Who are you trying to kid? Cancer deaths? Don't you know that even the ACS states that circumcision has NO effect on penile cancer? Do your research from non-fetish sites, please.

"Statistics for complication rates for neonatal circumcision in Africa are still incomplete at this time. More trials with properly trained staff are required to give an overall & accurate report."

Well thanks, it is nice to know you are supplying speculative complication rates--come back when you have some that are realistic.

DOCUMENTED deaths from circumcision--far different from those CLAIMED by Wiswell.

http://www.circumstitions.com/death.html

No amount of doubletalk or attempts at damage control will alter the BASIC cause-effect relationship;

NEITHER
circumcision --> death

NOR
circumcision--> XXX--> death

NOR

NO circumcision = NO death

It does not get any simpler than this...

http://www.timesonline.co.uk/tol/life_and_style/health/article5721088.ece

Baby bled to death after circumcision, inquest told
Lucy Bannerman
Windsor (UK)

A nine-week-old baby boy bled to death hours after being circumcised,
an inquest was told. Celian Noumbiwe was operated on in 2007 at a
doctor's surgery in Reading but later his parents opened his nappy
and found a "huge amount" of blood.

Recording a narrative verdict, the Berkshire Coroner criticised the
lack of advice given to the couple on postoperative care, noting that
the emergency number given to them did not work. After the surgery,
Carole Youmby and her partner, Monthe Bautrel, originally from
France, were encouraged to leave the surgery with the baby within ten
minutes when he should have been observed for longer, the court was
told. Ms Youmby said that she had been told that the child's nappy
should not be changed for four hours. After calling the emergency
number several times, the couple decided to call their GP in the
morning. The next day, February 22, 2007, the child was taken from
his home in Slough to the nearby Wexham Park Hospital where he died
in his mother's arms.

"Grand jury to probe death of baby after circumcision" The Des Moines Register, Nov. 20, 1982. ("A Polk County grand jury will decide if anyone is to blame for the bleeding death of a Des Moines infant ... three-month-old Christopher Dolezal, who died after extensive blood loss following a circumcision ... was circumcised ... two days before his death ... the child had gone through more than 20 bloody diapers.")

Five Minutes That Ended a Baby Boy's Life Two-week-old son of Nigerian Christian parents dies after home circumcision. The Independent, 4/30/91.

"Circumcision Kills Miami Baby, Costs Marin Baby Tip of Penis," by David O'Connor. United Press International, 1993. Bay Area Reporter, 7/8/93, p. 16.

"Circumcision doctor killed boy, 9, with heroin overdose" The Independent (40 City Road, London, England, ECI 2DB), July 9, 1994.

BOY IN COMA MOST OF HIS 6 YEARS DIES
The Associated Press
Spartanburg, South Carolina. A boy who was in a coma for more than six years while a legal battle raged around him has died. But the legal fighting will continue.
Allen A. Ervin was born in July 1985 and had been on life support since December 1985, when his brain was damaged from oxygen deprivation during circumcision.

He died at Spartanburg Regional Medical Center on Wednesday, three weeks before his 7th birthday. Doctors said he suddenly suffered severe heart problems, his mother, Stacey Stroble, said.

The Anesthesiologists who attended to Allen during the circumcision settled the case for $435,000 and agreed to lifetime payment of his medical bills.

Spartanburg Country Probate Court officials are overseeing the estate. Lawyer Charles Rice, who is in charge of investing the money, says a judge will have to decide who gets it.

It angers Stroble, 21, who has two young daughters, that she may have to hire another attorney to file a claim for her son's estate.

"The money's not my concern right now," she said. "But I have to pay for the funeral. I don't think that's right."

Allen's medical problems began when oxygen was pushed into his stomach, instead of his lungs, court records showed. Anesthesiologists inserted a tube into the baby's stomach to relieve the pressure but administered three times the recommended dosage of a drug to slow his abnormally high heart rate, stopping it.

He was revived 30 minutes later but never regained consciousness, although Stroble said Allen's eyes and head often followed the voices of people visiting him in his hospital room.

The legal problems began before that, however.

Stroble was 14 years old and unmarried when she gave birth to Allen. At the request of her mother, Maggie Ervin, a Family Court judge in October 1985 placed both mother and child in the custody of the South Carolina Department of Social Services.

The custody disputes and guardianship fights went through seven state and federal courts, including the state Supreme Court and the U.S. 4th Circuit Court of Appeals in Richmond, Virginia


"Boy in coma most of his 6 years dies" The State, Columbia, South Carolina, 7/10/95. "A boy who was in a coma for more than six years while a legal battle raged around him has died ... Allen A. Ervin was born in July 1985 and had been on life support since December 1985, when his brain was damaged from oxygen deprivation during circumcision. He died at Spartanburg Regional Medical Center on Wednesday, three weeks before his 7th birthday ... The anesthesiologists who attended to Allen during the circumcision settled the case for $435,000 and agreed to lifetime payment of his medical bills."

http://www.cirp.org/news/1995.07.28_HoustonChronicle/

BOY'S DEATH TO BE PROBED
Physician is suspended
by Lydia Sum and Ruth Sorelle

Saying they fear a "serious and immediate threat to public health," Texas Department of Health Officials sought permission Friday to investigate the death of a 5-year-old boy after a circumcision.

Meanwhile, Doctor's Hospital-Airline has suspended the anesthesiologist present during the July 18 circumcision, pending outcome of a peer review investigation and final autopsy of Jeremie Johnson.

The boy died Tuesday after a week in a coma and on life support.

Dr. T. Jose Tovar was suspended July 18, said Doctor's Hospital spokeswoman Jan Haines.

Family members said they brought the boy to the hospital that day for the 30-minute procedure but he stopped breathing afterward and had to be resuscitated.

A secretary for Tovar said the physician declined comment. Haines called the suspension routine in such instances.

Dr. Tovar has had many good years at this hospital," she said. "He has always been in good standing here and many know him in his field."

In Austin, spokeman David Vaughn said TDH officials asked the federal Health Care Finance Administration, which oversees Medicaid payments to find out why the boy died.

The heath department's bureau of heath care quality and standards and the HCFA share responsibility to monitor patients' treatment in Texas hospitals, Vaughn said.

He says he expects the investigation to begin early next week.

The boy's mother, British Gaines, expressed frustration Friday at the lack of explanation as to why he went into a coma.

Preliminary autopsy results only described the boy's medical condition when he was transferred to Texas Children's on July 18, Gaines said. Final results are not expected for another eight weeks.

"It's very sad because I was thinking we'd actually find out something, but there are just these big, medical terms that don't tell us anything we don't already know," said Gaines, 23.

In recent years, fewer boys have been circumcised because of conflicting medical opinion as to its necessity. But in some cases, medical conditions make it necessary.

Gaines said she thought the procedure on her son was successful until Dr. Michael Morris, who performed the circumcision told her the boys heart had stopped and he had resuscitated him.

Johnson was immediately transferred to Texas Children's, where he was in intensive care until his family decided to have him removed from a respirator Tuesday.

Gaines said Morris visited her son at Texas Children's to examine the result of the circumcision. She said Tovar also visited them at Texas Children's on July 18.

He said he was sorry, that he didn't know what happened, and patted me on the back," Gaines said.

Tovar graduated from medical school in Bogota, Colombia, according to the Texas Board of Medical Examiners and has been licensed in the United States since August 15, 1970. Board records show no disciplinary actions against him.

"Boy's death to be probed" Houston Chronicle, 7/28/95. "Saying they fear a serious and immediate threat to public health, Texas Department of Health officials sought permission Friday to investigate the death of a 5-year-old boy after a circumcision ... The boy died Tuesday after a week in a coma on life support."

July 18, 1995; Houston, Texas: A 5-year-old boy goes into a coma while being circumcised. He dies a week later. Jeremie Johnson. Doctor's Hospital-Airline Dr. T. Jose Tovar was suspended July 18.

Circumcision That Didn't Heal Kills Boy
CLEVELAND, October 20, 1998 -- A 3-week-old boy died while doctors were trying to fix a problem with his circumcision.
A pediatrician noticed the circumcision performed on Dustin Evans two weeks ago wasn't healing properly and the urethra was blocked. A routine surgical procedure was needed to correct the problem and clear the hole. While being administered anesthesia on Friday, the boy's heart stopped, said his father, Dustin Evans Sr., 27. Doctors at Rainbow Babies Childrens Hospital attempted to save the baby by massaging his heart and inserting breathing tubes. He was kept on a life-support ventilator system during the day until it was determined that his heart was healthy, but he had suffered massive brain damage. Dustin was disconnected from life support about 7:30 p.m. Friday. "You think, 'What could go wrong with a circumcision?' "Evans said. "The next thing I know he's dead." The Associated Press, 1998.

Dimetrius Mannaker – 1993 – Carol City, Ohio
Demetrius Mannker was a child killed by circumcision in Carol City, Florida,
in June, 1993.
"Baby bleeds to death after circumcision."
Miami Herald, Miami, Florida, June 26, 1993.
http://www.cirp.org/news/1993.06.21%3adeath/

BABY BLEEDS TO DEATH AFTER CIRCUMCISION
Miami, June 26, 1993
The Miami Herald reported the death of 6 month old Carol City baby, Demetrius Manker. Manker bled to death after being circumcised.

"I can't express the way it has affected me emotionally," the child's mother, Louise Manker, said. "It's something I'll never get over. This was my last child." A Miami pediatrician circumcised 25-pound Demetrius Manker in his office. After his mother took him home, she saw he was bleeding from the incision.

Manker subsequently called the doctor several times, according to their attorney, Patrick Cordero.

"One of the instructions was that she put Vaseline around the penis area to stop the bleeding." Cordero said, "she followed the instructions to the letter."

Louise Manker's sister grew so alarmed by his continued bleeding that she called paramedics, Cordero said. He was pronounced dead at the hospital.

An autopsy showed that his liver and other organs had gone pale from the loss of blood, said Dade [County] Chief Medical Examiner Dr. Charles Wetli.

*******"The message to get across is that this is weird, unusual," Wetli said. "I've done close to six thousand autopsies and this is the first I've seen where a baby died from circumcision. It's probably the safest procedure you could think of.********

An autopsy revealed a seemly normal circumcision, Wetli said.

The doctor who performed the surgery, Robert D. Young, said the circumcision had gone well. "I would not have let him go home if I didn't think so. Medical examiners will confirm the soundness of the operation.

Authorities say they will try to determine if the baby suffered from some rare disease that prevented his blood from coagulating. It's also possible that Louise Manker did not understand the extent of the bleeding, especially because a baby has a fraction of an adult's blood supply, Wetli said.

"There's two parts to the story," the deputy medical examiner said, Why was the child bleeding? And secondly what was the level of communication if the mother said he's bleeding but didn't say how much.

Andrew Ryan, 20, of Durham, NC

T.H. Houston, Texas – 1979

Joshua – April 1998

Steven Christopher Chacon, who died in his crib three days after being circumcised. 11/26/86

http://www.circumstitions.com/News10.html#ireland

"The men in those countries that have been circumcised may not have received proper disease prevention techniques and there is some concern regarding risk compensation (Cassell MM et al. Risk compensation: the Achilles’heel of innovations in HIV prevention? BMJ, 2006, 332(7541):605–607. see also page 26 of document titled “Male Circumcision: global trends and determinants” on malecircumcision.org)"

Without any hard data and a model to explain away this discrepancy, this is what is called a speculative excuse--not scientifically acceptable for failure to fulfill prediction.. come back when you have an explanation supported on hard data

The circ rates in Australia and New Zealand 50 years ago were about 90% and 95% respectively. The circ rates in Canada and the UK were never as high - about 35-40%, but it tended to be more of an upper class thing, and only rich people could afford it, so most of the doctors would have been.

I know that most circumcised men don't have a problem with it (same as most circumcised women btw), but that doesn't mean we should keep doing it, and there's certainly no reason not to wait until people can decide for themselves. Some people do have a problem with having been circumcised against their will, and men who are not circumcised can always get circumcised later, though it's rare. Adult circumcision isn't a big operation though. It's actually safer and less painful to get circumcised later, and the results are cosmetically better.

"The men in those countries that have been circumcised may not have received proper disease prevention technique"
The same applies to the men in those countries who were *not* circumcised though. If male circumcision had much of a protective effect, then there just wouldn't be seven countries where the circumcised men are more likely to be HIV+.

I honestly believe that anyone whose primary interest is fighting AIDS would be focussing on safe sex, fewer partners and condoms. Any partial solution, microbicides, circumcision, or a notional 40% vaccine runs the risk of making things worse.

It's not like we've actually tried the things that do work. In Malawi for instance, only 57% know that condoms protect against HIV/AIDS, and only 68% know that limiting sexual partners protects against HIV/AIDS. There are people who haven't even heard of condoms. It just seems really misguided to be hailing male circumcision as the way forward. It would help if some of the aid donors didn't refuse to fund condom education, or work that involves talking to prostitutes. There are African prostitutes that sleep with 20-50 men a day, and some of them say that hardly any of the men use a condom. If anyone really cares about men, women, and children dying in Africa, surely they'd be focussing on education about safe sex rather than surgery that offers limited protection at best, and runs a high risk of risk compensatory behaviour.

Let's scientifically debunk this HIV/circumcision hypothesis once and for all so we can address other excuses for circumcision.
Scientifically, the fundamental and most critical test of the validity of any hypothesis is its ability to make accurate predictions--it must fulfill its prediction every time to be considered valid.
The HIV/circumcision hypothesis is that circumcision reduces the incidence of HIV by 50%. Let's see if this prediction is fulfilled:

Circumcision rates:
Japan USA 80%
Ethiopia ~100% http://www.circumstitions.com/HIV.html#ethiopia


HIV rates:
Japan 0.1%
USA 0.6%
Ethiopia 4.4%

Protective factor: 1/0.5 =2X

US Vs. Japan:

USA: (80% X 2) + (20 X 1) = (160) + 20) = 180

Japan (1 X 2) + (99 X 1) = (2) + (99) = 101

Protected ratio : 180/101 =1.8 LOWER in the USA.

Reality rates: 6X HIGHER in the USA

discrepancy: 6.0 X 1.8 = 11X = 1100% error
************************************************

Ethiopia Vs. Japan.

circumcision rate:

Ethiopia 100%
Japan 0.4%

HIV rate:

Ethiopia 4.4%
Japan 0.1%


Ethiopia (100 X 2) = 200

Japan (1 X 2) + (99 X 1) = (2) + (99) = 101

Protected ratio : 200/101 = 2X LOWER in the Ethiopia

Reality rates: 44X HIGHER in the Ethiopia

discrepancy: 2 X 44 = 88 X = 8800% error

The largest acceptable error in science is 1 sigma = 5%

WHERE is this alleged reduction?

NotStyro,

My questions:

What is the limit for parental intervention? How does the gender of the child play into those limits? What rules, if any, are appropriate?

Robert,

“PloS is a nonprofit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource.“ - from the home page. Sure, it isn't as prestigious as the N Engl J Med or Lancet, but they are peer-reviewed and any payments requested go toward keeping the site going (and payments aren't a barrier to getting published).

Let us read what the ACS writes about circumcision - “Circumcision seems to protect against penile cancer when it is done shortly after birth. Men who were circumcised as babies have less than half the chance of getting penile cancer than those who were not.” While not quite a ringing endorsement, it falls considerably short of your attribution.


“Baby bled to death after circumcision, inquest told, Windsor (UK)”

While it is clear that the office and staff of the doctor's surgery are mostly at fault here, they are not entirely to blame. Sure they gave negligent post-operative care instructions (no diaper changes for 4 hours? What if he wets or soils himself?), an inoperative/unmonitored 'emergency' phone number and pushed the parents and newly-circumcised infant out the door in 10 minutes, but some fault must also lie with the parents. No, not for giving consent for the circumcision, but for not seeking emergency care immediately. The parents should have tried the contact number given then taken the child to an ER immediately. Waiting to go to a GP in the morning was a very poor and unfortunately terminal decision for their child.

"Circumcision doctor killed boy, 9, with heroin overdose"

That has to be an absolute case of medical malpractice if the doctor was giving a child heroin as an anesthetic before a circumcision. But if the doctor was the criminal, the judge should flogged, drawn & quartered for the one-year suspended jail sentence given to the doctor.

“BOY IN COMA MOST OF HIS 6 YEARS DIES“

“BOY'S DEATH TO BE PROBED”

“Circumcision That Didn't Heal Kills Boy”

Deaths by anesthesia/anesthesiologist. In a perfect world people would be properly trained for their position, people wouldn't be allergic to helpful drugs and male infants wouldn't be born with foreskins.

“BABY BLEEDS TO DEATH AFTER CIRCUMCISION”

Hemophilia and other blood clotting disorders are contraindicated for circumcision.


“Do your research from non-fetish sites, please.” Sorry, while looking at my valid citationa I was blinded by your citations from foreskin-fetish sites circumstitions.com and cirp.org (in pretty blatant disregard for proper use of the .ORG TLD).

Tony,

The answers you seek may be found by reading through the following document:

http://www.malecircumcision.org/programs/documents/human_rights_ethical_legal_guidance_03_08.pdf

Regarding limits for parental intervention...

“Consideration of the age of consent is important in the context of policy on male circumcision for
HIV risk reduction. This is particularly so, given the expected potential benefits of male circumcision
for adolescents and the likelihood that, in some places, male adolescents may wish to opt for
circumcision privately, without the knowledge of their parents or guardians. Countries will need to
have laws and guidance in place that protect the interests of children and the appropriate responsibilities of parents, but do not stand as barriers to accessing health-care services—a situation that has often been the case in the context of the protection of adolescents from HIV.”

“Decision-makers also need to consider issues related to age of consent in the context of existing
legislation and regulations regarding consent to health care and potential barriers to accessing
services. In some countries, national or subnational law identifies an age at which minors can give
their own consent to medical procedures—sometimes differentiated by the type of procedure and
the degree of risk associated with it. In other countries, laws direct health-care providers to assess
the capacity of adolescents to appreciate risks and benefits associated with a procedure, and to give
informed consent independent of parents or the legal guardian.”

“Given the importance of male circumcision in terms of HIV risk reduction, consideration should
be given to allowing adolescents who have the capacity to appreciate risks and benefits, access to
male circumcision independently of parental consent.”

Regarding gender...

“While both male circumcision and female genital mutilation are steeped in culture and tradition,
the health consequences of each are drastically different. Female genital cutting or mutilation comprises all surgical procedures involving partial or total removal of the external genitalia (type I) or
other injuries to the female genital organs. It frequently involves complete removal of the clitoris
(type II), as well additional cutting and stitching of the labia resulting in a constricted vaginal opening
(type III). These procedures put the woman at risk in the short and long term, and pose risks
to the mother and infant during childbirth: increased death rates among infants during and shortly
after birth and increased rates of obstetrical complications when mothers have undergone previous
genital cutting or mutilation (WHO, 2006). There are no known health benefits associated with
female genital cutting or mutilation. This practice should not be medicalized and should not be
allowed to continue. WHO supports communities in their efforts to abandon the practice and to
improve care for those who have undergone the procedure.”

As for rules, by the pre-publication status for the above mention document, I would have to think that the WHO & UNAIDS are still writing these rules and trying to work with nation-states to fit these rules into the legal framework of each nation-state.

NotStyro Wrote:


Let us read what the ACS writes about circumcision...

Yes, lets do that.

In the past, circumcision has been suggested as a way to prevent penile cancer. This suggestion was based on studies that reported much lower penile cancer rates among circumcised men than among uncircumcised men. However, most researchers now believe those studies were flawed because they failed to consider other risk factors, such as smoking, personal hygiene, and the number of sexual partners.

Most public health researchers believe that the risk of penile cancer is low among uncircumcised men without known risk factors living in the United States. Most experts agree that circumcision should not be recommended as a way to prevent penile cancer.

Further, they go on to point out, unlike most circumcision fetish sites, that vaccines have been developed that are essentially 100% effective against the two strains of HPV which are responsible for about 3/4s of cancer. It has also been demonstrated that the vaccine is effective against about 10 additional strains which are much less common. And once again we have a situation where there is a less invasive, safer, and more effective alternative, not that circumcision has ever been considered to be an important defense against penile cancer. Well, except in those fetish sites you link to.

And you still haven't answered the questions. None of that script discusses the ethical limits of parental intervention in the general sense so let's try again.

What is the limit for parental intervention?

The AAP Committee on Bioethics report states:

Pediatric health care providers. . . have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. . . . The pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent. American Academy of Pediatrics Committee on Bioethics. “Informed Consent, Parental Permission, and Assent in Pediatric Practice.” Pediatrics 95 (1995): 31 (p. 315)

While not to be out done, the British Medical Association said:

Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.

So, there we have the standard for ethical care and proxy consent. It seems rational, only provide medically therapeutic interventions on those who are being seen with proxy consent and start with the least invasive treatment and work forward. Circumcision is neither medially therapeutic in 99.9% of people nor is it the least invasive treatment in nearly all cases. So in a proxy consent situation it is generally unethical to perform circumcision. That seems rational but it seems you feel that it's unreasonable. This is what you must explain. And try and use your own words.

How does the gender of the child play into those limits?

Again you failed to address this issue with any reasonable depth. The script considering FC doesn't take into account that many practice much lighter forms in clinical settings. However, here in the US we have criminalized all forms no matter how invasive or benign, no matter where it's done, no matter by who it's done, regardless of culture, and regardless of religion. It is not tolerated to any degree so again please address how this is not discriminator on the bases of gender. And keep in mind that there is no clinical indication for circumcision in nearly 99.9% of infants and boys. Again your own words please.

What rules, if any, are appropriate?

I think what Tony means here is what is the ethical standard being applied and how or why. We already have an standard in industrialized countries that ensures the patient receives the most effective, least invasive treatments. Why is circumcision different, what rules are we applying that allow us to trump those already in place.

Notstyro tries to dance around excuses for death from circumcision. the bottom line is that NO deaths from unnecessary circumcision can be morally or ethically acceptable.

Interestingly he also avoids the idea that there are NO documented deaths from adult circumcision.

Seems he addresses what he wishes with excuses, and totally ignores those he cannot dance around or away from.

"“Given the importance of male circumcision in terms of HIV risk reduction, consideration should
be given to allowing adolescents who have the capacity to appreciate risks and benefits, access to male circumcision independently of parental consent.”

This OPINION is predicted on the existence of this alleged reductive effect, so until and IF this effect can be proven (and from the critical analysis, it cannot and will not) than this is not-even remotely justifiable.

"“While both male circumcision and female genital mutilation are steeped in culture and tradition,
the health consequences of each are drastically different. Female genital cutting or mutilation comprises all surgical procedures involving partial or total removal of the external genitalia (type I) or
other injuries to the female genital organs."

This opinion is complete BS.. the most common form of FGM is the clitoral hood--an EXACT analog of MGM....

NOT this silly claim of EXTERNAL parts removal--however the parts removed by MGM ARE external parts (for whatever that feeble argument signifies).

So, sorry, to disappoint, but these erroneous rationalizations still have not proven your point.

I'll address the other issues in a moment, but first, we need to clarify something.

...foreskin-fetish sites circumstitions.com and cirp.org...

We have to be very careful in throwing around the word "fetish". Attempt to make a case that such sites are propaganda or biased. I disagree, but I'm willing to defend that position just as I'm willing to defend my position that Morris and Schoen are biased propagandists. But that's a different claim than fetish.

The site I criticized in the entry is clearly a fetish site because it contains pornographic pictures of both circumcised and intact males designed specifically to demonstrate how much better the former is. That is a subjective opinion, unique to each person. It is not a medical reason justifying surgery on a non-consenting individual. That alone would make it fetish-oriented. Add the multiple examples of circumcision fiction to the mix and it is clear that the site is based on a fetish for the circumcised penis.

I also called CIRCList a fetish site because it is little different. There are pictures and stories designed to titillate, to demonstrate how a circumcised penis is aesthetically superior. There is also a section on female genital cutting - with pictures - aimed at demonstrating how much sexier genitals are after surgery. That is a fetish, not a medical claim. And the women depicted presumably volunteered for the procedure. That is in direct contrast to what the site advocates for males, again, for subjective reasons the non-consenting male may not agree with. It treads closer to the propaganda/fetish dividing line than the first site, but not by much.

Circumstitions, CIRP, Schoen and Morris are all different from that. There may be subjective claims being tossed around, and with the latter tow, at least, there are. But they're not provided with pictures and a "see, look how fucking hot that is" wink. That difference is obvious, so we all need to criticize accordingly.

NotStyro,

Joe gets to the heart of what I'm asking, which is lacking in the UNAIDS's human rights, ethical, and legal considerations. However, I would like to address the excerpt because I find it lacking in an interesting way. The first three paragraphs you provide rests on the singular assumption that parents will deny their sons the surgery their sons so desperately desire. It works from there to suggest all the ways governments need to coordinate to ensure that children can choose to be circumcised. That is a fantasy world. Do you think this is going to end with a determination that some children won't want to be circumcised? This is a conclusion in search of support and only support.

I'm much more interested in focusing on this from the document [emphasis added]:

Infant male circumcision: ethical, legal and human rights considerations Studies have shown that the circumcision of infants is simpler and carries fewer medical risks than circumcision of older people. Parents considering circumcision of an infant boy should be provided with all the facts so they can determine the best interest of the child. In these cases, determining the best interests of the child should include diverse factors—the positive and negative health, religious, cultural and social benefits. Because the HIV-related benefits of circumcision only arise in the context of sexual activity, and because male circumcision is an irreversible procedure, parents may consider that the child should be given the option to decide for himself when he has the capacity to do so.

After setting up the assumption that the subjective religious, cultural, and social preferences of the parents are the same beliefs the boy will hold throughout his life, even this document can't miss the obvious point that HIV-related benefits only arise in the context of sexual activity and that male circumcision is an irreversible procedure. They ultimately miss the point because they assign the duty to determine the validity of these factors to the parents rather than to the child.

The idea that subjective religious, cultural and social excuses can be considered benefits to justify surgically altering a healhty, non-consenting person is a blatant rejection of human rights and ethics. This is why I do not respect organizations like WHO and the UN. They engage in moral relativism.

While both male circumcision and female genital mutilation are steeped in culture and tradition, the health consequences of each are drastically different. ...

Yet, the document pretends that culture and tradition are valid reasons to circumcise an infant male. The organizations either believe that religious and cultural reasons are enough, or they don't. They clearly do, so their protests on FGM performed on those grounds are inconsistent and disingenuous.

If they want to defend only on the grounds of health "consequences", that's different. They'll reach the same conclusion, of course, and I'll continue my logical, reasoned rejection of every nonsensical reach for an extreme solution to a non-existent problem. But then we'll finally stand on an objective foundation for the debate rather than the subjective quicksand of potential benefits, cultural good tidings, God's love, and sacrificing the self for others.

My principle leaves each male free to do - or not do - to himself what achieves his preferences. My principle leaves each female free to do - or not do - to herself what achieves her preferences. It is universal, regardless of gender or subjective opinions imposed by others through a scalpel. There is a defined standard based on both objective science and immediate (lack of) need. My principle for proxy consent on genital cutting is short and universal:

Genital cutting on a healthy, non-consenting individual is ethically and morally wrong.

I'm trying to understand what yours would be, since the limits are not clear. From the pieces I can cobble together from what you imply, most or all of my intentionally-ridiculous examples fit within your almost boundless idea of proxy parental consent. The only limits I see are "interventions you don't like". That's hardly a standard, much less a principle.

What principle for parental proxy consent should we use?

"Circumstitions, CIRP, Schoen and Morris are all different from that. There may be subjective claims being tossed around, and with the latter tow, at least, there are. But they're not provided with pictures and a "see, look how fucking hot that is" wink. That difference is obvious, so we all need to criticize accordingly."

How are we to judge a site that links to fetish sites
..and/or if the person who hosts the site displays a fetish for circumcision; ie, travels to witness and photograph mass circumcision ceremonies?

"Joe, male infant circumcision is a minimally invasive procedure, just usually requiring two injections of local anesthetics for the dorsal penile nerve blocks."

Gee, and from this are we supposed to assume it is pain-free?
Sorry, but that assumption is fallacious:

""In summary, analgesia is safe and effective in reducing the procedural pain associated with circumcision " (emphasis added)

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/3/686

NOTE--REDUCE!

http://www.cirp.org/library/anatomy/cold-taylor/

British Journal of Urology (1999), 83, Suppl. 1, 34-44

The prepuce

C.J. COLD and J.R. TAYLOR*

Departments of Pathology, Marshfield Clinic, Wisconsin, USA, and *Health Sciences Centre, University of Manitoba, Canada

"The male prepuce has somatosensory innervation by the dorsal nerve of the penis and branches of the perineal nerve (including the posterior scrotal nerves) [35,36]. Autonomic innervation of the prepuce arises from the pelvic plexus. The parasympathetic visceral efferent and afferent fibres arise from the sacral centre (S2-S4), and sympathetic preganglionic afferent and visceral afferent fibres from the thoracolumbar centre (T11-L2). The parasympathetic nerves run adjacent to and through the wall of the membranous urethra [35]. Although most neonatal and childhood circumcisions are performed with no anesthesia [37], the complicated innervation of the penis explains why a dorsal penile nerve block provides incomplete pain relief for neonatal male circumcision [37,38]. Likewise, a penile ring block cannot block the visceral afferent fibres from the cavernosal nerve nor the posterior scrotal somatosensory branches of the perineal nerve [38]. A eutectic mixture of local anesthetic cream (EMLA) does not relieve the pain associated with circumcision because of the complexity of penile innervation and the multiple layers that would have to be penetrated by the topical cream in the newborn penis [39]. Amazingly, some modern urology textbooks even recommend wine as an anesthetic for newborn circumcision [24]."

How are we to judge a site that links to fetish sites ..and/or if the person who hosts the site displays a fetish for circumcision; ie, travels to witness and photograph mass circumcision ceremonies?

For me, it's the old standard that porn is hard to define but I know it when I see it. I don't like that standard, so I try to err on the side of caution.

I think it's possible to be a propagandist and a fetishist. But the distinction within the information provided is what matters. Someone posting pictures after travelling to a mass circumcision could be a fetishist posting propaganda. A photo of a male happy to have been circumcised is pointless in proving that infants should be circumcised, but I don't think it crosses into fetishism. Posting a picture of the male's penis, on the other hand, almost certainly is an obvious sign of fetish.

The second link I criticized, the one that quoted CIRCList, is an example of the line, I think. CIRCList is a fetish site, no question. The site that links to it merely engages in propaganda. From what I saw of it, I wouldn't classify it as a fetish site. I don't wish to speculate on its motives. I'm indifferent to any motive an individual uses to circumcise himself. I'm against all motives an individual uses to circumcise a healthy child.

Tony,
I find the circumcision fetishist to be interesting, albeit more than a little bizarre. Another question, would you consider a man who travels to witness and photograph mass circumcision a fetishist if he did not publish the pictures, but merely kept them for his own "use"?

And yes, cirklist is most definitely a fetish site as is evident from his invitational letters when starting his site...

OK you guys beat it out of me, here is the letter I got thanks to my wonderful anon account. It's from circlist, I think we can now officially call them what they are, a fetish group. While I don't personally have anything against these people and there somewhat odd sense of taste in this matter, I do think it's good to know about this stuff.

From: "CIRCLIST"

TO all...

From: "CIRCLIST"

CIRCLIST. "There is a small group of us who have formed a private listing (CIRCLIST) and we share stories and pictures of circumcision. Most all of us grew up Uncut, but sometimes fantasize about being circumcised. About half of us are US and the rest European. We find stories of teen boys and men getting circ'd very hot! We also share our own personal experiences growing up uncut and admiring the circ'd dicks along with accounts of our own personal circumcision, medical information, etc. ... we do have adult only circ fantasy material and stories of our own personal sexual experiences ... we have accumulated a variety of circumcision jpegs. Most are clinical pieces showing the man or boy before, during and after his circ. They were produced as educational pieces for medical students, etc. ... I also have some images of ritual or coming of age circumcisions such as those done in Africa, Egypt and Turkey (male & female) ... We are currently working on a web site to house the archives." For more information and application form: XXXXXXXXX.com.

Also:

I'm pleased to announce that the second meeting of the CIRCLIST California Chapter is planned for Saturday, November 13th in Los Angeles. If you are interested in attending, please contact me and I'll give you all of the particulars. At our last meeting in Oakland (January), about 10 folks attended. Many pictures, devices and live "show & tell" sessions occurred.
This meeting will be similar, but we will also try to arrange to show some adult circumcision videos. There is the possibility that a live adult circumcision may also be scheduled.

In route to California, I will be making a stop in Phoenix, AZ on Monday evening, November 8. If you live in that area and would like to meet and discuss our mutual interest, please let me know as well.

Thanks! Hope to see you!

>David
>CIRCLIST Moderator

Another question, would you consider a man who travels to witness and photograph mass circumcision a fetishist if he did not publish the pictures, but merely kept them for his own "use"?

Probably, yes. But it's hard to judge intent until someone blows by the arbitrary line.

That's why I think we all need to be careful how we use it. The fetish claim is disparaging, and the propaganda claim closes off debate. I don't want to give the impression that I'm implying anyone here is either. I've directly called two sites fetish sites, and we've all mentioned sites we consider propaganda. But I assume we're all commenting with good intentions.

What will ground will the pro=circers stand on when the AIDs vaccine is approved for human use? The argument that circ prevents HIV transmission is week and based on very flawed studies...as others here have stated.

Even if it were true that circumcision prevented/reduced HIV/STD transmission (WHICH IT DOESN'T) it would not be sufficient grounds to remove a functional, important part of the male sex organ of a non-consenting infant. A child will not be engaging in intercourse until he has reached puberty. By that time he can make the decision for himself.

For those that are arguing in favor of circ as an HIV preventative, would you willingly engage in intercourse without a condom with a person who is HIV positive. If the answer is "no" then my guess is that you don't truly believe it will protect you. I also somehow doubt that you would tell your son that he doesn't need to use protection b/c he was circumcised.

Sadly the US has the highest rate of STD transmission of any nation and the circ rate among sexually active men is still at around 85% (circ rates have only started to drop dramatically in the last 10 years)

What seems to interest me most is how many Americans believe that circumcision doesn't remove any sensitivity or function of the penis. I dare say that the removal of the male foreskin has more implications than the removal of the female foreskin and labia combined. Shifting the focus to the function of the foreskin is probably the most worthwhile, necessary step to understanding why every boy should have the right to decide over his own body.

"For those that are arguing in favor of circ as an HIV preventative, would you willingly engage in intercourse without a condom with a person who is HIV positive. If the answer is "no" then my guess is that you don't truly believe it will protect you. I also somehow doubt that you would tell your son that he doesn't need to use protection b/c he was circumcised."

An excellent point, and one that strikes at the very heart of the circumcision/HIV advocacy.

Succinct and direct.

"For those that are arguing in favor of circ as an HIV preventative, would you willingly engage in intercourse without a condom with a person who is HIV positive. If the answer is "no" then my guess is that you don't truly believe it will protect you. I also somehow doubt that you would tell your son that he doesn't need to use protection b/c he was circumcised."

Building strawmen, again, I see.

As you all should be aware, if you have done any research, that the WHO/UNAIDS and other international health organizations acknowledge that circumcision does not provide complete protection against HIV infection. As follow...

“While the research shows that male circumcision is a viable strategy for the prevention of
heterosexual transmission in men, male circumcision does not provide complete protection
against HIV infection for women or for men. Circumcised men can still become infected with the
virus and, if HIV-positive, can infect their sexual partners, and consistent condom use remains
the most effective tool for HIV prevention.”
-Male Circumcision Fact Sheet -http://www.malecircumcision.org/advocacy/documents/WWW_Male_Circumcision_Factsheet1.pdf

What is the limit for parental intervention?

This depends on the context. Outside of a medical emergency, I believe that parents may make all decisions regarding medical care for their child as long the choice they make is legally available and that the parents are or should be fully aware of the consequences for their decisions.

For example, if a parent decides not to have their child vaccinated, the parent should be aware or made aware that laws may exist to exclude their child from public schools.

How does the gender of the child play into those limits?

Other than laws regarding FGM, I doubt that a child's gender plays a role in parental entitlement.

What rules, if any, are appropriate?

Now that there are laws regarding FGM, the main thing left to do is to make sure that all parents, doctors and medical establishments are aware and follow the laws & rules. Naturally, these laws & rules are considered 'living' documents and may be subject to changes as situations warrant.

It might also be worth noting that whether the parents ability to make choices for their child be known as an 'entitlement', 'intervention','proxy' or some other word or phrase, this ability can usually be removed by state or federal justice for the effect of protecting the child from, among other things, decisions made by the parents that may have an adverse effect on the health or well-being of the child.

NotStyro I am still not clear why you are for circumcision.

You haven't put up any good arguments. Maybe you should re-iterate them.

Hey, Nostyro--you have given us nothing but OPINIONS--even after you have been presented with evidence that that opinion is not credible. I seems we have a conundrum--who should we believe, an opinion or reality?

Remember this phrase? "who are you going to believe, me, or your lying eyes"?

"What is the limit for parental intervention?"

C'mon Notstyro--

A lot of double talk--completely ignoring reality.. still to be answered is what SHOULD these limits be--not what is legal even if unconstitutional?
Could you please provide something a bit more substantial..and/or more comprehensible?

NotStyro,

Building strawmen, again, I see.

I like Jean's question as a conversation starter. It quickly demonstrates that there are more effective, less invasive ways to protect against HIV infection than circumcision. And there is a more ethical way to circumcise than circumcising infants, since adults can choose it for themselves. Or not, which is the eternal problem for circumcision advocates.

As a conversation ender, yes, it would be a strawman. But it's no more a strawman than linking to a poll asking adult males for their opinion on infant circumcision. (I debunked this here.)

On to the important stuff...

This depends on the context. Outside of a medical emergency, I believe that parents may make all decisions regarding medical care for their child as long the choice they make is legally available and that the parents are or should be fully aware of the consequences for their decisions.

First, thank you. This is the direction we need to go rather than tossing studies back and forth.

Remember the issue I raised early in this thread about slavery? It was "legally available" for a long period in our nation's history and a very long time in world history. Does that make it ethically/morally valid? Which is the proper frame for judging whether or not a practice should continue in a society?

The primary point is that circumcision that is not immediately medically indicated (i.e. lesser interventions are possible) should not be legally available to parents for their infant sons. Absent medical need, it is not medical care. There are no direct benefits from the surgery. There are direct harms, as well as risks of complications beyond that unavoidable harm. (And there's the pesky fact that a slim chance of death exists within the procedure that cures nothing in the healthy child.)

It's also impossible for parents to be fully aware of the consequences of making their sons's decision. My parents could not know that I would be against circumcision. They could not know that I would prefer individual choice to collective social customs. They removed part of my healthy body for their reasons, not mine. That is subjective. Only objective need passes the ethical test that pushes us to the legitimate question of informed consent. Yes, parents must be informed of all options when there is a medical need for intervention. But need is the prerequisite.

Other than laws regarding FGM, I doubt that a child's gender plays a role in parental entitlement.

And yet, you're saying it does play a role. You endorse a parent's ability to circumcise a male child for subjective cultural reasons. The anti-FGM law (pdf) states:

... no account shall be taken of the effect on the person on whom the operation is to be performed of any belief on the part of that or any other person that the operation is required as a matter of custom or ritual.

The gendered difference in this law clearly violates the Fourteenth Amendment to the U.S. Constitution. Do you reject the notion that parents may circumcise their sons for subjective cultural reasons? Or do you believe, contra the U.S. Constitution, that gender is a valid differentiator in medically unnecessary parental decisions? You can only answer "yes" to one.

That brings us to the question of medical need. The anti-FGM law states:

A surgical operation is not a violation of this section if the operation is— (1) necessary to the health of the person on whom it is performed, and ...

Are you claiming that circumcision is necessary to the health of an males born with a normal foreskin?

Tony,
Thank you for returning to the discussion. I frequently look forward to your posts as they are usually thoughtful and demonstrate comprehension of the subject.

Let us start with this statement - “The gendered difference in this [anti-FGM] law clearly violates the Fourteenth Amendment to the U.S. Constitution.” While I think that with all the lawyers in Congress that they should do an excellent job with securing laws from violations of the Constitution, I also have to consider the P.A.T.R.I.O.T. Act (Public Law 107-56) and its seemingly unconstitutional aspects. Nonetheless, lets take a look at the Fourteenth Amendment to the US Constitution:

Section 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the state wherein they reside. No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

http://www.law.cornell.edu/constitution/constitution.amendmentxiv.html

The assumed relevant sections I've taken the liberty to put in bold typeface.

To the layperson, the anti-FGM law may violate the 14th Amendment, and maybe if a suit climbs up to the US Supreme Court the justices may then decide to overturn the anti-FGM law. But, that would not be my 'best bet'.

A better interpretation of the 14th Amendment, and one that I would guess that lawyers and Congress-critters use, would be that all that all persons within the jurisdiction of any state cannot be denied equal protection of the laws. That is, in regard to your questioning of the anti-FGM law, that it would reflect and be regardless of (at least) the gender of the person attempting to obtain FGM surgery for themselves or any other person.

An example: in the event a father was to have a daughter and for some non-medical reason want her to undergo a procedure covered under the anti-FGM law, that no person could deny medical care/services or otherwise discriminate against that father for requesting an FGM procedure.

As a note, I'm ignoring the seemingly contradictory argument present that a doctor could be found in violation of the anti-FGM law for either performing the surgery or for refusing to provide the surgery as a service.

It would be in light of the 'better' interpretation and example that the anti-FGM law does not violate the 14th Amendment to the US Constitution.

Of course, all this is is seemingly academic as it appears that, according to govtrack.us, the anti-FGM bill S.1030 never went further than to be introduced into the Senate then read twice and referred to the Committee on Judiciary.

However, Wikipedia.org has a short entry regarding the passage of a Federal law and 17 states with anti-FGM similar laws (w/o citation). A search on Thomas (thomas.loc.gov) revealed an anti-FGM type wording in U.S. Code : Title 18 : Section 116. Also, REID AMENDMENT NO. 2711 (w/ wording very similar to S.1030), aka S.AMDT.2711, found attached as amendment to H.R.1868., which passed and was signed by the president into law on Feb 12, 1996.

Notstyro, you have avoided answering this basic question...

The gendered difference in this law clearly violates the Fourteenth Amendment to the U.S. Constitution. Do you reject the notion that parents may circumcise their sons for subjective cultural reasons? Or do you believe, contra the U.S. Constitution, that gender is a valid differentiator in medically unnecessary parental decisions?

You can only answer "yes" to one.

Which do you choose?

"Of course, all this is is seemingly academic as it appears that, according to govtrack.us, the anti-FGM bill S.1030 never went further than to be introduced into the Senate then read twice and referred to the Committee on Judiciary.

HUH?

http://www.mgmbill.org/usfgmlaw.htm

Perhaps you need a better search engine than wikipedia

Robert,
Maybe you should re-read what I have posted.

The premise that the anti-FGM amendment to HR 1868, and found in US Code title 18 section 116, may be in violation of the 14th Amendment to the US Constitution may be incorrect. Therefore invalidating the question.

As for S.1030...it is dead. Again, please read the last paragraph of my post more closely.

NotStyro,

I'll leave the S.1030 question to the side. The text is the same for what I quoted, so extending that debate is pointless. However, the mistaken link is my fault.

As for your interpretation, I have to say that I don't follow what you're saying. Using the link Robert cites, here's my section-by-section reading:

(a) Except as provided in subsection (b), whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years shall be fined under this title or imprisoned not more than 5 years, or both.

That section establishs a criminal offense and penalty for doctors who perform any genital cutting on female minors.

(b) A surgical operation is not a violation of this section if the operation is--

That section establishes that certain exceptions exist where the act is not considered a criminal offense.

     (1) necessary to the health of the person on whom it is performed, and is performed by a person licensed in the place of its performance as a medical practitioner; or

That section establishes that objective medical need must exist within the female minor's genitals, and that the person performing the medically-indicated surgery must be a doctor licensed by the state.

     (2) performed on a person in labor or who has just given birth and is performed for medical purposes connected with that labor or birth by a person licensed in the place it is performed as a medical practitioner, midwife, or person in training to become such a practitioner or midwife.

That section establishes that genital cutting to assist a female minor giving birth is permissible. I think this gives a bit too much range for lazy medicine, but I'm prone to question medical intervention. For example, basic ethics demands that a doctor discuss possible cutting, such as an episiotomy, with the patient before she is in the delivery room. Cutting should not be done just to make the doctor's job easier.

(c) In applying subsection (b)(1), no account shall be taken of the effect on the person on whom the operation is to be performed of any belief on the part of that person, or any other person, that the operation is required as a matter of custom or ritual.

That section clarifies that no cultural, social, or religious justification is permissible to permit cutting the healthy genitals of the female minor. Objective medical need is the only valid criterion.

Where the Fourteenth Amendment states that government may not "deny to any person within its jurisdiction the equal protection of the laws," the plain English reading of the anti-FGM law shows that Congress and President Clinton violated the Amendment. It provides a specific protection, but only to female minors. The law is underinclusive because male children are in the group "Minors", but are not in the group "Female". The only two valid responses are to rescind the anti-FGM law or to correct it to include male children. The latter is the only ethical choice.

The Ninth Amendment is also useful to the issue, as well as the application of the First Amendment to the individual.

Note: The anti-FGM law does not cover an adult female seeking the surgery for herself. That is legal, as it should be. Nor do I seek to prohibit voluntary, adult male circumcision.

Tony,
I really didn't need to have an explanation of each section of the anti-FGM law, so I'll take it that you are providing it for others. Good job.

Now about the 14th Amendment issue. First off, I don't believe either of us have been trained or taken to extensive education in the legal profession. In other words, I'm not a lawyer and I doubt you are either. But almost regardless of that, we can only guess at what kind of ruling the SCOTUS would provide were they to closely examine the anti-FGM law in consideration of the clause in the 14th Amendment regarding equal protection.

That being written, my opinion would be that SCOTUS would let the anti-FGM law stand, as the intent of the law is not to discriminate against males under the age of 18, but rather to protect the health and well being of females under the age of 18 from a procedure that is, at this time, medically unnecessary and has no proven medical benefits (although a provision has been left in case a medical benefit is found).

The 9th Amendment - “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.” It can be stated to address rights of the people that are not specifically enumerated in the Constitution, while also not creating federally enforceable rights. So, I'll take that that the people have more rights than those listed in the Amendment, but that those unlisted rights are not actually federally enforceable.

So, does the 9th Amendment work for the anti-FGM law? I highly doubt it. You may wave about rights of 'genital integrity', but the courts don't have to enforce it (or even acknowledge it).

As for shoe-horning the anti-FGM law into the 1st Amendment...I don't see it. You are just going to have explain that one to me since I don't see how anti-FGM relates to freedom of religion, speech (expression), press, assemblage, or petitioning the government.

NotStyro Said:


That being written, my opinion would be that SCOTUS would let the anti-FGM law stand, as the intent of the law is not to discriminate against males under the age of 18, but rather to protect the health and well being of females under the age of 18 from a procedure that is, at this time, medically unnecessary and has no proven medical benefits (although a provision has been left in case a medical benefit is found).

The provision is not for the possibility of finding a benefit, no one will ever dig as hard or look the way they try with MC. The exception is for cases where there is a true medical indication, an objective problem that must be dealt with surgically.

Male circumcision is also medically unnecessary. Pick any purported benefit you wish and it can be demonstrated that either the benefit is a myth, there are less invasive and more effective ways to realize that benefit, or the malady occurs at such a low baseline that it's trivial.

So if both are medically unnecessary in the general case then how does equal protection not apply?

Poor assumptions Joe, and you should know it.

Male circumcision has scores of research to backup the medical benefits. This is not the case with FGM. Just because you have a contrary opinion on the research doesn't mean the research is faulty, it just means that you are too stubborn to free your mind and change your opinion.

NotStyro, let us say that there were only studies showing that circumcision has medical benefits. There are no studies showing no benefit or a negative effect. And that none of the studies showing benefits had any flaws in them.

Even then, there still isn't a good reason to cut off an important body part without his consent. Why?

*Because the foreskin has a function.
*The medical benefit shown by the studies is minimal. (hence why the medical associations do not recommend it.)
*There can be many serious complications to the operation. The cosmetic effect(including the circumcision scar), the general loss in sensitivity and the gliding action of the skin are complications that occur every time are a given.

NotStyro Said:


Male circumcision has scores of research to backup the medical benefits. This is not the case with FGM. Just because you have a contrary opinion on the research doesn't mean the research is faulty, it just means that you are too stubborn to free your mind and change your opinion.

Ok, then tell me what is the clinical indication to circumcise a boy at birth, what is the medically therapeutic reason? A medical-benefits or "therapeutic" justification requires that:

1. The overall the medical benefits should outweigh the risks and harms of the procedure required to obtain them.

2. This procedure is the only reasonable way to obtain these benefits.

3. That these benefits are necessary to the well-being of the child.

So which purported benefit fits into that definition?

NotStyro Said:


Male circumcision has scores of research to backup the medical benefits. This is not the case with FGM. Just because you have a contrary opinion on the research doesn't mean the research is faulty, it just means that you are too stubborn to free your mind and change your opinion.

Ok, then tell me what is the clinical indication to circumcise a boy at birth, what is the medically therapeutic reason? A medical-benefits or "therapeutic" justification requires that:

1. The overall the medical benefits should outweigh the risks and harms of the procedure required to obtain them.

2. This procedure is the only reasonable way to obtain these benefits.

3. That these benefits are necessary to the well-being of the child.

So which purported benefit fits into that definition?

Joe,
I'm going to defer this line of questioning until later, as answering will just push the discussion back to the 'tossing of studies back and forth state' that Tony does not appreciate.

Now, if you all will permit, I think I'd just like to await a reply from Tony.

"As for S.1030...it is dead. Again, please read the last paragraph of my post more closely."

So, after all of the gobbedy-goop, are you trying to say that MGM is NOT illegal? That there is no MGM law?

I think you need to do a bit of logical thinking coupled to the facts.

"That being written, my opinion would be that SCOTUS would let the anti-FGM law stand, as the intent of the law is not to discriminate against males under the age of 18, but rather to protect the health and well being of females under the age of 18 from a procedure that is, at this time, medically unnecessary and has no proven medical benefits (although a provision has been left in case a medical benefit is found)."

Who cares about intent? it still violates the 14th amendment. Males also need to be protected from an UNNECESSARY violation.

Let's negate this silly nonsense about "medical benefits" for MGM--unless you can provide scientifically credible proof of medical benefits they are only SPECULATIVE benefits.

"Male circumcision has scores of research to backup the medical benefits. This is not the case with FGM. Just because you have a contrary opinion on the research doesn't mean the research is faulty, it just means that you are too stubborn to free your mind and change your opinion."

Having a bunch of studies, and having a scientifically-valid study are two different things.

Now unless you can provide a single PROVEN benefit, you are making a specious assertion.

"I'm going to defer this line of questioning until later, as answering will just push the discussion back to the 'tossing of studies back and forth state' that Tony does not appreciate."

And I would appreciate this subject BE discussed NOW since this lies at the very heart of circumcision!

There doesn't need to be any tossing back, and forth--just provide us a PROVEN benefit that outweighs the PROVEN harm and risks--then the discussion will simply end.

So, exactly WHEN can we expect you to provide even a single PROVEN benefit for non-therapeutic circumcision?

Robert,
I think I can see the problem here. You are stating that “we expect you to provide even a single PROVEN benefit for non-therapeutic circumcision.” The problem is that I've been thinking that you want the demonstrated value of therapeutic circumcision. This is, circumcision performed for prophylaxis or for another medical purpose.

I'm not sure how much research has been conducted into the value of non-therapeutic circumcision. Most studies regarding non-therapeutic circumcision focus on identifying types of reasoning, such as religious and societal/cultural. Among the societal/culture reasons for circumcision, a strong correlation was found between a woman's requested circumcision for her son and the woman's ideal male partner's circumcision status for intercourse. The next higher, but not exhaustive, of the cultural reasons were that a circumcised penis was cleaner, looked 'sexier', felt nicer to touch and lastly that it smelled more pleasant.

That a circumcised penis is cleaner is a hygiene/therapeutic issue so it doesn't fit your criteria. I'll consider 'smelled more pleasant' to be semi-related to hygiene, but not enough to exclude it.

Among the cultural reasons left for circumcision, I'm not sure any research has been done to support or prove these highly subjective reasons. I suppose one could design and build a study to objectively measure odors and rate from pleasant to offensive, but a tactile study would be difficult until you could objectively measure the term 'nice'.

Citation: Williamson ML, Williamson PS. Women's preferences for penile circumcision in sexual partners. J Sex Educ Hlth 1988; 14: 8-12.

NotStyro,

I agree that the Supreme Court of today would not overturn it, and would be unlikely to extend it equally to male minors. That doesn't mean they're right. We can point to past Supreme Court rulings that we now look at with dismay. The same applies to the the Ninth Amendment. It is not enforced, but that fault rests with our courts, not with the Ninth Amendment.

I also second Robert's statement that intent doesn't matter. The plain English of the law matters. The FGM law is objectively discriminatory.

I also disagree that the anti-FGM law leaves open the possibility to surgically alter female minors if we find potential benefits. It clearly states "necessary to the health of the person". Not that we'd ever authorize studies to look for benefits for adults, much less extending that to minors. We don't have an ethical blindspot when it comes to subjective excuses for genital cutting on female minors.

The First Amendment's protection of an individual's right to and from religion is relevant to this discussion. You've endorsed a view that parents may circumcise their sons for religious reasons. The parents do not know what religion their sons will take, and whether or not that religion will require circumcision as an act of faith. Religious freedom is an individual right. No one has a right to practice his or her religion on the body of another child. Providing the individual's DNA doesn't change that.

Poor assumptions Joe, and you should know it.

Male circumcision has scores of research to backup the medical benefits. This is not the case with FGM. Just because you have a contrary opinion on the research doesn't mean the research is faulty, it just means that you are too stubborn to free your mind and change your opinion.

Joe didn't deny specific potential benefits. He included the possibility that some are legitimate. His comment is clearly correct. Potential benefits are not an indication of medical need.

I don't wish to imply that citing studies is forbidden. Use them, if necessary. If Joe rejects a claim, defend your position. He (and everyone else) should do the same. But there is the ethical question of how to apply those studies that follows the findings, but precedes any decision to circumcise a healthy child. That is what Joe said.

I stated earlier that I accept the HIV findings. In their limited scope, they're fine enough because I don't care why adult males choose circumcision for themselves.

Research into voluntary, adult circumcision tells us nothing about what we should do to male minors. I must also clarify that I think the long-term results will show there is no difference. Screw around without condoms long enough and HIV is inevitable. A two-year window of research on this disease is hardly conclusive. And there are open questions about the methodology. Still, even after accepting the basic premise that the findings are accurate, the ethical question of applying findings on adult volunteers to non-consenting minors is impossible to ignore.

So, if we assume that voluntary, adult male circumcision reduces the risk of female-to-male HIV transmission during unprotected sex, how do those findings apply to healthy infant males who are not sexually active, live in a nation where the HIV epidemic is significantly different than female-to-male transmission, and have much better access to safe sex options and information?

This gets back to what I posted at the end of my initial analysis of the anti-FGM law:

A surgical operation is not a violation of this section if the operation is— (1) necessary to the health of the person on whom it is performed, and ...

Are you claiming that circumcision is necessary to the health of an males born with a normal foreskin?

"You are stating that “we expect you to provide even a single PROVEN benefit for non-therapeutic circumcision.” The problem is that I've been thinking that you want the demonstrated value of therapeutic circumcision. This is, circumcision performed for prophylaxis or for another medical purpose."

I don't see any proble at all--I see there needs to be a proven NEED for it to be justified..not some nebulous, subjective, and/ or culturally or religious EXCUSE.

"Citation: Williamson ML, Williamson PS. Women's preferences for penile circumcision in sexual partners. J Sex Educ Hlth 1988; 14: 8-12."

Gee, I didn't think you would be bringing up this silly excuse for a "study" by Williamson--most of these silly women had never even seen a normal penis, yet they have a "preference"? Sorry a preference based on ignorance is really a prejudice--and hence irrational..

You might wish to check out the critique of this "study"...

http://www.circumstitions.com/Iowa.html

On the larger picture, it seems that you cannot provide a SINGLE scientifically proven benefit, so you offer off this irrelevant and irrational nonsense to justify MGM?

How exactly is that supposed to justify an non-therapeutic, unnecessary, harmful, painful procedure? How DOES this work?

P.S. the tactile study has been done--and it quantifies the loss from circumcision..

http://www.nocirc.org/touch-test/bju_6685.pdf

http://www.prweb.com/releases/2007/3/prweb512999.htm

Study Confirms Male Circumcision is Genital Mutilation

A new study in the British Journal of Urology International shows that men with normal, intact penises enjoy more sexual sensitivity — as much as four times more — than those who have been circumcised. Circumcising slices off more of a male's sensitivity than is normally present in all ten fingertips.

http://www.urotoday.com/42/browse_categories/erectile_dysfunction_ed/finetouch_pressure_thresholds_in_the_adult_penis.html

Analysis of results showed the glans of the uncircumcised men had significantly lower thresholds than that of circumcised men (P = 0.040). There were also significant differences in pressure thresholds by location on the penis (p

This study suggests that the transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. It appears that circumcision ablates the most sensitive parts of the penis.

NotStyro,

I'm not sure how much research has been conducted into the value of non-therapeutic circumcision. ...

Almost all infant circumcision is non-therapeutic, especially those for the parents' cultural, social, and religious reasons. I don't want to get distracted by this because we're already getting to the larger issue involved. But allow me to repost part of this entry (responding to this). I covered the gist of what you mentioned in your comment.

**********

That's unsurprising because the article is structured to reach one conclusion. Among the arguments offered in favor of circumcision, the article includes "Appearance":

Research by Professor Marvel Williamson from the School of Nursing at Oklahoma City University found women prefer the look of a circumcised penis. "Generally women said it is more sexually appealing," says Williamson. "Ninety per cent of women said it looks sexier and 85% said it’s nicer to touch."

This is a non-medical argument used to excuse surgery on a non-consenting, healthy child. It's also a subjective criterion that will be irrelevant to the 10% and 15% of women, respectively, who disagree with the majority. It will also be irrelevant if the male is gay. This conclusion also demands that we accept an external locus of control for all male sexuality. What the society wants matters more than what the individual wants for himself. Human rights belong to the individual, so we must reject all of this.

But look at what the article explicitly ignored. It's obvious by the location of the research. A quick scan of the study reveals the omission.

This study clearly support the hypothesis that American women prefer circumcision for sexual reasons. The preference for circumcision does not necessarily come out of ignorance nor from lack of exposure to uncircumcised men.

Yeah, noting that the conclusion concerns American women might help Australian parents, except Australian statistics look nothing like American statistics in 2009. Also, this assumes that the mother's preferences - or the father's opinion about his own penis - matters. We're not assuming that because it doesn't matter. Professor Williamson incorrectly thinks it does, as shown in the design of her study:

Of 145 new mothers of sons responding to this survey, ...

Are we really so stupid that a parent's opinion on the sexual aesthetics of a child's genitals is considered a valid reason for surgical alteration? I want to believe we are smarter, but the evidence is very clear that parents can and do use this excuse. That position is indefensible. Remember that all tastes and preferences are subjective, unique to each individual. The choice on whether or not to allow the subjective tastes and preferences of his future sexual partners to influence his decision regarding cultural, medically unnecessary circumcision must be left to him. Ethically, parents may offer proxy consent to circumcision only when medical need exists, and then only when less invasive solutions are insufficient.

This is all subjective.

"The problem is that I've been thinking that you want the demonstrated value of therapeutic circumcision. This is, circumcision performed for prophylaxis or for another medical purpose."

No, therapeutic means a procedure to correct an EXISTING condition and/or problem..it does not take into account any speculative prophylaxis.

And I need more than "demonstrated value"--I require scientifically PROVEN VALUE".

NotStyro Said:


... will just push the discussion back to the 'tossing of studies back and forth state' that Tony does not appreciate.

Now, if you all will permit, I think I'd just like to await a reply from Tony.

But that is at the heart of the question. Traditional medical ethics require that a practitioner obtain consent, either direct or occasionally by proxy. When consent is by proxy, it is particularly important that the medical intervention sought is both a necessary intervention (meaning there is an immediate need) and the least invasive way of treating.

There could be a potential benefit but if there is a better way of realizing it then it is incumbent on the practitioner to provide the least invasive treatment first. As an example, intact men might potentially have a slightly higher risk of HPV however, the availability of an HPV vaccine deprecates any need to consider circumcision as a prophylaxis for HPV (and that is aside from the fact that the decision with regard to HPV can be made when direct informed consent is possible).

So again the question is are you claiming that circumcision is necessary to the health and well being of a boy and if that is the case how does that necessity fit in the context of a medically therapeutic and ethical intervention.

Tony,
I am glad that we can be in agreement that SCOTUS would likely not overturn the anti-FGM law. But I disagree that with the opinion that intent doesn't matter. From reading cases that SCOTUS has decided in the past, with regard to equal protection, intent of the law was among the highest factors. If a law is written with the intent to discriminate against a particular group of people, it is more likely that the courts will overturn the law based on the discriminatory intent. The anti-FGM law was not written with the intent to discriminate against minor males but with the intent to protect minor females.

Regarding circumcision for religious reasons, I'm not certain that I've endorsed parents circumcising for religion, but it is clearly one of the main reasons for non-medical circumcision, and one in which I'm fairly certain that the government will not interfere.

Prevention may be, and is frequently viewed as, one of the primary reasons for mothers and parents to circumcise their infant sons. This viewpoint is one that has been researched and proven, time after time after time. Prophylactic infant circumcision has been proven, it is safe and effective, so there is no reason to wait until the infant is stricken with an illness if you can prevent the illness easily and effectively.

The point that you seem to get stuck is with an ethical quandary. It is clear that parental entitlements allow parents to decide non-immediate medical procedures for their dependent child. National and International medical organizations agree that parents should consider options before making medical decisions for their child. I would hope that we can both agree that parents should make informed decisions regarding medical options and procedures for their child. I would further hope that we both would agree that if parents are going to decide for/against circumcision based upon medical/prophylactic grounds that parents are also given as much information, supported by research, as possible in regards to circumcision. With all that in mind, I don't see the ethical problem.

"The point that you seem to get stuck is with an ethical quandary. It is clear that parental entitlements allow parents to decide non-immediate medical procedures for their dependent child."

You are dodging the critical ETHICAL question.. DO THEY allow this, and WHY SHOULD they be allowed to harm children based on irrational excuses?

"National and International medical organizations agree that parents should consider options before making medical decisions for their child."

I hardly think OPINIONS without a PROVEN rationale justify this procedure --this is nothing but a lame "appeal to authority".

"I would hope that we can both agree that parents should make informed decisions regarding medical options and procedures for their child. I would further hope that we both would agree that if parents are going to decide for/against circumcision based upon medical/prophylactic grounds that parents are also given as much information, supported by research, as possible in regards to circumcision. With all that in mind, I don't see the ethical problem."

I don't agree with any of these excuses UNLESS they can provide a PROVEN benefit that exceeds the PROVEN harm and risks inherent in the procedure.

And unless this alleged prophylactic benefit can be PROVEN to exist, it cannot be used as a rationale.

THIS is the critical ethical question whether or not you wish to believe otherwise--and until you fully and adequately address these issues, you are merely providing nothing but an feeble apologia for circumcision.

NotStyro,

We don't achieve much by agreeing that SCOTUS would not overturn the anti-FGM law. This is just a practical analysis of our current situation. I'm not going to celebrate a scenario where the judiciary ignores the Constitution.

The same applies to intent. SCOTUS uses intent. Where there is ambiguity in a law, SCOTUS should send the law back to the legislature to clarify the law rather than assuming what legislators meant. Fortunately with the anti-FGM law, there is no ambiguity. The plain English reading of it shows that it is discriminatory.

Nor is the Congressional Record particularly beneficial on intent. From the origin of the law, Rep. Pat Schroeder spoke on the floor of the House:

Mrs. SCHROEDER. Mr. Speaker, today I and Representatives Collins of Michigan and Morella of Maryland are reintroducing a bill that would make it illegal to mutilate women in the name of tradition.

The practice is called female genital mutilation, a painful ritual that involves cutting off all or part of a female's genitalia. ...

The intent is to stop mutilation based in tradition rather than medical need. The then-proposed, now-passed law made no exceptions for any cutting for any purpose not related to a direct medical need.

Rep. Schroeder continued:

FGM is not comparable to male circumcision, unless one considers circumcision amputation. ...

She is wrong. In the way she lumps all female genital cutting into amputation, male genital cutting clearly matches her definition. The foreskin is amputated. We get to choose our words, but we do not get to choose what they mean. According to the plain English reading of the bill, all medically unnecessary cutting on a female minor is prohibited. That is the intent. Given that it seeks only to protect female minors rather than all minors, its intent is objectively discriminatory because it is underinclusive of minors who are mutilated for non-medical reasons.

Regarding the rest of your comment, cycling back to what we stated earlier about legitimate versus illegitimate parental authority continues your avoidance of the ethical issue. As I pointed out, if we assume all of the potential benefits are valid potential benefits, are you claiming that circumcision is necessary to the health of a male born with a normal foreskin?

Tony,
I think we have exhausted almost all avenues of discussion regarding the anti-FGM law. Save for this quote attributed to Rep. Schroeder:

“FGM is not comparable to male circumcision, unless one considers circumcision amputation...”

Obviously “circumcision amputation” was a poor choice of phrase. You may believe that she meant to say 'foreskin amputation', but the analogy would not fit. The only analogue to FGM for a male is penile amputation. This is found in the root cause for traditional/cultural FGM is sensory deprivation – removal of most or elimination of all sexual pleasure. In a male this can mainly be achieved by penile amputation.

We seem to be running this discussion around and around the issue of ethics. This is primarily, as I see it, your issue. As far as parental authority and circumcision, there are no organizations, save for anti-circumcision 'organizations', that claim that parents do not have authority to request circumcision for their male child.

Regarding the claiming that circumcision is, or is not, necessary for the health of a male infant based upon some flimsy statement about potential benefits... Sorry, the research has that there are actual as well as potential benefits to infant circumcision. My personal preference is that infant circumcision possess very little risk and pain as a trade for lifelong benefits. My beliefs, with statistics as proof, are that quite a lot of mothers and parents also share that opinion on infant circumcision.

"We seem to be running this discussion around and around the issue of ethics. This is primarily, as I see it, your issue."

We would not be running around and around IF you provided a RATIONAL and logical, ethical justification for infant circumcision--but all you keep providing scientifically are unsupportable OPINIONS.

"As far as parental authority and circumcision, there are no organizations, save for anti-circumcision 'organizations', that claim that parents do not have authority to request circumcision for their male child."

Who cares for yet another OPINION? Until and unless these organizations provide what I am requesting, they have no rational or logical foundation for these opinions.

"Appeal to authority" falls far short of providing a logical and rational justification.

"Regarding the claiming that circumcision is, or is not, necessary for the health of a male infant based upon some flimsy statement about potential benefits... Sorry, the research has that there are actual as well as potential benefits to infant circumcision."

PROOF for this assertion?
And by this, I mean scientifically credible proof.

Please provide ONE single "actual benefit".

"My personal preference is that infant circumcision possess very little risk and pain as a trade for lifelong benefits."

And just what is this "preference" worth without any substantive evidence to support it?

"My beliefs, with statistics as proof, are that quite a lot of mothers and parents also share that opinion on infant circumcision."

Who cares for still another OPINION when that opinion rests not on scientifically credible evidence?

According to this mindset, is all that is requires is mere BELIEF" to justify anything?

So, in the end, it seems that all you have to offer is mere belief--even when that belief is contradicted by reality.

Hardly persuasive, let alone compelling!

"Obviously “circumcision amputation” was a poor choice of phrase. You may believe that she meant to say 'foreskin amputation', but the analogy would not fit. The only analogue to FGM for a male is penile amputation."

Let's just ignore the actual words, and rely on mind-reading instead?

"This is found in the root cause for traditional/cultural FGM is sensory deprivation – removal of most or elimination of all sexual pleasure. In a male this can mainly be achieved by penile amputation."

Just as is the basis for circumcision in the USA--to curb masturbation due to sensory deprivation.. you might wish to research the history of circumcision in the USA--AND check out Miamonides.

And it seems you need to check out the REAL effects from FGM before merely repeating propaganda.

NotStyro,

Are you claiming that circumcision is necessary to the health of a male born with a normal foreskin?

Since you all have been requesting/demanding a list of prophylactic & medical grounds for circumcision, I found a list ready made and added citations to support. The citations for each argument are not exhaustive and I have read through only a few (due to time constraints to find and review what little is available in abstracts or free full texts).

Lack of circumcision:

---Is responsible for a 12-fold higher risk of urinary tract infections in infancy. Higher risk of UTI at older ages as well.

Wiswell TE, Geschke DW. Risks from circumcision during the first month of life compared with those for uncircumcised boys. Pediatrics 1989; 83: 1011-5.

Wiswell TE, Enzenauer RW, Holton ME, Cornish JD, Hankins CT. Declining frequency of circumcision: implications for changes in the absolute incidence and male to female sex ratio of urinary tract infections in early infancy. Pediatrics 1987; 79: 338-41.

Lohr JA. The foreskin and urinary tract infections. J Pediatr 1989; 114: 502-4

Roberts JA. Does circumcision prevent urinary tract infections? J Urol 1986; 135: 991-2

Schoen EJ, Colby CJ, Ray GT. Newborn circumcision decreases incidence and costs of urinary tract infections in the first year of life. Pediatrics 2000; 105: 789-93

---Confers a higher risk of death in the first year of life (from complications of urinary tract infections: viz. kidney failure, meningitis and other infections).

Chon CH, Lai FC, Shortliffe LM. Pediatric urinary tract infections. Pediatr Clin North Am 2001; 48: 1441-59

Rushton HG, Majd M. Dimercaptosuccinic acid renal scintigraphy for the evaluation of pyelonephritis and scarring: a review of experimental and clinical studies. J Urol 1992; 148: 1726-32

Jacobson SH, Eklof O, Eriksson CG, Lins LE, Tidgren B, Winberg J. Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. Brit Med J 1989; 16: 703-6

Koyle MA, Barqawi A, Wild J, Passamaneck M, Furness PD. Pediatric urinary tract infections: the role of fluoroquinolones. Pediatr Infect Dis J 2003; 22: 1133-7

Bachur R, Caputo GL. Bacteremia and meningitis among infants with urinary tract infections. Pediatr Emerg Care 1995; 11: 280-4

Smellie JM. Reflections on 30 years of treating children with urinary tract infections. J Urol 1991; 146 (Part 2): 665-8

---One in ~400-900 uncircumcised men will get cancer of the penis, which is over 20 times higher in uncircumcised men. A quarter of these will die from it and the rest will require complete or partial penile amputation as a result. (In contrast, invasive penile cancer is extraordinarily rare in men circumcised at birth.) (Data from studies in the USA, Denmark and Australia, which are not to be confused with the often quoted, but misleading, annual incidence figures of 1 in 100,000).

Kochen M, McCurdy S. Circumcision and risk of cancer of the penis. A life-table analysis. Am J Dis Child 1980; 134: 484-6

Maden C, Sherman KJ, Beckmann AM, Huslop TK, Heh OZ, Ashley RL, Daling JR. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Nat Canc Inst 1993; 85: 19-24

Micali G, Nasca MR, Innocenzi D, Schwartz RA. Penile cancer. J Am Acad Dermatol 2006; 54: 369-91

Schoen EJ, Oehrli M, Colby CJ, Machin G. The highly protective effect of newborn circumcision against invasive penile cancer. Pediatrics 2000; 105

Schoen EJ. Neonatal circumcision and penile cancer. Evidence that circumcision is protective is overwhelming. Br Med J 1996; 46: 313

Sanchez Merino JM, Parra Muntaner L, Jiminez Rodriguez M, Valerdiz Casola S, Monsalve Rodriguez M, Garcia Alonso J. Epidoid carcinoma of the penis. Arch Esp Urol 2000; 53: 799-808

World Health Organization, International Agency for Research on Cancer. Cancer Incidence in Five Countries. International Agency for Research on Cancer. Vol. vol 1 – vol 7. 1966-1997

---Is associated with 3-fold higher risk of inflammation and infection of the skin of the penis. This includes balanitis (inflammation of the glans), posthitis (inflammation of the foreskin), phimosis (inability to retract the foreskin) and paraphimosis (constriction of the penis by a tight foreskin). Up to 18% of uncircumcised boys will develop one of these by 8 years of age, whereas all are unknown in the circumcised. Risk of balanoposthitis = 1 in 6. Obstruction to urine flow = 1 in 10-50. Risk of these is even higher in diabetic men.

Schoen EJ, Male circumcision. In: Male Sexual Dysfunction. Pathophysiology and Treatment., Kandeel FR, Lue TF, Pryor JL, Swerdloff RS, Editors. 2007, Informa: New York. p. 95-107

Gairdner D. The fate of the foreskin: a study of circumcision. Brit Med J 1949; 2: 1433-7

Griffin AS, Kroovand RL. Frenular chordee: implications and treatment. Urology 1990; 35: 133-4

Fakjian N, Hunter S, Cole GW, Miller J. An argument for circumcision. Prevention of balanitis in the adult. Arch Dermatol 1990; 126: 1046-7

Kohn F-M, Pflieger-Bruss S, Schill W-B. Penile skin diseases. Andrologia 1999; 31 (suppl 1): 3-11

Kumar B, Narang T, Dass Radotra B, Gupta S. Plasma cell balanitis: clinicopathologic study of 112 cases and treatment modalities. J Cutan Med Surg 2006; 10: 11-5

English JC, Laws RA, Keough GC, Wilde JL, Foley JP, Elston DM. Dermatoses of the glans penis and prepuce. J Am Acad Dermatol 1997; 37: 1-24


---Means increased risk of problems that may necessitate 1 in 10 older children and men requiring circumcision later in life, when the cost is 10 times higher the procedure is less convenient, and the cosmetic result can be not as good as when done in infancy.

Wiswell TE, Tencer HL, Welch CA, Chamberlain JL. Circumcision in children beyond the neonatal period. Pediatrics 1993; 92: 791-3

Note - Apparently there has been little documented research in this field. A brief google search on adult circumcision costs showed uninsured costs may be about 10 times higher then neonatal circumcision.

---Increases by 2-4 fold the risk of thrush and sexually transmitted infections such as human papillomavirus (HPV), syphilis, chancroid and, in some studies Chlamydia.

Wilson RA. Circumcision and venereal disease. Can Med Ass J 1947; 56: 54-6

Hand EA. Circumcision and venereal disease. Arch Dermatol Syphilol 1949; 60: 341-6

Fergusson DM, Boden JM, Horwood LJ. Circumcision status and risk of sexually transmitted infection in young adult males: an analysis of a longitudinal birth cohort. Pediatrics 2006; 118: 1971-7

Diseker RA, Peterman TA, Kamb ML, Kent C, Zenilman JM, Douglas JM, Rhodes F, Iatesta M. Circumcision and STD in the United States: Cross sectional and cohort analysis. Sex Transm Infect 2000; 76: 474-9

---In the female partners of uncircumcised men is associated with a 5 fold higher incidence of cervical cancer (caused by sexually transmitted HPV), pelvic inflammatory disease, infertility from blockage of fallopian tubes, extopic pregnancy (each caused by Chlamydia), genital herpes, and other conditions.

Castellsague X, Bosch FX, Munoz N, Meijer CJLM, Shah KV, de Sanjose S, Eluf-Neto J, Ngelangel CA, Chichareon S, Smith JS, Herrero R, Franceschi S. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med 2002; 346: 1105-12


---Is the biggest risk factor for heterosexually-acquired AIDS virus infection in men. 3 to 8-times higher risk by itself, and even higher when lesions from STIs are added in. Risk per exposure = 1 in 300.

World Health Organization, UNAIDS. New data on male circumcision and HIV prevention: policy and programme implications. http://who.int/hiv/mediacentre/MCrecommendations_en.pdf 2007; (10 pages).

Fischbacher CM. Circumcision of newborn boys. Lancet 1999; 353: 669-70

Alanis MC, Lucidi RS. Neonatal circumcision: A review of the world's oldest and most controversial operation. Obstet Gynecol Surv 2004; 59: 379-95

I can find over 20 more citations to support this statement, but I doubt you will want to research all of them. Let me know if you want each of them listed.

NotStyro Said:


We seem to be running this discussion around and around the issue of ethics. This is primarily, as I see it, your issue. As far as parental authority and circumcision, there are no organizations, save for anti-circumcision 'organizations', that claim that parents do not have authority to request circumcision for their male child.

I don't think this is Tony's problem, he (as well as others) have asked relevant questions which it seems you're incapable of answering.

It is true that parents have the authority to make proxy decisions for their children but as in other cases of proxy consent, there are rules that must be followed which are stricter than in the case of obtaining direct consent. Whereas in a direct consent situation, one can choose any medical intervention they would like (whether it is therapeutic or not), and that the physician is willing to perform, in a proxy consent situation (such as parent for child) it is necessary to start with the least invasive most effective option (the therapeutic option) first.

For example, taken from your new list I will select (and let others who want to participate discuss the other points)

---One in ~400-900 uncircumcised men will get cancer of the penis, which is over 20 times higher in uncircumcised men. A quarter of these will die from it and the rest will require complete or partial penile amputation as a result. (In contrast, invasive penile cancer is extraordinarily rare in men circumcised at birth.) (Data from studies in the USA, Denmark and Australia, which are not to be confused with the often quoted, but misleading, annual incidence figures of 1 in 100,000).

And

-In the female partners of uncircumcised men is associated with a 5 fold higher incidence of cervical cancer (caused by sexually transmitted HPV), pelvic inflammatory disease, infertility from blockage of fallopian tubes, extopic pregnancy (each caused by Chlamydia), genital herpes, and other conditions.

And once again point out that the ACS does not endorse the use of circumcision as a prophylactic against penile cancer. Furthermore, both penile cancer and cervical cancer are primarily caused by HPV which (I give you the benefit of the doubt, perhaps you didn't know this) we've had an effective vaccine for for nearly four years. Plus, adults can make that decision for themselves. That is to say nothing is lost by delaying.

Since a vaccine is a far less invasive treatment and far far more effective then even the best estimates for circumcision, the vaccine is the correction option for most parents who are concerned about HPV type cancers.

So do you disagree that the HPV vaccine is a superior option? And I'll re-ask Tony's question:

Are you claiming that circumcision is necessary to the health of a male born with a normal foreskin?

Joe,
Regarding the HPV vaccine, it only covers a couple or few of the formerly common and high-risk variants of the HPV. Also, although the vaccine is available, it is not required that all young females be vaccinated. Furthermore, not all parents are allowing their pre-/teen daughters to be vaccinated due to the idea that the parents have that in allowing their daughters to be vaccinated allows the daughters a 'free pass' to have sexual intercourse. There is also, of course, that even knowing the vaccine is available, some young women are electing not to be vaccinated. All these factors have to be taken into account when considering that the vaccine is not the panacea that everyone would be hoping it would be.

Tony, el al.,

“Are you claiming that circumcision is necessary to the health of a male born with a normal foreskin? “
No, of course not. Millions of men worldwide suffer without the benefits, but why allow an infant or child to suffer when there is a safe and permanent preventative cure available.

NotStyro Said:

Regarding the HPV vaccine, it only covers a couple or few of the formerly common and high-risk variants of the HPV. Also, although the vaccine is available, it is not required that all young females be vaccinated. Furthermore, not all parents are allowing their pre-/teen daughters to be vaccinated due to the idea that the parents have that in allowing their daughters to be vaccinated allows the daughters a 'free pass' to have sexual intercourse. There is also, of course, that even knowing the vaccine is available, some young women are electing not to be vaccinated. All these factors have to be taken into account when considering that the vaccine is not the panacea that everyone would be hoping it would be.

Actually no, it covers about 70% - 75% of the most common (not formerly most common) types of HPV (16 and 18) and it is nearly 100% efficient at that. It is also considered effective against 10 additional strains (31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) which account for about the other 25%.

In light of very good results in a 2008 trial in boys and men, Merck has petitioned the FDA for approval to market Gardasil to boys in the same age range, this is expected to be approved it has long been available to boys in most other countries.

So you're telling me that one should consider circumcision an appropriate prophylactic against HPV cancers when they are pretty rare and there is now an effective vaccine?

Millions of men worldwide suffer without the benefits

Do you have evidence to back up this assertion?

Joe,
“So you're telling me that one should consider circumcision an appropriate prophylactic against HPV cancers when they are pretty rare and there is now an effective vaccine? “

Well, yes, you may want to re-read that paragraph again. HPV isn't very rare for the reasons given – in addition there are HPV variants that the vaccine does not immunize against that will spread and proliferate potentially causing health concerns in the future.

“Do you have evidence to back up this assertion?”

All male humans that are uncircumcised are at risk for health issues due to the lack of circumcision. If, or more likely When, they develop a UTI, physical ailment, cancer or other issue of the penis and/or urinary tract (others listed in a previous post) then they will have to suffer until they get circumcised or get your 'least invasive' treatment, get temporarily cured, then get another penis/urinary issue, suffer, get treated again and on, and on, and on....

NotStyro Said:

Well, yes, you may want to re-read that paragraph again. HPV isn't very rare for the reasons given – in addition there are HPV variants that the vaccine does not immunize against that will spread and proliferate potentially causing health concerns in the future.

You're right HPV isn't rare. It's the most common STD and it's estimated that by age 50 over 80% of the population will have been exposed to it. This is because it takes very little contact to transmit HPV, it doesn't even have to be sexual contact. However, in well over 90% of cases the body clears HPV (even the more aggressive ones often pass without issue). This combined with early detections, such as pap tests, has made cervical cancer quite rare. In the US there were only about 11,000 diagnosed cases in an at risk population approaching 120 - 130 million, the rate has been decreasing an average of 4% per year. Most of those 11,000 were in women who haven't had a screening in over five year too. All this without even figuring in the impact of a vaccine that is nearly 100% effective against the strains responsible for nearly 3/4s of those 11,000 cases. The numbers are actually so low that there are serious questions as to whether a vaccine is even necessary. Of course penile cancer is even less common still.

So again you think it's reasonable to consider a potential reduction in risk for HPV a good reason to cirucmcise? HPV, a disease we:

A. Have a vaccine for, which is nearly 100% effective.
B. In over 90% of cases has no effect on the body.
C. Is responsible conditions considered so uncommon in women, but especially in men, that there is credible discussion of whether the vaccine is even necessary?

NotStyro Said:

All male humans that are uncircumcised are at risk for health issues due to the lack of circumcision. If, or more likely When, they develop a UTI, physical ailment, cancer or other issue of the penis and/or urinary tract (others listed in a previous post) then they will have to suffer until they get circumcised or get your 'least invasive' treatment, get temporarily cured, then get another penis/urinary issue, suffer, get treated again and on, and on, and on....

This to me seems like you're rambling. I don't quite understand why you would characterize a less invasive, more effective solution in a pejorative sense. I know when I go to the doctor for a treatment, I generally select the least invasive option that is reasonably effective. When I had a cavity, I got it filled. I didn't have the tooth pulled. I guess by your estimation I am setting myself up for suffering down the road by not having that tooth pulled. And if that's how you manage your health care, I don't have a problem with that. But if it was a child I would. You fill the cavity you don't pull the tooth just like you treat any rare problem a boy has with his penis rather than circumcise him.

Also, if, as you say, millions upon millions of intact men are suffering why don't we see men going in droves to fix what their parents didn't do for them? I find it amazing that no other industrialized country see this problem as none of them circumcises routinely (for secular reasons), it's just the US. One would expect circumcision to be much more common if, as you say, millions of men were suffering regularly.

Gardisal is a less invasive approach to your HPV assertion, do you consider it inferior?

And though I don't want to get into UTI (I picked HPV) if you checked your references closely you would see that the demonstrated potential benefit has never been shown to exist beyond the first year of life. So intact men aren't suffering from more UTIs. What you need to do is determine how that potential benefit fits with the cost, like the Royal Australasian College of Physicians did:

Assuming an annual incidence of UTI of 1% during the first year of life for uncircumcised boys, the risk of UTI may be reduced from 10 per 1,000 to 1-3 per 1000, a difference of 7-9 per 1,000, or a need to circumcise between 110 to 140 boys to prevent one UTI during the first year of life. On the other side of the equation, taking a mid-range figure of 2% (20 per 1,000) for major complications from circumcision, mainly from haemorrhage and infection (see earlier section), for every 1,000 infants circumcised, about eight fewer will develop a UTI but 20 will develop a significant complication. Assuming that the “harm” of a UTI is about the same as a complication, routine circumcision is difficult to advocate as a public health measure.

So you would have to circumcise on average 130 boys (expose 130 to surgical risks up to and including loss of penis and death) to prevent one boy from taking a round of antibiotics in the first year of life. In what world does that make sense? Certainly not to most people outside this country.

"“So you're telling me that one should consider circumcision an appropriate prophylactic against HPV cancers when they are pretty rare and there is now an effective vaccine? “

I am telling you that circumcision is not a scientifically credible prophylaxis against HIV cancers --PERIOD. And just repeating this specious claim, does not make it so.

"All male humans that are uncircumcised are at risk for health issues due to the lack of circumcision."

You keep making this assertion, isn't it about time that you support it with scientifically credible evidence--mere repetition does not reality make.

"If, or more likely When, they develop a UTI, physical ailment, cancer or other issue of the penis and/or urinary tract (others listed in a previous post) then they will have to suffer until they get circumcised or get your 'least invasive' treatment, get temporarily cured, then get another penis/urinary issue, suffer, get treated again and on, and on, and on...."

Please spare us this fright-tactic--it is ineffective until and unless you can scientifically support these assertions.

Do you even know what scientifically credible evidence is?

Hey Notstyro,
In case you haven't noticed, I am a participant in this discussion. So why are you ignoring me and my posts?

You repeatedly make assertions that I repeatedly ask you to support with scientifically credible evidence. You have never provided ANY, yet post as if I have never posted at all. WHY is this?

Do you honestly believe that ignoring my requests; yet continuing to make empty assertions provides you with any credibility?

Robert, NotStyro conveniently ignores question when he cannot find the right answer. Now that I have found him as well, I will like to ask him ONCE AGAIN the question he never answered me at change.org.

NotStyro,
If you believe that circumcision is an appropriate prophylactic against HIV, how about you try this:

Go with your circumcised penis and have unprotected sex with an infected person, you need to report back the results that in fact you are protected and got no virus at all. How about STD's? Test those as well, but you do need to come back with your results and see how 'protected' you are!

Another question.... Do you have a daughter? BECAUSE I HAVE 2! They have gotten UTI's and how would you treat those? Would you cut off their genitals too?

NotStyro,

“Are you claiming that circumcision is necessary to the health of a male born with a normal foreskin? “
No, of course not. Millions of men worldwide suffer without the benefits, but why allow an infant or child to suffer when there is a safe and permanent preventative cure available.

Your "no" answer is correct. Thank you for answering it directly. Therefore, you need to prove why it should be done, not place the burden on me to prove why it shouldn't. Of course, you can't prove that because the child is, in fact, healthy. Remember, first do no harm. Circumcision is surgery that harms the child. Even if circumcision only harms for the time needed to heal, which I reject, it is harm and risk without direct benefit. Therefore, it is unethical to impose it, just like it would be unethical to remove a female minor's breast tissue to reduce her much-higher risk of breast cancer. Chasing potential benefits is not a defense of parental proxy consent.

All male humans that are uncircumcised are at risk for health issues due to the lack of circumcision. If, or more likely When, they develop a UTI, physical ailment, cancer or other issue of the penis and/or urinary tract (others listed in a previous post) then they will have to suffer until they get circumcised or get your 'least invasive' treatment, get temporarily cured, then get another penis/urinary issue, suffer, get treated again and on, and on, and on....

I think Joe effectively refuted it with his comment, particularly the tooth example, so I'll second that and ask for proof. What you claim has no credibility in data. It is also a subjective statement. Is it possible that a male could prefer having his foreskin and dealing with - suffering, even - the consequences over the option of circumcision? Do you know that your judgement is better for another man than his own?

Also from Joe:

And though I don't want to get into UTI (I picked HPV) if you checked your references closely you would see that the demonstrated potential benefit has never been shown to exist beyond the first year of life.

This is true, and should not be ignored or extrapolated to older males. Your claim of lifelong woe from "lack of circumcision" needs to be proven, point-by-point. So far, I don't think you've approached that with the right data.

There were too many points to pull from the long list of risks NotStyro posted. I'll use that list to continue the series, which I will do soon. I think some structure would be good and we're roughly at a transition point because the ethical issue will persist. We can come back to it.

Or we can continue here.

Tony - It's your show. :)

Hey-ho, I'm back (momentarily).

Robert, apologies for seemingly ignoring your requests for scientifically credible evidence. A post I made on March 4, 2009 @ 05:53 PM should contain the citations for which you have been patiently waiting.

Enith, been a while, how have you been? Good, I hope. Did it take you long to find me? I know, 'hiding' in plain sight is an easily overlooked tactic.

As for your questions...the one on HIV has been answered somewhere previously. I believe we have also addressed FGM and the fact that it is not in any manner related to male circumcision. I would recommend that you to treat your daughters UTI's in the same manner that you have treated your own UTI's (and/or take them to a doctor).

Tony, et al., I look forward to reading & discussing this further when I can get a chance.

"Robert, apologies for seemingly ignoring your requests for scientifically credible evidence. A post I made on March 4, 2009 @ 05:53 PM should contain the citations for which you have been patiently waiting."

It takes more than citing a bunch of questionable studies to provide scientifically credible evidence...

Apparently you do not understand the difference between scientifically credible evidence and questionable evidence.

The two most basic and critical requirements for scientific credibility are:

That the conclusion NOT be based on studies with known flaws..
&
The prediction inherent in a hypothesis be fulfilled every time.

Now all you need to do is show me a single benefit that meets these critical and basic two requirements.

When can we expect them from you? How much longer must I patiently wait?

"As for your questions...the one on HIV has been answered somewhere previously. I believe we have also addressed FGM and the fact that it is not in any manner related to male circumcision. I would recommend that you to treat your daughters UTI's in the same manner that you have treated your own UTI's (and/or take them to a doctor).

Now that you have been given the requirements for scientific credibility, are you ready to admit that the HIV/circumcision hypothesis is not scientifically credible?

You have not logically addressed FGM, you have merely danced around the subject--neither logically nor rationally ANSWERED.

reminder: CHE vs. foreskin amputation.

Female UTI's-antibiotics: male UTI's-amputation?????

Robert,
So, with a minor change of your mind you denounce all the scientifically valid research posted?! Sorry, but with that type of reaction you are moving from reasonable to trollish very quickly.

As for the HIV discussion, maybe this will remind you:
“As you all should be aware, if you have done any research, that the WHO/UNAIDS and other international health organizations acknowledge that circumcision does not provide complete protection against HIV infection”

“Female UTI's-antibiotics: male UTI's-amputation”
Well, I prefer the more correct terminology – 'circumcision' or 'prophylactic surgery'.

"So, with a minor change of your mind you denounce all the scientifically valid research posted?! Sorry, but with that type of reaction you are moving from reasonable to trollish very quickly."

So, the basic requirements for scientific credibility are a minor change of MY mind? How exactly does this work?

"As for the HIV discussion, maybe this will remind you:
“As you all should be aware, if you have done any research, that the WHO/UNAIDS and other international health organizations acknowledge that circumcision does not provide complete protection against HIV infection”

So, again with the unsupported OPINIONS?
What difference does it make what the OPINION if neither version can be scientifically supported?

Back to the tired, old "appeal to authority" nonsense.. seems you believe no one is able to critically analyze the evidence, and therefore must rely on the OPINIONS of others? Maybe YOU must, but frankly I would rather use the logical and rational abilities I was born with.

“Female UTI's-antibiotics: male UTI's-amputation”
Well, I prefer the more correct terminology – 'circumcision' or 'prophylactic surgery'."

PREFER all you want, but trying to re-define terms with more-pleasant euphemisms only means you have nothing else to offer--UNLESS and until you can scientifically support your redefinition of the terms.

So CAN you scientifically support that this IS a prophylactic measure and that the foreskin is NOT amputated?

Notstyro, do you believe the foreskin has a function or do you think it is a useless flap of skin?

Robert,
Ok, I may have not been entirely clear on your denouncement of scientifically valid research. What I meant was that neither you, nor I, nor Tony, nor anyone else currently seen in this discussion are likely in form or factor to judge whether the research that has been provided is scientifically valid or opinion unless the citation does not have and/or does not cite research to support the finding(s). Naturally our opinions don't really have any small or great impact on the researchers, scientists and/or their findings.

Our discussions here, as they have been since the beginning, are just our opinions. I'm not try to convince the anti-circers here, and you all are not convincing me, to change opinions.

Here is the quote regarding HIV, circumcision & condoms:
“Male circumcision should never replace other known methods of HIV prevention and should
always be considered as part of a comprehensive HIV prevention package, which includes:
promoting delay in the onset of sexual relations, abstinence from penetrative sex and reduction
in the number of sexual partners; providing and promoting correct and consistent use
of male and female condoms; providing HIV testing and counseling services; and providing
services for the treatment of sexually transmitted infections.”

Citation: http://www.malecircumcision.org/advocacy/documents/WHO_UNAIDS_New_Data_MC_recommendations_03_06_07_layout.pdf


Regarding amputation, then as long as you meant to write 'Female UTI's-antibiotics: male UTI's-foreskin amputation' then you would be technically correct. But that is not what you wrote.

James,
At one time the foreskin may have played some role in protecting the penis from environmental threats, but in the modern world it is largely useless (if not a hindrance to health). Millions of circumcised men enjoy sexual pleasure and reproduce without any problems and without a foreskin. Whatever cells, nerves, or other tissue comprise the foreskin are apparently not necessary for the function of the penis.

"What I meant was that neither you, nor I, nor Tony, nor anyone else currently seen in this discussion are likely in form or factor to judge whether the research that has been provided is scientifically valid"

Yadda, yadda, yadda--one can most certainly determine what is NOT scientifically credible--merely check to see if they meet the basic and critical requirements for scientific validity--we no opinions, ot cites..only the hypothesis it self and a critical analysis.

Sooy, but we are discussing the validity of the HIV/circumcision hypothesis--NOT wheteher ot not a speciafic OPINION has any valididty..

The critical questions are..

Are the studies and the data used to bolster the hypothesis free of KNOWN flaws.

Does circumcision reduce the incidence of HIV in every instance?

If not, then it is not scientifically valid.

"Regarding amputation, then as long as you meant to write 'Female UTI's-antibiotics: male UTI's-foreskin amputation' then you would be technically correct. But that is not what you wrote.

So, back to the last resort --word games? Is something amputated from males or not! Simple question.

"At one time the foreskin may have played some role in protecting the penis from environmental threats, but in the modern world it is largely useless (if not a hindrance to health). Millions of circumcised men enjoy sexual pleasure and reproduce without any problems and without a foreskin. Whatever cells, nerves, or other tissue comprise the foreskin are apparently not necessary for the function of the penis.

Thanks for this worthless opinion.. too bad you are sadly mistaken--they ARE necessary for optimum function! Limiting the functions to what you choose to include is the crassest and most self-serving form of cherry picking.

"(if not a hindrance to health)".

Gratuitous BS!

[Ed. note: This comment was held in the moderation queue by accident until noon on 3/8. That should be factored into comments that came after it.]


Robert,
Three HIV & circumcision studies conducted in Africa have proven that men having been circumcised have a reduced rate HIV transmission among heterosexual partners. HIV transmission was cut by 60%, 53% & 51% respectively. Links to abstracts follow:

http://www.ncbi.nlm.nih.gov/pubmed/16822094

http://www.ncbi.nlm.nih.gov/pubmed/17321310

http://www.ncbi.nlm.nih.gov/pubmed/17321311

All three studies have been reviewed and accepted by a panel of experts convened by WHO, and together with UNAIDS wrote the previously quoted text regarding HIV & circumcision. Further research is currently being taken to determine & clarify social & cultural conditions.

“too bad you are sadly mistaken--they ARE necessary for optimum function!”
Millions of men worldwide would contest your ridiculous opinion that they have less than an optimally functional penis.

“Gratuitous BS!” and your opinions are pearls of wisdom that are expelled from your anus.

Robert Samson Said:

It takes more than citing a bunch of questionable studies to provide scientifically credible evidence...

Apparently you do not understand the difference between scientifically credible evidence and questionable evidence.

The two most basic and critical requirements for scientific credibility are:

That the conclusion NOT be based on studies with known flaws..&
The prediction inherent in a hypothesis be fulfilled every time.

Now all you need to do is show me a single benefit that meets these critical and basic two requirements.

Actually, it's partly this but there is really much more that NotStyro is missing from his evaluation. First off, yes the science must be correct and part of being correct is meeting the criteria that you outline. Part of this is being able to take what you observe in a controlled experiment and seeing it in the real world. But (and this is the part that NotStyro is blinded to) the ethics must be sound when applying those finding because good medicine demands good ethics. This means that in the case of circumcision (actually in the case of any medical intervention) we can offer any given procedure but should encourage the least invasive, most effective treatments. This is especially true in proxy consent situations and circumcision doesn't even come close to being an ethical choice in most cases.

This is why it's simply not enough to just post some list of studies. First you have to read and understand the studies and the countervailing evidence. Then if you believe that the science is accurate you have to determine if it is ethical medicine. For example, say we believe that circumcision does in fact reduce incidence of HPV, is that of any practical value and is it ethical to use circumcision in that way? The answer is clearly no because:

1. HPV cancers are very rare in the population, it would take several hundred, proabably thousands of circumcisions to prevent one case of HPV related cancer.
2. We have much better ways of reducing that already low risk.
3. One could easily choose that for themselves when they were older if they felt the evidence was compelling.

All other purported benefits fail the ethical test similarly, even if we were to say that for each one the science was sound. For some it might be but it doesn't really matter. The interesting thing is that circumcision seems to enjoy a cloak of immunity from ethical examination probably because of it's religious roots. I have little doubt that were it not for it's religious roots, circumcision, performed without demonstrated medical need, would have been outlawed long ago for anyone under 18.

NotStyro Said:


At one time the foreskin may have played some role in protecting the penis from environmental threats, but in the modern world it is largely useless (if not a hindrance to health).

This is not really true. It was protective then it is protective now.

NotStyro Said:


Millions of circumcised men enjoy sexual pleasure and reproduce without any problems and without a foreskin. Whatever cells, nerves, or other tissue comprise the foreskin are apparently not necessary for the function of the penis.

Whether or not this is true is largely irrelevant to the question at hand.

"All other purported benefits fail the ethical test similarly, even if we were to say that for each one the science was sound. For some it might be but it doesn't really matter. The interesting thing is that circumcision seems to enjoy a cloak of immunity from ethical examination probably because of it's religious roots. I have little doubt that were it not for it's religious roots, circumcision, performed without demonstrated medical need, would have been outlawed long ago for anyone under 18."

AMEN!! circumcision seems to be immune to every ethical and medical standard needed for any other intervention.

“circumcision seems to be immune to every ethical and medical standard needed for any other intervention.”

Interesting opinion there Robert & Joe. Do either of you have any proof, or are you two just venting frustrations because male infant circumcision hasn't been found to cause any damage and has been found to be beneficial?

"Interesting opinion there Robert & Joe. Do either of you have any proof, or are you two just venting frustrations because male infant circumcision hasn't been found to cause any damage and has been found to be beneficial?"

Do YOU have any proof that circumcision causes NO damage? I mean, are you serious? The risks are well documented, but you're just choosing to ignore them, instead focusing on WAY overstated "benefits"?

If circumcision really had no risks/no damage and was purely beneficial, then all the major health organisations in the world would be recommending it. Guess what? They don't.

I agree with Joe. A while ago, there was a petition sent to the British Prime Minister asking for male circumcision to be outlawed. The reason given for turning it down was because of fear of offending religious groups.

Sorry for my delayed response. I was tied up job stuff yesterday. That makes this comment long.

--------

NotStyro,

I believe we have also addressed FGM ...

We have.

... and the fact that it is not in any manner related to male circumcision.

We have not reached this conclusion. The evidence so far is overwhelmingly that they are the same violation. They are both medically unnecessary genital surgery on a healthy, non-consenting individual. A difference in degree is not a difference in kind.

This is a bit like the question of intent. When looking at a crime, there is the act and the intent. They are separate in the analysis. American parents do not believe they harm their sons when they circumcise them. That does not negate the physical harm caused. When we get to criminalizing medically unnecessary genital surgery on minors for both genders, the punishment will factor the intent. But there would be legally proscribed punishment for the initial violation, regardless of intent.

Robert gets it correct with this:

Female UTI's-antibiotics: male UTI's-amputation?????

That is an insane approach, unless there is proof that antibiotics do not work in male children.

Well, I prefer the more correct terminology – 'circumcision' or 'prophylactic surgery'.

This is semantics because I think your later explanation to Robert - foreskin amputation - was clearly implied in Robert's statement. No one here believes that "amputation" from circumcision means penile amputation. (Except when it does, which occurs.)

But if we play along, the disparate, gender-unique responses to the threat of UTIs is still indefensible. The risk for females in the first year of life is several times higher than it is for intact males. Softening the words doesn't change the dismissal of logic needed to excuse prophylactic surgery for males. Again, the removal of breast tissue from infants would be justified if we follow that strain of unthinking.

Whatever cells, nerves, or other tissue comprise the foreskin are apparently not necessary for the function of the penis.

Not necessary is not a synonym for functionless. I assume that mixing the two ideas is common, but it is incorrect.

Joe said: This is why it's simply not enough to just post some list of studies. First you have to read and understand the studies and the countervailing evidence. Then if you believe that the science is accurate you have to determine if it is ethical medicine.

Apart from the obvious point that seeing the sexual results of circumcision requires sexually-active participants, the reality that all of the HIV-circumcision studies involved adult volunteers is critical to understanding the ethics.

Public health organizations are blind to the ethical flaw of imposed male genital cutting, so they always forget voluntary, adult. But assume scientists proposed a study to look at voluntary, adult female genital cutting to reduce the risk of infection. (Let's ignore the Stallings study for this, because we could discuss UTI.) Would that be approved for funding?

I think it would not. Why, since the study is just the pursuit of science among willing participants. More information is good, right? I think it is, but then I'm aware that minors need their individual liberty protected more diligently than adults. Still, I think the ethics review committee would fear the eventual implementation of those findings if they show that voluntary, adult female genital cutting reduced the risk of infection. They would see the distinct ethical issue involved and overreact scientifically to protect female minors.

If they approved such a study, there would be the explicit caveat that the findings will not be used to violate medical ethics and cut female minors. We have a framework for achieving those benefits with lesser interventions. The ethical difference between adult volunteers and non-consenting minors is obvious and embedded in our legal code for females. The ethics don't change because of gender.

Our discussions here, as they have been since the beginning, are just our opinions. I'm not try to convince the anti-circers here, and you all are not convincing me, to change opinions.

For me this is a large chunk of the debate. I'm not trying to change anyone's opinion on circumcision. Frankly, I don't care what people think. But I am trying to change opinions (and laws) about what people may do to another person.

You like being circumcised. I'm happy for you. Your opinion is valid - for you. I'm not suggesting that you should feel harmed or that you should base your opinion on my subjective criteria instead of your subjective criteria.

However, your opinion would not be valid for your children, just as my parents' opinion was not valid for me. I do not like being circumcised. I do not claim that my life would be better because I do not know. But I know that my choice about my body was eliminated. I was healthy at the time I was circumcised. All else was speculation. Speculative opinion is not a valid argument for authorizing surgery on a healthy, non-consenting person.

All discussions, here and beyond, are identified incorrectly when they are labelled pro-circumcision and anti-circumcision. To borrow unrelated phrasing, this is pro-individual choice and anti-individual choice. The pro- and anti- roles are reversed when assessing the debate correctly. That's why this always comes back to ethics. If the child is healthy, intervention is not indicated. It is unethical.

Do either of you have any proof...

I think Robert, Joe, and I (and others) have explained the ethical case with reasoned points. As I said in a previous comment, the burden of proof is on you as the advocate for an intervention you admit is medically unnecessary. You attempted to address that early in this thread when defending proxy consent for medically necessary and medically unnecessary "best interests" decisions, so I'm not suggesting that you've avoided the issue. We are saying that your defense has obvious flaws.

NotStyro Said:


Interesting opinion there Robert & Joe. Do either of you have any proof, or are you two just venting frustrations because male infant circumcision hasn't been found to cause any damage and has been found to be beneficial?

Sure. Proof can be seen each time doctors or politicians discuss restrictions or bans on the procedure. Each time it happens, and it happens every few years, religious groups strongly protest the actions. Even when those actions are to try and improve the safety. When that happens, politicians tend to back down.

And circumcision most definitely causes damage in every case. There is cutting, there is bleeding, there is a wound that must heal, scar tissue forms. Scar tissue is by definition damage. It's only a question of how much damage and how many get more damage than expected.

Actually, most medical procedures do cause damage and wounding but those wounding are justified by the therapeutic aim of the procedure. This therapeutic aim is an essential justification under conditions of proxy consent, consent for those unable to consent to the wounding for themselves. Just so there is no mistake NotStyro, the burden of proof of justification is on the person who causes (or wishes to cause) the wounding, that would be you. Consequently, a physician (or parent) would need to show that infant male circumcision was medically necessary before it would be justified. If there is equal doubt as to whether or not it is medically necessary (which is by far the most favorable position that, at present, could be taken in favor of infant male circumcision), then the procedure must not be carried out. In other words, in situations of equal doubt, the person with the burden of proof (the physician or the parent) cannot proceed.

"Interesting opinion there Robert & Joe. Do either of you have any proof, or are you two just venting frustrations because male infant circumcision hasn't been found to cause any damage and has been found to be beneficial?"

Denial and unsupported repetition seems to be your last refuge. Damage has been proven--it is just, as is your want, you choose to ignore it.

And you have YET to support this assertion of any PROVEN benefits.

Claire, I think you have posited an obvious t
truth and tactic so often used by Notstyro--

"Do YOU have any proof that circumcision causes NO damage? I mean, are you serious? The risks are well documented, but you're just choosing to ignore them, instead focusing on WAY overstated "benefits"?

This is the structure of social ritual discussed by Prof Catherine Bell in "Ritual Theory, Ritual Practice."
Denial, Deferral, Deflection and Deceit.

Sound familiar? Where have we seen examples of this?

Robert,

“Denial, Deferral, Deflection and Deceit. Sound familiar? Where have we seen examples of this?"
Your postings. Denial of benefits, denial of lack of damages, etc...

Three HIV & circumcision studies conducted in Africa have proven that men having been circumcised have a reduced rate HIV transmission among heterosexual partners. HIV transmission was cut by 60%, 53% & 51% respectively. Links to abstracts follow:

http://www.ncbi.nlm.nih.gov/pubmed/16822094

http://www.ncbi.nlm.nih.gov/pubmed/17321310

http://www.ncbi.nlm.nih.gov/pubmed/17321311

All three studies have been reviewed and accepted by a panel of experts convened by WHO, and together with UNAIDS wrote the previously quoted text regarding HIV & circumcision. Further research is currently being taken to determine & clarify social & cultural conditions.

“too bad you are sadly mistaken--they [foreskins] ARE necessary for optimum function!”
Millions of men worldwide would contest your ridiculous opinion that they have less than an optimally functional penis.

Tony,
Why are some posts getting caught in an 'awaiting moderator approval' cycle.

What word/phrases are being censored/held? The last post had nothing objectionable considering the topic.

Catching up now. No words or phrases are targeted. Any comment with multiple links (3, I think) will get caught in the queue. It's a holdover from the pre-"orange" catchphrase days. I haven't tinkered with the code because I'm switching platforms soon. (Or "soon".)

Two posts from NotStyro were stuck. I missed the first one from yesterday morning (12:19am). My apologies for that.

NotStyro,

Millions of men worldwide would contest your ridiculous opinion that they have less than an optimally functional penis.

The point for me is not about optimal, which is largely a subjective definition here. The point is normal versus altered. Again, you think altered is good. I don't.

Of course, I don't know that being circumcised is worse. But you don't know that being circumcised is better if you were circumcised as an infant, as I assume you were. Both of us evaluate our situation based on incomplete knowledge. That's why I find the ethical debate about circumcision the most compelling. It is the most obvious, most objective standard. It's based in our understanding of natural rights as we believe them to exist independent from and protected by our legal system.

I doubt we can ever reach perfection in our understanding and protection. But I can't sit by while an obvious oversight exists. My experience fuels my determination, but I won't turn a blind eye to any injustice. When I began, I focused exclusively on male circumcision. I still focus on that because others take care of the other angles. But male circumcision (i.e. MGM when medically unnecessary), FGM, and intersex children are part of the same principle. It's the principle that matters, not the foreskin.

That said, I think we should shift the debate to specifics. I'll put up a new post in the next day or so. I'll use the list you used above as a guide.

Let me add why I think continuing is useful. My goal is not to demonize you, as I hope your goal is not to demonize me. Our opinions do not make us evil. I've seen a few of your recent tweets that I think are very responsible, like pointing out qualifications. That's helpful, in my view. But referring to anti-circ groups as "mad buggers" is anecdotal generalization that appears designed as a smear to dismiss rather than challenge a viewpoint.

I don't think it's my job to change your behavior, or that I can. But I'm engaging you to demonstrate not only my view that you're missing an important part of the debate, but also that "mad bugger" is an anecdotal oversimplification. Reasoned, calm opposition exists.

I know this is a significant time commitment. I don't expect to occupy everyone's time. But I would like to continue with the specific issues rather than general topics. I don't mind delays between responses, for example.

"Millions of men worldwide would contest your ridiculous opinion that they have less than an optimally functional penis."

Sorry, but it is hardly a "ridiculous opinion"--it is concrete scientific fact--even if YOU and THEY choose to ignore it..

They are missing thousands of penile nerves (the majority)..and 3/4 of their sensitivity and sensation..
Proof of this has been posted many times before, and, as yet, unrefuted.

"Three HIV & circumcision studies conducted in Africa have proven that men having been circumcised have a reduced rate HIV transmission among heterosexual partners. HIV transmission was cut by 60%, 53% & 51% respectively. Links to abstracts follow:"

So, still confused about what qualifies and scientifically valid evidence?

Do these studies meed the necessary criteria for scientific validity? NO they don't!

Scientific proof requires a lot more than a bunch of questionable statistical studies..remember the two basic tenets?

"All three studies have been reviewed and accepted by a panel of experts convened by WHO, and together with UNAIDS wrote the previously quoted text regarding HIV & circumcision. Further research is currently being taken to determine & clarify social & cultural conditions."

Sorry, but their OPINION does not confer scientific credibility.

You might wish to try thinking for yourself, and not simply deferring to authority.

Try again.

"“Denial, Deferral, Deflection and Deceit. Sound familiar? Where have we seen examples of this?"
Your postings. Denial of benefits, denial of lack of damages, etc..."

Cute, but no cigar for you.

Notstyro, why have you NOT addressed these posst--you have more than ample time to do so?

Robert Samson February 27, 2009 10:39 AM

&

Posted by: Mark Lyndon | February 27, 2009 05:45 AM

&

Robert Samson | February 27, 2009 09:04 AM

"As for your questions...the one on HIV has been answered somewhere previously. I believe we have also addressed FGM and the fact that it is not in any manner related to male circumcision. I would recommend that you to treat your daughters UTI's in the same manner that you have treated your own UTI's (and/or take them to a doctor)."

nice try NotStyro, but you know that you are wrong. Actually there are more parts in the female genitalia that if we cut the whole thing off we can prevent these infections. Trust me I HAVE A VAGINA! Yet we are not cutting these off, at least not in the US.

I really wish you could do the STD test for me, but you will never respond. You will NEVER offer yourself as guinea pig because YOU KNOW that your circumcised penis is NOT protected.

Peace!

When I was 18 I contracted an STD from a circumcised male. Thankfully it was a treatable one. All it took was one lapse in judgement and I was infected.

US has the highest rate of STD transmission of any country. It has been speculated that almost 1 in 3 people in the US have an STD. The man that infected me was my 3rd sexual partner.

The circ rate among sexually active men in the US is still around 85%.

The problem with STDs is that they are rarely symptomatic in men. When a man shows no symptom he doesn't get tested. Also, a man should not urinate for many hours before the test. This is b/c the urine will wash away the bacteria making it impossible to get a good culture. Many men don't know this and get tested after having urinated. The most reliable testing is done in the morning before a man has urinated.

So the percent of men that get tested is already low b/c they don't often show symptoms so they don't get tested. The percent of reliable testing is even lower b/c many men don't get tested correctly.

I dare say that if a foreskin increases the chances that a man will show the symptoms of STD then it would be much better for everyone b/c they would get themselves tested and treated. This would protect more men and women than any amount of circumcision. Just food for thought...

"I dare say that if a foreskin increases the chances that a man will show the symptoms of STD then it would be much better for everyone b/c they would get themselves tested and treated. This would protect more men and women than any amount of circumcision. Just food for thought... "

In the case of yeast infections, this certainly is true..

There is no significant difference between carriage rate in circumcised and uncircumcised male although the chance of symptomatic infection is higher in the uncircumcised men.

Circed men are just as likely to have a yeast infection as intact men, they just don't know it, whereas an intact man's yeast infection might show itself on his very sensitive glans. What this says to me is that women are more likely to receive a yeast infection from a circed man since he probably would have no idea that he has it and probably would not seek any treatment.

Tony,
I'm not sure that the ethical arguments about male infant circumcision are compelling, but they can be interesting if you are into those types of studies.

I understand your point of view regarding the rights of the individual and personal self determination. There is no doubt that these rights are held and enforceable throughout most societies. But these rights are not thrust upon an individual at birth, they are gradually introduced as the individual grows and gains knowledge and experience.

As you know, infants are totally dependent for others, usually parents, for life. All decisions and care must be given by the parents based upon their knowledge, experience and beliefs. If the parents believe, based on knowledge, experience or culture, that a certain item or event will be in the best interest of the infant, then the parents may pursue that item or event. This is an entitlement, or right, of the parents – to decide what is in the best interest of their child. This entitlement is usually only surrendered when the laws of the society decide that the child should be sufficiently developed enough to make most or all decisions for itself.

I don't know of too many people that would argue against the principles of those precepts. Sure, minor quibbles about semantics, verbiage and such, but nothing to drastically change the core meaning.

While I initially took some interest in this discussion due to your different take on the subject, as you don't generally post thoughtlessly and respond with inane opinions that have no backing, the arrival of some others that do not exhibit your traits have considerably dampened this interest. That being written, I am still looking forward to your next post.

Notstyro..

Again you return to saying that a mere belief of it being in the best interests of the child is enough to justify deliberately harming infants. This is a really a childish and self-serving view of ethics.

Every person should have the right to be protected from unnecessary harm regardless of age...and protected from harmful results of harmful beliefs of their parents being inflicted upon them.

NotStyro,

But these rights are not thrust upon an individual at birth, they are gradually introduced as the individual grows and gains knowledge and experience.

The right to vote is such a right. The right to be free from harm is not such a right. Otherwise, parents could murder their children without recourse. I know you're not claiming that parents may murder their children, but you haven't made any allowance for societal prohibitions. That's where medically unnecessary genital cutting rests. Society's lag doesn't invalidate the claim.

All decisions and care must be given by the parents based upon their knowledge, experience and beliefs. If the parents believe, based on knowledge, experience or culture, ...

That doesn't make them correct. A well-intentioned decision made with an ignorant lack of knowledge is an ignorant decision. If we're using parental intent rather than child need, that also excuses anything and everything a parent wants to do, as long as they state that they believe it's in the child's best interest. Again, removing a female minor's breast tissue could meet such a criterion.

As I mentioned early on, based on the argument you're making, we could decide that slavery was ethical as long as 50% + 1 of the population favored it. That's obviously wrong. Action is separate from intent.

What delineates acceptable and unacceptable decisions?

The tragedy of Notstyro's attempt to ethically justify unnecessary circumcision is that his argument is based on a feeble attempt to conflate "what is ALLOWED" with "what is ethical". They are not and cannot be conflated. they are separate and disparate points.

An empty and frankly an ethically bankrupt argument.

Tony,
Yes, the 'free from harm' universal 'right' – the only problem with using it in the context of this discussion is that male infant circumcision does not cause harm to the person to whom is it being performed upon. Those parents that decide to have their child circumcised for medical and/or hygiene purposes most likely view circumcision as beneficial to the health of their child. Some of the doctors that are performing circumcision may see the procedure as unnecessary, but that there are, or may be, benefits and therefore clearly being allowed by their Hippocratic Oath (and some doctors don't take the oath).

As for accounting for societal prohibitions, the US societies and cultures herein are fairly flexible, lenient and sometimes forgiving. We have quite a potpourri, or melting-pot, of peoples from societies that span the globe. Peoples that cannot stop fighting amongst themselves in other countries can come here and live as far, or near, as they wish and usually never will their relationship come to blows.

Taking these societal prohibitions into the context of male infant circumcision and you will still find people being largely flexible and lenient. Sure, there are some loud/strong extremists around – usually on the internet writing their opinion criticizing parents for 'mutilating' their son and/or posting other emotionally-laden pleas for parents, or parents-to-be, to not circumcise based on some flimsy and incorrect argument. But people and parents are generally smarter than taken and will do research and consider things before making a decision. All that is also taken that society largely believes that male infant circumcision is a parental, and usually private, decision.

So, do you believe that US society is lagging in comparison with others? Our three closest societies – Canada, UK and Australia all had societies that had no/little problem with male infant circumcision until their socialized medicine decided to stop coverage due to governmental financial difficulties. The people being largely unaccustomed to paying for their own medical care also decided that circumcision was an option they couldn't afford and within a few generations most public opinion changed. But even if the public largely isn't deciding to circumcise their boys, they also aren't anti-circumcision – parents that want it for their sons can find doctors that will operate, as well as mohels and possibly other traditional practitioners.

Ideally, parents that know they are expecting a boy should do some research into circumcision before making a decision. But, from what I have read/heard, most hospitals will provide some unbiased information regarding circumcision along with the consent form. Parents are also free to ask nursing staff and doctors about circumcision and should also receive unbiased information.

My opinion is that some parents will do research on the subject and make a decision based on that information, other parents maybe make a decision based on the state of the father and his opinion on his condition, single mothers may make a decision based on some sort of consensus regarding past lovers and/or input from family members. But all in all, parents will make a decision for their child regarding circumcision based upon their knowledge, experience, beliefs and/or culture, and the child will likely live with that state until medical intervention is required and/or death.

Lastly, “What delineates acceptable and unacceptable decisions?” society and law. When society finds something offensive, repugnant and/or abusive enough then enough people will try to coerce/demand lawmakers into changing the law to make it illegal. Other times lawmakers will take their own initiative to make things illegal that society should find offensive (whether anybody does or not).

"Yes, the 'free from harm' universal 'right' – the only problem with using it in the context of this discussion is that male infant circumcision does not cause harm to the person to whom is it being performed upon."

So you are STILL trying to ethically justify circumcision by maintaining your fantasy of no harm done--LOSS is harm!

"Those parents that decide to have their child circumcised for medical and/or hygiene purposes most likely view circumcision as beneficial to the health of their child."

A mistaken belief does not justify harming others, male or female, so unless there is PROOF of any benefit, this is a specious and facile argument--try again with something other than empty repetition.

"Some of the doctors that are performing circumcision may see the procedure as unnecessary, but that there are, or may be, benefits and therefore clearly being allowed by their Hippocratic Oath (and some doctors don't take the oath)."

BELIEF does not reality make--PERIOD! Unnecessary harm is unnecessary harm!

Your arguments are nothing but empty repetition ...maintained by a fantasy.

"Lastly, “What delineates acceptable and unacceptable decisions?” society and law. When society finds something offensive, repugnant and/or abusive enough then enough people will try to coerce/demand lawmakers into changing the law to make it illegal. Other times lawmakers will take their own initiative to make things illegal that society should find offensive (whether anybody does or not)."

The tragedy of Notstyro's attempt to ethically justify unnecessary circumcision is that his argument is based on a feeble attempt to conflate "what is ALLOWED" with "what is ethical". They are not and cannot be conflated. they are separate and disparate points.

NotStyro Said:

Tony,
Yes, the 'free from harm' universal 'right' – the only problem with using it in the context of this discussion is that male infant circumcision does not cause harm to the person to whom is it being performed upon.

You see thought that is not true. All circumcision causes harm it's just a question of how much. There is an expected amount of damage that will result many could get more and some are severely maimed. When the procedure is not necessary for the health of a child, how many complications (severe or otherwise) or deaths do you think are acceptable? Just throw out a number, one, two, one-hundred. Or perhaps you find percentages easier. Like, for a non-therapeutic intervention complications and death of less than X% are acceptable.

NotStyro Said:

Those parents that decide to have their child circumcised for medical and/or hygiene purposes most likely view circumcision as beneficial to the health of their child.

Belief is not enough. Though I can understand why parents might think that way. There are years of BS to untangle. That is why education is necessary.

NotStyro Said:

Some of the doctors that are performing circumcision may see the procedure as unnecessary, but that there are, or may be, benefits and therefore clearly being allowed by their Hippocratic Oath (and some doctors don't take the oath).

No, this is not the case. As I said in a previous post it is incumbent on those proposing the intervention to demonstrate that it is necessary to the health of the child and the proposed intervention represents the least invasive intervention. This is an essential in proxy consent situations. You would think this would be common sense but just in case their members forget it, medical societies have made declarations along these lines:

The AAP Committee on Bioethics report states:

"Pediatric health care providers. . . have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. . . . The pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent."

(American Academy of Pediatrics Committee on Bioethics. “Informed Consent, Parental Permission, and Assent in Pediatric Practice.” Pediatrics 95 (1995): 314).

Where as the British Medical Association states (on circumcision specifically):

"Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate."

The bar for proxy consent has clearly been set by the various medical organizations. So it's really a case of judging them by their own standards. Clearly, by their own admissions it is unethical. Which begs the questions, why do they permit their members to continue?

NotStyro Said:

As for accounting for societal prohibitions, the US societies and cultures herein are fairly flexible, lenient and sometimes forgiving.
...
Taking these societal prohibitions into the context of male infant circumcision and you will still find people being largely flexible and lenient.

Based on your framework, I could justify any behavior I wanted so long as I could get enough people to agree it was just fine. Does that mean you would have supported slavery? Do you also support the oppression of women in other countries because their society says it's ok? It seems to me unless you say 'yes' you're a hypocrite.

NotStyro Said:

Sure, there are some loud/strong extremists around – usually on the internet writing their opinion criticizing parents for 'mutilating' their son and/or posting other emotionally-laden pleas for parents, or parents-to-be, to not circumcise based on some flimsy and incorrect argument. But people and parents are generally smarter than taken and will do research and consider things before making a decision. All that is also taken that society largely believes that male infant circumcision is a parental, and usually private, decision.

Perhaps some are more passionate than others but they're on the right side of ethics and morality. So far you haven't provided any objective reason that circumcision should be permitted (excluding clear medical indication) either from an ethical perspective or a clinical one.

NotStyro Said:

So, do you believe that US society is lagging in comparison with others?

Yes, we are lagging far behind.

NotStyro Said:

Our three closest societies – Canada, UK and Australia all had societies that had no/little problem with male infant circumcision until their socialized medicine decided to stop coverage due to governmental financial difficulties. The people being largely unaccustomed to paying for their own medical care also decided that circumcision was an option they couldn't afford and within a few generations most public opinion changed. But even if the public largely isn't deciding to circumcise their boys, they also aren't anti-circumcision – parents that want it for their sons can find doctors that will operate, as well as mohels and possibly other traditional practitioners.

This is not at all true. It is true that circumcision ended in Britain in the late forties and it could be tied with the introduction of NHS. However, it was never as wide spread anyway and the reason it was not covered was because it had no value. Both the Canadian and Australian national health systems covered circumcision well past the points where their medical societies dismissed the procedure as pointless. This occurred in the late 70s and the procedure had continued to be covered in most of Canada through the mid 90s and in some parts of Australia until about two years ago. The rates had come down on their own as doctors increasingly discouraged the procedure and parents came to realize that it was essentially a lemon. Also, most of the Europeans I've spoken to on the subject are often stunned past the point of rational thought when they hear how common circumcision is in the US. The only reason it isn't illegal in those countries that don't routinely do it is because of its religious connection. Somehow religion makes any action OK.

NotStyro Said:

Ideally, parents that know they are expecting a boy should do some research into circumcision before making a decision. But, from what I have read/heard, most hospitals will provide some unbiased information regarding circumcision along with the consent form. Parents are also free to ask nursing staff and doctors about circumcision and should also receive unbiased information.

Most staff at a hospital aren't permitted to discuss this issue with the patient. At least that's what the nurses I know have told me. It's a discussion that is usually had with the Pedi or OB but the information they provided isn't usually reliable. If you have an older Dr or one of certain ethnic backgrounds, you won't get the straight dope.

NotStyro Said:

Lastly, “What delineates acceptable and unacceptable decisions?” society and law. When society finds something offensive, repugnant and/or abusive enough then enough people will try to coerce/demand lawmakers into changing the law to make it illegal. Other times lawmakers will take their own initiative to make things illegal that society should find offensive (whether anybody does or not).

Again, when slavery was legal, you would have supported it?

NotStyro,

I wrote this before reading responses from Robert and Joe. They cover much the same ground.

Yes, the 'free from harm' universal 'right' – the only problem with using it in the context of this discussion is that male infant circumcision does not cause harm to the person to whom is it being performed upon. Those parents that decide to have their child circumcised for medical and/or hygiene purposes most likely view circumcision as beneficial to the health of their child.

The mocking quotes you use are indefensible. You have yet to provide a consistent basis for parental intervention in the normal, healthy bodies of their children. I've offered repeated examples. The best you can do is to suggest that circumcision is not harm because parents have good intentions?

I'm using a literal definition of harm. The child is healthy. Removing part of his body removes healthy tissue and nerve endings, leaves a scar and imposes an unavoidable degree of risk. That is objective harm.

Objective harm can be overcome in order to permit parental proxy. However, we require an objective benefit as the goal. The child is healthy. There is no objective benefit to be obtained. Surgery is unjustifiable. QED.

Taking these societal prohibitions into the context of male infant circumcision and you will still find people being largely flexible and lenient. Sure, there are some loud/strong extremists around – usually on the internet writing their opinion criticizing parents for 'mutilating' their son and/or posting other emotionally-laden pleas for parents, or parents-to-be, to not circumcise based on some flimsy and incorrect argument. But people and parents are generally smarter than taken and will do research and consider things before making a decision. All that is also taken that society largely believes that male infant circumcision is a parental, and usually private, decision.

First, I've offered no emotionally-laden pleas, nor have I offered an incorrect argument. My three previous paragraphs in this comment are all that's necessary. You can't overcome them. If you could, you'd have to defend every other intentionally absurd example offered in this thread. Removing an infant female's breast tissue would be acceptable under your hodge-podge of subjective reasoning. You have no ethical base to reject anything a parent wishes to do if you wish to continue arguing this line.

Second, parents are not generally smarter than taken and do not do research and consider things before making decisions. I've encountered parents who think that circumcising infant males is required by law. That's anecdotal, but we must deal with individuals, not society-wide statistics.

Generally, the argument boils down to a combo of the father is circumcised and the mother (and/or father) thinks intact penises are icky. The rest is tacked on to help the parents reconcile their irrational decision.

So, do you believe that US society is lagging in comparison with others? Our three closest societies – Canada, UK and Australia all had societies that had no/little problem with male infant circumcision until their socialized medicine decided to stop coverage due to governmental financial difficulties. The people being largely unaccustomed to paying for their own medical care also decided that circumcision was an option they couldn't afford and within a few generations most public opinion changed. But even if the public largely isn't deciding to circumcise their boys, they also aren't anti-circumcision – parents that want it for their sons can find doctors that will operate, as well as mohels and possibly other traditional practitioners.

Yes, we're lagging. You can find doctors to perform circumcision in those countries. Of course. As long as you have circumcised adults, you will have people willing to perform it and people willing to impose it. I won't theorize the reasons this is so, but I will point out that this is exactly why circumcision grabbed its hold once Americans started circumcising infants. It's also why public health officials now want to use HIV findings on adult volunteers to justify circumcising sexually-non-active infants.

I think it's fairly clear that circumcision is seen as barbaric among most Brits and a growing number of Canadians and Australians, particularly younger people. The British decision to stop funding infant circumcision is six decades in the past. That's ancient history to most people today. And from the non-Americans I speak to every year when I protest in front of the U.S. Capitol, the response is almost always complete shock that circumcision is as widespread as it is in America.

Also, I can pull posts from my archives where I state that I don't believe single-payer health care in America would end unnecessary infant circumcision. There's a cowardice to stand up to populist opinions among our politicians. This is doubly-true when the stand must be made against religious practices, even though the practice is carried out by one person against another person. That's true of all Anglo-Saxon countries.

Ideally, ...

Ideally, we wouldn't have ignorant, uninterested doctors and parents. We do.

... parents that know they are expecting a boy should do some research into circumcision before making a decision. But, from what I have read/heard, most hospitals will provide some unbiased information regarding circumcision along with the consent form. Parents are also free to ask nursing staff and doctors about circumcision and should also receive unbiased information.

When my brother and his wife filled out paperwork with her doctor in late 2007 before the birth of their first child, they stated "no" to circumcision before they knew they were having a girl. The nurse challenged them and gave them the hard-sell on circumcising.

The unbiased information on circumcision most people offer is equivalent to giving unbiased information on whether or not you should start smoking. Sure it could kill you, but think of how cool you'll look. The pro- and con- column are now even at 1 apiece. But only if you're willing to weigh objective and subjective criteria together. I am not, when it comes to decisions made by one individual for another.

Put another way, do you think I'm going to get adequate, correct information against circumcision if my doctor is someone like Edgar Schoen?

... But all in all, parents will make a decision for their child regarding circumcision based upon their knowledge, experience, beliefs and/or culture, and the child will likely live with that state until medical intervention is required and/or death.

What other surgeries should we permit parents to authorize for their children based on their knowledge, experience, beliefs, and/or culture? Not one of those criteria is objective. My family has a history of high-blood pressure. Should my brother start sharing his medicine with his daughter based on his experience? Or is that ridiculous because she's objective healthy, lacking any current need for those pills?

Lastly, “What delineates acceptable and unacceptable decisions?” society and law. When society finds something offensive, repugnant and/or abusive enough then enough people will try to coerce/demand lawmakers into changing the law to make it illegal. Other times lawmakers will take their own initiative to make things illegal that society should find offensive (whether anybody does or not).

When slavery was legal in the United States, was it morally wrong?

I'm going to soften my criticism of parents a bit. When I write that parents are not smarter, I mean that figuratively, not literally as a pejorative.

Parents are biased towards confirmation of their existing beliefs. "I'm circumcised, I'm happy, nothing's wrong, so my son will enjoy it, too." Or "I had to get circumcised as an adult, which I didn't like, so he'll want to be spared that pain." It's easy to see how they get there, but it's still illogical and too generalized.

I'll have to tell you Tony, I am not sure how much blame lays with the parents. I am not implying that you are blaming them explicitly but there is some culpability, the question is how much. In my mind there is a bit of a sliding scale where, up to about 10 years ago, I'd say it was near 0. With contrary, let alone balanced, information unavailable, parents had to rely on their doctors who we know are not always reliable, considering that the AAP has said since the early 1970s that circumcision had no value.

But with the advent of the Internet that equation has changed and I think there is a shift where, with each passing year, parents are more culpable. I am not sure where that needle lies but it's defiantly different for everyone but it's also increasing for everyone.

Joe,

To some extent, I agree, which is why I tried to soften my criticism. I don't think most parents are evil or stupid. I think many are so intellectually lazy that they border very closely to evil. If you can't be bothered with something involving a child, you shouldn't have a child. But that's a small percentage. And in my last comment, I added "doctors" to the line "Ideally, we wouldn't have ignorant, uninterested doctors and parents." Like you state, I think that's where the core issue rests, then and now.

However, I think parents must share the blame much further back. As I'm sure you know, the AAP issued this statement in 1971:

"There are no valid medical indications for circumcision in the neonatal period."

That was two years before I was born. I'm not letting anyone escape some responsibility after that.

I understand and somewhat agree with your caveat. It's unrealistic to expect parents to look that up in 1971. Our world is different today. Peer pressure, ignorance, and lack of written "informed" consent all factor to push a significant amount of blame for the past to the supposedly-scientific doctors.

I'm not using that as my primary basis for judgment. Logic demanded that parents question why they would permit a doctor to surgically remove part of their healthy son. They likely believed that he wasn't healthy because they bought the nonsense that the foreskin was dangerous. I think it is reasonable to judge that they should've questioned that assumption.

Tony Said: However, I think parents must share the blame much further back. As I'm sure you know, the AAP issued this statement in 1971:

"There are no valid medical indications for circumcision in the neonatal period."

That was two years before I was born. I'm not letting anyone escape some responsibility after that.

Yep, it was pretty clear. The only problem, and I don't know this for sure because I wasn't there, I think it would have been difficult for a lay person to get that information in 1971 or even for a long time forward. Like you say:

I understand and somewhat agree with your caveat. It's unrealistic to expect parents to look that up in 1971. Our world is different today. Peer pressure, ignorance, and lack of written "informed" consent all factor to push a significant amount of blame for the past to the supposedly-scientific doctors.


I can picture that at the time, a lay person would simply ask the doctor (whatever the question in this case circumcision) and the doctor would say, "Yes, you should do that." Ask two more doctors you would proabably get that same answer. Add to that everyone else you know did or is doing it and those are hard pressures to beat even if you had a feeling it wasn't right, though most didn't.

Go forward 10 years, little has changed. I think the popular "Dr. Spock" had changed his book by this time so perhaps some parents should have been more inquisitive but information is still hard to come by. Go to 1991 and little still has changed but by 2001, there is a significant change. The scenario is a bit different. You might first ask the doctor but then you come home and Google questions too. All of a sudden you learn there is an alternative opinion. You learn most people in the world don't circumcise. You learn that there is an official position. You now have better questions to ask your doctor, should you choose to explore those questions. At this point, that is when, I think, the culpability shifts because now you have the right questions to ask and the duty to ask them on your sons behalf (Actually, you clearly always had the duty but the important point is that you might know the questions to ask).

So I think that even as late as the mid 90s it would have been difficult for a lay person to learn the AAP position without a well stocked local library and a lot of determination. They might not even know there is an official position. I am not saying it wouldn't have been their responsibility to try and learn that but it wouldn't have occurred to most people to investigate further after getting one or more doctor's opinions. It would have been the same for just about everything else then too, you have a medical question, you would have gotten a few opinions and that's it. Now one gets some opinions and Googles. It's just a different world you know. ;)

That's why I say I have a hard time blaming parents even partly before the late 1990s. I think there is some blame I just don't know what is the appropriate amount. Besides the obvious question about why do I have to perform this intervention on a healthy child? Which one would expect should be enough, but with all the collective medical opinion you might have gotten making the case to hit the university library to pour over medical journals is hard.

I think the better question is why did (do) the doctors allow it to persist. Even today, they drive the practice. One thing I find very interesting is that many doctors, nurses, and other similar type of staff tend not to circumcise but aren't as proactive about stopping it overall. Perhaps they think, thought, it is just too big or perhaps they're concerned about criticizing a religious practice, I just don't know.

I admit I've mostly let my natural skepticism mutate into cynicism on this issue. I hold parents to the standard I have on this topic. It's unrealistic, given our reality. The inverse of the shocked foreigners I encounter is the shocked Americans who don't realize that the U.S. is the only Western nation that regularly circumcises for non-religious reasons. What you point out explains it well, but I think my expectation is fair, even pushed into the past.

I think you're right that the medical community is ultimately/primarily to blame, if only for its complete indifference to the ethical issues it should understand. In my activities I've encountered doctors who get it, but brush aside any need to proactively push for an end because "I don't perform circumcisions." That's not good enough. This is directly related to pediatrics and obstetrics. All doctors involved have an ethical obligation.

I have hope for the future. Recent textbooks include the foreskin in anatomical drawings, for example. That's an improvement. And awareness of the issue is definitely improving, with more doctors willing to say it's not necessary, even if they don't go far enough to say that parents shouldn't do it.

Tony Said:

I admit I've mostly let my natural skepticism mutate into cynicism on this issue. I hold parents to the standard I have on this topic. It's unrealistic, given our reality. The inverse of the shocked foreigners I encounter is the shocked Americans who don't realize that the U.S. is the only Western nation that regularly circumcises for non-religious reasons. What you point out explains it well, but I think my expectation is fair, even pushed into the past.

I think your expectation is more and more appropriate. Like I said, and you know, there is an exponentially increasing availability of information available so it becomes less credible that parents even know that there is significant contention on this issue. Forgetting Google, just consider that more and more parents are joining parenting boards where the topic, comes up frequently if it's not censored. So ignorance is decreasingly credible. Let's remember that Marilyn circumcised her sons too, before she knew better.

My question is why after 38 years we are still tip toeing around this issue. As I see it there should have been a slow but steady decline beginning in the early 70s that would have been largely driven by the medical community. Much like when they withdrew the small pox vaccine in the early late 60s, early 70s because they knew at that point it was not useful because of the low prevalence. I don't think there is anyone under 40 or so who got that vaccine, unless you got it for a special reason (military or whatever).

Keep your sister's experience in mind too. Even today, there are places where people get the used car sales experience on this. Over at Mothering there is a whole thread of regretful parents. I think when you have doctors who give a hard sell or are indifferent it's easy to take our information over the doctor's. Even though it is more rational and logically coherent. One would hope that a parent would take that and dig further themselves but some won't.

Tony Said:

I think you're right that the medical community is ultimately/primarily to blame, if only for its complete indifference to the ethical issues it should understand. In my activities I've encountered doctors who get it, but brush aside any need to proactively push for an end because "I don't perform circumcisions." That's not good enough. This is directly related to pediatrics and obstetrics. All doctors involved have an ethical obligation.

Exactly, considering that their own guidelines that I quoted above make it clear:

"Pediatric health care providers. . . have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. . . . The pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent."

(American Academy of Pediatrics Committee on Bioethics. “Informed Consent, Parental Permission, and Assent in Pediatric Practice.” Pediatrics 95 (1995): 314).

I think that makes it clear as day. I believe that Ronald Goldman or one of the other DOC members inquired the AAP about this statement and its obvious clash with the practice of RIC. The response they got, if I recall, was predictable, vague, and unsatisfying. It's like that 800lbs gorilla in the room and nobody wants to touch it. There is no doubt that doctors are acting unethically.

Tony Said: I have hope for the future. Recent textbooks include the foreskin in anatomical drawings, for example. That's an improvement. And awareness of the issue is definitely improving, with more doctors willing to say it's not necessary, even if they don't go far enough to say that parents shouldn't do it.

Awareness is defiantly improving. There is one important and specific way that I don't want to speak about publicly I'll email you about it.

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