Author: Tony

Can protection be harm?

Via A Stitch in Haste, ABC News ran a social experiment in two cities, Verona, N.J. and Birmingham, Ala.

Two years ago, ABC News hired two actors, a man and a woman, to publicly display their affection for each other by kissing in public at a restaurant. Reactions from other restaurant-goers varied; some onlookers enjoyed the sight of young love, while others lost their appetite.

This year, we once again decided to explore how the public responds to public displays of affection — but this time, our couples were gay.

911 “hilarity” ensued in Birmingham, as Kip highlighted. Shameful, but not my point here. Instead, this:

… A topic that did come up repeatedly was children. “I don’t really find it inappropriate, especially during the day when schoolchildren aren’t running around. They might get confused and want an answer for what’s going on,” bystander Mary-Kate told us. The majority of the people who spoke about children seemed to echo Mary-Kate’s feelings. They are indifferent to gay PDA but did not want to, or know how to, address homosexuality with children.

People wilt under the pressure of addressing “tough” issues with children. (Some to a greater extent than others.) But when children get confused and want an answer for what’s going on in the world, the proper response is to treat them like human beings who deserve respect. Adults must apply tests to decide what information is appropriate to censor or finesse, but shielding children from information solely because the question makes the adult uncomfortable is not a rational response to reality.

Obviously I’m drawing a comparison to circumcision, so I’m not going to dance around the topic. When I’ve protested on the lawn of the U.S. Capitol against infant male circumcision¹, children approach to discuss the topic. I discriminate based on age. Without a good qualifier, it’s best to let the child ask. This generally leads to self-selection among the children who are capable of understanding and discussing. The youngest child I’ve spoken to is probably 10 or 11. And I still limit the discussion away from the anatomical function of the foreskin during intercourse and masturbation. However, those children are capable of understanding the core of the issue. They know when they’re being lied to. I’ve witnessed parents offering excuses to children while shielding them from any consideration. The children rejected these excuses by asking further questions.

I’m dismayed at how many people, even when not rejecting that same-sex relationships exist, fear that children can’t understand love if it’s not packaged in a specific, safe manner. Safe, of course, refers to the perceptions of the adult, not the child.

¹ Here’s a writing tip for you. The first edit of the footnoted sentence read:

When I’ve protested against infant male circumcision on the lawn of the U.S. Capitol …

There are no circumcisions occurring on the lawn of the U.S. Capitol, to my knowledge. Clarity demands that the writer group “on the lawn” with what occurred on the lawn.

I will use this in conversation.

In the course of providing an enjoyable three–part-and-counting narrative of a recent trip to New York City with his wife, Wil Wheaton wrote this, in part three:

It was getting late, and though our bodies thought it was three hours earlier, we’d still been up for about 14 hours on less than five hours of quality sleep. All of a sudden, we were exhausted, and ready to collapse like the Mets down the stretch.

I laughed out loud, enough to scare Emmett, who is sleeping at my feet. I love that both for the beauty of an excellent simile and the mocking poke at the Mets. (Go Phillies!) Bravo, Mr. Wheaton.

The U.S. owes the world. The world owes nothing to individuals.

Here’s an interview (part 2 of 3) with Stephen Lewis¹, a former diplomat now involved in HIV/AIDS issues. Here are a few curious excerpts (italics added):

What do you think should be done [to fix PEPFAR]?

People should demand more – much more. No one denies that when you pump several billion dollars into a response it will mean something. Of course it will; millions of people will be treated. That’s terribly important.

But that’s what we deserve to expect from the United States. You don’t kneel down before a country because it’s doing… something that the world has a right to receive. The American administration is so discredited, George Bush is such a lamentable president, that when anything of a positive kind happens people are prostrate at the unlikelihood of it and they shouldn’t be.

It gets worse from there, but it’s most important to focus on the key assumption. The world has a right to receive American funding for its problems. I’d like to know the socialist theory Lewis is using to arrive at the conclusion. Presumably we’re only allowed to call our giving “charity” if we need to feed our American egos. The world will acquiesce with that concession, but the dollars must continue to roll in to satisfy the world’s right to receive.

I don’t have anything else nice to say about that, so I’ll move on to the next interesting bit. (Again, italics added.)

How about the response of the United Nations to HIV/Aids in Africa?

There is just so much more to be done. Frankly, one of the things that is inadequate is the United Nations agencies. Some of it is bewildering.

For example, you get the Minister of Health in South Africa (Dr. Manto Tshababala-Msimang [sic]) attacking and dismissing circumcision as a preventive technology. Here you have three determinative studies, definitive studies, we have UNAIDS and WHO encouraging male circumcision as a way of reducing transmission and you get an attack on it by the minister of health in South Africa. Where is the United Nations’ voice? Why haven’t they taken on the minister? Why haven’t they said what should be said, which is that she’s effectively dooming people to death and it need not be done? You have to have a much stronger voice of advocacy from the United Nations in dealing with disease and related matters.

Dr. Manto Tshabalala-Msimang is nuts is HIV, yes, but Lewis’ rant against the United Nations is bizarre. Whether it’s pushing circumcision through UNAIDS with breathless calls-to-action, issuing press releases touting the latest hype on the original story from WHO, or endorsing gender-based human rights violations through its remaining organizational reach, I’m not sure it’s possible to do more for the organization to insert its reach any further into this debate on the wrong side of human rights. But that’s defensible. Instead, let’s complain that they never criticized Dr. Tshabalala-Msimang for being stupid and dangerous.

Except, they did.

The United Nations special envoy for Aids in Africa has closed a major conference on the disease with a sharp critique of South Africa’s government.

Speaking at the end of the week-long gathering in Toronto, Canada, Stephen Lewis said South Africa promoted a “lunatic fringe” attitude to HIV/Aids.

Mr Lewis described the government as “obtuse, dilatory and negligent about rolling out treatment”.

Hey, wait a minute. Stephen Lewis? Stephen Lewis, working as special envoy for AIDS in Africa, attacked Dr. Tshabalala-Msimang’s comments in August 2006. Denouncing idiotic statements is necessary, but move on. Leave the grudge match to the WWE. Instead, every microphone is dead horse meets Stephen Lewis’ stick.

I did thoroughly enjoy this, in an “I’m disgusted” way:

“It really is distressing when the coercive apparatus of the state is brought against the most principled members of society,” he said.

Clearly Lewis is exhibiting a textbook case of Kip’s Law. I would challenge Lewis’ assertion that he is principled, since the UN’s Declaration of the Rights of the Child clearly forbids medically unnecessary genital cutting, without exceptions for gender or potential disease prevention. Nor am I particularly moved by his claim of oppression. Are infants subjected a coercive apparatus when they are circumcised, in part based on the rantings of individuals like Stephen Lewis?

¹ The following biography accompanies the article:

Formerly the special envoy for HIV/Aids in Africa for United Nations Secretary-General Kofi Annan, [Stephen Lewis] is now chairman of the board of the Canada-based Stephen Lewis Foundation, which endeavors to ease the pain of HIV/Aids in Africa by funding grassroots projects. Lewis is also co-director of Aids-Free World, a new international Aids advocacy organization based in the United States.

This will be important later in the entry.

With advocacy like this, who needs enemies?

Advocates for Youth is

… dedicated to creating programs and advocating for policies that help young people make informed and responsible decisions about their reproductive and sexual health. Advocates provides information, training, and strategic assistance to youth-serving organizations, policy makers, youth activists, and the media in the United States and the developing world.

Helping young people make informed and responsible decisions about their reproductive and sexual health is a noble goal. This is not that:

  • Human rights—Planners must take an approach to offering male circumcision that acknowledges the human rights of the client:
    • Every adult male who is considering circumcision for himself should be able to give informed consent.[1]
    • Where a minor is the prospective client, counselors must take extra time to ensure that the minor and his parents understand the procedure and that the young male consents to it.[1]
    • When an infant is to undergo the procedure, his parents must be fully informed.

If he is an adult, the male must consent. If he is young, the male must consent. If he is an infant, no human rights principles apply to him. That is a pathetic view of human rights. Anyone who accepts that view is not an advocate. At best, he is a propagandist who does not believe in principles, only principals who may act on another according to an undefined criterion.

What is the delimiter indicating when a male ages out of “pre-young” and into young, conferring a human rights requirement for consent before his healthy genitals may be surgically altered? I reject the answer in advance for reasons I’ve explained in detail. Still, I want to know because I do not understand the magical powers wrapped around the penis that reduces mankind’s ability to think when applying principles to its anatomical sanctity. So, advocates of the “pre-young” qualifier within human rights, when do “pre-young” males get the (ahem) equal right to consent – or refuse consent – to the surgical alteration of their healthy genitals that young and adult males possess?

Post Script: The footnote attached to the young and adult requirements points to an excuse from the usual suspects in infant male genital cutting advocacy. I will not provide a link to that report here.

Post Post Script: I addressed a similar, gender-based ethical lapse in a previous entry challenging nonsense from UNAIDS.

Only an elitist allows results determine his efforts.

Let’s all show our surprise that abstinence education doesn’t work.

Programs teaching U.S. schoolchildren to abstain from sex have not cut teen pregnancies or sexually transmitted diseases or delayed the age at which sex begins, health groups told Congress on Wednesday.

Teens will have sex. Who knew? And they will make bad choices, as well as “bad” choices. Yet, if the information is structured with a “just say no” pretense, everything will be okay. People who believe that should not be in charge of anyone else’s money. They probably shouldn’t operate heavy equipment, either.

More pathetic, though, is the resort to ad hominem from our culture warriors, aka politicians.

Rep. John Duncan, a Tennessee Republican, said that it seems “rather elitist” that people with academic degrees in health think they know better than parents what type of sex education is appropriate. “I don’t think it’s something we should abandon,” he said of abstinence-only funding.

I guess “elitist” is the new “for the children.” But about those parents providing preferred types of sex education, if they’re the ones teaching their children abstinence, why is the federal government spending taxpayer money on something that parents know how to teach? Isn’t there an implication that parents won’t provide their children the appropriate type of sex education if it’s not funded by taxpayers? I guess that doesn’t qualify as “elitist”.

Link via John Cole.

It’s like legislating that puppies are cute.

Congress, protecting you from the world they built:

Lawmakers have agreed to make it illegal for employers and insurance companies to deny applicants jobs and health care coverage because DNA tests show they are genetically disposed to a disease.
…

It also makes clear that, while individuals are protected from discrimination based on genetic predisposition, insurance companies still have the right to base coverage and pricing on the actual presence of a disease.

Here’s an idea: eliminate the favorable incentive that irrationally ties health insurance in America to employment. If employers are no longer in the insurance business, they’ll have no opportunity to discriminate on the basis of future health care expense. Instead, Congress leaves the underlying problem that permits possible discrimination and codifies “discrimination is bad, mmmkay.” Never mind that politicians discriminate against the unemployed, under-employed, and self-employed.

Naturally Congress misses the point that discrimination is not inherently evil. It is often used for reasons we don’t like, so we’ve attached an exclusively pejorative interpretation to it. But I discriminate against meat when I choose vegetables instead. I discriminate against Ford when I drive a MINI. The Phillies discriminated against a local player when they traded him for a player they value more. Politicians discriminate against one expenditure when they vote for another. Sometimes, discrimination is just about making choices in a world with limitations.

I’m playing semantics right now. Conceded. But semantics matter, as this shows:

[Senator Olympia] Snowe noted that nearly 32 percent of women offered a genetic test for breast cancer risk by the National Institutes of Health declined because of concerns about health insurance discrimination.

I’m not advocating mandatory screening against a person’s wishes. But I’m also against prohibiting insurance companies from pricing risk more precisely by requiring genetic information through the voluntary application process. (Is that the inevitable future from this legislation?) Yet, just as an insurance provider may require the test, no applicant is forced to accept that condition. Competition breeds options where it is permitted. To a significant extent, it is not permitted while insurance is tied to employment, so we get further legislation.

Although it’s not explicit, I think the sponsors of this legislation are more content with the collective outcome of this. Insurance providers are good at knowing their business. They understand risk and how to price it based on statistics. Congress seems to be saying that pricing it better – to the individual, based on the individual – is discriminatory. Perhaps. But the risk will be priced. The only question for discussion is who pays. Is it shared across the insurance pool or paid by each according to his risk?

Legislation like this, as opposed to the more logical solution that removes the faulty incentive, clarifies the political mandate: genetic luck, just like financial “luck”, increases one’s responsibility to the unlucky.

Consent plays a role, too.

This article on adult circumcision was the companion piece to the recent Los Angeles Times article on infant circumcision. It would’ve been easy and proper to focus on consent, here and in the article on infants, but instead it’s mostly fluff seemingly intended to prove that men really, really like circumcision. The facts don’t support the article’s implications, although you have to know the facts because they weren’t provided in the article. I suspect this is mostly because the reporter lazily relied on urologists, who will inevitably see only men with an issue. Healthy, happy intact men don’t generally visit a doctor to say everything’s fine.

Still, I found one useful nugget (emphasis added):

Dr. David Cornell, a urologist who runs the Circumcision Center in Atlanta, sees men who want a circumcision because they prefer the appearance and because they want to feel more comfortable socially.

“I hear a thousand times a year from men who don’t feel that they look like most other men in the locker room. In our society, there’s an overriding preference for circumcision,” says Cornell, who performs 250 procedures a year on men who, for cosmetic reasons, want a circumcision or a revision to one they don’t think looks right.

Even where the male eventually agrees with his parents and/or society’s subjective judgment that circumcision is more aesthetically appealing, what is specifically appealing is also subjective. Dr. Cornell surgically alters (consenting¹) circumcised men toward the body they want. This part of his practice demonstrates that even when parents guess correctly, there is no guarantee that this will be sufficient.

Of course, men could also choose this if left intact, with a better chance of getting exactly what they want² because they have everything to work with, rather than the remnants of the original circumcision.

¹ Also from the article:

Though frequently attacked by anti-circumcision activists, [Dr. Cornell] says, “I’m doing a cosmetic operation on a consenting adult. Why he’s doing it is his business.”

He’s correct. Those activists damage the legitimacy in this debate. Circumcision is only the expression of the real issue, the lack of consent from healthy minors whose genitals are surgically altered.

² Or what they think they want. I know at least one man whose parents did not circumcise him. He chose it for himself as an adult to conform to societal expectations. He hates the results and regrets his action.

Let’s organize a One Million Cow March on the Capitol.

The New York Times editorial board has an interesting reaction to PETA’s announcement of a $1 million prize to anyone who can produce commercially-viable in vitro chicken-meat by June 30, 2012. (The requirements are strict; it’s unlikely anyone could possibly meet this deadline.) Consider:

We are disgusted by the conventional meat industry in this country, which raises animals — especially chicken and pigs — in inhumane confinement systems that cause significant environmental damage. There is every reason to change the way meat is produced, to make it more ethical, more humane. …

So far, so good. But there has to be a “but”.

… But the result of the technology that PETA hopes to reward could be the end of domesticated farm animals. This has often seemed as if it were the logical conclusion of some radical animal-rights activists: better for animals not to exist at all if there is a chance that they would suffer.

I doubt seriously we’d see the end of domesticated farm animals, even in a world where everyone went vegan. Existing endangered-species legislation suggests we’d take an unkind view to complete extinction. And given that such a world will never exist, this fear is particularly worthless.

Nor is it particularly radical to suggest that it’s better for an animal not to exist than for it to suffer. I’ll temporarily pretend that the inevitable slaughter of the animal does not qualify as suffering. The “happy meat” argument in favor of Humane-Certified is different from the majority of animal agriculture in the United States today. Assuming “happy meat” animals will suffer only at their end, most animals raised for food will suffer throughout their lives. That warrants a discussion, even if the eventual answer is to default to the status quo.

This is not an adequate defense:

We prefer a more measured approach. Ensure the least possible cruelty to animals, by all means, and raise them in ways that are both ethical and environmentally sound. …

Again, so far, so good. Even for those who disagree because they prefer an abolitionist approach, this is better than nothing. But there has to be a “but”.

… But also treasure the cultural and historical bond between humans and domesticated animals. Historically speaking, they exist only because of the uses we have found for them, and preserving their existence means, in most cases, preserving the uses we have made for them. …

This is a ridiculous defense, but I’ll defer to Erik Marcus, where I found the link:

You know: the cultural and historical bond that involves one party cutting the other party’s throat. Yeah, let’s treasure that. …

As I implied earlier, treasuring the bond does not require death. For other species, we requires letting the species live, to the detriment of nearly every other consideration. That may be right, or it may be wrong. In the debate the costs of protection must be considered. But existing evidence undermines the “slaughter or extinction” nonsense.

At least they didn’t say that animals want us to eat them.

Businesses are people, too.

From Robert Samuelson, here’s an odd column in today’s Washington Post. I’m not interested in tackling specifics because Mr. Samuelson seems to offer mostly his own guesses as to the future of spending in America. But he did amuse me with a contradiction.

To say that the shopping spree is over does not mean that every mall in America will close. It does mean that consumers will no longer serve as a reliable engine of growth. Consumption’s expansion required Americans to save less, borrow more and spend more; that cycle now seems finished. Without another source of growth (higher investment, exports?), the economy will slow.

This is an interesting thesis, perhaps. But much later, he offers this:

What can replace feverish consumer spending as a motor of economic growth? Health care, some say. Health spending will surely increase. But its expansion will simply crowd out other forms of consumer and government spending, because it will be paid for with steeper taxes or insurance premiums. Both erode purchasing power. Higher exports are a more plausible possibility; they, however, depend on how healthy the rest of the world economy remains without the crutch of exporting more to the United States.

How is health spending not consumer spending? Economically, is paying a doctor to fix my heart different than paying a mechanic to fix my car’s fuel pump? Both are payment for a service. The importance we apply to the two, as well as demographics in both population aging and car ownership, matters, but not in how we think about spending. In a free market, people will spend on what they value. But people will spend.

Mr. Samuelson’s point that health spending will crowd out consumer spending is strange, coming after he posited that consumer spending is declining. It’s also strange to claim as a blanket statement that higher insurance premiums erode purchasing power. Surely at least some of the risk protection purchased through premiums will be consumed through health spending. How – and how much – does it matter who pays the service provider?

Inevitably that leads to another point. Higher exports are a more plausible possibility. Fine. But to suggest that this is surprising or new requires an unwillingness to define “consumer” as one who consumes rather than an individual who consumes. Does the business creating new products not need equipment to build those products or computers to manage that production? Does the business shipping those products to foreign markets not need trucks and ships? What about packaging material to protect those products during shipment?

It’s possible, maybe even probable, that Mr. Samuelson’s prediction will prove true. It’s problematic because it views specific spenders as the objectively preferable path. It’s better to understand that the economy is large, global, and dynamic. It will change. When allowed to adapt, change will mean long-term progress, despite any short-term bumps. But when viewed as something to be wrapped around a preferred path, problems abound. It’s projecting tomorrow based on yesterday, when every first year finance student is exposed to learns the idea that past performance does not equal future performance.

Mr. Samuelson concludes that “the ebbing shopping spree may challenge the next president in ways that none of the candidates has yet contemplated.” The economy will always challenge the president in ways not yet contemplated. That’s why the president should avoid meddling.

Surgery as a Replacement for Parenting

I used to feel some reservation about quoting parents when they’ve said something stupid about circumcision. You’ve probably figured out that I shed that a long time ago. When someone says something stupid to a reporter, I highlight it solely to point out that people are using stupidity to justify imposing permanent, medically unnecessary surgery on their child. (Doctors are complicit in this nonsense, which will also be obvious.) From an article out of St. Louis:

“I tell people there’s not a real medical reason for them to have [ed. note: Have? Force.] a circumcision,” said Dr. Jack Klein, chief of obstetrics at Missouri Baptist Medical Center, where 1,873 of the 2,144 boys born in 2007 were circumcised. “I will tell you the majority reason that people get circumcised is because they want their kid to look like other kids.”

That social conformity is reason enough, say some parents concerned about future locker room comparisons and sexual relationships.

“I really didn’t want to be faced with a teenage boy asking me why I didn’t do this and not have a really good reason for him,” St. Louis resident Amy Zimmerman said of her 2-year-old son John.

Notice who she is concerned about. Her concern was about her own feelings, her own desire to avoid the potential for (allegedly) tough questions from her son. That was enough for her to justify unneeded surgery on her son. She seems to wish to parent her son only in ways that do not exceed her level of comfort with potential issues. If it might be uncomfortable for her, her fear is enough to dismiss the healthy, intact (i.e. normal) individual he was, as well as the preference he may one day hold for having his genitals intact. Ms. Zimmerman fails to understand what it means to “not have a really good reason”.

Not that he would’ve complained if she didn’t have him circumcised. That’s speculation. But even if he would eventually complain, it’s an easy position for parents to say “We didn’t cut your healthy penis because it was healthy.” That’s rather simple. If he’s not placated by that, it would still have been possible for him to choose circumcision. But if she’s faced with a teenage boy asking why she did this, and he is not happy about it, what then? Oops?

If an individual does not want to parent his or her children, that person should not have children. Cosmetic surgery on healthy children to avoid future questions is a coward’s solution.

**********

Unfortunately, doctors are complicit in this abdication of parenting. Dr. Klein’s statement above makes this clear, since the surgery is objectively not indicated. But they cede this point in the name of parenting, a very poor conception of that responsibility.

Ultimately, it’s a personal decision, said Dr. Joseph Kahn, chief of pediatrics at St. John’s Mercy Medical Center.

“Like every decision for every surgery on every child,” he said, “it really needs to be something that’s discussed with the parents.”

Ultimately, we don’t treat it as a personal decision. The male choosing or rejecting circumcision for himself would be a personal decision. And like every other decision for every other surgery on every female and male child, it really needs to be something that’s medically necessary. That’s the first principle that’s ignored. Or can parents just order any cosmetic surgery for their child son(s)?

Female genital cutting is prohibited, of course, regardless of the “personal decision” parents might wish to make. We don’t listen to nonsense about parents deciding what’s best for their family, the newest mantra I see developing around male genital cutting. What’s best for your family, when you decide to have a family, is that each person’s bodily integrity is respected. You decide to have children. When they arrive healthy, you do not then have a special veto power over the form of that child’s body just because he is a he and not a she.

Where medical need is absent, intervention is illegitimate.