Talk About The Issue, Not Rush Limbaugh

I’m probably supposed to deal with this:

Limbaugh then elaborated on the reference to him in the lyric. “I would remind the rapper Jay-Z: Mr. Z, it is President Obama who wants mandated circumcision. That means if we need to save our penises from anybody, it’s Obama. I did not know I was on anybody’s balls, either. I’m happy to know that they think I am, though.” The mention of Obama is in reference to the fact that the Center for Disease Control is considering recommending circumcision to high-risk adult men to reduce the spread of HIV, according to The New York Times.

Rush Limbaugh is a hack using controversial buzzwords because he knows it will get him attention, which is all he wants. He’s a deejay, not a political thinker. Using his nonsense for political arguments on any side of any debate is stupid.

With that out of the way, Ed Brayton has a post in which he begins:

The record of demagoguery and lunacy from the right wing continues. The CDC is considering — just considering, mind you — adopting a policy to encourage — just encouraging, mind you — people to have their children circumcised on the grounds that it reduces the risk of disease. Run that through the silly straw prism of right wing spin and it magically becomes “Obama is going to force us all to cut off our genitals!”

Fine, fair enough. Again, Rush Limbaugh is a moron. But Mr. Brayton links to an article that unfairly maligns Ed Morrissey’s post about circumcision and the CDC’s potential recommendation that I used yesterday as a starting point for discussing single-payer and circumcision. Whatever other issues Mr. Morrissey may have in how he presents political arguments, he was correct in the suggestions of his piece. Any other interpretation is a failure by the reader to interpret his words using their common meanings. As he wrote:

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

As I mentioned in my entry, he unnecessarily cluttered his argument with the term “ObamaCare,” but other than that, I can’t find anywhere he mentioned that the government would force circumcision on anyone. “Pressure” does not mean “force”. The writer at Salon directly, and Mr. Brayton indirectly, are undeniably wrong.

Yet, Mr. Brayton’s post generated this comment:

… While I think the net effect of such a policy would be detrimental, to equate it with forced circumcision is BAT SHIT INSANE. …

To equate a recommendation with forced circumcision is not BAT SHIT INSANE. I’ve written this several times over the last week, but it’s worth repeating here: For the circumcised male, why does he care whether circumcision is mandated by the government or merely by his parents? The result – forced circumcision – is the same for him. Eliminating the choice of a healthy child is the issue, not who forces the circumcision.

We can and should rebuke those like Limbaugh who offer absurd suggestions of government-mandated circumcision as a result of health care reform. It’s political nonsense intended to distract. But we mustn’t falsely accuse someone of making that argument who hasn’t, in fact, made the argument. Doing so is no less a distraction from the legitimate issues.


From another comment to the Ed Brayton post:

You can count on Limbaugh to say something stupid, but the Ed Morrissey quote is right. CDC guidelines are pressure on doctors and patients. They are supposed to be. The real problem with the Morrissey piece is the following:

“Why should the CDC push circumcision at all? The government has no business being in the middle of that decision.”

That is wrong. The point of the CDC is to study the spread of infectious disease and recommend the most effective ways to slow or stop the spread.

As Mr. Morrissey wrote in the paragraph before the one I excerpted above:

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

Any recommendation to circumcise infant males to reduce the risk of HIV is unethical because it encourages genital cutting on a healthy, non-consenting individual. It is also stupid. Infant males are not at risk of HIV now, and will be at little risk of the only type of transmission (female-to-male) that voluntary, adult male circumcision has been shown to reduce when they begin having sex, even if they do not use condoms, which no one is suggesting they may do after circumcision. Like WHO and UNAIDS, the CDC is considering recommending infant circumcision because they know such recommendations convince parents. If they were confident that men would embrace it, they’d focus on adult volunteers. They know that’s a dead-end for mass acceptance, so they recommend it for those who can’t say no. It is not force by government, but when told to a receptive audience acting on behalf of another, the difference is in tactic, not outcome.

Matt Steinglass Is Mistaken On Circumcision

In the interest of context for this post, Chris Bodenner did what Hanna Rosin didn’t, which is to apply critical thinking to the circumcision question. He wrote:

Studies are a red herring, however, when it comes to the ethical part of the debate. Even if there are no discernible differences between cut and uncut on average, there are still many individuals who are better or worse off from a procedure their parents imposed. As one reader puts it:

It’s my dick. It’s my dick. It’s my dick. It is no one else’s dick but my dick. And I should have the choice to circumcise it when I am old enough to make that decision.

Matt Steinglass reacts:

Let me reassure this guy: no one is planning to do anything to his dick. Assuming, that is, that he is more than 8 days old. But with respect to the practice of circumcision, the important point is this: he’s my son. Not yours. Parents have the right to decide on medical treatment for their children, presuming such medical treatment is not actively harmful. And parents have the right to include their children in cultural rites and practices, again presuming no harm is done.

Proxy consent is valid where medical treatment is indicated (i.e. necessary). Parents do not have a right to impose medical treatment – in this case, surgery – because they like that medical treatment, for whatever reason they value it. This is precisely because it fails the test Steinglass establishes: it causes harm. Circumcision is surgery. It removes healthy, functioning tissue. There is scarring. There is an inherent risk of further complications, starting with “excessive” bleeding and infection and extending all the way to death. The more extreme complications are, of course, rare, but the risk itself is a form of harm. Parents cannot know if their son will be the statistic. Good intentions are not a substitute for objective criteria.

He continues:

What, then, of female circumcision? Well, I understand, perhaps wrongly, that there are some forms which are not particularly medically invasive, and which do not entail significant medical consequences. I think that such forms of female circumcision are a matter of cultural practice that should be left up to parents to decide. The more invasive forms of female circumcision entail serious negative medical consequences. Obviously that’s not cool. And female circumcision is carried out on girls aged 7 to 12 or even older; at that age, the child gets a vote, too. In any case, this doesn’t have much to do with anything, because we’re talking about a medical recommendation.

I’ll address his strange tangent on female genital cutting in a post script. For now, I’ll point out that his criteria fail because the cultural genital cutting is not a medical recommendation backed by need, regardless of the child’s gender. Medically unnecessary genital surgery on an unconsenting individual is unethical. Again, it causes harm in 100% of cases for no objective benefit or attempt to correct a genital malady. The intervention is indefensible.

He concludes:

… Men who are circumcised don’t complain about it. There may be some vanishingly small number of guys who are upset about the fact that their parents circumcised them. It’s a weird thing to be upset about. The whole issue of treating this as some kind of mutilation of a rights-endowed human being who should be allowed to decide for himself seems to me like an insane metastasis of the American fixation with individual rights-based ideology. Children are born into families. Those families have cultures and beliefs, and are entitled to make decisions about how their children will be treated, shaped, and raised.

He perceives no harm and thus dismisses the individual making the rights-based claim against something he, Matt Steinglass, thinks is a “weird thing to be upset about”. That tells us nothing because it’s about Matt Steinglass, not circumcision. He writes only of culture and family without considering that the male may not value that culture or that circumcision is objective harm.

Yet, he’s not in favor of families deciding how their children will be treated, shaped, and raised without limits. He stated that he believes parents have the right to make decisions as long as it’s not actively harmful to the child. He is making a rights-based argument that centers on the child possessing certain individual rights. There are limits to how much culture may play a role. This makes the role and influence of the family and culture irrelevant here; his claim hinges first on the merits of circumcision as surgery on a healthy child. It fails for the reasons I’ve stated, which prevents moving to cultural considerations. It’s important to remember that he implicitly agreed to that test because of his caveat. He probably disagrees that circumcision is objective harm. He is wrong, if he does, but he hasn’t bothered to attempt the defense. Instead, he is essentially proposing that subjective preferences are valid for parental decisions as long as the parents believe them to be culturally valid. That’s madness.


Post Script: To his credit, I suppose, his paragraph on female genital cutting shows that he is consistent in his error. But I’m not sure why he thinks that girls aged 7 to 12 or even older get a vote. Is he saying they do or that they should? If it’s the former, he is mistaken. If it’s the latter, we limit the rights of children to the extent that we deem them capable of consenting. In this “ideal” world where children are asked before their parents surgically alter their healthy genitals, is a 7-year-old competent to make that permanent decision without undue influence? More importantly, do we believe parents will refrain if the child rejects it? Is the child to be considered potentially opposed to genital cutting only if she’s old enough to voice opposition, whether or not she could reasonably be expected to comprehend the full implications? Is there a similar age for male minors?

The shorter version here is that I don’t think he thought that paragraph through before he posted the entry. It’s incoherent.

Insults Instead of Inquiry

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

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

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

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

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

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

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

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

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

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

Back to his claim about fetishists:

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

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

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

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

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

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

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

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

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


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

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

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

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

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

Single-Payer and Circumcision in America

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

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

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

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

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

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

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

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

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

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


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

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

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

Hanna Rosin Is Still Mistaken On Circumcision

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

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

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

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

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

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

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

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

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

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


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

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

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

Hanna Rosin Is Mistaken On Circumcision

Hanna Rosin, guest-blogging for Andrew Sullivan, attempts to dismiss opposition to yesterday’s news about the CDC potentially recommending infant male circumcision.

But the procedure is only “controversial” because people have emotional, psychological and religious reactions to it. Scientifically speaking, it’s not remotely controversial. …

Ms. Rosin’s statement is nonsense because she ignores the ethics of implementing the findings. Her statement is nonsense because it ignores the evidence-based reality for infant males. The child’s genitals are healthy at the moment of surgery. This is not “emotional,” it is fact. Potential benefits do not make the surgical intervention on healthy infant males any more defensible.

Ms. Rosin continues:

… The anti-circumcision sites always refer to the American Academy of Pediatrics’ 1999 policy statement on circumcision, which declined to recommend the procedure. But that statement was issued before the most compelling studies emerged about the role circumcision plays in reducing the risk for transmission of HIV and other STD’s. …

The “most compelling studies” from Africa were performed on adult volunteers, which is the key point before we get to an assessment of the significant differences in the HIV epidemics in sub-Saharan Africa and the United States. The ethical issue can’t be resolved simply by noting that American culture already values the circumcision of males. American culture gets it wrong on what should be permitted on healthy children who do not need medical intervention and can’t consent to cosmetic surgery. Proxy consent must require medical need first, and medical ethics should demand only the least-invasive effective treatment for sick children. Prophylactic infant male circumcision fails both standards.

Ms. Rosin later acknowledges the differences between Africa and the United States, but she seeks to pretend that “the evidence is still pretty strong, and even stronger for STD’s” qualifies as a rebuttal. It doesn’t. The only supported suggestion is that adult male circumcision reduces the risk of female-to-male HIV transmission. Even if that accurately described the American situation, which it doesn’t, wasting finite medical resources on infant males who will not be engaging in any sexual activity, protected or not, for many years is asinine. And unethical, since we must loop back to the evidence-based reality that healthy infant males do not need circumcision.


At the end of her post, Ms. Rosin raises a separate issue, apparently as a “gotcha”.

Over on DoubleX, KJ Dell’Antonia makes the good feminist point. With the HPV vaccines, conservatives raise a fuss that removing the risk of STD’s will make girls more sexually promiscuous. In the circumcision debate, silence on the promiscuity front.

There’s a double standard. What does that prove with respect to justifying infant male circumcision? Because a group of people make a stupid, sexist assertion about one point, their silence on another human sexuality topic confers credibility to the intervention? Focusing on this gives the unserious nutters too much credit.

Anyway, it’s far more logical to highlight the double standard inherent in having anti-FGM laws in America that prohibit parents and doctors from altering the genitals of female minors for any reason other than medical need, including the cultural and religious claims of the parents, while leaving open the option for parents to circumcise healthy male minors for any reason. There are important caveats to raise in the differences in male and female genital cutting, but the ethical question involves basic human rights. When considering that less invasive cutting is prohibited on female minors compared to what is permitted (and potentially encouraged) on male minors, the difference is in degree, not in kind, and can’t be swept away with the same tired deference to potential benefits. But that would involve addressing the issues rather than side-stepping them to score cheap rhetorical points and declaring victory.

I Do Matthew Yglesias’ Homework

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Because… HIV!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Training To Do As We’re Told

I haven’t blogged nearly enough recently, or in the last year. Blah, blah, blah. The only reason I’m raising that point is because today’s the 6th anniversary of Rolling Doughnut. I’ll only remark in jest that I should wipe one of those years off, given the breaks I’ve taken recently. But that’s not fair to myself since I’ve still managed nearly 200 entries in the last year. I just need to be more consistent.

That’s a meta way to advance to today’s story, which is strangely related to my post marking last year’s anniversary. Last August 16th, you’ll remember, I had an adventure with TSA and an experimental, voluntary search that I refused because I could. They didn’t like that, not that it surprised me. But it made the point that we’re becoming a more complacent society, that we’ve agreed to stop valuing liberty when it comes to being searched. The appearance of safety is enough for most.

Today, I purchased Madden 10 at Best Buy. This should be a simple process. Instead, it involved asking for it at the register, the cashier charging me for it, me paying, the cashier giving the game to the security person at the door, and me showing my receipt to the security person. This is two¹ steps too many.

I stated my displeasure to the security person. I’ve done this before, so I knew I’d get the same explanation. Best Buy (or any store) can explain that it’s to guarantee the customer gets what he paid for, which is nonsense. Even if that’s true, my perception is that the store doesn’t trust its customers. At best it suggests they don’t trust their cashiers. If that’s the case, they should spend the time they’re wasting with me on training or different oversight.

When I told the security person all of this, he tried to deflect by saying that many stores are doing this. True, and I don’t have to shop at them or Best Buy. To this he responded: “It’s just like you have to stand in line for security at the airport.”

Buying Madden for the Xbox 360 is not like boarding an airplane. Entertaining the notion that it is demonstrates the extent to which we’ve accepted every intrusion, no matter how stupid, inefficient, and unproductive. When a business says “Line up,” we can so “no” by requesting a refund. I didn’t today, but I have in the past. I’m sure I will in the future. But that’s a low cost process. I can always go to Game Stop or Target to buy Madden. If we won’t challenge those without guns, we should expect no better treatment from those with guns.

So, yeah, I’m still here.

¹ Three, really, but I’ll skip the idiocy of the first step.