Month: November 2007

The differences become similarities upon inspection.

John Tierney raises the issue of female genital mutilation, wondering whether “African women be allowed to engage in the practice sometimes called female circumcision?” My short answer is, of course, if they’re deciding for themselves as an adult without pressure. There’s far more difficulty, of course, since those ideal conditions don’t appear to exist in countries that practice FGM. Anything that doesn’t meet my short answer must be condemned.

But Mr. Tierney’s question isn’t really my focus here. I’m more interested in the comments that result from his article. There is a mass refusal to permit any comparison of male and female genital cutting in our society. It’s reflexive, to the point that evidence to the contrary is ignored outright. As such, I knew going in I’d find them easily. I highlight a few here to show the intellectual rigidity that vehemently opposes female genital cutting, even with the patient’s consent, while any possible concern over male genital cutting is dismissed.

I can’t believe such ignorance. Please lets get the facts right. Female mutilation is *not* circumcision. The name says it all, circum-cision means “cut around”, i.e. cut around the extra skin on a man’s penis, which has many health benefits — penis cancer is unknown among circumcised men, plus the penis is allowed to grow more freely without a constricting fold of skin.
…

There is no health benefit whatsoever [to FGM] and much less an “aesthetic” benefit as has been claimed. …

*** The sole real purpose of female genital mutilation is to prevent women from feeling sexual pleasure. ***

Posted by Marisa Landau

There’s much more in there, but this excerpt is enough. Aside from the mind-numbingly ridiculous claim that the circumcised penis “is allowed to grow more freely”, notice the immediate rush to claims of health benefits for male genital cutting. Or I should say, notice the immediate rush to inaccurate claims of health benefits. Circumcised men get penile cancer, and the healthy foreskin is not a risk factor for penile cancer. Regardless, because we’ve studied and found potential benefits, it now slips the bounds of medical ethics we hold for every other invasive procedure on healthy children. Why?

I’ll just point out that aesthetic claims are subjective to the person making them. Still we allow aesthetic claims from parents to influence the decision to circumcise their sons. It’s possible that Ms. Landau would reject them, too. (More on this in a moment.) What matters is that she knows why female genital cutting is performed, despite evidence to the contrary. Mr. Tierney quotes Dr. Fuambai Ahmadu:

It is difficult for me — considering the number of ceremonies I have observed, including my own — to accept that what appears to be expressions of joy and ecstatic celebrations of womanhood in actuality disguise hidden experiences of coercion and subjugation. Indeed, I offer that the bulk of Kono women who uphold these rituals do so because they want to — they relish the supernatural powers of their ritual leaders over against men in society, and they embrace the legitimacy of female authority and particularly the authority of their mothers and grandmothers.

I do not know anything about Kono women, so I’m not willing to judge the validity of what Dr. Ahmadu says. I’m skeptical, especially since it appears that minors are subjected to FGM. But reasonable skepticism does not support Ms. Landau’s conclusion without evidence she fails to provide. (Note: This absolute claim is common, appearing in virtually every discussion of FGM.)

Back to male genital cutting, Ms. Landau later states:

…

Male circumcision on babies can be objected too because it is done without their consent, but it does not harm a man’s health and ability to feel pleasure.

— Posted by Marisa Landau

It most certainly harms a man’s health if he doesn’t make it to adulthood. Death as a result of male circumcision is rare, but it occurs. [ed. note: The five links in the next sentence are NSFW.] And other complications frequently occur, including a 100% incidence of scarring and a 100% removal of erogenous nerve tissue. He may be able to feel pleasure, but he does not feel pleasure the way he would if left with his normal, healthy foreskin. Is that not a human rights violation?

Moving on:

The New York Times and John Tierney do this issue a tremendous disservice in continuing to refer to this practice as “circumcision”. Unlike circumcision, there is nothing cosmetic about this procedure. It removes a girl’s clitoris, not exactly on a par with removing foreskin. To call it an “initiation rite” also diminishes its brutality. This practice is about sexual control through a most unsanitary and barbaric “surgery”. How people can equate this with circumcision completely misses the tragic reality of this disgraceful act. Very sad indeed.

— Posted by EvilTwin2

I’m not sure if I’m supposed to believe that subjective cosmetic justifications would make it acceptable, if they existed, but I know the blanket statement that FGM removes a girl’s clitoris is not always true. Regardless, it’s about sexual control. Evidence to the contrary, however unconvincing, be damned.

Remember, too, that medical male circumcision began in the United States to “cure” masturbation in young children. Does the research that finds alleged potential medical benefits legitimize away the original beginnings? If so, what’s to stop us from now seeking potential medical benefits from female genital cutting?

The comparison with male circumcision is misleading. Not only is it less invasive, with much lower risk of serious complications, there IS actually scientific evidence to back up health benefits. …

I have yet to see any science that could justify ritual female cutting.

— Posted by M.I.

I wonder if M.I. would permit any. It would be hard to find any if we’re not allowed to look. If we’re not allowed to look, I go back to my question of whether or not medical research on males is now legitimized, as it applies to children, despite its start. Do we sweep the past away and accept only the facts we like?

These debates merely reinforce the only politically correct, if not factually correct, position regarding medically unnecessary genital cutting: women ar
e always oppressed through surgery and men can never be oppressed through surgery. Gender should not matter in the ethical rejection of forced genital cutting without the individual’s consent. Our society incorrectly demands that we consider it relevant.

Parental powers are not parental rights.

Sherry Colb summarizes the larger point (barely) hiding in the recent Oregon circumcision case:

Though it is, in some respects, very unusual, this case nonetheless highlights a somewhat hidden and more widespread assumption embedded in our laws – that if a couple’s mainstream religion requires them to inflict harm upon their child, then the law will not interfere with that prerogative.

Within the article, Ms. Colb offers a few key rebuttals to the idea that legally permitted practices are valid by virtue of being permitted. We think we’re rational. That does not mean we are.

There are still those who claim that the procedure is painless for newborns, though such claims seem inconsistent with the infant’s capacity to feel pain and discomfort in other respects. Nonetheless, because no one can “ask” a newborn about the sensation, and because he might not remember the experience for very long, it strikes some who observe the ritual as relatively innocuous. Perhaps because the newborn baby is still so different from the rest of us, we can imagine – as many do in the case of other sentient animals – that their experience of pain is somehow not as terrible as our own. (And yes, I realize that one could say this of unborn babies as well, but that discussion is for another day.)

This is an old stand-by. Would you rather be circumcised as a newborn when you won’t remember it or as an adult when you will? But this is argument is silly because it ignores two key points. First, the child feels pain when he is being circumcised and while he heals. This matters. Second, there is a third choice, the extreme likelihood that a male not circumcised as an infant will neither need nor want circumcision for himself in his lifetime. Advocating infant circumcision relies on ignoring this truth.

Speaking of the Boldt case, specifically, Ms. Colb states:

The child also – and significantly – has a second parent, a mother, who does not want her child circumcised. The mother therefore can and does make arguments on the child’s behalf that would ordinarily be unavailable to him – such as the suggestion that amputating a healthy part of a child’s anatomy containing a concentration of nervous tissue is child abuse. If that argument sounds persuasive to the reader, it is at least in part because the case does not involve either an infant or a unified couple asserting its unambivalent authority over its offspring.

I don’t have much to add to that. I quote it here because I’ve witnessed the excuses she mentions. Generally the belief is that this jumps into the second choice from above, that the child will now remember it. It’s too easy to lose the point that his foreskin is healthy, requiring no surgical intervention.

Also, I don’t know if I’ve stated my stance this strongly, but allow me to be clear. Routine/ritual circumcision – the surgical alteration of a healthy child – is child abuse. It is mutilation. There is no intent to abuse or mutilate, but the action does not require intent to create that outcome.

One reason for our collective decision generally not to intervene in one another’s religious practices, despite what I have said, is that such intervention could easily lead to the persecution of a minority religion by a majority religion.

There was a time I worried about being labeled anti-semitic. I do not worry about it now. I know I am not, so such accusations are irrelevant. I accept that people should be free to exercise their religion, to whatever extent they believe it commands. They may raise their children in their religion. If that religion teaches genital surgery, so be it. I can think it’s stupid or admirable as an expression of faith. Neither matters.

But I will only stand aside when the infliction of physical harm (i.e. surgical removal of a healthy body part) involves a personal choice imposed only on the individual deciding. A child does not consent to this intrusion on his body. He can reasonably assumed to desire his healthy body and to be free from unnecessary intervention. He may ultimately choose circumcision, but he must have the opportunity to reject it.

Remember, too, that federal law guarantees that parents may only surgically alter the genitals of their daughters if the surgery is medically indicated. Any other reason is prohibited from consideration. We understand that the individual right involved does not involve an alleged, non-existent individual right to impose surgery on the healthy body of another. Parents do not own their daughters.

They do not own their sons, either, even if God commands it. Man may need to answer to God, but until he meets Him, he must answer only to himself. He need have no reason for wanting the body he was born with or demanding that, absent disease, he not have it taken against his will. Society’s only legitimate purpose here is to protect that right. Denying it out of fear, inertia, or good intentions is a cowardly abandonment of individual liberty.

I’m shocked – SHOCKED! – by this development.

Rejecting our earlier sanity wasn’t enough. Now the United States government wants to perpetuate our cognitive dissonance regarding circumcision through bribery:

The U.S. President’s Emergency Plan for Aids Relief (PEPFAR) has requested beneficiary governments to draft policies that encourage male circumcision to reduce on the risks of spreading of HIV/Aids.

The Principal Deputy Coordinator of PEPFAR, Dr Thomas Kenyon, said via a video link from the U.S., that PEPFAR was prepared to provide funds to any country that is willing to undertake mass male circumcision, Dr Kenyon said.

The only way to undertake “mass” male circumcision involves the systematic violation of infant males’ rights. This, of course, requires a willingness to ignore both the voluntary and adult aspects of the recent circumcision/HIV studies.

I’m supposed to be mollified by this:

“We can only release the funds for circumcision to a country which has come up with a clear policy on how it is going to carry out the exercise.

I’m not mollified. The presence of a policy does not guarantee effective (or ethical) outcomes. In this approach, boys will be injured beyond the 100% guarantee of “acceptable” injury. Boys will be disfigured beyond the 100% guarantee of “acceptable” disfigurement. Boys will die. And men will still get HIV through unsafe sex.

But we’re America. We care. Our money proves it. Isn’t that enough?

Random Bits

First, courtesy of John Cole, Virginia Republicans have a novel idea:

The State Board of Elections on Monday approved a state Republican Party request to require all who apply for a GOP primary ballot first vow in writing that they’ll vote for the party’s presidential nominee next fall.

There’s no practical way to enforce the oath. Virginia doesn’t require voters to register by party, and for years the state’s Republicans have fretted that Democrats might meddle in their open primaries.

I’ve voted in both Democratic and Republican primaries in the past. I planned to vote in one or the other next year to vote for the least objectionable candidate, a stance I don’t expect to carry out next November. Now I’m certain I’ll vote in the Republican primary. If they’re not compelled to keep their promises or act ethically, why should I grant them as much in my vote?

Next, grow up:

The Democratic National Committee, finding itself in the middle of labor disputes between television writers and CBS, announced this evening that it was canceling the debate among Democratic presidential candidates that had been scheduled to be broadcast on some of the network’s stations on Dec. 10.

The last thing we need is another of these press conferences, but seriously, grow up. This is why Democrats are no better than Republicans and why, in the face of colossal mistakes by Republicans, Democrats haven’t dominated. Stop worrying about meaningless appearances and act like a leader. It’s tough and ugly to do so, but it’s all that’s effective in the end. And it’s the only thing that will ever earn my vote again.

Last, Quote of the Day:

There’s a disturbing tendency to think that every problem is the result of inadequate regulation.

The quote is from Megan McArdle regarding sub-prime lending and what some think Alan Greenspan should have done to prevent it, but that line is more than serviceable in so many areas.

21

It’s easy to become wrapped up in sports outcomes and minutiae beyond what is reasonable. That’s what makes it fun. But the perspective-inducing intersection of that fantasy world and horrible reality is a painful, frustrating price. Two days ago I was angry at the Redskins and Joe Gibbs for losing a winnable game through an ill-advised attempt at a first down when the field goal was the best play. Today, that’s irrelevant. I mourn the death of free safety Sean Taylor in the small, insignificant way I matter in this as a Redskins fan.


(Picture from ESPN)

R.I.P.

(Not Really) Newsflash: UNAIDS lies.

This story should make me angry. I suppose it does, but I’m so numbed to the incredible pile of garbage people distribute in defense of their agenda that I have a harder time bringing forth an outburst than I’d like.

The United Nations’ top AIDS scientists plan to acknowledge this week that they have long overestimated both the size and the course of the epidemic, which they now believe has been slowing for nearly a decade, according to U.N. documents prepared for the announcement.

AIDS remains a devastating public health crisis in the most heavily affected areas of sub-Saharan Africa. But the far-reaching revisions amount to at least a partial acknowledgment of criticisms long leveled by outside researchers who disputed the U.N. portrayal of an ever-expanding global epidemic.

The latest estimates, due to be released publicly Tuesday, put the number of annual new HIV infections at 2.5 million, a cut of more than 40 percent from last year’s estimate, documents show. The worldwide total of people infected with HIV — estimated a year ago at nearly 40 million and rising — now will be reported as 33 million.

Having millions fewer people with a lethal contagious disease is good news. Some researchers, however, contend that persistent overestimates in the widely quoted U.N. reports have long skewed funding decisions and obscured potential lessons about how to slow the spread of HIV. Critics have also said that U.N. officials overstated the extent of the epidemic to help gather political and financial support for combating AIDS.

Good intentions are enough, remember. There is no need to worry about effectiveness, even in the reality of limited resources. There’s certainly no need to worry about uncomfortable details. If the method promotes what is good, it is worthwhile. Or so goes the logic of UNAIDS and the United Nations.

Of course HIV is terrible. Yes, we should work to promote effective strategies. But the desire to do good does not justify misrepresentation. We have to have this conversation? This doesn’t discredit, or at least render questionable, everything else the organization claims?

Remember this the next time someone from UNAIDS or the United Nations advocates male circumcision. It can’t even get the ethics of properly representing the problem correct. Who should trust them to get the ethics of genital cutting correct?

Just as frustrating, despite the clear indication that some renewed questioning is justified, the media is comfortable repeating the preferred story line:

Rates are lower in East Africa and much lower in West Africa. Researchers say that the prevalence of circumcision, which slows the spread of HIV, and regional variations in sexual behavior are the biggest factors determining the severity of the AIDS epidemic in different countries and even within countries.

The studies looked at voluntary, adult circumcision. That’s more accurate than a blanket statement about male circumcision. Isn’t the point of this report that details matter? Why ignore the most important scientific and ethical aspect of the recent studies in reporting them? (Unfortunately that’s rhetorical because I know the answer is about cognitive dissonance.)

To the point, researchers said that nearly 40 million people are infected with HIV. That’s not true. But we should believe them about circumcision without clarification on correlation and causation? Why? Statistics from the countries involved in the reporter’s claim are messier than advertised. (See here.) Also, it’s reasonable to assert that education had a far more effective benefit for all study participants than voluntary, adult circumcision had. (See here.)

Still, it’s supposed to be okay to take everything – lumped together without questioning – and trust that something will work if we try them all. I don’t particularly care about anyone pursuing that intellectually lazy path. People should have the right to make stupid decisions about their lives. But I demand that we follow all parameters involved when we make decisions for another. Particularly, voluntary and adult must never be forgotten.

Eternal vigilance is the price of integrity, Coach Gennaro.¹

I forget where I first saw this story (Balloon Juice, I think), but the case of a Utah State Trooper tasering a motorist deserves sufficient attention for the way it demonstrates excessive police use of tasers. The video, in case you’ve missed it:

Before going any further, my take: Mr. Massey was resisting arrest. The officer, John Gardner, needlessly escalated this incident into a pissing match, given that he could’ve simply written that Mr. Massey refused to sign the ticket. He did not choose that route, instead preferring a display of authority for the sake of authority. His actions leading to the Mr. Massey getting out of the car were unnecessary and demonstrate a lack of fitness for police work. However, the point stands that, in an escalated scenario, Mr. Massey resisted arrest. That is incidental to what transpired as a result.

Courtesy of Michael D. at Balloon Juice, this editorial in the Salt Lake Tribune:

… If you watched closely, and heard Gardner order Massey to put his hands behind his back, there’s no doubt that by walking away, Massey was resisting arrest. There’s no doubt that the use of the Taser was justified; that an attempt to physically subdue Massey may have forced both men into oncoming traffic.

The use of the taser was not justified. First, Trooper Gardner made no other attempt at lesser force to subdue Mr. Massey. Second, he tasered Mr. Massey in the back. Third, he tasered him as he approach the traffic lanes. Fourth, after he tasered Mr. Massey, Mr. Massey fell back, clearly either in or dangerously close to the traffic lane.

In this entry Kip states the reasonable:

A big part of the problem with tasers is that they were originally marketed as a substitute for guns, but have become a substitute for exertion. Tasers are, increasingly, not used to save lives but to merely make cops’ lives easier.

If the rule were: “Never use your taser unless you would also be willing to shoot your firearm…” then I can’t imagine too many incidents of “taser brutality.” … But instead the rule seems too often to be: “Use your taser whenever you perceive a risk to yourself.” Or, worse: “Use you taser whenever you deem it convenient.”

That simply cannot be right — not to the tune of 50,000 volts.

Exactly. The four violations – five if you count the initial, unnecessary escalation – demonstrate that Trooper Gardner’s use of the taser was indefensible.

For what it’s worth, this kind of nonsense occurs on almost every new episode of Cops. I love Cops, but it’s getting increasingly unbearable to watch because of the police state inclination it highlights. It’s basically an orgy of tasering and moral superiority over drug users. When I watch, I’m more often rooting for the “bad” guys. It’s uncomfortable, like watching someone try to humiliate me while he has food stuck to his face.

¹ Headline reference here.

The disease is feelgooditis.

Grover Norquist offers support for a rather peculiar, anti-liberty amendment to the U.S. Constitution:

A bipartisan revulsion at this recrudescence of an aristocracy – Democrats think there have been too many Bushes, Republicans think there have been too many Clintons – has led concerned citizens (OK, me) to launch a campaign to enact a constitutional amendment to ban this practice. The draft now circulating was written by the legal scholar Bruce Fein and reads:

Section 1. No spouse, sibling or child of an elected or appointed federal, state or local official outside the civil service may immediately succeed that official in the same elected or appointed office.
…

This amendment is in keeping with other restrictions on who can run for office in the US. Presidents must be at least 35 years old; senators, 30; congressmen, 25. Presidents must be born in the US. Fifteen states have enacted term limits on state legislators of six, eight or 12 years.

Indeed there have been too many Bushes and we’re certainly poised to have too many Clintons. Voters already have the power to avoid that outcome, although it’s still unclear whether enough will exercise such wisdom, so that isn’t the point. The problem is wrapped up in Norquist’s precedent.

This proposed amendment is not in keeping with other restrictions. The restrictions he cites are tailored specifically to individuals, designed to preserve the best opportunity for a qualified person concerned first with America’s interests to arise to the office of President. With some of the charlatans we’ve had, it clearly isn’t foolproof. But the design is obvious and easy to defend.

Instead of such wise, minimal restrictions equally applied to every individual American (natural-born, of course), this proposed amendment offers further restrictions for a tiny minority of citizens. To prevent something we feel is terrible – something that has never occurred in the office of president – we wish to prevent possible “unfair” benefits by placing unfair burdens. We would deny equal opportunity to individuals for what is not their doing.

Worse, Norquist understands the faulty logic at work:

… While our amendment would not have forbidden George W. Bush from running for president eight years after his father or Hillary Clinton eight years after her husband, both Republicans and Democrats see this amendment as sending a message about the other party’s abuse of familial power.

The Constitution is apparently no longer¹ the place to protect the rights of individuals by defining the limits on our government. “Sending a message” to a few dozen individuals is sufficient justification. Again, we should just ignore that voters already have the power to prevent the hideous possibility of dynastic democracy. We’ve generally shown our indifference. I don’t like it, but I also understand that liberty is more important. Supporting it sends a message.

Link via Andrew Sullivan.

¹ The 18th Amendment made this clear. Did the 21st Amendment teach us nothing?

Luckily, I have a forum to grind my axe.

Via Kevin, M.D. I read a recap from a doctor who had to amputate a patient’s finger. It’s an interesting enough story, but something caught my eye in the middle of the story.

… there’s a deeply ingrained taboo that prohibits me from causing permanent damage.

If you read Rolling Doughnut, you won’t be surprised at what immediately popped into my mind. I wonder what this doctor thinks about unnecessary infant circumcision? Based on experience, I guess the answer. I find it, precisely as guessed, here, from three years ago (about a topic I discussed last year):

Note to anti-circumcision trolls: I will ruthlessly delete or negatively alter your screeds about how awful regluar circumcision is, etc. I fully support circumcision done under normal hygenic circumstances. If you desire to grind your axe, do so elsewhere.

I wouldn’t have posted on the entry if I’d seen it in 2004, but I’ve been called an anti-circumcision troll a few times. It’s always a misguided smear offered at the end of a debate by the advocate of routine infant circumcision when his or her only fair response would be to admit defeat in defending the indefensible. The desire to excuse the unnecessary cutting of children is too deep for that, of course.

Wishful thinking about all the possible horrors the child will presumably no longer face – which he most likely wouldn’t have faced anyway, without circumcision, and almost never to an extent requiring surgery – are irrelevant, as are claims about the religious validity of this unnecessary surgery. If anyone should get this, it should be a doctor. Unfortunately, that too often flops in practice. From the 2004 entry, GruntDoc stated this about infant circumcision:

… I believe it is painful to the infant. So is falling down, hitting the coffee table, slamming a finger in a car door. Since I have never read about an infant describing his circumcision, it’s one of those things I think is best done as soon as possible (ask any adult who’s had a circ: it’s like chickenpox, the younger you have it the better off you are).

One painful incident is not like the others in his example.

It’s anti-intellectual to claim that not remembering pain is relevant to the discussion. The surgery is medically unnecessary; no further excuse-seeking is justified. If we factor in the child’s ability to not remember the pain as valid, we may excuse any number of surgical interventions with a potential to prevent future disease. Just look at the prevalence of breast cancer in males. Should we think of the good that can be done for those few men if we remove the breast tissue from the majority of newborn males? They won’t remember it! The thought is absurd, of course. Circumcision is the same. But circumcision advocacy isn’t about facts in context.

As to his last point, I can direct anyone interested to men circumcised as adults who don’t think it’s better. They think they’ve made a tragically stupid mistake. I can also point anyone interested to men circumcised as adults who state that the pain was less than it’s made out to be by the fear-mongers. Are those examples subjective? Of course. But so is the nonsense that all men are happy with being circumcised as infants or that the subjective preference of parents for potential benefits is superior to the subjective preference of the male when there is no medical indication for intervention.

Also, forgive me if I don’t cheer the logic of defending the 100% guarantee of pain imposition on an infant who hasn’t consented, no matter how well forgotten, over the low-single-digit risk that the male would need circumcision later in life, with pain that would be better managed through more effective pain relief techniques. I sympathize with the pain men who need adult circumcision will feel, but life has risks. That’s part of the deal. And the men who merely choose it will get no sympathy because they clearly value whatever benefit they perceive more than avoiding the pain. Yet, I’m supposed to value both equally – to the detriment of infants – through crude analysis implying that delayed pain, however unlikely or unnecessary, is worse than pain now. I will not because I am not irrational. Those few who need or choose adult circumcision should not dictate what happens to healthy infants.

For example:

My main argument for it is hygeine. Yes, many many men take good care of themselves, but you only need to see a couple of men with severe balanitis or penile CA, and the argument gets better. I was once told by a urologist that after a slew of penile cancers / amps following WWI (hard to keep clean in a trench), circ became mainstream more as a preventive med thing than an act of religious faith.

Typically, we (allegedly) must also factor in that a few men will face some consequence from being intact as an excuse to circumcise. Those many many men who take good care of themselves are not to be rewarded for their common sense and ability with an intact body. They are to sacrifice for the good of the few who will be delinquent or incompetent in their hygiene. After all, parents can’t know in advance if their son will practice good hygiene, and they can’t teach him good hygiene. Why assume that he will figure it out? There’s only so much a parent can do. Obviously. Being the good parents they are, they should opt to have his genitals cut, even though it exposes him to the risk of surgery. They’re responsible in a way he could never be.

From GruntDoc’s entry about amputating a finger:

Only after telling myself several times that this was actually no longer a finger was I able to take the sharp implement and cut off most of a finger.

How similar is the descent from reason that permits a doctor to remove the healthy, functioning foreskin from his patient at the request of his patient’s parents?